Rando MSK facts
What is a synovial cyst?
"synovial cyst" describes a continuation or herniation of the synovial membrane through the joint capsule. It consists of a fluid collection, lined by a continuous layer of "true" synovial cells. There is always communication with the adjacent joint. Usually, associated joint disease is present, like osteoarthrosis, inflammatory and post-traumatic joint diseases.
When does the apophysis of the fifth metatarsal appear in kids?
10. So if you see a pt < 10 year old with a lucency at base of fifth, even if it is obliquely oriented like a normal apophysis. Recall that the typical appearance of a fx is a horztal lucency rather than oblique lucency (apophysis).
Where will you look for deep branch of peroneal n?
About 9cm prox to lateral mal, the deep branch of peroneal n can be seen emerging from between the peroneus longus and extensor digitorum muscles, then piercing the superficial crural fascia to become superficial in location.
Contrast for abscess vs phlegmon
Abscess walls will abscess but the fluid wont and will correspond to high/fluid signal on IR, while phlegmon will enhance and may be high signal but not fluid on IR.
What is the largest tendon in the body?
Achilles tendon
Which joints in ankle communicate?
Anterior and middle subtalar, naviculocuneiform, and ankle joint (talotibial); the posterior subtalar joint does NOT communicate with rest of joint.
What should u think of when u see patchy high signal in a subcortical and periarticular distribution??? Or patchy high signal on the PD without edema?
Complex regional pain syndrome -looks like polk a dots of fatty marrow lesions
What is the numerical cutoff for spinal stenosis? (originally meant for cervical spine but used for lumbar spine too)
anything greater than 15mm in spinal canal is considered SS (not measured at disc space)
Most common place runners get a femoral neck fx
basicervical
Where do runner fx?
basicervical femoral neck
Most common component of cartilage?
cartilage contains predominantly type II collagens w/ lesser amounts of type IX and type XI
When does tibia fuse in boys? girls?
boys-16 girls-14
Ewing sarcoma vs osteosarcoma
Ewing should typically have a soft tissue mass and is diaphyseal. Even if a lesion does not produce Osseeous matrix but you see lifting of periosteum and kid is appropriately age (..), think osteo sarcoma.
LOOK AT FACET JOINTS ON SAGITTAL
LOOK AT FACET JOINTS ON SAGITTAL. Must comment on fused facets on MRI.
What clinical tests are used to evaluate the meniscus?
Lachman test, anterior drawer test,
What is the superficial most layer of cartilage called?
Lamina splendens
What is a tx for hallus valgus?
Lapidus surgery, fusion of first TMT joint
Tx for hindfoot varus?
Lateral clacaneal sliding osteotomy,
Tx for hindfoot valgus
Lateral column lengthening, PTT repair. Cotton osteotomy or lapidus to help with forefoot??
Where does sural n originate from?
Lateral cutaneous sural n originates from common peroneal n and medial cutaneous n originates from tibial n. Both converge in distal lower extremity to form the sural n proper and is found in subq fat adj to lesser saphenous vein.
What is epiphyseal dysplasia?
Long bones normally elongate by expansion of cartilage in the growth plate (epiphyseal plate) near their ends.
Biceps tendon
Long head: The long head of the biceps arises from the supraglenoid tubercle. Short head: short head of the biceps arises from the coracoid process.
In addition to burns when else can u see Heterotopic ossification?
Long term bed rest.
What is the critical zone of supraspinatus?
critical zone of the rotator cuff is an area approximately 8-15 mm from the insertion of the rotator cuff tendons onto the greater tubercle of the humeral head, mainly within the supraspinatus tendon. -its basically located in the acromiohumeral interval.
What does superior migration of humeral head associated with?
cuff tear arthropathy
What else did Fabricant et al find out about peds population and PTS?
PTS flattens with age
What is athletic pubalgia?
Pain in pubic symphysis, assoc with strain of adductor tendson **Adductor longus is main tendon implicated**
What are indications for Girdlestone?
Painful stiff hip after tuberculosis of hip Peri-prosthetic infection Aseptic loosening of hip Recurrent dislocation of hip Failed internal fixation of femoral neck fractures
What peroneal tendon pathology is cavovarus associated with?
Peroneal tendon pathology
PCI
Peroneocalcaneus internus (PCI). Sequential axial T2-weighted MR images in a 73 y/o female patient with heel pain, numbness, and a clinical diagnosis of tarsal tunnel syndrome. At the distal tibia, the PCI muscle (red) interdigitates with the flexor hallucis longus muscle (blue). Distally, the PCI tendon (red arrow) is seen lateral to the flexor hallucis longus tendon (blue arrow). Both tendons are highlighted by tenosynovial fluid (asterisk) posterior to the talus and sustentaculum tali. The neurovascular bundle is seen medial to these tendons (yellow outline). The PCI tendon inserts on the medial calcaneus below the sustentaculum tali (red arrow head).
What is the name of the accessory tendon found posterior to fibula?
Peroneus quartus--it originates from peroneus brevis and insters on lateral aspect of calcaneus at retrotrochlear eminence.
What is lateralization of the tibialis anterior?
Pes cavovarus deformity
What is a tumor which causes oncogenic osteomalacia?
Phosphaturic mesenchymal tumor
How do u approach posterior subtalar jt?
Place probe parallel to long axis of lat malleolus, then go posterior to it
What is the primary function of the peroneus longus?
Plantar flexion first metatarsal bone
What findings are associated with osteogenesis imperfecta?
Platybasia (flattening of angle between clivus and sphenoid), basilar invagination, wormian bones, enlarged sinuses, and abnormal teeth.
What is vascular supply to Achilles tendon?
Post tibial artery (prox and distal) Peroneal artery-mid portion of achilles
What is hindfoot impingement?
Posterior hindfoot impingement most commonly occurs in middle-aged and older individuals with a chronic hindfoot valgus deformity
Ramp lesion?
Posterior horn MM
What is the most common location for tibial stress fx?
Posterior medial If fx is anterior, its very bad because the tibial is normally bowed anteriorly, so an anterior fx will just keep breaking.
What is a typical location for a cortical desmoid?
Posterior medial femoral metadiaphysis at medial gastroch attachment, usu in boys 10-15 yo, or posteromedial aspect of the distal femoral metaphysis at the attachment of the adductor magnus tendon. The lesion lacks an outer margin.
Equinus
Posterior tubercle of Calcaneous points up-tight heel cord.
Posterior facet
Postermed fibers of Glut medius
Physiologic bowing
Posteromedial
So who gets what?
Prebuscent: --physeal-sparing all-epiphsyseal all-inside with hamstring autograft --Physeal-sparing ITB recon( over-the-top) Young adolescent, growth remaining: --Partial transphyseal with over-the-top femoral position or epiphyseal femoral tunnel with hamstring autograft Older Adolescent: --Complete transphyseal, BTB or hamstring autograft
What is mumford procedure?
REsection of distal clavicle for severe ACJ arthrosis
How can you tell posterolateral instability on MRI?
Radial head subluxes posteriorly wrt to capitellum.
More on posterior impingement-soft tissue causes
Soft-tissue causes of impingement encompass synovitis of the flexor hallucis longus tendon sheath, the posterior synovial recess of the subtalar and tibiotalar joints, and the posterior intermalleolar ligament.
What 3 tendons blend together to form the Achilles tendon?
Soleus, gastrocnemius, plantaris
what is mc place in knee for gout?
Sprapatellar recess
What is Weaver's bottom?
TB of ischial tuberositu
What prevents communication between radiocarpal joint and the dRUJ?
TFCC
What happens to old people who have anterior dislocation?
THey don't dislocate; instead, they tear their subscapularis.
What is tarsal tunnel syndrome?
Tarsal tunnel syndrome is an entrapment neuropathy, which occurs as a result of compression of the posterior tibial nerve.
Who are candidates for surgical tx of acl?
Tear greater than one half the thickness of the ACL, tear of the posterolateral bundle, skeletal age of 14 or more
What are factors which predispose to patella tendon rupture?
Tendinosis, dz, RA, SLE, gout, CPPD, Diabetes, hyperparathyroidism
Why do you get loose bodies in a tendon sheath?
Tendon sheaths have synovial lining like a joint does. ALso why you get PVNS of tendon sheath.
What accounts for the prox third of clavicle being projected superiorly and the distal third remaining attached to AC joint in handle bar injury?
Unopposed motion from sternocleiodomastoid accounts for prox clavicle going upwards and the coracoclavicular ligament keeps distal third of clavicle in place and articulated with acromion
What do valgus and varus refer to?
The alignment of the talus with the tibia.
What characterizes a Lisfranc injury on xray?
Widening of interval between medial cuneiform and base of second metatarsal of >2mm.
What is the first branch off the lateral plantar nerve?
The inferior calcaneal nerve--course between the abductor hallucis and quadrator plantae muscles, then plantar to the calcaneus.
What does the transverse ligament of the hip insert onto in the hip?
The ligamentum teres
How can you distinguish the heads of the triceps?
The long and lateral heads are a combined tendon and are more superficial while the medial is deep/ anteriorly located at forearm and elbow.
Wha is Bryan Kelly's landmark for 12:00 position during labral repair?
The rectus femoris direct head
What is the difference between the rectus femoris components?
The rectus femoris muscle has two tendinous origins, the direct or straight head, which arises from the anterior inferior iliac spine (AIIS), and the indirect or reflected head, which arises from the superior acetabular ridge and the posterolateral aspect of the hip joint capsule
What are some pathologies that can occur with an os tibiale externum?
Think of stress rx, fracture of os tibiale externum, osteonecrosis, or bipartite os tibiale externum. -SN: an os tibiale externum is not the same thing as a os naviculare though I am not sure what the difference is.
What should you think of if you see proliferative narrowing of hip joint?
Think of synovial proliferative disease such as PVNS, synovial chondromatosis,
Diff between epidermal inclusion cyst and glomus tumor in distal tuft?
glomus tumor will destroy bone, epidermal inclusion cyst is purely a soft tissue tumor and should not destroy bone
What is reln between dysfuroxamine and thalassemia?
it is the tx for it.
Ligamentum mucosum. Infrapatellar plica
kids can f trhough it
why not allowed to put more than 13ml contrast for myelo?
literatures says risk of seizures
What is most common location of tibial stress fx?
medial and prox femur
What does modified crass and crass do for shoulder US?
moves the supraspinatus more anterior to bring it out from underneath the acromion
Describe pes deformities
pes planus pes cavus hindfoot equinus midfoot equinus
What is DARRACH PROCEDURE ?
resection of the distal part of the ulna done for DRUJ dysfx
Long thoracic
serratus anterior, medial scapular winging
Platyspondylodysplasia + epiphyseal dysplasia-->
spondyloepiphyseal dysplasia
Old ladies most common place fracture
subcapital femroal neck fx
Growth plates widened without slip
think Rickets (resorption)
Which growth plate fuses first in knee?
tibia--fuses posterior to anterior
Describe hindfoot alignment terms:
tibial/hindfoot alignment- hindfoot valgus- hindfoot varus- vertical talus-
What is tx for ulnar impaction syndrome and DRUJ instability?
ulnar impaction syndrome and combined DRUJ instability, ulnar shortening osteotomy can improve DRUJ stability by increasing the tension of the ulnocarpal ligaments
What is LEFT SCARF OSTEOTOMY, MODIFIED MCBRIDE AND AKIN OSTEOTOMY for hallux valgus
xx
What is Salto Talaris arthroplasty?
xx
Posterior inferior labral tear?
Question a posterior dislocation
What is ranawat line?
AP line at cervicmedullary junction
What two entities can give you a popcorn like calcification appearance?
**Fibrous dysplasia and **osteogenesis imperfecta
What are contents of sinus tarsi?
**Talocalcaneal interosseoseus ligament**-most important; medial, intermediate and lateral roots of the inferior extensor retinaculum, lateral cervical ligament.
What is PTT tear associated with?
**the spring ligament complex (superomedial and inferomedial calcaneonavicular ligaments) and those of the sinus tarsi are frequently ruptured.
