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264 Cards in this Set
- Front
- Back
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created by torsion injury to shoulder that sucks nitrogen out of solution. See cartilage contrasted by gas at GH jt.
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Vacuum shoulder phenomenon
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thinning traebeculae in the cortical bone of the humeral head or greater tuberosity. Well-defined lytic process.
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Pseudocyst/tumor of humeus
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when clavicle and acromion don't meet. May be due to sudden humeral shoving into AC joint or weight on humerus
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Os Acromiale
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sit of attachment of rhomboid ligament dug out of undersurface of clavicle NORMAL
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Rhomboid fossa
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shadow of soft tissue on skinny people with sunken thoracic outlet triangles
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clavicle companion shadow
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caused by skin curving around the clavicle
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clavicle companion shadow
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osseous density on inf. aspect of clavicle that may form an accessory/false joint with coranoid process of scapula
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prominent conoid tubercle of clavicle
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list 4 qualifications of Madelung's deformity (bayonnette appearance)
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1. angulated radial articular surface, 2. Ulnar variance
3. angulated distal radius/short, 4. posterior subluxation of ulna |
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an inconsistent bone of body that does not develop in everyone. Occur at areas of ossification (where cartilage becomes bone).
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ACCESSORY
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separations of ordinary bones during development
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accessory bones
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independently developing bones that consistently appear at known locations. Embedded in tendons.
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sesamoid bones
*little sesame seeds |
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another word for accessory bone (separated from main bone)
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ostyloideum
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os epiphyramis / os epitriquetrum
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multiple ossicles in hand
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fusion of skin between digits
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syndactyly
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fusion of phalanges
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symphalangism
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many digits
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polydactyly
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shortening of one of the metacarpals
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brachymetacarpy
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abnormal shortness of the metacarpal bones
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brachymetacarpy
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enter or exit holes
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vascular or nutrient canals/foramina
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can there by multiple sesamoid bones of the hand?
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yes, and feet
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non-union of the secondary center of ossification in the acetabular shelf
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Os Acetabuli
*non-united that doesn't form shelf |
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groove for nutrient arteries in the ilium, usually "Y" shaped
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vascular channels
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notches in ilium near SI most prevalent in females. Due to change from gluteal artery
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paraglenoid sulcus
*preauricular sulcus |
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3 groups that are the boundaries for of Ward's triangle of femur
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1 - principle compressive (head)
2-Secondary compressive (greater trochanter) 3 - principle TENSILE group (neck) |
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pseudo-tumor appearance just below growth plate in lateral knee of skeletally immature
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Ludloff's spot
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where does the patella always have bipartite or tripartite anomalies?
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Superior Lateral
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the Ludloff's spot is due to
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thinning of trabeculae
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little bean sesamoid bone in the lateral head gastrocnemius tendon
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Os FABELLA
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sesamoid bone in the popliteus
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Os Cyamella
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transverse growth lines in the metaphyseal region - horizontal sclerotic band where growth stopped then started again
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Harris' growth arrest lines
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lucer's line and Park's line are also called
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Harris' growth arrest lines
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circular radiolucent defect in the superolateral pole of patella
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DORSAL DEFECT of the patella
*on dorsal/underside |
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unattached bones of the ankle
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os subfibulare
os subtibiale os talotibiale os peroneum |
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split navicular in foot
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bipartite navicular
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unattached bone under fibula/lateral malleolus
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os SUBfibulare
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unattached bone under tibia/medial malleolus
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os SUBtibiale
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unattached bone in the talotibial joint of ankle
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Os talotibiale
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unattached bone at insertion of peroneus/fibularis muscle near cuboid
