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161 Cards in this Set

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What is an involucrum? How is it different from a sequestrum?)
Rim of living bone that surrounds the sequestrum is an involucrum
DDx for a bony sequestrum?
1) osteomyelitis
2) LCH ("button" sequestrum)
3) osteoid osteoma
4) lymphoma
5) fibrosarcoma
How do you differentiate periosteal reaction in infection from physiologic etiology?
Infectious periosteal rxn affects the metaphysis.
What is Caffey disease? How is it different from physiologic periosteal reaction?
1) infantile cortical hyperostosis.
2) coarse, irregular, asymmetric periosteal reaction
and soft tissue swelling
DDx for diffuse periosteal rxn in the newborn/infant?
1) physiologic (1-6 months, no metaphyseal involvement)
2) trauma
3) infection
4) PG therapy
5) Caffey disease (infantile cortical hyperostosis)
Spine appearance:
1) "Rugger jersey"
2) "Sandwich"
3) "Picture frame"
1) renal osteodystrophy
2) osteopetrosis
3) Paget disease

*Don't forget about mets!
DDx for b/l symmetric sacroiliitis?
1) ank spondylosis
2) IBD
3) RA
4) hyperparathyroidism
DDx for b/l asymmetric or unilateral sacroiliitis?
1) reactive arthritis
2) psoriatic arthritis
3) OA
4) septic arthritis
DDx for proximal arthropathy in the hands/feet?
1) RA
2) CPPD
3) gout
4) CVD
5) hemochromatosis
DDx for distal arthropathy in the hands/feet?
1) OA
2) erosive OA
3) psoriatic arthritis
4) reactive arthritis
5) RA
What feature of gout separates it from other erosive arthropathies?
joint preservation
Fluffy periostitis and erosions in the hands/feet is characteristic of which 2 arthropathies?
1) reactive arthritis
2) psoriatic arthritis
Which arthropathy can lead to a SLAC wrist?
CPPD
What does CPPD stand for?
calcium pyrophosphate dehydrate
What differs beaklike osteophytes in CPPD from hemochromatosis?
CPPD beaklike osteophytes often spare the 4th and 5th MCP joints
DDx for chondrocalcinosis?
1) CPPD arthropathy
2) hyperparathyroidism (usually primary)
3) hemochromatosis
4) Wilson disease
DDx for vertebra plana in a child?
1) LCH
2) leukemia/lymphoma
3) infection
4) mets
How do you tell the difference between TB and other infectious processes of the spine?
preservation of disk space
What disease demonstrates wormian bones and hypoplasia/absence of the clavicles?
cleidocranial dysostosis
What disease demonstrates wormian bones and "bullet" vertebrae at the thoracolumbar junction?
hypothyroidism
DDx for wormian bones (at least a couple of things):
1) Down's syndrome
2) OI
3) Rickets
4) Cleidocranial dysostosis
5) hypothyroidism
What is a Madelung deformity?
Triangular configuration of the distal radius and ulna articulation with wedging of the proximal carpal bones between the distal radius and ulna
DDx for Madelung deformity?
1) idiopathic
2) Turner syndrome
3) skeletal dysplasia
4) trauma
5) infection
What are three eponyms found in scurvy?
1) metaphyseal spurs (Perlkan spur)
2) osteopenic epiphysis with dense peripheral calcs (Wimberger ring)
3) lucent metaphyseal bands adjacent to a thickened zone of provisional calc (zone of Frankel)
What is the Wimberger sign that is found in syphilis?
bilateral upper medial tibial destruction
What metabolic disease causes cupping and fraying of the distal metaphysis?
Rickets
DDx for lucent metaphyseal bands?
1) Leukemia
2) Rickets
3) Infection
4) neuroblastoma mets
5) Scurvy
6) Syphilis
DDx for a chondroid, medullary lesion?
1) enchondroma
2) chondrosarcoma
3) bone infarct
4) chronic osteomyelitis
DDx for acro-osteolysis?
1) hyperparathyroidism
2) scleroderma
3) trauma (burn, frostbite)
4) psoriasis
5) Hajdu-Cheney syndrome
What is another name for PVNS affecting a tendon sheath?
Giant cell tumor of the tendon sheath
What are the hallmarks of PVNS?
1) joint effusion
2) subchondral cysts
3) erosions
4) preservation of the joint
DDx for a dense joint effusion?
1) hemarthrosis
2) chronic juvenile arthritis or hemophilia
3) PVNS
4) septic arthritis
5) crystalline arthropathy
Where does juvenile arthritis cause damage?
1) knee
2) facet joints in the spine
3) hands/wrists
4) odontoid process
Loose bodies in a joint effusion with endplate erosions ddx?
1) synovial osteochondromatosis
2) pigmented villonodular synovitis
3) RA (rice bodies)
Expansile rib lesion in a child ddx?
1) fibrous dysplasia
2) enchondroma
3) bone cyst
4) LCH
5) Ewing sarcoma
6) mets
Posterior element lytic lesion ddx?
1) ABC
2) osteoblastoma
3) infection
4) mets
5) LCH
What should be suspected when the lunate and the capitate are malpositioned on the lateral wrist view?
midcarpal dislocation (ligamentous injury at the lunotriquetral jt)
What is the "triple signal intensity" seen on T2 with synovial sarcoma?
1) hemorrhage
2) fibrous tissue
3) cystic components
How do you tell the difference between extraskeletal osteosarcoma and myositis ossificans?
MO should demonstrate a zone of mature ossification peripherally.