What else?
-Accessory soleus?
What is ddx for rhizomelic skeletal dysplasia?
-Achondroplasia -Hypochondroplasia -Kyphomelic dysplasia -spondyloepiphyseal dysplasia congenita -rhizomelic chondrodysplasia punctata -
What is the imaging hallmark of metallosis?
-Deposition of prominent low-signal intenisty metallic wear debris, often with low-signal intensity osteolysis. -Pts can have features of both metallosis and ALVAL combined.
Deep radial layer
- deep radial layer - largest part of the articular cartilage - it distributes loads and resists compression; -highly organized collagen fibers that are oriented parallel to the cartilage surface. In addition, this zone has the highest proteoglycan content and the lowest water content.
What is transitional or middle layer
- transitional layer - this zone involves transition between the shearing forces of surface layer to compression forces in the cartilage layers; - composed almost entirely of proteoglycans -accounts for 40% to 60% of the thickness and has a higher compressive modulus than the superficial zone. The collagen fibers are randomly oriented in this zone. -less strongly bound.
Haglund deformity
-"Kump" bump -Triad of retro-achilles bursitis, retrocalcaneal bursitis, thickening of distal achilles tendon.
Qu for ortho:
--in a TSA or hemi, what is point of tenodesing a biceps tendon to the pectoralis major tendon? --
Plantar fascia components?
-3 components -Thick central portion -thinner membrane like lateral portion -Medial cord of plantar fascia -Plantar fasciitis is thickening of the plantar fascia (central cord>4mm)
What is trident acetabulum?
-3 inferior-pointing spikes (upside-down trident), - Jeune syndrome, Ellis-van Creveld syndrome, thanatrophoric dysplasia.
Synovial vs ganglion cyst?
-A ganglion cyst represents an advanced stage of a degenerated synovial cyst, in which the continuous synovial lining and the communication with the joint may be lost during the process of degeneration
What is a Ramp lesion?
-A ramp lesion is a Posterior horn meniscal tears which is thought to be commonly found in conjunction with anterior cruciate ligament (ACL) injury. -It is a lesion of the peripheral attachment of the posterior medial meniscus
Posteromedial impingement?
-A severe ankle inversion injury in which the deep posterior fibers of the medial deltoid ligament become crushed between the medial wall of the talus and the medial malleolus. -become crushed between the medial wall of the talus and the medial malleolus. -MR imaging can show the lesion, thickened soft tissues, and evidence of bone marrow edema of both the medial talus and medial malleolus
what is chondrodyspasia calcifications congenita?
-AKA Conradi disease -
What is nail-patella syndrome?
-AKA Fong diz -is a rare autosomal dominant condition which results from symmetrical mesodermal and ectodermal abnormalities. -Clinically, the key feature is absent/hypoplastic nails from birth. Individuals may have flexion contractures and recurrent knee dislocations.
Describe all epiphyseal ACL recon?
-AKA the Anderson technique: two incision, transepiphyseal reconsturction in pts Tanner stage I, II, III. It is a 4-strand hamstring autograft secured by means of suspensory fixation on femoral side, and screw and post on tibial side
What views are best for head neck junction anatomic offset?
-AP pelvic, a 45° or 90° Dunn, a frog-leg lateral, and/or a cross-table lateral view, the anterior aspect of the femoral head-neck junction can be classified in relation to the posterior aspect of the femoral head-neck junction on the basis of the gross appearance of the radius of curvature at each location. -if the anterior aspect of the head-neck junction has a convexity, as opposed to a concavity, the head-neck junction is considered to have a prominence
What are the accessory muscles of ankle?
-Accessory muscles around the ankle include: the flexor digitorum accessorius longus, the peroneocalcaneus internus, the accessory soleus, and the accessory peroneal muscles.
What abn can pts get in the toes?
-Adventitious bursitis -Adventitious bursae are not permanent native bursae. They can develop in adulthood at sites where subcutaneous tissue becomes exposed to high pressure and friction -MC location is plantar surface metatarsal heads, contrast with intermetatarsal bursae that occur in between the metatarsals.
What is a lateral column lengthening procedure?
-An incision is made on the outside of the foot, and the front half of the calcaneus is cut. A bone wedge is then placed into the cut area of the calcaneus. This wedge helps to "lengthen" the heel bone and rotate the foot back into its correct position. The wedge is usually kept in place using screws or a plate. The wedge can be taken from a cadaver or from a patient's own hip.
What is articularis genu?
-Articularis genu is a small flat muscle of the anterior knee. During knee extension it acts to tighten the synovial membrane superiorly thereby preventing impingement of the synovial folds between the femur and the patella.
What are assoc ST injuries with clip injury?
-Associated soft-tissue injuries can include varying degrees of sprain or disruption of the MCL. -**Injury most commonly involves the proximal portion of the ligament near the femoral attachment site.**
What is a BPOP?
-Bizarre parosteal osteochondromal proliferation -Also known as a Nora lesion) is a benign exophytic osteochondral lesion which has an appearance similar to an osteochondroma, and is typically seen in the hands and feet. -BPOPs are continuous with the underlying cortex, but usually without continuation of the medulla.
Why are Ramp lesions so important?
-Cant be seen arthroscopically if anteromedial or anterolateral approach is seen -and is thought to be of importance for knee stability against anterior translation of tibia.
What is subtle cavus foot?
-Characterized by mild heel varus, plantarflexed first ray. -Abn foot is explained by theories including aberrant morphology of calcaneus and/or subtalar joint, and/or overactive peroneus longus tendon -Flexible phase at heel strike where calcaneus becomes relatively valgus, eversion of subtalar joint occurs, nonparallel talus and calcaneus on AP radiograph. -In this position the hindfoot (is flexible) and absorbs the force of heel strike -Progresses to flatfoot and toe-off results in varus calcaneus, inverstion of subtalar joint, and parallelism of the talus and calcaneus on AP radiographs.
What is Baxter neuropathy?
-Compression of the inferior calcaneal nerve (Baxter neuropathy) may occur secondary to microtrauma (calcaneal spur, internal foot derangement) or to plantar fasciitis, particularly if associated with a flexor digitorum brevis muscle and soft-tissue edema. The patient experiences heel pain similar to plantar fasciitis. -imaging sign secondary to this neuropathy is isolated fatty atrophy of the abductor digiti quinti muscle
Why does supramalleolar osteotomy work?
-Corrects the medial displacement of the load line
What is looser zone?
-Cortical infraction, AKA pseudofracture, lucency occuring perpendicular to cortex -Occurs at: pubic rami MEDIAL proximal femur lateral scapula posterior proximal ulna ribs
What is the difference between acetabular profunda and acetabular protrosio?
-Coxa profunda is characterized by medial displacement of the floor of the acetabular (the medial aspect) with respect to the ilioischial line. Acetabular protrusio is characterized by medial displacement of the medial femoral head with respect to ilioischial line.
Malignant fibrous histiocytoma
-Deep soft tissue tumor--different types-myxoid, angiomatoid, inflammatory. -Large circ mass with bony extension is hallmark for MFH. Synovial sarcoma will not extend to bone. -Most MFHs are primary ST or osseous MFHs; 20% arise as secondary MFH occur in abnormal bone from malignant transformation -MFH can occur in an area of ostenecrosis -
What are associated ST injuries with hyperextension injury?
-Depending on the amount of force applied, associated soft-tissue abnormalities may include injury to either the ACL or PCL and a meniscal injury. -MR imaging characteristics of ACL or PCL injury are similar to those described earlier. If a substantial force is applied, dislocation of the knee may occur, along with injury of the popliteal neurovascular structures complete disruption of the posterolateral complex, and, possibly, gastrocnemius injury.
Mechanisms of biceps tendon rupture?
-Distal biceps tendon ruptures most commonly present after a single traumatic event. However, evidence suggests that tendon hypovascularity and mechanical impingement during forearm rotation are contributory factors, increasing tendon susceptibility to rupture. Consequently, tendinosis and partial tears of the distal biceps tendon may precede complete ruptures. **Smoking and anabolic steroid use may also increase the risk of distal biceps rupture. -Distal biceps tears in women are extremely rare and typically occur over the age of 60. The injury is most often a partial tear unrelated to a single traumatic event but with a more insidious onset. -Injuries of the distal musculotendinous junction with an intact distal tendon are exceedingly rare and most commonly occur with the elbow extended, the forearm supinated, and the glenohumeral joint in active or passive elevation.
SI joint involvement in ankylosing spondylitis.
-Erosions occur first at iliac side because it has thinner cartilage -Remember that the synovial side of joint is anterior inferior aspect
What other biomechanical risk factors do females have that predispose them to ACL tears over men?
-Females are quadriceps dominant ; meaning they have higher quadriceps/hamstring activation ratios compared with males -Also increased anterior pelvic tilt, increased femoral anteversion, increased quadriceps angle, decreased intercondylar notch width, increased posterior tibial slope
What is femoral anteversion?
-Femoral anteversion refers to the orientation of the femoral neck in relation to the femoral condyles at the level of the knee. -In most cases, the femoral neck is oriented anteriorly as compared to the femoral condyles. -An increased femoral anteversion is often seen in patients with developmental dysplasia of the hip. -It has been shown that abnormal femoral anteversion can contribute to the development of femoroacetabular impingement (FAI); reduced femoral anteversion is associated with cam-type FAI -Femoral anteversion can be determined by measuring the angle formed between the long axis of the femoral neck and a line parallel to the dorsal aspect of the femoral condyles (posterior condylar axis, or PCA) on axial slices at MRI or CT.
What is fibrous dysplasia ossificans progressiva?
-Fibrodysplasia ossificans progressiva (FOP), previously known as myositis ossificans progressiva (MOP), is a rare, inherited disorder characterised by progressive fibrosis and ossification of muscles, tendons, fasciae, aponeuroses, and ligaments of multiple sites. It is disabling and ultimately fatal. -hallux valgus -monophalangic first toe -shortened metacarpals -pseudoexostoses (ossification of ligamentous insertions) -microdactyly of the first metacarpal/metatarsal -neck muscle oedema -C2-C7 facet joint fusion
Medial epicondylitis?
-Golf players, common flexor tendon
What is a grade I MCL injury?
-Grade I: A grade I sprain of the MCL is visualized on MR images as contour irregularity and edema superficial to the MCL. The fibers, however, remain intact. -Grade II: A partial tear of the MCL is a grade II injury and can be seen on MR images as a partial discontinuity of the fibers with adjacent areas of increased signal intensity on T2-weighted images in the setting of acute injury; some fibers will remain intact. -Grade III: Complete disruption can be seen as complete discontinuity of the MCL fibers, with extensive surrounding high signal intensity on T2-weighted images in acute cases. -Increasing degrees of flexion of the knee at injury may result in disruption of the ACL and a tear of the medial meniscus. This extensive injury combination is better known as the O'Donoghue triad.
What is Hereditary multiple diaphyseal sclerosis (Ribbing disease)?
-Hereditary multiple diaphyseal sclerosis (Ribbing disease) is another disorder of intramembranous -The disease is characterized by cortical thickening involving the periosteal and endosteal surfaces of the diaphyseal portion of long bones (Fig 12). -The epiphyses are characteristically spared, and there may be narrowing of the medullary canal (13,15,16). The distribution of osseous involvement differs from that in progressive diaphyseal dysplasia in that there is either unilateral or asymmetric and asynchronous bilateral involvement of long bones, typically the tibia or femur
What is hyperextension injury?
-Hyperextension of the knee can result when direct force is applied to the anterior tibia while the foot is planted or from an indirect force, such as a forceful kicking motion. The most severe cases often result from direct injury (eg, a car bumper hitting the anterior tibia of a pedestrian). -During the brief moment of hyperextension, the anterior aspect of the tibial plateau strikes the anterior aspect of the femoral condyle, resulting in the "kissing" contusion pattern of bone injury. -If a valgus force is also applied at hyperextension, the kissing contusions will be located medially.