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os peroneum
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heel spur
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calcaneal enthesophyte
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accessory bone on the back of the talus
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Os TRIgonum
*dorsiflexion brings on symptoms |
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accessory bone located just medial to the navicular
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Os tibiale EXTERNUM
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osseous projection off anterior talar neck that limits motion
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talar BEAK
*pes planus common |
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NORMAL, fragmented and sclerotic appearance of calcaneal apophysis
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Calcaneal apophysis mistaken for
SEVER'S DISEASE |
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what is often mistaken for Server's disease
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calcaneal apophysis (busted calcs from serving)
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a fibrous or osseous union between two tarsal bones
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tarsal coalition
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an area of lucency that may be visualized within the anterior calcaneus, due to normal trabecular patterns
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pseudocystic triangle
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shortening of usually the 4th metatarsal of foot
BILATERAL 25x more common FEMALES |
brachymetatarsia
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extra bones between the interphalangeal joints
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os interphalangeus
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NO articulation between a proximal and distal or middle phalanx
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Phalangeal symphalangism
*webbing between the digits - most common anomaly of HAND |
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webbing between the digits - most common anomaly of the HAND
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syndactlyly
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congenital ankylosing of the PROXIMAL phalangeal joints
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symphalangism
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Presacral space norm
child: adult: |
Presacral space
child 1-5 mm adult 2-20 mm |
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Tear Drop distance
Norm: Problem: |
Tear Drop distance
Norm: 6-11 mm Problem: more than 2 deg. difference (WALDEN STROM) |
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reasons for increase in Tear Drop distance
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inflammatory disease
trauma avascular necrosis |
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Hip joint space width -
describe |
Superior joint space 3-6mm
Axial joint space 3-7 mm Medial joint space 4-13 mm |
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Hip 36 and 37 year olds take the 4:13 to London & smoke a joint.
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Hip joint space:
Superior 3-6 mm Axial 3-7 mm Medial 4 -13 mm |
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Which disease attacks one of the 3 hip joint space compartments?
Which disease attacks axial and medial hip joint spaces? |
any: degenerative arthritis (weight bearing FA jt. is Superior 3-6mm)
axial & medial: rheumatoid arth. |
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An increase in hip joint space, vs the reduction caused by osteo- and rheumatoid arthritis, may be due to hip ___________
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effusion
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Kohler's line measures the
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Protrusio Acetabulum
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A single line from the innermost pelvic brim to most lateral obdurator foramen.
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Kohler's line looking for protrusion (protrusio acetabulum)
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Pubic symphysis width:
Males Females |
Pubic symphysis width
Males: 4.8-7.2 mm Females: 3.8 - 6.0 mm |
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increases may be evident with cleidocranial dysplasia or pregnancy
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pubic symphysis width
males 4.8-7.2 females 3 - 6 |
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smooth line from superior border of obturator foramen in an arc to femoral head joint space inferiorly.
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Shenton's line
*disruption indicates fracture |
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what does a disrupt of Shenton's line possibly indicate?
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SFCE - slipped capital femoral epiphysis or fracture or dislocation
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line drawn paralleling the posterior margin of the sacrum. Another line drawn along first line paralleling the side edge of the xray
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Sacral inclination/pelvic tilt
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normal iliac angle index
0-3 months 3-12 months |
0-3 months iliac angle: 35-58 deg
3-12 months iliac angle: 43-67 |
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increase in iliac angle index in a child may show
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congenital hip dysplasia
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from one triradiate cartilage to another. Also called Hilgenreiner's, Y-symphyseal or YY line
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iliac index angle for congenital hip dysplasia in pediatrics
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how does acetabular angle differ from iliac index angle aesthetically?
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acetabular angle is along acetabulum so much smaller than iliac index angle
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normal for acetabular angle
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12-29 degrees
(vs. 35-67 for iliac angle) |
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Decrease in acetabular angle may indicate hip dysplasia (like iliac angle can), but also?
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DOWN's SYNDROME
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Tear drop distance is also the __________ joint space of the hip
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medial
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what should not happen with Kohler's line?
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the acetabular floor (socket) should not cross the line. This would be protrusio acetabulo
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line (arc) from ilieum to femoral neck to greater trochanter
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Ilieo-femoral line
*could indicate fx |
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Hip AP how is patient's leg positioned?
