Msk (Musculoskeletal) Board Review

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Paget’s Disease

Cotton Wool appearance
The osteolytic phase is called osteoporosis circumscripta and appears as multiple geographic, well-demarcated regions of bone resorption that may be mistaken for metastases

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Calcaneonavicular Coalition

Anteater Nose

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Aneurysmal Bone Cyst

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Osteopetrosis

Bone in Bone sign

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EG

Button Sequestrum
Could also be ostomyelitis

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Intraosseous Lipoma

A classic appearance of intraosseous lipoma of the calcaneus is the presence of a well defined lytic lesion with a central calcification resembling a cockade. A cockade is badge, usually in the form of a rosette, or knot, and generally worn upon the hat

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Rotatory subluxation of scaphoid

Signet ring sign

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AVN

Air Crescent Sign
Fractures that occur in the subchondral bone may be recognized by a crescentic lucent zone that separates the fragment from the remainder of the femur

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Middle Subtalar Coalition

Lateral radiograph of the foot revealing a classic C sign which is a C-shaped line formed by the medial outline of the talar dome and the inferior outline of the sustentaculum tali

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Unicameral Bone Cyst

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Hemolytic Anemia

Hair on End Appearance
Thallasemia vs. SCD
The ‘hair’ represents the accentuated trabeculae extending between the inner and outer skull tables in the expanded diploic marrow spaces

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Psoriatic Arthritis

Ivory Phalanx

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Ivory Vertebra

most common causes of ivory vertebrae are typically metastatic disease, and Paget’s
Lymphoma
Infection
Degenerative
Oseoid Osteoma

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Thanatophoric Dwarf

The is no gas in the lungs. The ribs are very short, as are the limb bones.
The rib ends and metaphyses are flared.
The femora are curved, like an old telephone handset.
The ilia are small and square.

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CDH

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Osteoid Osteoma

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Stress Fracture

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Multiple Enchondromas

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Fibrous Cortical Defect

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Chondrosarcoma

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Rickets

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Scapholunate ligament tear

Terry Thomas sign

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Osteonecrosis

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Vertebra Plana

MELT
metastasis, multiple myeloma
eosinophilic granuloma
lymphoma
trauma, tuberculosis

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Aneurysmal Bone Cyst

The list of entities that involve the epiphysis or apophysis is relatively short, and includes:
chondroblastoma
infection
giant cell tumor
aneurysmal bone cyst (ABC)
enchondroma
Geode

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Rickets

widening of the metaphyses with ragged, "frayed" margins
Two main causes of osteomalacia:
problems with vitamin D metabolism
problems with renal tubular phosphate loss

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Madelung Deformity

Findings:
increased width between the distal radius and ulna.
relatively long ulna compared to radius (positive ulnar variance).
decreased carpal angle.
triangularization of the distal radial epiphysis.
wedging of the carpus between the deformed radius and the protruding ulna, with the lunate at the apex of the wedge

Post-traumatic
extension injuries to radial epiphysis
excessive or repetitive loading of an immature joint
young gymnasts
Dysplastic
multiple hereditary exostosis syndrome
dyschondrosteosis (a mesomelic variety of dwarfism)
onycho-osteodysplasia syndrome (HOOD syndrome: nail-patella syndrome)
Genetic
Turner's syndrome
Idiopathic

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Paget’s Disease

3 major phases:
1) lytic
2) mixed lytic-sclerotic
3) sclerotic

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Anterior Instability / Chronic Dislocation

Hill Sachs
impaction fracture seen in the humeral head due to anterior dislocation

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Calcaneal Stress Fracture

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GCT of Apophysis

DDx
ABC

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Rheumatoid Arthritis

60-70% of patients with RA develop cervical spine symptoms
Erosion of the dens occurs in 14-35% of patients with RA
A potentially devastating complication of RA is atlantoaxial subluxation

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FCD

Fibroxanthoma / NOF / FCD

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Metastatic RCC

Thyroid mets can look similar
DDX
ABC / Telangiectatic osteosarcoma
GCT
Chondroblastoma
Brown Tumor

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Tumoral Calcinosis

Idiopathic Tumoral Calcinosis
mass-like calcific deposits about joints
usually normal or slightly elevated serum calcium and phosphate

ST Calcifications

Renal Osteodystrophy
amorphous visceral calcifications in heart, lungs, muscle, stomach and kidneys
amorphous nonvisceral calcifications in eyes, skin, arteries, and periarticular areas -- these may occasionally be globular and mass-like
metastatic calcification if the calcium-phosphate product is elevated
chondrocalcinosis if secondary hyperparathyroidism is present

Calcinosis universalis
Associated with scleroderma or dermatomyositis
Calcification is usually in thin, plaque-like and in skin and subcutaneous tissues
No large, lobular masses are usually not seen
Calcinosis circumscripta
40% are associated with scleroderma, dermatomyositis or Raynaud's
Calcifications are thin, and occur in fingertips and "toe-tips"

Milk-alkali syndrome
Large, calcified periarticular masses
History of milk, antacid consumption in huge quantities
elevated serum calcium, azotemia, alkalosis
Calcification also of lung, kidneys, vessels

Hypervitaminosis D
Due to toxic level intake (4 - 18 million Units/day)
Elevated serum levels of calcium and Vitamin D
Metastatic calcification (hyperparathyroidism and chronic renal disease)
Serum PTH and calcium levels abnormal
Soft tissue calcifications are usually fine and punctate

Heterotopic ossification
Scleroderma
Usually thin calcifications of hands, feet
Dermatomyositis
Usually associated with fine, reticular calcifications

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GCT

DDX
Giant cell tumor
Aneurysmal bone cyst
Chondroblastoma
Infection
Mets

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Cysticercosis

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Cleidocranial Dysplasia

Autosomal Dominant
Findings
Clavicular dysplasia
Wormian bones
Narrow iliac wings
Pubic Bone dysplasia
Coxa vara

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Fx Hamate / Dorsal Dislocation of 4th MC

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Hyperparathyroidism

"salt and pepper" appearance
DDx of initial film
Paget’s
Myeloma
Reversal of findings strongly suggests hyperparathyroidism

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Scleroderma

acro-osteolysis.
soft tissue calcinosis.
soft tissue atrophy, especially at fingertips (sclerodactyly).

Differential diagnosis for acro-osteolysis

Scleroderma
Hyperparathyroidism
Thermal injury
Psoriasis
Neuroarthropathy
Trauma
diabetes mellitus
leprosy
etc.

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Enchondroma

Less likely low grade chondrosarcoma