What sort of achilles tendonosis pathology is there?
-Hypoxic (most common)--that affects the tendon diffusely -Mucoid-more focal high signal, looks like circles ie vacuoles of degeneration -Combinations of hypoxic, mucoid, calcific, and fatty degeneration occur with aging or with overuse, resulting in a disorganized collagen structure and increased tendon stiffness.
How does posterior sloping of the lateral tibial slope increase the risk of ACL injury?
-Inc PTS causes anterior translation of the tibia during weight bearing activities, potentially placing more strain on the ACL and increasing the risk of ACL injury. -increased ACL strain is more pronounced with loading of knee in position near full extension ie landing from a jump or pivot maneuver -SN: a pivot shift represents anterior tibial subluxation of the lateral tibial plateau and represents lateral compartment instability. -Of note, studies have also shown that pts with increased LATERAL posterior tibial slope (PTS) increase risk of re-injury in patients who have already had ACL repair. -No difference in risk of ACL injury with medial tibial plateau.
Caffey's dz
-Infantile Cortical Hyperostosis -Cortices are thick and wide with periosteal rxn -The clavicles, mandibles and mandible are the most common sites of involvement in infantile cortical hyperostosis. One or both clavicles may be affected. 2. The disease is seen in infants less than 5 months of age. 3. The etiology of this disease is unknown. It may represent an infectious process.
What is Weavers bottom?
-Inflammation of the ischiogluteal bursa
Identify pat pads
-Infrapatella (Hoffa's fat pad): yellow -posterior suprapatellar (prefemoral or supratrochlear): blue -anterior suprapatellar (quadriceps fat pad): red
Why is a bone contusion not called a fracture?
-It is a misnomer--rep fracture of cancellous/trabecular bone -Fracture is reserved for fx of the outer bone/cortical bone
What is Adverse lymphocytic-vasculitis associated lesion (ALVAL)?
-It is a subtype of ALTR. -It is a type IV lymphocyte-mediated delayed hypersensitivity reaction that may lead to aggressive soft tissue damage and poor prognosis after arthroplasty revision in patients.
What should u consider when you see a jet phenomenon on sagittal T2 spine MRI?
-Jet phenomenon--think pseudomeningocele. -Pseudomeningocele--think subdural hematoma
What is joggers foot?
-Jogger's foot is related to entrapment of the medial plantar nerve branches in a narrow space located between the abductor hallucis muscle and the anatomic crossover between the flexor hallucis longus and flexor digitorum longus tendons (master Knot of Henry). -The medial calcaneal nerve (Fig 8) arises from the posterior tibial or lateral plantar nerve. It pierces the flexor retinaculum and divides into multiple superficial sensory branches that innervate the skin covering the medial aspect of the Achilles tendon, the posteromedial aspect of the heel, and the plantar fat pad. -Repetitive microtraumas can be responsible for medial calcaneal neuropathy in joggers. Fat pad atrophy, particularly in association with sudden weight loss or diabetes, can also be involved in medial calcaneal neuropathy.
Who gets a reverse total shoulder arthroplasty?
-Large RC tears, No functioning rotator cuff, plus intact deltoid -Failed conventional TSA -Fx
How do you tell acetabular dysplasia on AP radiograph?
-Lateral Center of Edge angle -Values of <25° may indicate inadequate coverage of the femoral head.
What are three surgical tx for pes planus deformity?
-Lateral column lengthening -Medializing Calcaneal oseotomy -
What is ECU subsheath?
-Major stabilizer of ECU and prevents it from subluxing -tennis, golf
What does ALVAL look like on imaging?
-Marked synovitis and soft tissue damage, and thicker synovitis correlated with more severe ALVAL reaction histologically. -Capsular dehiscence and complex type synovitis are more indicative of a more severe soft tissue reaction. -other findings include large synovial fluid distention, abductor disruption, low signal intensity deposits, osteolysis, soft-tissue edema, lymphadenopathy and neurovascular impingement
Where are morton's neuromas found?
-Morton's fibromas are most commonly found in the second and third intermetatarsal spaces. - reveal a widening of the interdigital nerve on sag MRI
Typcial location for osteopoikolsis?
-Multiple enostoses are laid down at the ends of short tubular bones; in the tarsal, carpal, and pelvic bones; and in the meta-epiphyseal regions of long bones
What should you tell the surgeon in report about ganglion cyst??
-Must describe the stalk (ie where ganglion is arising from); -must resect underlying osteophyte results volar ganglions have higher recurrence after resection than dorsal ganglions (15-20% recurrence)
What are three causes of hemihypertrophy?
-NF-1 -Hemangiomatosis -Lymphangiomatosis
Waht are some known anatomic characteristics of a knee joint that have been reported to predispose to ACL injury?
-Narrow intercondylar notch -generalized joint laxity -increased Q angle -Anterior pelvic tilt -Increased LATERAL posterior tibial slope
What are the most common complications of reverse TSA?
-Neurologic injury-traction on brachial plexus during surgery -ACROMION or scapula spine fx -Baseplate fx -Infxn
What is a normal Q angle in males? Females?
-Normal for men is 14 degrees and for women is 17 degrees. -Women usually have a higher Q angle due to their naturally wider pelvis. If measured laying down the angle will be 1-3 degrees lower. -A high Q angle often results in maltracking of the patella, that is it does not travel over the front of the knee joint as it should. Overtime this can cause microtrauma to the cartilage on the rear of the patella which causes pain, often known as anterior knee pain, patellofemoral pain or chondromalacia patella. -Having over-pronated feet also places additional strain on the Q angle due to excessive internal rotation of the tibia.-
What is the normal alignment of hindfoot?
-Normally 5-7 degree valgus
What is osteopetrosis?
-Osteopetrosis is a dysplasia of the primary spongiosa with both autosomal-dominant and autosomal-recessive subtypes. -**osteoclast dysfx -Radiographically, the hallmark of osteopetrosis is increased density within the medullary portion of the bone with relative sparing of the cortices. -Although patients with osteopetrosis have decreased osteoclastic activity, their overall bone mass is increased, which may lead to decreased elasticity of the bone or impaired repair capabilities and, therefore, increased risk of fracture. -**These patients are at risk for postsurgical complications, including delayed union, nonunion, and infection.
What is a persistent median artery?
-Persistent median artery of the forearm is an accessory artery that arises from the ulnar artery in the proximal forearm and is a persistent embryological remnant of the axial artery that usually regresses by eight weeks gestation. -a continuation of the anterior interosseous artery and accompanies the median nerve as it passes through the forearm and carpal tunnel. It is unilateral ~67% of the time and is associated with anomalous median nerves ~70%- most commonly bifid median nerves followed by high division of the median nerve. It is contained within the epineurium of the normal or bifid median nerve. -Located on the ulnar aspect of the normal median nerve median nerve is bifid the persistent median artery is located between the two nerve bundles.
What are consequences of PTT tear?
-Pes planus deformity, weakened inversion
Posterior impingement
-Posterior ankle impingement syndrome refers to a group of abnormal entities that result from repetitive or acute forced plantar flexion. -AKA os trigonum syndrome, talar compression syndrome, and posterior block of the ankle. The mechanisms of injury have been likened to a nut in a nutcracker because the posterior talus and surrounding soft tissues are compressed between the tibia and the calcaneus during plantar flexion of the foot. -This syndrome has been extensively described in classical ballet dancers,or active people. - bony CAUSES include the os trigonum (an accessory ossicle of the lateral tubercle of the talus that may persist unfused into adulthood in 7% of individuals), an elongated lateral tubercle of the talus termed "Stieda's process," a downward sloping posteriorlip of tibia, the prominent posterior
What cause hindfoot valgus?
-Posterior tibial tendinopathy is a common cause of hindfoot valgus deformity. -Pts wit hPTT dysfx experience both pain and disability. The pain is initially along the medial aspect of the foot, often associated with swelling due to tenosynovitis. With progressive collapse of the longitudinal arch and development of a hindfoot valgus deformity, lateral foot pain develops, found to frequently relate to extra-articular talocalcaneal or calcaneofibular impingement -Affected patients may also experience subluxation or dislocation of the peroneal tendons, causing a popping sensation at the posterior margin of the lateral malleolus. -This instability is not related to the lateral impingement, but rather is caused by severe hindfoot valgus malalignment, and resultant overactivity of the unopposed peroneus brevis in the presence of posterior tibial tendon insufficiency.
How do you determine acetabular version on AP xray?
-Presence or absence of the crossover sign -
Whats the mechanism of injury for PCL?
-Primary restraint to posterior translation of tibia and a secondary restraint to external rotation of the tibia. -PCL is marginally stronger than the ACL. -Injury is from direct blow to tibia with knee flexed (dashboard injury); hyperflexion injury (skiing) (tibia is planted in skiis but femur keeps going); dashboard injury, athlete falling on flexed knee, with foot in plantar flexion
Why does this work?
-Provides a fulcrum on which the shoulder is able be abducted, now solely by the deltoid -Provides a deeper socket that prevents the ball from sliding up as shoulder is raised.
Most sensitive locations for RA?
-Radial aspect of 2nd metacarpal head; 5th metacarpal also. -5th MTP -ECU tendon -2nd flexor tendon
What is Larson's syndrome?
-Rare, AKA osteochondrodysplasia -joint hypermobility -multiple congenital dislocations (typically knees) -characteristic facies -brachycephaly -cleft palate -club feet
What is cubital tunnel syndrome?
-Result of repetitive VALGUS stress. -Cubital tunnel syndrome is the second most common peripheral neuropathy of the upper extremity. Moderate compression of the nerve within the cubital tunnel, such as occurs due to physiologic decrease in cubital tunnel volume during elbow flexion, may be normal and may not result in neuropathy. -- Cubital tunnel syndrome arises from pathologic compression or a lesion of the ulnar nerve within the cubital tunnel, where the nerve passes beneath the cubital tunnel retinaculum (also known as the epicondylo-olecranon ligament or Osborne band).
What factors predispose to peroneus brevis tears?
-Shallow or Convex fibular groove, lax superior peroneal retinaculum,
What is the sinus tarsi syndrome?
-Sinus tarsi syndrome is caused by hemorrhage or inflammation of the synovial recesses of the sinus tarsi with or without tears of the associated ligaments. This disease entity commonly occurs following an inversion injury and is often associated with tears of the lateral collateral ligaments. It may also be related to related to rheumatologic disorders and abnormal biomechanics such as flat foot deformity secondary to posterior tibial tendon tear. -- -Patients with sinus tarsi syndrome present with hindfoot instability and pain along the lateral aspect of the foot. -Sensation of hindfoot instability that patients present with is due to disruption of proprioceptive fibers found in the sinus tarsi. -Hindfoot stability is maintained by the talocalcaneal ligaments located within the sinus tarsi. -Associated with ankle sprains--injury to ATFL and calcaneofibular ligament
What is the difference between a steida process and os trigonum?
-Stieda process (not to be confused with a Pellegrini-Stieda lesion) refers to an elongated lateral tubercle of the talus. It is often considered an anatomical variant. It forms from fusion of a secondary ossification center at the posterolateral aspect of the talus with rest of the talus (this typically occurs between 7-13 years)
What is Caries Sicca?
-TB of shoulder joint -Symmetrical obliteration of the left shoulder joint space with complete destruction of the humeral head. There is involvement of the left humerus and the adjacent glenoid.
What about tendon procedures related to flat foot
-Tendon and Ligament Procedures The posterior tibial tendon runs underneath the arch of the foot. It is often stretched and dysfunctional in patients with flatfoot. The tendon often requires removal if it is thickened or torn. Usually the tendon that bends the little toes can be transferred (rerouted) to help support the arch. The stresses placed on the flatfoot can lead to tearing of the ligaments that support the arch (spring ligament) and the inside of the ankle (deltoid ligament). Finally, the flatfoot condition is often associated with tightness of the Achilles tendon. This can be treated using a lengthening procedure to stretch the muscle fibers of the calf.
Lateral epicondylitis?