The opposite is true for sarcomas.
DDx for periarticular soft tissue calcifications?
1) hemangioma
2) scleroderma
3) myositis ossificans
4) gout
5) soft tissue sarcomas
6) tumoral calcinosis
What are the different types of osteosclerotic dysplasias?
1) osteopoililosis
2) melorrheostosis
3) osteopathia striata (Voorhoeve syndrome)
What are 4 features of a pathologic spinal fx on MR?
1) abnormal marrow signal with ill-defined margins
2) extension of abnormal marrow signal into the pedicles
3) associated soft tissue lesion
4) marked abnormal enhancement
Epiphyseal lucent lesion in a child ddx?
1) chondroblastoma
2) GCT
3) LCH

*Adults, think also infection, mets, chondrosarcoma
What is the difference between parosteal and periosteal osteosarcoma?
Parosteal:
-arise from outer layer of periosteum
-low grade tumor
-cauliflower-like with lucent cleavage plane between lesion and cortex

Periosteal:
-arise from inner layer of periosteum
-intermediate grade
- saucerized cortex with cortical thickening and periosteal reaction adjacent to chondroblastic soft tissue mass
What is the "trough sign" and where is it found in?
1) posterior shoulder dislocation
2) linear impaction fx of the anterior humeral head
What is a Monteggia fx?
ulnar fx with prox radial dislocation
What is a Galeazzi fx?
radial shaft fx with distal radioulnar dislocation
What is a Essex-Lopresti fx?
radial head fx and distal radioulnar dislocation
What is a Colles's fx? Smith?
distal radius fx with:
1) dorsal angulation
2) ventral angulation
What is a Barton's fx?
IA distal radius fx/dislocation
What is a Bennett's fx?
Fx/dislocation at base of 1st MC
What is a Rolando fx?
comminuted Bennett fx
What is a gamekeeper's thumb?
ulnar collateral ligament injury at the 1st MCP
What is a Chauffeur's fx?
IA fx of radial styloid (can have dorsal displacement).

Comes from car drivers getting kick-back when they started the engine using a lever
What is a Duverney's fx?
iliac wing fx
What is a Malgaigne's fx?
SI jt or sacral fx with both ipsilateral pubic rami fx
What is a Straddle fx?
Fx of all four pubic rami (both obturator rings)
What is a Segond fx?
Fx at the lateral tibial condyle.