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internally 10-15 degrees
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patient's heel is positioned on contralateral suprapatellar region
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frog-leg hip projection
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Mickulicz's angle
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femoral angle
normal 120-130 degrees |
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Mickulicz's angle
less than 120 degrees greater than 130 degrees |
less than is coxa varus
greater than is coxa valgus |
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With Skinner's line, where should the fovea centralis be?
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above the horizontal line
*suspect femoral head displace |
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a little of Kline's bald head should be above the line or we suspect
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SFCE
slipped femoral capital epiphysis |
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How to tell if there is normal coverage of acetabulum over femoral head?
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Center Edge Angle (Ceagle) -
A Ceagle can see 20/40 |
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Arterial
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· due to a well formed cervical rib or to an incompletely formed first rib;
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Neurological
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· related to the fibrous band associated with a rudimentary cervical rib or a giant transverse process of C7
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Post-traumatic
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· secondary to a fracture of the clavicle
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Sometimes in young patients without the
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typical risk factors for development - Venous thrombosis
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Venous or "effort thrombosis
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- The most common vascular problem in athletes
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Venous or "effort thrombosis
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- Have occurred with mild exertion
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Venous or "effort thrombosis
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- The incidence represents less than 6% of all deep venous thromboses
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Muscle hypertrophy, poor technique, or overuse
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can contribute to thoracic outlet syndrome
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Thoracic Outlet Syndrome
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controversial fifth syndrome of TOS is entirely?
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· syndrome is entirely subjective → made only of symptoms
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1. Hypotonic shoulder muscles
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- Mostly in women
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1. Hypotonic shoulder muscles
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- Responds well to specific and simple exercises
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2. Post- accident
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- Whiplash type of injury in most cases
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· More than one third of patients acutely complain of paresthesias caused by
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§ Trigger points and thoracic outlet syndrome
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· More than one third of patients acutely complain of paresthesias
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§ Less commonly by cervical radiculopathy
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TOS is made only of symptoms: "diagnosing" it has led to scores of operations,
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scalenotomy in the past, now mostly resection of the first rib, sometimes scalenectomy
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* TOS Predominantly Vascular symptoms
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* Predominantly Vascular 8 symptoms
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PV Usually an indication of interference with
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- subclavian vessels, and/or distribution of sympathetic vasomotor fibers
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Diminished
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radial and ulnar pulses
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Obliteration of radial pulse when
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- the shoulder is abducted and extended, and on Adson’s test
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Bluish discoloration of the
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- hand
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Local peripheral symptoms with
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- ‘dead’ fingers
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Cramp-like pain in the
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hand and fingers
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A pulsating lump above
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- the clavicle
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The limb may develop
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claudication and become gangrenous with ulceration of the digits
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Predominantly Neurological
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Predominantly Neurological
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Usually interference with the brachial
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plexus and/or associated autonomic neurons
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· Upper plexus compression
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- Median nerve
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· Lower plexus compression
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- Ulnar nerve
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· C8- T1 Paraesthesia
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- Often bilateral
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· Numbness
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- Subjective with no actual sensory loss
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· Numbness
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- Sometimes objective
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Arterial
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· due to a well formed cervical rib or to an incompletely formed first rib;
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· T1 supplied muscle weakness and wasting
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- A tendency to drop things and to be clumsy
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Neurological
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· related to the fibrous band associated with a rudimentary cervical rib or a giant transverse process of C7
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· T1 supplied muscle weakness and wasting
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- Inability to do up buttons, thread needles or perform small repetitive finger movements like winding a watch
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Post-traumatic
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· secondary to a fracture of the clavicle
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Predominately neurological TOS presents with Pain in the (3)
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hand, forearm and arm
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Sometimes in young patients without the
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typical risk factors for development - Venous thrombosis
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Spasmodic hypertonus
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· of finger flexors (flexor cramp)
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Venous or "effort thrombosis
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- The most common vascular problem in athletes
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Conduction velocities confirm the
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clinical diagnosis
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· Horner’s syndrome may sometimes be observed
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Interruption of the oculosympathetic nerve pathway
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Venous or "effort thrombosis
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- Have occurred with mild exertion
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· Horner’s syndrome may sometimes be observed
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- Ptosis, pupillary miosis and facial anhidrosis
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Venous or "effort thrombosis
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- The incidence represents less than 6% of all deep venous thromboses
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Clinical Course
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Clinical Course
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Muscle hypertrophy, poor technique, or overuse
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can contribute to thoracic outlet syndrome
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Considerable variations
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between patients
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Frequent remission
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or slow progression
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Thoracic Outlet Syndrome
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Signs and symptoms rarely either
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vascular or neurological
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controversial fifth syndrome of TOS is entirely?