-Tennis players, common extensor tendon -Classically the extensor carpi radiialis brevis -Can occur with radial collateral ligament complex-due to varus stress
What is the origin and insertion of ACL
-The ACL is typically best visualized in the oblique sagittal plane. It extends from the roof of the intercondylar notch at the lateral femoral condyle to its tibial attachment site adjacent and anterior to the tibial spines. Its course should parallel the roof of the intercondylar notch.
What is ECU anatomy?
-The ECU originates as two heads which attach to the lateral epicondyle and the middle third of the posterior ulna. It has a single distal insertion upon the posterior aspect of the base of the fifth metacarpal. --The ECU functions to extend and adduct the hand, and is important in the ability to ulnar deviate the hand. -A unique anatomical characteristic of the ECU is the fibro-osseous tunnel which stabilizes the tendon at the level of the distal ulna. This fibro-osseous tunnel is formed by the distal ulna and a 1.5 to 2cm in length band of connective tissue referred to as the ECU subsheath. The subsheath lies deep to the extensor retinaculum, which itself does not attach to or stabilize the ECU tendon. The ECU, its subsheath, and the extensor retinaculum are readily seen using MRI. -Ulnar sided ruptures of the subsheath, likely the most common pattern of injury, usually result in dislocation followed by reduction in which the tendon returns to a location deep to the subsheath. With radial sided subsheath rupture, the tendon is more likely to relocate in a manner that leaves it lying atop the ruptured subsheath, preventing functional healing of the subsheath.
What are some ulnar sided accessory muscles?
-The accessory abductor digiti minimi is the most common of the accessory muscles. -It is seen radial and volar to the pisiform and inserts with the abductor digiti minimi (ADM) at the ulnar base of the 5th proximal phalanx, projecting into Guyon's canal. -Normally there should be no muscle tissue in Guyon's canal at the level of the pisiform
What are some radial sided accessory muscles?
-The accessory flexor digitorum superficialis indicis is a replacement of the FDS tendon by muscle at the carpals or second metacarpal. Like the palmaris longus, there are several variants including complete replacement, a digastric muscle belly and distal extension of the muscle into the carpal tunnel -The flexor carpi radialis brevis vel profundus extends from the distal radius to the capitate and base of the third and fourth metacarpals. It passes between the pronator quadratus and FCR muscles.
What makes up the ankle syndesmosis?
-The anterior and posterior tibiotalar ligaments which are located just above the tibiotalar joint -interosseous membrane
What are the associated ST injuries with dashboard injury?
-The associated soft-tissue injuries include disruption of the posterior cruciate ligament (PCL) and rupture of the posterior joint capsule. --The PCL is usually depicted at MR as a thick, bandlike structure, has low signal intensity with all pulse sequences, and extends from the intercondylar notch at the medial femoral condyle to the posterior sloping aspect of the tibial plateau. It is typically seen in its entirety on a single oblique sagittal image of the knee and possesses a horizontal portion and a more vertical portion, which are connected by a gentle curve (the genu). **A dashboard injury disrupts the PCL rather than the ACL because, with the knee flexed, the PCL is taut and the ACL is lax. In addition, the PCL usually limits posterior tibial translation, whereas the ACL limits anterior translation.**
How is IT band reconstruction done?
-The central 1/3 of ITB is harvested proximally and left attached to Gerdy's tubercle distally. The graft is brought through the knee in an over- the -top-position posteriorly and passed under the intrameniscal ligament anteriorly on the tibia. The graft is fixed with suture to the intermuscular septum and periosteum on the femoral side and to the periosteum on the tibial side.
What is the contusion pattern for patellar dislocation?
-The classic bone contusion pattern seen after lateral patellar dislocation includes involvement of the anterolateral aspect of the lateral femoral condyle and the inferomedial aspect of the patella. In rare cases, edema may also be seen in the adductor tubercle of the medial femoral condyle secondary to an avulsion injury of the medial patellofemoral ligament. -Classic MOI: fixed tibia, internal femoral rotation, and quadriceps contraction. Transient lateral dislocation of the patella occurs, which results in impaction of the medial patellar facet against the lateral femoral condyle.
What is clip injury?
-The clip injury is a contact injury that occurs after a pure valgus stress is applied to the knee while the knee is in a state of mild flexion (ie, 10°-30°). This injury is common among American football players. -With clip injury, bone marrow edema is usually most prominent in the lateral femoral condyle secondary to the direct blow, whereas a second smaller area of edema may be present in the medial femoral condyle secondary to avulsive stress to the MCL.
List the types of OI
-The congenital types, types II and III, are severe and characterized by multiple fractures at birth. -Type II is incompatible with life and is fatal in the neonatal period. Type III is moderately severe and leads to sig- nificant deformities such as bowing of the bones and short-limbed dwarfism as seen in this patient. The con- genital subtypes may be inherited as an autosomal recessive trait or occur as a spontaneous new mutation. -The latent types, types I and IV, are inherited as an autosomal dominant and are milder by comparison.
What is the difference between merchant and sunrise views?
-The difference is the degree of flexion. -The merchant view is 30 degrees of flexion while sunrise is a lot more 115 degrees of flexion. -sunrish allows you to see femoral groove better (which is where patella slides) -Sunrise has more knee flexion, which can reduce and hide transient patellar subluxation.
What is the function of the lacertus fibrosus?
-The lacertus fibrosus functions to help protect the neurovascular structures, to aid in transmitting the biceps flexion force to the ulna, and with forearm muscle flexion may redirect the orientation of the biceps.
What are some midline accessory muscles?
-The palmaris longus muscle with distal muscle tissue protruding into carpal tunnel -
What is pivot shift injury? http://pubs.rsna.org/doi/pdf/10.1148/radiographics.20.suppl_1.g00oc19s135
-The pivot shift injury is a noncontact injury commonly seen in skiers or American football players. -This injury occurs when a valgus load is applied to the knee in various states of flexion combined with external rotation of the tibia or internal rotation of the femur. -This type of injury usually occurs with maneuvers such as rapid deceleration and simultaneous direction change. These maneuvers load the anterior cruciate ligament (ACL) and can result in its rupture. -Once the ACL is disrupted, anterior subluxation of the tibia relative to the femur occurs which results in impaction of the lateral femoral condyle against the posterolateral margin of the lateral tibial plateau. -**The resulting bone contusion pattern involves the posterior aspect of the lateral tibial plateau and the **midportion of the lateral femoral condyle near the condylopatellar sulcus. -The exact location of the lateral femoral condyle injury depends on the degree of flexion of the knee at injury. Increasing degrees of flexion result in a more posteriorly located bone bruise, whereas less flexion results in a more anteriorly located edema pattern. **Another recently described bone contusion pattern associated with the pivot shift injury is edema within the posterior lip of the medial tibial plateau.** This pattern is thought to result from contrecoup forces in the medial compartment at the resolution of the forced valgus forces.
What muscle group is the plantaris apart of?
-The plantaris is a component of the triceps surae muscle group, which includes the soleus and gastrocnemius muscles in the superficial posterior compartment of the calf. -Like the gastrocnemius muscles, the plantaris muscle traverses two joints, which may make it more vulnerable to injury.
Which head of biceps most commonly ruptures?
-The short head component is most commonly torn with variable involvement of the more proximally inserting component by tendinosis, partial tear, or complete tear. **Isolated tears of the long head component are less commonly seen
Where facets of the GT does the GT bursa cover?
-The trochanteric bursa covered the posterior facet and the lateral insertion of the gluteus medius muscle. -The subgluteus medius bursa was located in the superior part of the lateral facet, underneath the gluteus medius tendon. -The subgluteus minimus bursa lies in the area of the anterior facet, underneath the gluteus minimus tendon,
Where does the ulnar nerve arise from?
-The ulnar nerve arises from the medial cord of the brachial plexus (C8 and T1)
Clavicle
-first bone to ossify in utero -Conoid tubercle of clavicle is attachment site of coracoclavicular lig -Absent clavs: Cleidocranial dysostosis, progeria (premature aging) -OI, Oxalosis, Holta-ram dz involves clavicles -Nonunion is common in fractures of the clavicle that occur distal to the attachment of the coracoclavicular ligament. -Fractures in the newborn usually occur at the junction of the mid and distal thirds because of pressure on the shoulder by the maternal pubic symphysis during birth -Last ossification center to fuse (so don't mistake it as fx in a young pt/teenager), they may just not have fused yet.
What is the lacertus fibrosus (bicipital aponeurosis)?
-Thick fibrous bands which keeps the biceps tendon in place. -The lacertus fibrosus (bicipital aponeurosis) arises at the level of the distal biceps myotendinous junction.
Biceps insertion (long head and short head)
-This change in orientation results in a distal insertion of the tendon from the short head (blue) of the biceps muscle, and a proximal insertion of the tendon from the long head (red) of the biceps muscle on the bicipital tuberosity. -The insertional footprint of the short head is larger than the more proximal long head.
Who gets tears of the UCL?
-Throwers/repetitive valgus stress -Little league elbow
What are components of the deltoid ligament?
-Tibiotalar -tibiocalcaneal -talonavicular - spring ligament--the medial most portion of deltoid lig
What are options for shoulder arthroplasty?
-Total shoulder-Usu done for severe OA with good cuff integrity and good glenoid bone stock -Reverse-No cuff integrity, good glenoid bone stock (if bad glenoid bone stock, can use bone graft material but failure rate is high) -Hemiarthroplasty-done for severe OA but low glenoid bone stock
What is patella dislocation?
-Transient dislocation of the patella typically occurs in teenagers and young adults involved in athletic activities and results from a twisting motion of the knee while the knee is in a state of flexion. -The femur rotates internally on a fixed tibia while the knee is flexed; contraction of the quadriceps occurs, resulting in lateral dislocation of the patella out of the trochlear groove. -Individuals with a shallow trochlear groove are at increased risk for lateral patellar dislocation.
What is Erdheim Chester?
-extraosseous manifestations of the disease include diabetes insipidus, painless bilateral exophthalmos, chronic renal failure, hydronephrosis, pulmonary fibrosis, and heart failure. Osseous involvement typically affects the appendicular skeleton, with the lower extremities being involved more often and more severely than the upper extremities. -bilateral and symmetric distribution involving the diaphyses and metaphyses with sparing of the epiphyses, a distribution similar to to that of progressive diaphyseal dysplasia. -The axial skeleton, hands, and feet are typically spared. Radiographically, cortical thickening is observed, with narrowing of the medullary cavity and loss of the corticomedullary junction -**diabetis insipidus, pulmonary fibrosis
Which muscles are hip abductors?
-glut max, medius, min and tensor fascia lata -
Longitudinal meniscal tear?
-Usu acute
What is coxa valga?
-a deformity of the hip where there is an increased angle between the femoral neck and femoral shaft. eformity of the hip where the angle formed between the head and neck of the femur and its shaft is increased, usually above 135 degrees. It is caused by a slipped epiphysis of the femoral head. Normal range is 120-140. Anything greater than 140 is coxa valga.
Normal
-anterior process of calcaneous should point up (posterior tuberble points down).
Why are Ramp lesions also important?
-because in ACL-deficient knees, there is more of a dependence on a healthy posterior horn MM which sees more load due to increased anterior translation due to ACL-deficiency. So important to identify at MRI before pt goes to surgery for ACL-reconstruction so that both can be repaired.
What is spondyloepiphyseal dysplasia
-disorder of cartilage and bone development primarily affecting the ends of the long bones in the arms and legs (epiphyses) -Long bones normally elongate by expansion of cartilage in the growth plate (epiphyseal plate) near their ends. -ddx: congenital hypothyroidism (cretinism) , chondrodysplasia calcificans congenita, mother on anticoagulant therapy
Who gets Weavers bottom?