Associated with ACL injuries
What is a Pilon fx?
IA, comminuted distal tibia fx
What is a Tillaux fx?
SH-3 fx of the lateral distal tibia
What is a triplane fx?
Tillaux fx with extension into the tibial metaphysis (SH-4 fx)
What is a Wagstaffe-Le Fort fx?
avulsion of the medial margin distal fibula
What is a Dupuytren's fx?
fx of fibula above tibiofibular ligament
What is a Lisfranc fx?
tarsometatarsal fx/dislocation
What two ways can help you identify the supraspinatus tendon from the infraspinatus tendon on the coronal oblique sequence?
1) usually on same plane as the AC joint
2) the biceps anchor is in view
What represents the fluid collections sometimes seen lateral to the biceps tendon on axial imaging of the shoulder?
anterolateral branch of the anterior circumflex artery and vein
What is the rotator interval? What makes up its contents?
1) space between the supraspinatus and subscapularis tendons
2) biceps tendon, coracohumeral ligament, SGHL
What makes up the boundaries of the coracoacromial arch? What are its contents?
1) coracoacromial ligament anteriorly
2) HH posteriorly
3) acromion superiorly

Part 2:
1) subacromial/subdeltoid bursa
2) supraspinatus
3) LH of biceps tendon

Impingement occurs when there is a decreased size of the coracoacromial arch.
What are some causes of shoulder impingement?
1) acromial shape/orientation
2) os acromiale
3) AC deg changes
4) post-traumatic etiology
5) shoulder instability
6) muscle overdevelopment
7) thick coracoacromial ligament
How do you tell the difference between tendon degeneation or partial thickness tears from magic angle?
1) magic angle occurs at specific location (1 cm from SS insertion onto HH)
2) no irregularity to tendon with magic angle
3) signal abnormality disappears on T2W imaging with magic angle
What is a rim rent tear?
partial thickness tear of the insertional fibers onto the greater tuberosity
What's the problem with keeping the shoulder in internal rotation during an MR?
can miss a rim rent tear of the SS tendon because it approximates the bicipital groove
What hold the biceps tendon in the bicipital groove?
transverse humeral ligament
What is posterosuperior impingement syndrome?
impingement of the IS/SS tendons between HH and posterosuperior labrum

Common in pitchers
Subcoracoid impingement is associated with tears of what RC tendon?
subscapularis tendon
Absence of subcoracoid fat on T1W sagittal images indicates what disease?
adhesive capsulitis
What represents thickenings of the anterior shoulder joint capsule?
the glenohumeral ligaments

(Note: the IGHL arises from both the anterior and posterior inferior labrum.)
What is the main stabilizing ligament of the shoulder?
inferior glenohumeral ligament
What anatomic landmark helps to tell the difference between SGHL and MGHL on axial MR imaging?
coracoid process.

SGHL is at the level of the coracoid, while the MGHL is at the inferior tip of the coracoid.
What is a sublabral foramen?
where the anterosuperior labrum is not attached to the glenoid
What is a Buford complex?
Anterosuperior labrum congenitally absent with a thick MGHL
What is a HAGL lesion?
Humeral avulsion of the glenohumeral ligament, particularly the anatomic neck of the humerus avulsing with the IGHL
What is a Bennet lesion (of the shoulder)?
mineralization of the posterior band of the IGHL from chronic traction (usually from pitching).

May be associated with a posterior labral tear.
What is a Bankart lesion?
Tear of the anteroinferior labrum with torn periosteoum. May have an associated fracture (bony Bankart).
What is an ALPSA lesion?
Stands for Anterior labroligamentous periosteal sleeve avulsion.

Variation of the Bankart lesion with injury to the anteroinferior labrum, but the periosteum remains intact.
What is a GLAD lesion?
Stands for Glenolabral articular disruption.

Tear of the anteroinferior labrum with a glenoid chondral defect.
What is the condition where there is a congenital absence of the bony posterior lip of the inferior glenoid?
glenoid dysplasia.

Associated with an increased incidence of posterior labral tears or detachments.
What is a SLAP tear? What are the four types?
Tear of the superior labrum, oriented in an anterior and posterior direction, occurring at the attachment site of the LH of the biceps tendon.

