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Case Review Series - MSK
Terms in this set (22)
What are two manifestations of calcium hydroxyapatite crystals in the soft tissues?
1. Calcific Tendinitis
The rotator cuff consists of?
Where does the supraspinatus attach?
The middle facet of the greater tuberosity
The suprasinatus is the most commonly rotator cuff muscle.
What is the natural progression of rotator cuff calcific tendinitis?
Resolves and heals spontaneously.
or, can progress causing symptoms
Milwaukee shoulder (destructive arthropathy with hydroxyapatite deposits and rotator cuff tears)
What is the treatment of rotator cuff calfcific tendonitis
Needling, aspiration, and lavage if symptomatic
Extracorporeal shock wave therapy can help
What changes can you expect in spondylolisthesis?
1. erosion of the inferior endplate of the subluxed vertebra
2. rounding of the superior endplate of the inferior vertebra
3. degeneration of the disk
4. anterior and posterior of the disk
5. hypertrophy of the anterior epidural fat.
Differential diagnosis of a well circmscribed radiolucent lesion surrounded by a thin rim of sclerosis?
Intraosseus Lipoma (central nidus of dystrophic calcification is nearly pathopgnomonic)
Simple bone cyst
Normal trabecular variation (pseudocyst)
Use MRI to differentiate.
What are the different subtypes and locations of osteosarcoma?
Periosteal osteosarcoma (diaphyseal)
Parosteal osteosarcoma (metaphyseal)
Can osteosarcoma appear cystic?
Yes - telangiectasic osteosarcoma is an osteolytic subtype that may appear benign.
In Scaphoid Fracture, what is considered delayed union?
incomplete union after 4 months of cast immobilization.
If you do not see a scaphoid fracture, but suspicion is high, what is the next step?
Splint and re-image in 7-10 days.
Which section of the scaphoid is most at risk of AVN?
fracture of the proximal pole
What are some causes of Myositis ossificans traumatica
Rhabdomyolysis, such as crush injury, severe muscle strain, and electrocution.
What is the difference between calcific myonecrosis and myositis ossificans traumatica?
Calcific myonecrosis = sheet of calcification
What is Kummel's Disease
Delayed post-traumatic collapse of a vertebral body. The hallmark is gas within the vertebral body.
micro-trauma and some kind of process that interferes with healing --> avacsular necrosis of the vertebral body.
the avascular necrosis shows up as decreased height, +/- increased density, and GAS within the body (which represents vacuum phenomenon).
Risk factors: corticosteroid use, alchoholism, radiation therapy.
Attachment of PCL
Medial aspect of the medial femoral condyle to the posterior tibia
Direction of the femoral head in slipped capital femoral epiphysis
Posterior and inferior displacement of the proximal femoral epiphysis.
widended cartilaginous growth plate
irregularity and rarefaction of the metaphysis.
What is the key to diagnosing slipped capital femoral epiphysis?
AP and frog leg radiographs
What is Tibia Vara?
Aka Blount's Disease
- a growth disorder of the tibia that causes it to angle inwards + shortening of the leg.
causes is an insult to the growth of the MEDIAL aspect of the proximal tibial epiphysis for either trauma or dysplasia.
There are two types: infantile type (first few years of life), 8x more common, and bilateral in 50-75% of cases.
Adolescent type is usually unilateral and likely post -traumatic causing growth arrest of the tibia.
Resoption of bone in the first carpometacarpal joint + radial subluxaton of the first metacarpal bone
- soft tissue resoprtion
- conical shape to the ends of the digits
- calcification of the soft tissue or joint capsule
What helps distinguish a chondroblastoma from other lesions?
occurs in 5-25yo
radiographic hallmark is a well defined osteolytic lesion that is centrally or eccentrically located within the epiphysis or apophysis of a bone.
+/- calcifications (50%)
Typical signal for cartilage: T1: low intensity, T2/STIR: bright
MRI --> look for bone marrow edema (not found in enchondroma or giant cell tumor)
4 characteristics of a giant cell tumor
1) occurs only with a closed growth plate
2) abuts articular surface: 84 - 99% come within 1 cm of the articular surface
3) well defined with NON-sclerotic margin
4) eccentric : if large this may be difficult to asses
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