-has been known to be common in people whose occupations are related with frequent irritation to the ischiogluteal bursa, and this irritation can occur during long periods of time spent in the sitting position. -When vibration is involved in working, such as with heavy powered sewing machine (weavers), tractor-driving or road equipment machines, the ischiogluteal bursa can become inflamed. It can also be affected by an acute or chronic shearing force on the ischial tuberosity caused by falling on his or her backsides (buttocks) in athletes, resulting in chronic and sometimes disabling discomfort that can prevent athletes from participating in their sporting activities. -if infectious etiology, THINK TB
What is the anatomy of the posterior tibial nerve?
-https://pubs.rsna.org/doi/pdf/10.1148/rg.233025053 -The PTN trifurcates in the fibroosseous tunnel called the tarsal tunnel into a lateral plantar branch, medial plantar nerve and medial calcaneal nerve. The first branch off the lateral plantar nerve is the inferior calcaneal nerve which innervates the abductor quinti digiti minimi (Baxter).
What is the difference between the ischiofemoral and quadratus femoris space?
-ischiofemoral space: smallest distance between the lateral cortex of ischial tuberosity and medial cortex of the lesser trochanter. -quadratus femoris space: the smallest distance between superolateral surface
Fx of cartilage?
-it provides both a cushion & slick surface for movement -consistency of the extracellular matrix allows the tissue to bear mechanical stresses without permanent -shock-absorbing because it is resilient -smooth surface allows sliding against it
What are some complications of arthroplasty?
-osteolysis -periprosthetic fractures -stress reaction -hematomas -bursitis -infection -polyethylene wear -tendon tears -neurovascular comprise -disruption of the pseudocapsule -tendon related complications -heterotopic ossification -
What are causes of cubital tunnel syndrome?
-overuse, subluxation of the ulnar nerve because of congenital laxity in the fibrous tissue, humeral fracture with loose bodies or callus formation, an arthritic spur arising from the epicondyle or olecranon, a muscle anomaly (eg, an anconeus epitrochlearis muscle), a soft tissue mass, ganglion, osteochondroma, synovitis secondary to rheumatoid arthritis, infection (eg, tuberculosis), and hemorrhage. ----Other possible causes include acute or chronic external compression (eg, "sleepy palsy," perioperative damage), trauma (eg, from use of a jackhammer), and compression by a thickened retinaculum (or arcuate ligament) of the flexor carpi ulnaris muscle
What is the plantaris muscle?
-plantaris muscle is of questionable physiological importance. It is thought to be a vestigial structure and is absent in 7% to 10% of the population. -arises from the lateral supracondylar line of the distal femur, just superior and medial to the lateral head of the gastrocnemius muscle, and from the oblique popliteal ligament. The plantaris muscle belly lies deep to the lateral head of the gastrocnemius muscle, but the long thin plantaris tendon courses obliquely and medially, lying between the soleus muscle and the medial head of the gastrocnemius muscle. -Distally, the tendon lies near the medial border of the Achilles tendon, and inserts on the calcaneus just anteromedial to the Achilles tendon
What findings on MRI shoulder suggest prior posterior translation?
-posterior inferior labral tear or posterior capsular injury
Which 3 factors suggest adhesive capsulitis?
-scarring in rotator interval -scarring in coracohumeral lig -thickening axillary pouch
What are thigh splints?
-stress fracture inner thigh prox femur, typically seen in runner -Variant is avulsion of adductor tendon insertion from posteromedial prox femur. Will see edema in posteriomedial adductor muscles and prox femur in runners.
What is important about the posterolateral humeral head?
-where Hill sachs lesions occur -Also a common location for erosions from inflammatory arthritis such as psoriatic arthritis
What are the five types of injury mechanisms that may occur in the knee?
1) pivot shift injury 2) dashboard injury 3) hyperextension injury 4) clip injury 5) lateral patellar dislocation.
What are the three MCL injury grades?
1, II and III
Which 3 structures reinforce the hip joint capsule?
1. Iliofemoral (the strongest) 2. Pubofemoral 3. Ischiofemoral **Iliofemoral inserts on the intertroch line, explaining why the entire femoral neck is intracapsular
What are the most common locations for ganglion cysts in wrist?
1. Volar-Volar radiocarpal joint capsule (worry about Radial artery) or STT joint, worry about median or ulnar nerve compression 2. Doral-Scapholunate ligament
What age defines skeletal maturity in: girls?
13 y.o.
What age defines skeletal maturity in: boys?
15 y.o.
What is normal ankle gutter space?
4 mm
How many zones of cartilage are there?
4 zones of articular cartilage -Superficial layer (lamina splendens) -transitional later -Deep radial layer -Calcified cartilage layer (contains the tide mark) -the normal thickness of cartilage is 2-5m
How many facets does the greater troch have?
4-Anterior, posterior, superiorposterior, lateral
How common is b/l AVN in hips?
40% of cases are B/L
How thick should supraspinatus tendon be (normal)?
4mm
What is pes planavalga?
=Flatfoot deformity ie severe valgus/eversion deformity AND cx gastroc or achilles tendon -Supination deformity -Calcaneous points outward -
Why do you get shiny corners in the vertebral bodies in AS?
=It is where Sharpey's fibers mineralize to form osseous bridging syndesmophytes.
Enchondroma protuberans
??
Knee "popping and locking"
?? menisc tear
What is Southwick angle?
A Southwick angle is a radiographic angle used to measure the severity of a slipped capital femoral epiphysis (SCFE) on a radiograph. It was named after Wayne O. Southwick, a famous surgeon.
What is the best predictor of midfoot instability after Lisfranc injury?
A disruption of the PLANTAR LATERAL CAPSULE...ie a torn C1-M1M2 portion of the ligament which is the plantar portion of the lisfranc ligament connecting the medial cuneiform and the bases of the second and third metatarsals. If ligament is normal on MRI, then no need to get manual stress views under anesthesia. The plantar ligament is much stronger than its dorsal counterpart (dC1-M2).
What is a ganglion cyst?
A ganglion cyst also contains a mucinous fluid, but the wall consists of a discontinuous layer of flattened pseudosynovial cells, surrounded by connective tissue. Communication with the adjacent joint is not always present
What is another destructive arthritis?
A missed subchondral hip fx that progresses to a rapidly progressive OA
Other ulnar sided muscles?
A normal muscle that can be mistaken for a variant is the palmaris brevis, which lies in the subcutaneous tissues volar to the neurovascular structures of Guyon's canal. -The palmaris brevis is distal to the pisiform and inserts into the skin
What is the difference between a sublabral foramen, sublabral sulcus, and Buford complex
A sublabral foramen is a variant where there is absence of fixation of the labrum in the anterosuperior aspect of the rim (between 1- and 3-o'clock). A sublabral sulcus is a cleft between the superior labrum and the glenoid. This can mimic a superior labral tear. -A Buford complex is the absence of the anterosuperior labrum associated with a thickened, cordlike middle glenohumeral ligament.
What is subtalar dislocation?
AKA "basketball foot"
Which comes from APL or EPB?
APL is the more radial ligament.
What is the most common location for supraspinatus partial thickness tears?
ARTICULAR SIDED
Superficial layer
AKA tangential zone -makes up 10% of cartilage; -consists of 2 sub-zones: -fibrilar sheet / lamina splendens is the more superficial layer; - clear film consisting of a sheet of small fibrils with little polysaccharide and no cells; - cellular layer w/ flattened chondrocytes; - flat chondrocytes and collagen fibers are arranged tangentially to the articular surface; - thinnest layer, with the HIGHEST content of collagen and the lowest concentration of proteoglycans; - collagen (type IX) is arranged parallel to the articular surface which allows for tensile strength ability to resist shear stresses and serves as a gliding surface for joint; - may also function to limit passage of large molecules between synovial fluid and cartilage; - superficial zone is the first to show changes of osteoarthritis;
What is ddx for aggressive lesion that does not destroy the cortex?
ABC, GCT
What main lesions seen in posterior elements spine?
ABC, osteoblastoma (sometimes pedunculated)
What two major tendons do not have a tendon sheath?
Achilles, patellar tendon
What are some acquired syndromes with increased bone density?
Acquired syndromes with increased bone density, which may simulate sclerosing bone dysplasias, include renal osteodystrophy, osteoblastic metastases, Paget disease of bone, Erdheim-Chester disease, myelofibrosis, and sickle cell disease.
What are the two most common places to get fx after reverse TSA?
Acromion and spine of scapula
What is the ddx for anterior tibial lesions?
Adamantimoma in adults, osteofibrous dysplasia or chondromyxoid fibroma in kids or fibrous dysplasia.
What is adverse local tissue reaction (ALTR)?
Adverse local tissue reaction is an all encompassing term characterizing various immune mediated reactions related to metal wear debris and corrosion products, as may be seen around metal-on-metal bearings and stems with modular junctions.
What is the function of the iliocapsularis?
Although the true function of the iliocapsularis muscle is unknown, it has been suggested the iliocapsularis muscle tightens the hip capsule. Theoretically, this is particularly important in dysplastic hips, where this muscle contraction would help stabilize the femoral head in the deficient acetabulum. If this is correct, then one would anticipate the muscle would be hypertrophied in dysplastic hips and, conversely, atrophied in stable and well-constrained hips with excessive acetabular coverage.
Post op spine xray
Always look at position of screw on both views make sure screw is not inferior to pedicle because implies going into neural foramen.
What gives you holes in the bones?
Amyloid arthropathy after rheumatoid
What is an os intermetarseum?
An accessory ossicle found between the bases of first and second metatarsals and the medial cuneiform
Significance of intact lacertus fibrosus?
An intact lacertus fibrosus may prevent significant retraction of the torn tendon and may make the differentiation of a complete rupture from a partial tear more difficult
For a Bennet fx, what is the name of the ligament to which the smaller, volar fragment is attached?
Anterior oblique ligament (AOL). The remainder of the metacarpal is pulled proximally, radially and dorsally by the abductor pollicis longus tendon.
Where does AVN occur first in femoral head?
Anterior superior femoral head, between 10 o'clock to 2 o'clock
What is bony landmark for lateral femoral cutaneous nerve?
Anterior superior iliac spine.
Lateral facet
Anterlat fibers of glut medius
Which abductor tendon most common to tear?
Anterolat fibers of gluteus medius
NF-1
Anterolateral bowing
Which fibers of gluteus medius get affected by hip arthroplasty?
Anterolateral fibers
What are the types of ankle impingement?
Anterolateral, anterior, anteromedial, posterior medial
What is a normal femoranteversion angle?
Anteversion averages between 8 and 14 deg, w/ an average of 8 degrees in men and 14 degrees in women;
Location of ligaments
Aqua = Posterior oblique ligament POL (Deep to EPB) Yellow = dorsal central ligament Green= dorsal radial ligament (Deep to APL)
Varus type OA of ankle assoc with?
Assoc with medial stress at ankle joint
What are associated ST injuries of patella disloc?
Associated soft-tissue injuries include sprain or disruption of the medial soft-tissue restraints. -These restraints include the medial retinaculum, the MPFL, and the medial patellotibial ligament. The MPFL has been shown to be the most important stabilizing structure of the patella preventing lateral subluxation.
What is cavovarus associated with?
Associated with stress fx of metatarsals particularly 4th and 5th metatarsals.
Where do most triceps tendon tears occur?
At insertion onto olecranon process.
What anatomic location does the peroneus brevis and longus diverge on lateral ankle?
At peroneal tubercle (bony prominent on calcaneous) at level of cuboid tunnel
What is athletic pubalgia?
Athletic pubalgia is a clinical syndrome of chronic lower pelvic and groin pain, usually encountered in athletes. It is either a musculo-tendinous or osseous injury that involves the insertion of abdominal muscles on the pubis and the upper aponeurotic insertion of the adductor muscles. Although it can occur following an acute injury, it is most often the result of repeated microtrauma.
Where does G. Med attach?
Attaches to Posterior superior greater trochanter.
Where does G. Min attach?
Attaches to anterior superior greater trochanter.
What is the MOI for LF injury?
Axial load appied to heel while ankle is plantarflexed resulting in tensile force to tarsometatarsal articulations. This forces the metatarsals dorsally, disrupting the ligaments. Also, a twisting or bending force across the midfoot with foot in a fixed postion and the body rolling over midfoot.