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· syndrome is entirely subjective → made only of symptoms
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The typical constellation of signs and symptoms in the upper extremity are generated from
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· myofascial, neurologic and vascular structures
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1. Hypotonic shoulder muscles
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- Mostly in women
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The typical constellation of signs and symptoms in the upper extremity are generated from
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- Pain
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1. Hypotonic shoulder muscles
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- Responds well to specific and simple exercises
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The typical constellation of signs and symptoms in the upper extremity are generated from
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- Parasthesias
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2. Post- accident
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- Whiplash type of injury in most cases
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The typical constellation of signs and symptoms in the upper extremity are generated from
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- Weakness
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· More than one third of patients acutely complain of paresthesias caused by
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§ Trigger points and thoracic outlet syndrome
|
|
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The typical constellation of signs and symptoms in the upper extremity are generated from
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- Temperature changes in the arms and hands
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· More than one third of patients acutely complain of paresthesias
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§ Less commonly by cervical radiculopathy
|
|
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TOS is made only of symptoms: "diagnosing" it has led to scores of operations,
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scalenotomy in the past, now mostly resection of the first rib, sometimes scalenectomy
|
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* TOS Predominantly Vascular symptoms
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* Predominantly Vascular 8 symptoms
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Often exacerbated by
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arm movements, usually in hyperabduction
|
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PV Usually an indication of interference with
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- subclavian vessels, and/or distribution of sympathetic vasomotor fibers
|
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Loss of tone in shoulder
|
- shoulder girdle muscles
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Postural weakness
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or changes
|
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Diminished
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radial and ulnar pulses
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Causes/Etiology
|
Causes/Etiology
|
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Obliteration of radial pulse when
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- the shoulder is abducted and extended, and on Adson’s test
|
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Other causes of TOS
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§ Obesity
|
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Bluish discoloration of the
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- hand
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Local peripheral symptoms with
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- ‘dead’ fingers
|
|
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Other causes of TOS
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§ Pregnancy
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Cramp-like pain in the
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hand and fingers
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Other causes of TOS
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§ Congenital anomaly
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A pulsating lump above
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- the clavicle
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Other causes of TOS
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§ Exostosis
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The limb may develop
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claudication and become gangrenous with ulceration of the digits
|
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Thoracic outlet syndrome: diagnosis and conservative management
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Thoracic outlet syndrome: diagnosis and conservative management
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Predominantly Neurological
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Predominantly Neurological
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Diminished pulse by such maneuvers is not considered
|
reproducing the symptoms by careful patient positioning
|
|
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Accurate diagnosis requires
|
significant
|
|
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Usually interference with the brachial
|
plexus and/or associated autonomic neurons
|
|
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Proper treatment requires accurate
|
understanding of the postural factors involved
|
|
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· Upper plexus compression
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- Median nerve
|
|
|
Most recent programs consider evaluation
|
of joint mobility and muscular imbalance essential.
|
|
|
· Lower plexus compression
|
- Ulnar nerve
|
|
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The importance of patient education is stressed.
|
relaxing shortened muscles and less on shoulder girdle strengthening exercises.
|
|
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· C8- T1 Paraesthesia
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- Often bilateral
|
|
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Treatment approaches today place more emphasis on
|
Properly educating the patient to achieve behavior modification, exercise compliance, symptom control, and postural correction is requisite to optimal results
|
|
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· Numbness
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- Subjective with no actual sensory loss
|
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· Numbness
|
- Sometimes objective
|
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· T1 supplied muscle weakness and wasting
|
- A tendency to drop things and to be clumsy
|
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Cervico-Axillary Canal
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· Cervicoaxillary Syndrome.