Part 2:
1) fraying of the free edge of the superior labrum
2) detachment of the superior labrum from the glenoid. Note that detachment indicates extension to the biceps anchor.
3) bucket-handle tear of the superior labrum.
4) bucket-handle tear extending into the LH of the biceps tendon

Note: A "bucket-handle" tear of the labrum is a full thickness tear, separating the labrum into medial and lateral components.

Just remember the important features of SLAP lesions:
1) labrum: detached or torn? If torn, partial thickness or bucket handle?
2) biceps anchor: torn? Not torn?
What is Parsonage-Turner syndrome?
acute brachial neuritis, usually affecting the suprascapular, axillary, subscapularis, and long thoracic nerves
The scapholunate ligament is separated into three parts: volar, middle, and dorsal.

Which part is the strongest? Which part can have perforations, which may be a normal variant?
1) dorsal
2) middle
Discontinuity of the scapholunate ligament is associated with which 2 instability patterns?
1) DISI (dorsal intercalated segmental instability)
2) SLAC (scapholunate advanced collapse)
What is associated with a tear of the lunotriquetral ligament (name 2)?
1) VISI
2) TFC tear
What are the most important intrinsic ligaments of the wrist?
1) scapholunate ligament
2) lunotriquetral ligament
What is Parsonage-Turner syndrome?
acute brachial neuritis, usually affecting the suprascapular, axillary, subscapularis, and long thoracic nerves
The scapholunate ligament is separated into three parts: volar, middle, and dorsal.

Which part is the strongest? Which part can have perforations, which may be a normal variant?
1) dorsal
2) middle
Discontinuity of the scapholunate ligament is associated with which 2 instability patterns?
1) DISI (dorsal intercalated segmental instability)
2) SLAC (scapholunate advanced collapse)
What is associated with a tear of the lunotriquetral ligament (name 2)?
1) VISI
2) TFC tear
What are the most important intrinsic ligaments of the wrist?
1) scapholunate ligament
2) lunotriquetral ligament
What are the most important volar extrinsic ligaments of the wrist?

dorsal?
1) radioscaphocapitate
2) radiolunotriquetral

Part 2: radioscaphoid, radiolunate, and radiotriquetral
What are the components of the triangular fibrocartilage comples (TFCC)?
1) TFC
2) radioulnar ligaments (dorsal and volar)
3) extensor carpi ulnaris tendon sheath
4) ulnar collateral ligament
5) meniscus homologue
Where does the TFC attach?
1) medial aspect of the ulnar styloid
2) lateral radial cartilage (emphasize "cartilage" and not "bone." Do not confuse high signal of cartilage with a tear.)
How do you tell the difference between the TFC and the radioulnar ligament?
The RU ligaments attach directly to bone, while the TFC attaches to the cartilage (of the radius).
How do you tell the difference between the adductor aponeurosis and the ulnar collateral ligament of the thumb?
The UCL is found deep to the adductor aponeurosis
What is a Stener lesion?
Tear and retraction of the UCL, which is displaced superficial to the adductor aponeurosis (switch places)
Which condition of the thumb is described as a "yoyo on a string"?
The Stener lesion.

The yoyo is the retracted UCL. The string is the adductor aponeurosis.
What are the 6 extensor compartments of the wrist?
1) abductor pollicus longus, extensor pollicus brevis
2) extensor carpi radialis longus and brevis
3) extensor pollicus longus
4) extensor indicis and extensor digitorum
5) extensor digiti minimi
6) extensor carpi ulnaris
Where is Lister's tubercle?
Between the 2nd and 3rd extensor component on the dorsal aspect of the radius
de Quervain's syndrome affects which extensor compartment?
First
What are some findings in carpal tunnel syndrome?
1) focal or segmental swelling of the median nerve
2) flattening or angulation of the median nerve at the distal carpal tunnel (level of the hook of the hamate)
3) bowing of the flexor retinaculum (increased bowing ratio)
4) increased T2 signal of the median nerve
Which nerve is most commonly affected by a fibrolipomatous hamartoma?
median nerve
What goes through Guyon's canal? What makes it up?
1) ulnar nerve, artery, and vein
2) flexor retinaculum, hypothenar musculature, pisiform, and hook of the hamate
What is an os styloideum?
bony proturberance on the dorsal aspect of the wrist, located at the base of the 2nd and 3rd metacarpals
What are the two most common locations for osteonecrosis in the wrist?
1) proximal pole of the scaphoid
2) lunate
What are the signal characteristics of a giant cell tumor of the tendon sheath?
low T1 and T2

Remember, think PVNS.
What is the most common mass found in the wrist?