How do you know which muscle is the flexor carpi ulnaris on axial MRI of elbow?
Because FCU has two heads on axial image, which both sandwich the ulnar nerve just outside of (distal to) the cubital tunnel.
Other features of pykno:
Because the medullary cavities are preserved, patients with pyknodysostosis (unlike patients with osteopetrosis) tend not to have concurrent anemia (2). On the other hand, as with osteopetrosis, the bones are brittle and prone to recurrent fractures.
Why do we not call SLAP tears at HSS?
Because too much interobservor ability between orthopods after arthroscopy
Why is MRI better to use than radiographs to measure tibial slope?
Because you can see articular cartilage on MRI which is the functional part of the femorotibial articulation.
What is ddx for hemihypertrophy?
Beckwidth wiedman syndrome, NF, Hemangiomatosis, Lymphangiomatosis
What is a cementoblastoma?
Benign mass deep to molar tooth. Imaging is radiodense lesion surrounded by radiolucent line.
Who gets lateral fem fx
Bisphosphonate users
Osteitis condensans
Bony sclerosis at medial aspect of clavicle in middle aged women
Myositis ossificans progressiva
Brachydactyly-short 5th metacarpal Platyspondyly Diffuse ossificiation of Soft tissues
Flipped fragment
Bucket handle tear
Which meniscal tears have a lower risk of healing well?
Bucket handle, complex tears
Which side is more common for RCT, articular or bursal?
Bursal more common
What is it?
Cadence ankle replacement
What dz preferentially gives patellofemo OA?
CPPD arthropathy
What is in differential for SAPHO?
CRMO--findings are similar for SAPHO or CRMO-looks like infection-periosteal rxn, sclerosis or osseous destruction, but when they bx its normal or just inflammatory cells.
Weird anatomy:
Calcar-thick cortical bone medial to lesser trochanter in hip Sigmoid notch:
What is transphyseal reconstruction?
Can be partial or complete transphyseal: -Partial includes sparing of either the tibial or the femoral physis, transphyseal stabilization on the opposite side -Any tanner stage I-V. -Autologous hamstring is preferred -Autologous tendon with bone-patella-bone can induce local growth arrest if placed across physis -Harvesting of the patella can also cause injury to the tibial tubercle (tibial recurvatum)
What does Flexor Digitorum Accessorius Longus look like?
Can be seen in tarsal tunnel and cause tarsal tunnel syndrome
Whats the issue with os intermetatseum?
Can cause dorsal foot pain, and when it does, it can be related to compression of deep peroneal nerve. Can also cause tendinosis and adventitial bursae to form.
What should u think of when you see equnivalgus?
Cerebral palsy
What is thanatophoric dwarf?
Characterized by newborn with short limbs and normal torson, die within first few hours. -Small thorax--they die from respiratory failure -Radiographic findings: platyspondyly with narrowing of the vertebral bodies most pronounced in the midline and narrow interpediculate distances. -In the pelvis, the findings include short iliac bones in the cran- iocaudad dimension with horizontal acetabular roofs, small sciatic notch, and short and broad ischial bones. -In the chest, the thorax is narrow with cupped anterior ribs, small scapulae, and long clavicles that are hooked. -The extremity bones are markedly short with flared metaphyses and are bowed. The tubular bones of the hands and feet are broad. The skull is enlarged with a small foramen magnum, small face, and depressed nasal bridge. A "cloverleaf" skull is an occasional finding.
What should you think of when you see cavovarus?
Charcot-Marie tooth.
What is the double line sign in AVN?
Chemical shift artifact from necrosis surrounding fatty marrow
DDX of sacral lesions
Chordoma, Chondrosarcoma, GCT
What are the subtypes of hereditary corticalis generalista?
Classified into four main types— Van Buchem disease, Truswell-Hansen disease (sclerosteosis), Worth disease, and Nakamura disease—according to mode of inheritance and radiographic features. All types involve mutations in the Wnt signaling pathway of osteoblasts
What is SAPHO?
Cluster of manifestations referring to synovitis, acne, palmoplantantar pustulosis, hyperostosis, osteitis.
What is Chopart joint?
Combination of the talonavicular and calcaneocuboid joints -Important because it separates the hindfoot from the midfoot
What are causes of congenital shortening of 4th metacarpal?
Common causes: idiopathic **Turner syndrome** post-infective (e.g. osteomyelitis, yaws, tuberculosis dactylitis) pseudohypoparathyroidism/pseudopseudohypoparathyroidism post-traumatic (acute and chronic/healed) Uncommon causes: basal cell naevus syndrome (Gorlin syndrome) hereditary multiple exostosis syndrome 5 juvenile idiopathic arthritis sickle cell disease with secondary infarction homocystinuria Langer-Giedion syndrome Isolated shortening of the 5th metacarpals has been recently described in a familial variant of type 1 diabetes mellitus 3.
What is hereditary corticalis generalista?
Common radiographic findings of the endosteal hyperostoses include dense, homogeneous endosteal cortical thickening of the diaphyses of long bones; thickening of the skull, facial bones, and mandible; increased density of the axial skeleton; and narrowed medullary canals.
What is the concern with a high take off of tibial artery from popliteal artery?
Concern for pseudoaneurysm during total knee arthroplasty.
What should you consider in a pedi pt with painful flatfoot deformity or repeated dislocations?
Consider subtalar coalition
What structures get injured in subtalar dislocation?
Contents of sinus tarsi and have to worry about developing AVN in navicula as sequelae of subtalar dislocation.
What will a tear of ulnar collateral ligament in elbow look like on MRI?
Contrast extending medial to the sublime tubercle.
What constities the biceps pulley?
Coracohumeral ligament, superior gh lig
What is coxa plana?
Coxa plana is flattening of the femoral head epiphysis and is associated with many skeletal disorders: Legg-Calve- Perthes disease haemophilic haemarthrosis Gaucher disease hypothyroidism spondyloepiphyseal dysplasia multiple epiphyseal dysplasia haemoglobinopathies, e.g. sickle cell anaemia, thalassemia
What is spondylothoracic dysplasia?
Crab like deformity of ribs, shortened thorax, scoliosis, kyphosis.
Where does the peroneal tendons commonly tear?
Cuboid tunnel, peroneal tubercle on calcaneous.
What are complications of ACL recon in skeletally immature pt?
Distal femoral valgus deformity, tibial recurvatum, genu valgum, limb-length discrepancy.
Triceps tears
Distal triceps tears most commonly spare the anterior component (primarily muscular medial head insertion) and completely avulse the posterior component (combined tendon of the long and lateral head insertion). Retraction of the posterior component is common in these patients.
What are some accessory muscles in hand?
Divided by ulnar sided, radial sided or central in hand.
What is dashboard injury?
Dashboard injury occurs when force is applied to the anterior aspect of the proximal tibia while the knee is in a flexed position. This injury most commonly occurs when the knee strikes against the dashboard during an automobile accident, but it can also occur when the knee strikes against the ground during a fall. Edema is seen at the anterior aspect of the tibia and occasionally, at the posterior surface of the patella.
What is stenosing tenosynovitis of the first extensor tendon sheath called?
De Quervains--APL, EPB
What is a common complic of RC repair?
Deltoid dehicense
What is perichondrium?
Dense connective tissue sheath which covers cartilage, not at the articular surface. It has an outer fibrous later and inner chondrogenic layer.
Dermatofibrosarcoma protuberans?
Dermatofibrosarcoma protuberans (DFSP) is an uncommon exophytic, slow growing, low grade, spindle cell tumour arising in the dermal and subcutaneous tissues, particularly of the trunk region with excellent outcome after complete surgical resection.
Caffey's
Diffuse periostitis
How many heads of rectus femoris?
Direct (ASIS), and reflected (attaches to acetabulum)
So if subtalar dislocation suspected, what should you look for?
Disruption of talocalcaneal interossesous ligament in sinus tarsi
MC location for ganglion cyst wrist?
Dorsal-SL lig Volar-Radioscaphoid joint
What is most common loc for ganglion cysts in wrists?
Dorsal-scapholunate ligament Palmar-Radioscaphoid joint
Severe/advanced flatfoot
Double or Triple Arthrodesis In the later stages of flatfoot, deformities are frequently inflexible (stiff). Arthritis of the foot may be present as well. Surgical correction of these severe cases requires fusion of one or more of the foot joints. This procedure is referred to as a double or triple arthrodesis depending on the number of joints fused.
When ACL tear results in bulge on PCL how can you describe this in report?
PCL demonstrates secondary deformity but is otherwise intact.
How do you characterize (location) of knee fat pads?
Each one interposed between the joint capsule and the synovium, and therefore intracapsular and extrasynovial
Where does the peroneus brevis tendon most commonly tear?
Either just distal to the fibular tip or beyond the inferior extensor retinaculum.
Enchondroma vs bone infarct on MRI
Enchondroma will have septations with vascularity so will see enchancement or high signal on T2W due to internal vascularity -Bone infarct will have a peripheral zone of low signal on all sequences, will sometimes be flame shaped region of heterogenous SI -both will be medullary in location, and may have calcification. -calcification in an enchondroma is from chondroid matrix, and calc in a bone infarct is from dystrophic calcs
What do patients on fluoroquinolones get wrt to achilles tedon?
Enthesopathy
CET
Extensor carpi radialis brevis (most anterior), extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
What muscles make up the common extensor tendon?
Extensor carpi radialis brevis, extensor carpi radialis longus, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
What is trevor's dz
Extremely rare, non-hereditary disease that is characterised by osteochondromas arising from the epiphyses. -AKA Diaphyseal Epiphysealias Hemimelica
which fuses last?
Femur-fuses centripetally, from outer to inner.
Which mass associated with the sciatic nerve can be associated with sciatic nerve sx?
Fibrolipomatous hamartoma
Ribbon appearance of bones??
Fibrous dysplasia
Where in foot do u look for RA?
Fifth metatarsal head; IP joint of the first digit;
CFT
Flexor carpi radialis, Flexor carpi ulnaris, flexor digitorum superficialis, palmaris longus.
What muscles make up the common flexor tendon?
Flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis
What can cause diffuse enthesopathic changes?
Fluoride treatment
What is the difference between a full thickness tear and a complete rotator cuff tear?
Full thickness tear: Goes from bursal to articular side Complete: Anterior to posterior -A complete tear has to be a FT tear, but A FT tear does not mean a complete tear
What do pts on Alendronate therapy get/
Fx
DDX for end of bone lesion?
GCT, aBC, clear cell chondrosarcoma, chondroblastoma
What is a ganglion?
Ganglion cysts are benign masses containing a highly viscous fluid located within a dense fibrous connective tissue wall lacking a synovial lining. Ganglia can be unilocular or multilocula round or lobular, and communication between ganglia and adjacent joints is uncommon. -Ganglia can produce pain and swelling, but they are usually asymptomatic; when symptomatic they may require drainage or excision.
Which tendon make up the Achilles?
Gastroc and soleus
Whats blood supply to menisci?
Geniculate arteries
Patello fem load?
PF load is sheer forces, not axial load like fem-tib compartment.
What is greater troch bursitis assoc with?
Glut med tear
Anterior facet of Greater troch
Glut minimus
Who is predisposed to Achilles tendon tears?
Gout, diabetes, lupus, hyperparathyroidism
What is one of the most destructive arthritis?
Gout??? Can have complete resorption of multiple distal tufts or other bones without seeing a large tophus.
What is the mechanism for distal third clavicle fx?
Handle bar injury Other common mech are FOOSH, direct blow, skiing -MC bone to be fx -Middle third is most common site since it is the thinnest -Distal third has highest rate of nonunion because the distal third remains attached to AC joint and CC ligament while prox fragment floats cranially (unopposed pulling from SCM)
What are risk factors for these complications?
Hardward placed across the lateral distal femoral physis, bone plugs placed across the lateral distal femoral physis, tunnel size > 12mm, hardware extending across the tibial tubercle, over the top femoral position.