|
|
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· T1 supplied muscle weakness and wasting
|
- Inability to do up buttons, thread needles or perform small repetitive finger movements like winding a watch
|
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Within which there are three sites of possible compression or irritation
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· Scalene triangle, Costoclavicular spine, Subcoracoid/Pectoralis Minor space
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- Anterior scalene tightness
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Compression of the interscalene space between the anterior and middle scalenes
|
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Predominately neurological TOS presents with Pain in the (3)
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hand, forearm and arm
|
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§ Probable etiology anterior scalene tightness (3)
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Nerve root irritation
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Spasmodic hypertonus
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· of finger flexors (flexor cramp)
|
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§ Probable etiology anterior scalene tightness (3)
|
Spondylosis or,
|
|
|
Conduction velocities confirm the
|
clinical diagnosis
|
|
|
· Horner’s syndrome may sometimes be observed
|
Interruption of the oculosympathetic nerve pathway
|
|
|
§ Probable etiology anterior scalene tightness (3)
|
Facet joint inflammation leading to muscle spasm
|
|
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- Costoclavicular approximation
|
§ Compression in the space between the clavicle, the first rib and the muscular & ligamentous structures in the area
|
|
|
· Horner’s syndrome may sometimes be observed
|
- Ptosis, pupillary miosis and facial anhidrosis
|
|
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§ Probable etiology costoclavicular approximation causes (2)
|
§ Postural deficiencies or,
|
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Clinical Course
|
Clinical Course
|
|
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§ Probable etiology costoclavicular approximation causes (2)
|
§ Carrying heavy objects
|
|
|
Considerable variations
|
between patients
|
|
|
Frequent remission
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or slow progression
|
|
|
- Pectoralis minor tightness
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§ Compression beneath the tendon of the pectoralis minor under the coracoid process
|
|
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§ Probable etiology
|
§ Repetitive movements of the arms above the head (shoulder elevation and hyperabduction).
|
|
|
Signs and symptoms rarely either
|
vascular or neurological
|
|
|
The typical constellation of signs and symptoms in the upper extremity are generated from
|
· myofascial, neurologic and vascular structures
|
|
|
Differential Diagnostic Considerations
|
· Cervical spondylosis
|
|
|
The typical constellation of signs and symptoms in the upper extremity are generated from
|
- Pain
|
|
|
Differential Diagnostic Considerations
|
· Cervical rib
|
|
|
Differential Diagnostic Considerations
|
· Syringomyelia
|
|
|
The typical constellation of signs and symptoms in the upper extremity are generated from
|
- Parasthesias
|
|
|
Differential Diagnostic Considerations
|
· Pancoast tumor (superior pulmonary sulcus tumors are uncommon primary bronchogenic carcinomas)
|
|
|
The typical constellation of signs and symptoms in the upper extremity are generated from
|
- Weakness
|
|
|
The typical constellation of signs and symptoms in the upper extremity are generated from
|
- Temperature changes in the arms and hands
|
|
|
Differential Diagnostic Considerations
|
· Shoulder arthropathy
|
|
|
Often exacerbated by
|
arm movements, usually in hyperabduction
|
|
|
Differential Diagnostic Considerations
|
· Ulnar and carpal tunnel syndromes (also double crush)
|
|
|
Loss of tone in shoulder
|
- shoulder girdle muscles
|
|
|
Differential Diagnostic Considerations
|
· Hormonal imbalances in menopausal women causing increased fluid retention
|
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Cervical Rib
|
Cervical Rib
|
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Postural weakness
|
or changes
|
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CR Pain, proximal at first, then
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· progresses down the arm
|
|
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Causes/Etiology
|
Causes/Etiology
|
|
|
Other causes of TOS
|
§ Obesity
|
|
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CR Pain, proximal at first, then
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- Usually medial but may go lateral
|
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CR Especially when provoked by repetitive movements with arms
|
· repetitive movements with arms outreaching or held overhead
|
|
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Other causes of TOS
|
§ Pregnancy
|
|
|
CR Fingers may become icy cold and
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· and numb at room temperature
|
|
|
Other causes of TOS
|
§ Congenital anomaly
|
|
|
CR Paresthesia
|
- Sensibility changes may be patchy
|
|
|
Other causes of TOS
|
§ Exostosis
|
|
|
Thoracic outlet syndrome: diagnosis and conservative management
|
Thoracic outlet syndrome: diagnosis and conservative management
|
|
|
CR Hyperaesthesia of some fingers and
|
§ and dysaestheisia of others
|
|
|
CR Muscle
|
- weakness and/or wasting
|
|
|
Diminished pulse by such maneuvers is not considered
|
reproducing the symptoms by careful patient positioning
|
|
|
Accurate diagnosis requires
|
significant
|
|
|
CR Weak
|
- grip
|
|
|
CR Wasting of small