2nd most common?
1) ganglion cyst
2) Giant cell tumor of tendon sheath
What describes a glomus tumor in the finger on MR?
1) high T2, low T1
2) intense enhancement
3) bony erosion
4) usually located on the dorsal aspect of the fingertip, beneath the nail
Which synovial cyst of the wrist is very common, but not associated with inflammatory arthritis?
pisotriquetral synovial cyst
What is the tendon found medial to the Achilles tendon?
Plantaris tendon.

Don't confuse this for an Achilles tear!
Which tendons tend to be affected by xanthomas?
1) Achilles tendon
2) extensor tendons of the hands
What is Haglund's deformity?
Triad of retro-Achilles bursitis, retro-calcaneal bursitis, and thickening of the Achilles tendon distally

AKA "pump bumps"
What is the most commonly abnormal medial tendon of the ankle?
posterior tibial tendon

Tears can lead to flat foot. Tears are associated with sinus tarsi syndrome and abnormalities of the spring ligament. Tears are more common with accessory navicular bones.
Where does the posterior tibial tendon insert most importantly?
navicular bone.

It also inserts onto all the cuneiforms and the 1st through 4th metatarsals, but can't really see this with MR.
Which ankle tendon sheath commonly communicates with the ankle joint?
flexor hallicus longus
Which ankle tendon is associated with the os trigonum syndrome?
flexor hallicus longus
How do you diagnose a dislocated peroneal tendon?
1) identify a tear of the retinaculum
2) the tendons are located lateral to the distal fibula, instead of posterior to it
What makes up the deltoid ligament in the ankle?

Which is most medial?
1) tibiotalar ligament
2) tibiocalcaneal ligament
3) talonavicular ligament
4) spring ligament (most medial)
Which lateral ankle ligament can be confused for a loose intra-articular body on sagittal MR imaging?
posterior tibiofibular ligament
Which lateral ankle ligament is best seen on coronal sequences (if at all), as opposed to the other ligaments which are best seen on axial sequences?
calcaneofibular ligament

Think: C is for calcaneofibular and coronal.
What are the contents of the tarsal tunnel?
1) PTT
2) post tibial artery/vein
3) post tibial nerve
4) FHL tendon
5) flex digitorum tendon
What is a Morton's neuroma?
chronic plantar digital nerve entrapment, leading to perineural fibrosis.

Usually found in and plantar to the metatarsal heads.
What is the most common soft tissue abnormality to occur in the region of the hallux sesamoids?
turf toe

(hyperdorsiflexion at the 1st MTP joint
What MR features of an osteochondral lesion suggest instability?
1) high T2 signal surrounding the fragment
2) absent or displaced fragment
3) crack in the overlying cartilage
4) large subchondral cysts deep to the fragment
Where do osteoid osteomas like to present in the foot and ankle?
talus and calcaneus
DDx for tumor in the calcaneus?
1) lipoma
2) UBC
3) ABC
4) giant cell tumor
5) chondroblastoma
What is the most common malignant soft tissue tumor of the foot?
synovial sarcoma
DDx for tumor in the hip/pelvis?
1) enchondroma
2) giant cell tumor
3) chondroblastoma
4) mets
5) myeloma
6) chondrosarcoma
What is the largest bursa in the body?
iliopsoas
Which arthropathy affects the hips, is bilateral, is low on T1 and T2, and has erosions?
amyloid arthropathy
What are the regions of the femoral neck with regards to fracture classification?
Divided into intra-capsular and extra-capsular.

