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28 Cards in this Set
- Front
- Back
Shoulder Dislocation
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Anterior most common
look for impaction injury of posteriolateral humeral head -- CALLED HILL SACHS! ant. inf. glenoid is called BANKHART post 2nd most common assoc with seizures and electrocution luxatio erecta (inf. glenohumeral discloations) are rare and associted with axillary vessel and brachial plexus injury |
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Elbow Ossification
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Capitulum
Radius Internal epicondyle Trochlea Olecranon External epicondyle |
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Fractures
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Collies -- fracture of distal radius
Tuft -- distal phalanx Boxers -- fourth of fifth metacarpal bones Gamekeeper's thumb -- type of injury to ulner collatoral ligament of thumb just at metacarpal (occurs among ordinaory people who sustain fall onto outstretched hand) |
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OA - radiographs
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asymmetric joint space narrow and bone proliferation
osteophyte formation PIP = bouchards nodules DIP = heberden's |
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Rheumatoid Arthritis
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changes in bare areas btw articular cartilage and joint capsule
subtle erosions along radial bases of prox phalanges ulner sublaxation and deviation |
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Lupus
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ulner subluxation and deviation without erosions
avascular necrosis and linear soft tissue calcifications arthritis in 75%-90% pts |
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Scleroderma
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soft tissue calcification
thining of soft tissue lining fingers |
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CPPD Arthropathy
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knee, wrist and pubic symphsis
symmetric radiocarpal and MCP joint space narrowing |
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Gout
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calcified if calcium precipitated
overhanging edges |
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Psoriasis
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soft-tissue swelling of single finger/toe
sausage digit DIP involvement with narrowing and central erosions EROSIONS can results in PENCIL in CAP DEFORMITY |
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Osteomyelitis
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Erosion with loss of normal white cortex
may not be visible on radiographs for 1-2 weeks after bacterial infection of bone so need MRI or CT!!! |
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Pubis Fracture
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*Assoc. with bladder rupture and urethral injury
*Chondrocalcinosis pubic symphysis, septic arthritis and Reactive arthritis (reiters) can cause |
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Unilateral Sacroiliitis
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Erosions involving only 1 of the sacroiliac joints
May be a reparative response (sclerosis) or widening from the prior destruction Degree of erosions is usually worse on the iliac-side as the overlying cartilage is 1 mm thick compared to 3 mm thick overlying the sacral-side Differential diagnosis: Seronegative spondyloarthropathy which includes psoriasis, Reiter’s (reactive) or septic arthritis |
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Intracapsular Fracture
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Any intracapsular fracture can result in avascular necrosis of the femoral head due to disruption of the blood supply
This includes subcapital, trancervical, and basicervical femoral head/neck fractures |
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Segond fracture
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avulsion fracture (soft tissue structures tearing off bits of their bony attachment) of the lateral tibial condyle of the knee, immediately beyond the surface which articulates with the femur.
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Lauge-Hansen
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5 types of injury patterns
SER – Supination External Rotation SAD – Supination Adduction PER – Pronation External Rotation PAB – Pronation Abduction Pronation Dorsiflexion Supination External Rotation (SER): most common; fibular fracture is usually in a posterior superior to anterior inferior orientation Pronation Abduction (PAB): fibular fracture is usually in a posterior inferior to anterior superior orientation or inferomedial to superolateral (8) |
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Gout
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Deposition of urate crystals in the soft tissues
About the 1st MTP joint and the TMT is a preferred area Extra-articular erosions with resultant overhanging edges Soft tissue tophi which are often dense of calcified |
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Rheumatoid Arthritis
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Peri-articular erosions involving the MTP and PIP joints
The 5th metatarsal head is a preferred site of involvement Can have angular def |
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Diffuse Idiopathic Skeletal Hyperostosis (DISH)
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Ossification of soft tissues, specifically at attachments sites of ligaments and tendons
Spine is most common site (thoracic>lumbar>cervical) Often results in anterior longitudinal ossification which can result in dysphagia given the proximity to the esophagus At least 4 contiguous levels must be involved |
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Spine Fractures
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Jefferson -- atlas (C1) --- open mouth!
Hanged Man's -- C2 fracture |
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Dens fractures
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Type I – through the superior tip of the odontoid process (dens on C2)
Type II – through the base of the odontoid process Type III – through the base of the odontoid process and obliquely through the body of C2 |
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Traumatic imaging of the cervical spine
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********Standard of care is a CT of the cervical spine
As the sensitivity of CT is greater and the severity of the fracture can be life threatening, ALWAYS get a CT of the cervical spine, NOT a radiograph! |
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Lumbar Spine X-Rays
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*Highest dose of radiation in x-ray -- Limited to no information for disc herniation -- Therefore, if concerned for disc herniation, consider MRI for more information!!! -- However, most recommendations are to wait several weeks before imaging!!! -- If concerned for compression fracture or metastases, recommend a lumbar spine x-ray
*A lumbar spine radiograph has the highest x-ray exam dose (~ 2.1 mSv) -- Unless the patient has a history of trauma, cancer, or infection, a lumbar spine radiograph or imaging is not indicated Conservative therapy including NSAIDS, rest, and heating pads are recommended |
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Degenerative Disk Disease
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Not a vague term, but a distinct entity
Common ageing process As the lumbar spine vertebral bodies and their respective intervertebral discs are NOT a synovial joint this is NOT osteoarthritis Findings including decreased disc height, endplate osteophytes and sclerosis, disc vaccuum phenomenon |
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Disk Hernation
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Disc bulge = greater than 180 degrees of disc material is displaced
Protrusion = less than 180 degrees with the base of the herniation greater than the length Extrusion = less than 180 degrees with the base of the herniation less than the length |
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Psoriasis x-ray
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In both psoriasis and Reiter’s (reactive) arthritis, there can be non-marginal sometime bridging osteophytes
Are more bulky than the thin syndesmophytes in ankylosing spondylitis |
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Ankylosing Spondylitis x-ray
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Ascending ankylosis from the SI joints to the cervical spine
Findings in the lumbar spine include syndesmophytes (ossification of Sharpey’s fibers) squaring of the vertebral body and shiny corners (from erosion and secondary repair), bamboo spine, dagger sign |
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Radiographs vs. MRIs
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Radiographs are better than MRI for:
Calcification Metal Air |