What is a rare complication of burns?
Heterotopic ossification
How does subtalar dislocation occur?
High energy injury ie basketball (jumping up to basket)
Parameniscal cyst
Horizontal tear
What nerve innervates the greater troch bursa?
INferior gluteal nerve -inferior gluteal nerve is formed from the posterior divisions of the L5, S1 and S2 nerve roots of the sacral plexus. -The nerve is also the primary motor nerve that supplies the gluteus maximus muscle.
How can you tell epidural lipomatosis on MRI spine?
If fat extends over the spinous process versus just the interspinous region (if just interspinous then say prominence of epidural fat contribute to central canal stenosis)
So whats the big deal with increased PTS
If you read a case with a pt who is incidentally noted to have an increased tibial slope (greater than 4 degrees in native ACL or greater than 12 degrees in ACL reconstruction), then mention in because pt is potentially at inc risk ACL injury. -This is found in both adults and pediatric pt populations (Fabricant HSS peds ortho).
What is strongest ligament maintaining the hip joint?
Iliofemoral lig. The other ligs are iliolumbar and ligamentum teres.
Which structure is the largest bursa in body?
Iliopsoas
L3
Iliopsoas, Quad lumbrum, obturator externus
What are the modern operative techniques for ACL reconstruction in skeletally immature pt?
Iliotibial band reconstruction, transphyseal reconstruction, all-epiphyseal reconstruction, all-inside transphyseal reconstruction
How do you image a posterior glenoid impingement?.
Image the patient in external rotation and abduction
What is prob with diagnosing LF injury?
In cases of low impact injury, widening of 2mm may not be easily see. So need weight bearing xrays OR manual stress xrays under anesthesia.
What is the most common location for patella tendon rupture?
Inferior pole (at enthesis/insertion)
What is ligamentum mucosum?
Infrapatella plica--commonly injuried in kids. It runs through the Hoffa's fat pad.
What prevents communication between the radiocarpal joint and midcarpal compartment?
Interosseous ligaments--Interosseous scapholunate ligament and interosseous lunotriquetral ligament
examples of NON-HEREDITARY sclerosis bone dysplasias?
Intramedullary osteosclerosis, melorheostosis, and overlap syndromes, whereas acquired syndromes with increased bone density, which may simulate sclerosing bone dysplasias, include osteoblastic metastases, Paget disease of bone, Erdheim-Chester disease, myelofibrosis, and sickle cell disease.
What does the flexor retinaculum form?
It forms the roof of the tarsal tunnel
What is Meary's angle?
It has been used to identify the apex of deformity in patients with pes cavus and pes planus on lateral weight bearing radiograph. -It is the angle between a line drawn from the centers of longitudinal axes of the talus and the first metatarsal. -In the normal weight-bearing foot, the midline axis of the talus is in line with the midline axis of the first metatarsal. -Normally Meary's angle is 0 degree. -angle> 4 degrees (convex upward) - pes cavus -angle> 4 degrees (convex downward) - pes planus
What happens to the calcaneofibular ligament if both the ATFL and PTFL are torn?
It indicates that the calcaneofibular ligament must be torn!
What is arthrogryposis?
It is a clinical or imaging descriptor that denotes congenital non-progressive joint contractures involving two or more body regions. -Associations: -abnormal limb/extremity positioning clenched hands knotted fingers persistently extended legs persistently bent legs clubbed feet scoliosis: long C-shape neurogenic type and/or indirect features such as: short umbilical cord oligohydramnios polyhydramnios 1: some forms pulmonary hypoplasia camptodactyly micrognathia
What is Internal (posterosuperior glenoid) impingement?
It is a posterosuperior glenoid tear and rotator cuff tear at the junction of the infraspinatus and supraspinatus tendons in a throwing athlete.
What is Iliotibial band reconstruction?
It is an extraphyseal/physeal sparing technique with combined intra-and extra-articular stabilization. -Who gets this sx? Tanner stage I & II
What is OI?
It is an inherited disorder of connective tissue that affects the synthesis and of fibrillar collagen.
What are NOFs associated with?
Jaffe Campanacci, Fibrous dsyplasia, NF-1
How do you tell diff between synovities, joint fluid and ganglion?
Joint fluid will compress, synnovitis and ganglion wont. Check color doppler for hypermia-that will indiciate synovitis.
Clavicle
Just about anything can affect the clavicle-hemangioma, ABC, SBC, GCT, LCH, hyperparth, osteolysis, RA (esp AC joint),
What diagnosis can manifest as multiple lincoln log deformities in in spine reflecting compression fractures?
Juvenile idiopathic arthritis
What is ddx for fused facets?
Klippel Feil Congenital JIA in a kid
What is Kniest dysplasia?
Kniest dysplasia is on the spectrum of dwarfism.
What is the name of anatomic location where FHL and FDL cross?
Knot of Henry
What is lateral hindfoot impingement?
Lateral hindfoot impingement is an extra-articular osseous impingement affecting the talus, calcaneus and distal fibula. Its development relates to hindfoot valgus malalignment, and a lateral shift of the calcaneus which may lead to abnormal bony contact between the talus and calcaneus specifically at the posterior peripheral margin of the sinus tarsi.
Lethal skeletal dysplasias.
Lethal skeletal dysplasias form a heterogeneous group which are commonly characterised being non-survivable for prolonged periods ex-utero. They include: achondrogenesis atelosteogenesis campomelic dysplasia chondrodysplasia punctata: lethal variants metatropic dysplasia: lethal variants 4 Pacman dysplasia 3 perinatal lethal hypophosphatasia: primarily a metabolic abnormality but has major skeletal manifestations osteogenesis imperfecta type II: 2nd commonest lethal skeletal dysplasia thanatophoric dysplasia: commonest lethal skeletal dysplasia short rib polydactyly syndromes (SRPS) References
Nail patella syndrome
Look for spines on iliac bones
Which three findings indicate severe OA in shoulder?
Look up Walch criteria: -Posterior subluxation humeral head, Biconcave morphology of the glenoid due to chronic erosion.
What does Giant cell reparative granuloma look like?
Looks like a solid ABC -GCRG has a similar appearance but most commonly affects the mandible, maxilla, hands, or feet (basically looks like a GCT but is not in the typical locations for a GCT)'.
What do tug lesions of the femur look like?
Looks like and is in same location as a cortical desmoid on posterior lateral femur.
What is acetabular inclination?
MEasured by tonis angle: -determined by drawing three lines on the anteroposterior pelvic radiograph: (1) a horizontal line connecting the base of the acetabular teardrops; (2) a horizontal line parallel to line 1, running through the most inferior point of the sclerotic acetabular sourcil (point I); and (3) a line extending from point I to a point L at the lateral margin of the acetabular sourcil (the sclerotic weight-bearing portion of the ace-tabulum). The Tönnis angle is formed by the intersection of lines 2 and 3. -Nl is 0-10 degrees
What are MR imaging features of hindfoot impingement?
MR features of this diagnosis are bone marrow edema and bony cystic changes, located at the apex of the lateral talar process and the calcaneus at the apex of the angle of Gissane.
Anterolateral impingement
MR findings of an abnormal soft-tissue mass or fibrous band in the anterolateral ankle gutter, distinct from the anterior talofibular ligament, suggest the diagnosis of anterolateral impingement.
What malignancy is osteonecrosis assoc with?
Malignant Fibrous Histiocytoma (MFH) now known as undifferentiated pleomorphic sarcoma
What gives coxa vara?
Morquio
What is arthrodesis?
Means fusion
What is medial cuneiform dorsal opening wedge osteotomy or fist TMT fusion?
Medial Cuneiform Dorsal Opening Wedge Osteotomy or First Tarsal-Metatarsal Fusion Arch collapse can lead to the big toe side of the foot being raised above the ground. Your surgeon may perform a dorsal opening wedge osteotomy of the medial cuneiform bone to treat this problem. An alternative is to perform a first tarsal-metatarsal joint fusion. Both procedures involve an incision over the top of the foot. In the case of the dorsal opening wedge osteotomy, a bone wedge is placed into the top portion of the bone to push it down toward the floor. In the case of the fusion, the bone is pushed down toward the floor at the level of a joint in the middle of the foot and the bones are fused into that position. Screws or a plate can be used to keep the wedge in place or to fuse the joint.
Tibial n gives rise to the??
Medial and lateral plantar nerves (when scanning, medial plantar is anterior and lateral plantar is posterior)
Where does tib ant insert?
Medial cuneiform, base of first metatarsal
Where else can u get stress fx in femur
Medial fem neck
What is a Medializing Calcaneal Osteotomy?
Medializing Calcaneal Osteotomy A medializing calcaneal osteotomy (heel slide) procedure is often used when the calcaneus (heel bone) has shifted out from underneath the leg. An incision is made on the outside of the heel, and the back half of the heel bone is cut and slid back underneath the leg. The heel is then fixed in place using metal screws or a plate.
What are the deep fibers of MCL called?
Meniscofemoral and meniscotibial ligaments
What is metallosis?
Metallosis is a subtype of adverse local tissue reaction which is characterized histologically by a histiocytic foreign body reaction which results in less aggressive periprosthetic soft-tissue damage than hypersensitivity type adverse local tissue reaction.
What is catch phrase for dumbell shaped extremeties?
Metatropic dysplasia: -short tubular bones with metaphyseal widening (dumbell shaped) -Flat acetabular roofs -platyspondyly -kyphoscoliosis
Where do ACL tears most frequently occur?
Midsubstance>>>Femoral attachment>Tibial attachment
What is considreed mild, moderate or severe spinal stenosis?
Mild: 10-12mm Mod: 8-10mm Severe: 8mm or less
How many accessory peroneal tendons are there?
Multiple accessory peroneal muscles have been described throughout the literature, including peroneus tertius, peroneus accessorius, peroneocalcaneus externum, peroneus digiti minimi, and peroneus quartus (PQ) muscle
What is organ piping on X-ray associated with?
Multiple enchondromas
How does Ollier's look on xray?
Multiple lucent striated lesions, will not have cortex like an osteochondroma does. The lucent appearance is what is referred to as "organ piping".
AVN vs subchondral insufficiency fx?
Must see serpiginous low signal high signal for AVN. If not may just be insufficiency fx.
IF a pt is diffusely osteoporotic with multiple spine/vertebral body fx what two ddx should u think of?
Myeloma and mets
What anatomic characteristics of the knee predispose to ACL tear?
Narrow intercondylar notch, generalized joint laxity, steep posterior tibial slope, increased Q-angle.
Femoral nerve
Nerve Roots: L2-L4 Motor: Innervates the anterior thigh muscles that flex the hip joint (pectineus, iliacus, sartorius) and extend the knee (quadriceps femoris: rectus femoris, vastus lateralis, vastus medialis and vastus intermedius), Sensory: Supplies cutaneous branches to the anteromedial thigh (anterior cutaneous branches of the femoral nerve) and the medial side of the leg and foot (saphenous nerve).
Does the achilles have a tendon sheath?
No because doesnt come into contact with other structures along its length. -Cannot have changes of tenosynovitis as only has a paratendon, so paratendinitis
Note about ACL reconstructions in patients nearing skeletal maturity
No concern for growth arrest in children who may have open physes but are nearing skeletal maturity
Is developmental dysplasia of hip painful?
No, it is not painful so has to be diagnosed with barlow and ortolani maneuvers
What does a frankly dislocated peroneus longus tendon look like?
Normally, both longus and brevis are tucked posterior to the lateral malleolus tip on coronal. If you see the longus lateral to the lateral mal, its dislocated. On sag, should see both longus and brevis curving posterior to lat mal. Obviously if you see it more proximally its even more dislocated.
What is diff bn os tibialis externum and os naviculare?
Not sure, but do not use interchangeably. If you see an accessory navicular, call it an accessory navicular or os tibialis externum.
Multifocal Giant cell tumor assoc with Paget's?
Noted to be in pt with heritage of being in Avellino, Italy.
