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28 Cards in this Set

  • Front
  • Back
Shoulder Dislocation
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
Elbow Ossification
Capitulum
Radius
Internal epicondyle
Trochlea
Olecranon
External epicondyle
Fractures
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)
OA - radiographs
asymmetric joint space narrow and bone proliferation
osteophyte formation
PIP = bouchards nodules
DIP = heberden's
Rheumatoid Arthritis
changes in bare areas btw articular cartilage and joint capsule
subtle erosions along radial bases of prox phalanges
ulner sublaxation and deviation
Lupus
ulner subluxation and deviation without erosions
avascular necrosis and linear soft tissue calcifications
arthritis in 75%-90% pts
Scleroderma
soft tissue calcification
thining of soft tissue lining fingers
CPPD Arthropathy
knee, wrist and pubic symphsis
symmetric radiocarpal and MCP joint space narrowing
Gout
calcified if calcium precipitated
overhanging edges
Psoriasis
soft-tissue swelling of single finger/toe
sausage digit
DIP involvement with narrowing and central erosions
EROSIONS can results in PENCIL in CAP DEFORMITY
Osteomyelitis
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!!!
Pubis Fracture
*Assoc. with bladder rupture and urethral injury
*Chondrocalcinosis pubic symphysis, septic arthritis and Reactive arthritis (reiters) can cause
Unilateral Sacroiliitis
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
Intracapsular Fracture
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
Segond fracture
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.
Lauge-Hansen
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)
Gout
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
Rheumatoid Arthritis
Peri-articular erosions involving the MTP and PIP joints
The 5th metatarsal head is a preferred site of involvement
Can have angular def
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
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
Spine Fractures
Jefferson -- atlas (C1) --- open mouth!
Hanged Man's -- C2 fracture
Dens fractures
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
Traumatic imaging of the cervical spine
********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!
Lumbar Spine X-Rays
*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
Degenerative Disk Disease
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
Disk Hernation
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
Psoriasis x-ray
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
Ankylosing Spondylitis x-ray
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
Radiographs vs. MRIs
Radiographs are better than MRI for:
Calcification
Metal
Air