Intra-capsular:
1) subcapital
2) transcervical
3) basicervical

Inter-trochanteric are extra-capsular
What are the three articulations of the elbow?
1) proximal radioulnar jt
2) radiocapitellar jt
3) ulna (olecrenon) with the trochlea of the humerus
Where does an osteochondral lesion most commonly occur in the elbow?
capitellum
What is Panner's disease?
Osteochondrosis of the capitellum, which occurs in throwers as a result of trauma.

Other info:
-5-10 yr olds
-No loose body formation (seen in an osteochondral lesion)
-diffuse low T1 and high T2 signal of the capitellum.
What ligaments make up the radial collateral ligament complex in the elbow?

Which is most important? Where does it originate?
1) radial collateral ligament proper
2) lateral ulnar collateral ligament (most important)
3) annular ligament
4) accessory collateral ligament

Part 2: lateral epicondyle, deep to the common extensor tendon
What makes up the ulnar collateral ligament complex?

Which is most important? Where does it originate and insert?
1) anterior bundle (most important)
2) posterior bundle
3) transverse bundle

The anterior bundle originates at the medial epicondyle and inserts onto the medial coronoid process of the ulna.
Where does the biceps tendon insert? What lies deep to the biceps tendon? What keeps the biceps tendon in proper position? Is there a tendon sheath distally?
1) radial tuberosity
2) brachialis muscle/tendon
3) bicipital aponeurosis
4) no
What muscle helps you to determine laterality on a elbow MR?
anconeus muscle is lateral, and arises from the lateral epicondyle, inserting onto the olecrenon
Which muscle is partially avulsed in lateral epicondylitis?
extensor carpi radialis brevis
What are the four muscle components in the elbow?

Place these muscles into their respective compartment:
a) biceps
b) triceps
c) supinator
d) anconeus
e) brachialis
f) pronator teres
g) common extensor
h) common flexor
i) brachioradialis
1) anterior, posterior, medial, lateral

2) answers:
a) biceps -- anterior
b) triceps -- posterior
c) supinator -- lateral
d) anconeus -- posterior (and lateral)
e) brachialis -- anterior
f) pronator teres -- medial
g) common extensor -- lateral
h) common flexor -- medial
i) brachioradialis -- lateral
High signal in the pronator quadratus muscle on T2W imaging is indicative of what disease?
anterior interosseous nerve syndrome
What makes up the roof and floor of the cubital tunnel in the elbow? What nerve goes through it?
Roof -- flexor carpi ulnaris aponeurosis
Floor -- ulnar collateral ligament and capsule

Ulnar nerve
What is the arcade of Struthers? Why is it important?
thin aponeurotic band extending from the medial head of the triceps to the medial intermuscular septum.

Cause for ulnar neuropathy
How many bow ties should be seen on sagittal MR images of knee menisci?

Abnormalities with too few bow ties?

Abnormalities with too many bow ties?
1) 2

2) bucket handle tear, radial tear, medially flipped flap tear, and meniscal cyst

3) discoid meniscus
What is a cyclops lesion?
arthrofibrosis in Hoffa's fat pad after ACL reconstruction
Where does the IT band insert?
Gerdy's tubercle of the tibia
What are the components of the posterolateral corner of the knee?

What is a reliable indicator of a arcuate ligament tear?
1) LCL
2) arcuate ligament
3) popliteofibular ligament
4) popliteus tendon

Part 2: disruption of the joint capsule at the lateral joint line on axial imaging.
What are the three plicae of the knee?
1) medial
2) suprapatellar
3) infrapatellar
Where does osteochondritis dissecans affect the knee joint?

What other disease is confused with this one, but occurs on the opposite side?
1) non-weight bearing surface (lateral aspect) of the medial femoral condyle

2) spontaneous osteonecrosis of the knee, now known as insufficiency fx of knee, which occurs on medial side (wt bearing surface)
Pt with gracile bones, fatty infiltration of musculature. Refused vaccines.
polio
Soft tissue calcs with marked muscle edema. Dx?
dermatomyositis
Pt with 2nd digit enlargement and OA changes. No skin findings.
macrodystrophia lipomatosa
Bone within a bone DDx?
1) sickle cell
2) osteopetrosis
3) Paget's
4) hypervitaminosis D