|
- hand muscles
|
|
|
Proper treatment requires accurate
|
understanding of the postural factors involved
|
|
|
CR Worse when?
|
· at night
|
|
|
Most recent programs consider evaluation
|
of joint mobility and muscular imbalance essential.
|
|
|
The importance of patient education is stressed.
|
relaxing shortened muscles and less on shoulder girdle strengthening exercises.
|
|
|
Treatment approaches today place more emphasis on
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Properly educating the patient to achieve behavior modification, exercise compliance, symptom control, and postural correction is requisite to optimal results
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Cervico-Axillary Canal
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· Cervicoaxillary Syndrome.
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Within which there are three sites of possible compression or irritation
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· Scalene triangle, Costoclavicular spine, Subcoracoid/Pectoralis Minor space
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- Anterior scalene tightness
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Compression of the interscalene space between the anterior and middle scalenes
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§ Probable etiology anterior scalene tightness (3)
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Nerve root irritation
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§ Probable etiology anterior scalene tightness (3)
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Spondylosis or,
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§ Probable etiology anterior scalene tightness (3)
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Facet joint inflammation leading to muscle spasm
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- Costoclavicular approximation
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§ Compression in the space between the clavicle, the first rib and the muscular & ligamentous structures in the area
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§ Probable etiology costoclavicular approximation causes (2)
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§ Postural deficiencies or,
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§ Probable etiology costoclavicular approximation causes (2)
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§ Carrying heavy objects
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- Pectoralis minor tightness
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§ Compression beneath the tendon of the pectoralis minor under the coracoid process
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§ Probable etiology
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§ Repetitive movements of the arms above the head (shoulder elevation and hyperabduction).
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Differential Diagnostic Considerations
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· Cervical spondylosis
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Differential Diagnostic Considerations
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· Cervical rib
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Differential Diagnostic Considerations
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· Syringomyelia
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Differential Diagnostic Considerations
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· Pancoast tumor (superior pulmonary sulcus tumors are uncommon primary bronchogenic carcinomas)
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Differential Diagnostic Considerations
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· Shoulder arthropathy
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Differential Diagnostic Considerations
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· Ulnar and carpal tunnel syndromes (also double crush)
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Differential Diagnostic Considerations
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· Hormonal imbalances in menopausal women causing increased fluid retention
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Cervical Rib
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Cervical Rib
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CR Pain, proximal at first, then
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· progresses down the arm
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CR Pain, proximal at first, then
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- Usually medial but may go lateral
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CR Especially when provoked by repetitive movements with arms
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· repetitive movements with arms outreaching or held overhead
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CR Fingers may become icy cold and
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· and numb at room temperature
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CR Paresthesia
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- Sensibility changes may be patchy
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CR Hyperaesthesia of some fingers and
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§ and dysaestheisia of others
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CR Muscle
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- weakness and/or wasting
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CR Weak
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- grip
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CR Wasting of small
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- hand muscles
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