Other ddx for anterior knee pain
PAtella sleeve--avulsion of unossified cartilage from inferior pole of patella.
PB and PL insertions?
PB: base of fifth metatarsal PL: first metatarsal base and medial cuneiform
What are multiple enchondromas called?
Ollier's dz. it's usu unilateral because not hereditary it occurs because of random gene mutation.
Sclerotic posterior element vertebral body young pt
Osteoid osteoma
What causes a double density on bone scan?
Osteoid osteoma
What is osteopathia striata?
Osteopathia Striata a disorder of the secondary spongiosa is osteopathia striata AKA (Voorhoeve disease). -usually discovered incidentally at radiography performed for some other reason. -an X-linked dominant inheritance pattern has been suggested
What is mild prominence of vertical oriented trabecula on MRI mean?
Osteopenia
What should you think of when you see abnormal spotted high signal (fat) in marrow in subcondral or periarticular bone?
Osteopenia secondary to complex regional pain syndrome.
What are examples of HEREDITARY sclerosis bone dysplasias?
Osteopetrosis, pyknodysostosis, osteopoikylsis, osteopathia striata, hereditary multiple diaphyseal dysplasia, progressive diaphyseal dysplasia, hereditary multiple diaphyseal sclerosis, hyperostosis corticalis generalisata),.
What is osteopoikilosis?
Osteopoikilosis is a disorder of endochondral ossification involving the secondary spongiosa. -The bone lesions are asymptomatic, although there is a frequent association with dermatofibrosis lenticularis disseminata, a connective tissue disorder characterized by papular fibromas throughout the extremities and back.
What is Osteopoikilosis pattern of inheritance?
Osteopoikilosis is inherited in an autosomal-dominant fashion
What do you see on imaging?
Osteosclerotic lesions in upper chest (medial clavicle), vertebral bodies, erosions of vertebral plates
What are ST injuries associated with ACL tear?
Other soft-tissue injuries occasionally associated with the pivot shift injury include tears of the posterior capsule and arcuate ligament, the posterior horn of the lateral or medial meniscus, and the medial collateral ligament (MCL). Osteochondral impaction or shear injuries may also involve the posterior tibial plateau or the lateral femoral condyle. -Deep femoral sulcus sign (impaction fx femoral condyle) has high specificity for ACL disruption.
What is alpha angle?
Other useful quantitative measures of head-neck junction deformities include the alpha angle and the head-neck offset ratio. >42 is abnormal head neck offset -
What is dysplasia epiphysealis hemimelica?
Overgrowth of femoral head
Which structure has the most cartilage in body?
Patella
What are features of pykno?
Patients with pyknodysostosis present with a complex of characteristic features, including dwarfism; pectus excavatum; short fingers from acro-osteolysis (Fig 4); and hypoplasia of the facial bones, causing dysmorphic
How do pts with tarsal tunnel syndrome present?
Patients with tarsal tunnel syndrome may complain of paresthesia or burning pain at the plantar aspect of the foot and toes. However, depending on the compression site and the nerve branch involved, clinical symptoms can be more focal, localized to the medial plantar aspect of the heel (Fig 1) or radiating proximally along the medial calf. The main clinical finding in tarsal tunnel syndrome is the Tinel sign: Gentle percussion over the course of the nerve causes pain or paresthesia that radiates in the sensory distribution of the nerve.
Describe pelvic ring fractures
Pelvic ring fractures are broadly categorized into lateral compression, anteroposterior compression, and vertical shear injuries. About 50% of pelvic fractures are caused by a blow to the lateral side of the pelvis (lateral compression). -These are classified into three types: type 1, the lateral force is to the posterior pelvis, producing unilateral or bilateral pubic rami fractures, crush injury of the sacrum, and central acetabular fractures (20%); type 2, the force is more anterior resulting in ipsilateral displacement of the innominate bone with either rup- ture of the SI joint (2A) or fracture of the iliac wing (2B) and ipsilateral pubis; and type 3, the force also is directed anteriorly, resulting in internal rotation of the innominate bone on the injured side and lateral displacement on the contralateral side, with disruption of the SI joint and posterior ligament complex (3A) or the ipsilateral iliac wing (3B) and bilateral pubic fractures. -There are three types of anterior compression injuries: type I, vertical pubic ramus fractures or mild pubic diastasis; Type II, "open book" injuries with pubic diastasis and disruption of anterior SI ligaments and posterior ligaments; and type III, further widening of pubic symphysis and SI joint. Vertical shear injuries are characterized by disruption of the hemipelvis through the symphysis or pubic rami with disruption of the ipsilateral sacroiliac joint or iliac bone.
What are some pre-existing conditions that cause secondary MFH?
Preexisting conditions that are underlying causes of secondary MFH include Paget disease, osteonecrosis, irradiated tissues, fibroxanthorna, nonossifying fibroma, fibrous dysplasia, enchondrorna, and chronic osteomyelitis. Several cases of both osseous and soft-tissue MFHs related to cemented and noncemented total hip replacement.
What entity is associated with bone within bone?
Primary oxalosis
What is the most common cause of a subchondral insufficeincy fx in knee?
Prior meniscetomy or a Meniscal tear
What is progressive diaphyseal dysplasia?
Progressive diaphyseal dysplasia (Camurati-Engelmann disease) is a disorder of intramembranous ossification. It is inherited in an autosomal-dominant manner
Progressive diaphyseal dysplasia?
Progressive diaphyseal dysplasia (Camurati-Engelmann disease) is a disorder of intramembranous ossification. It is inherited in an autosomal-dominant manner. The result is hyperostosis, which occurs along the periosteal and endosteal surfaces of long bones
What is a bunionette deformity?
Prominence of the 5th metatarsal head (white arrows) and increased angulation between the 4th and 5th metatarsals.
What does the volar and doral bands of the radioulnar ligament do?
Provide major stability for the DRUJ, as the sigmoid notch of the distal radius is relatively shallow, limiting the osseous stability of the DRUJ itself.
Where is a rare location for triceps tear?
Proximal at supraglenoid tubercle, seen in surfer.
What is proximal femoral focal deficiency (PFFD)?
Proximal femoral focal deficiency (PFFD) is a congenital partial absence of the proximal end of the femur with shortening of the entire lower limb. The diagnosis and classification have been based mainly on plain radiograph findings. -Assoc with fibular hemimelia/ hypoplasia -Assoc with absent patella -the severity of coxa vara, if present, will influence treatment selection. -MRI: The ability of GRE imaging to clearly depict cartilage is of particular value in this setting. Routine coronal and axial MR images may be adequate, however, oblique images may be useful in some patients.
What is ddx for anterior knee pain?
Proximal patellar tendinopathy (jumper's knee) presents anterior knee pain as well, and a local pressure of the proximal tendon reproduces the patient's symptoms. Whereas ultrasound can easily confirm the diagnosis of jumper's knee, this technique is useless in diagnosing HFP impingement.
What factors do surgeons consider when considering a skeletally immature pt for an ACL recon?
Pt's physiologic age, skeletal maturity and growth remaining, activity level and athletic goals.
What is RTSA?
Putting the ball where socket should be and socket where ball should be
What is Pyknodysostosis (Maroteaux-Lamy disease?
Pyknodysostosis (Maroteaux-Lamy disease) is a disorder of the primary spongiosa that is often diagnosed in infancy or early childhood. This dysplasia is inherited as an autosomal-recessive trait with a mutation in the cathepsin K gene
What are radiographic features of OS?
Radiographically, osteopathia striata is characterized by dense linear striations in the diaphyses and metaphyses of long and tubular bones. The striations run parallel to the long axis of the bone and are typically seen in areas of rapid growth such as the femur. **In the iliac bones, the striations can demonstrate a fan-shaped appearance due to the growth pattern of these bones (Fig 8) (2). In some patients, sclerosis of the skull may occur, which can lead to cranial nerve palsies .
What are radiographic features of DD?
Radiographically, there is bilateral and symmetric cortical thickening involving both the periosteal and endosteal surfaces of long bones. Narrowing of the medullary canals may occur. The tibia is the most commonly affected bone, followed by the femur, fibula, humerus, ulna, and radius. The metaphysis and epiphysis are typically not involved, since these regions are formed by endochondral ossification In rare cases, sclerosis can be found in the skull base, and in such cases, cranial nerve palsies may develop Other areas that can characteristically be involved by progressive diaphyseal dysplasia include the midsegment of the clavicles. In severe cases, sclerosis isolated to the posterior aspect of the vertebral body and arches may be seen.
What are radiographic features of pykno?
Radiographically, there is generalized osteosclerosis similar to osteopetrosis, but with preservation of the medullary canal of long bones. The calvaria and skull base can also be sclerotic, and wormian bones are often present. Lack of pneumatization of the paranasalsinuses is also characteristic. In the spine, there may be kyphoscoliosis with increased lumbar lordosis and dense vertebral bodies with characteristic sparing of the transverse processes.
OS trigonum
Refers to a seperate bony ossicle at the lateral tubercle of the talus.
Palmaris longus
Remember not everyone has one, but for those who do, it travels just superficial to the carpal tunnel
What dz gives tendon avulsions in adults?
Renal osteodystrophy
What is girdlestone resection?
Resexn femoral head Girdlestone procedure is excision arthroplasty of hip in which femoral head, neck, proximal part of trochanter and the acetabular rim are removed. The procedure was described for chronic deep seated infections of hip joint. -Was used for patients with TB pre abx
What findings suggest multidirectional instability on MRI shoulder?
Scarring in interval, patulous interval, scarring of biceps pulley (SGHL, CHL)
Buzzwords: Meniscus
See next flashcard
Anteromedial impingement
Result of a meniscoid lesion, which is represented by a soft-tissue thickening anterior to the tibiotalar ligaments. -The anteromedial meniscoid lesion can appear isolated or arising from a partially torn deep deltoid ligament. -This thickened ligament or a meniscoid lesion impinges on the anteromedial corner of the talus during dorsiflexion of the ankle, resulting in osteophyte formation, a chondral lesion, or both. - associated with an inversion mechanism -
What is best view to see an accessory medial cuneiform?
Sagittal PD
What does a ramp lesion look like?
Sagittal T2 MRI showing high signal irregularity with complete fuid flling between the posterior horn of the medial meniscus and capsular margin indicating a ramp lesion (arrow)
What as a different imaging feature of Ramp lesion?
Sagittal T2 magnetic resonance image of the medial compartment of a right knee demonstrating subtle separation in the posteromedial meniscocapsular junction consistent with a ramp lesion (yellow arrow
Whats a ddx for GCRG in mandible?
Same. The radiographic appearance is indistinguishable from that of odontogenic cyst, ABC, ameloblastoma, odontogenic myxoma, and odontogenic fibroma
Which structure is the longest muscle in body?
Sartorius
What is STAR procedure?
Scandinavian Total Ankle Replacemetn -Has a tibial and talar dome metal components with a plastic spacer which is mobile (only part that is mobile)
Ganglion cysts
Scapholunate lig-dorsal Radiocarpal jt-volar
Which two bursa do not communicate with knee joint?
Semimem-MCL and pes anserine bursa.
What does posterior subluxation of glenoid imply?
Severe OA of glenohumeral joint
L4
Short external rotators and adbductors
What is coxa breva?
Short fem neck
What is the innervation for biceps femoris tendon?
Short head-common peroneal Long head-tibial branch of sciatic
What should you look for with a CC of lateral sided ankle pain?
Sinus tarsi syndrome, peroneal tendonothpathy, subtalar impingement or arthrosis
What does a mesenchymal chondrosarcoma look like?
Soft tissue chondrosarcoma in young pt
What maintains stability at CMC joint?
Stability at the thumb CMC joint is maintained by a capsuloligamentous complex which allows greater joint mobility and consists of five main components: the anterior oblique, or "beak", ligament (AOL), the dorsoradial ligament (DRL), the dorsal central ligament (DCL), the posterior oblique ligament (POL) and the intermetacarpal ligament (IML)
Where do old ladies fx?
Subcapital femoral neck
What are you looking for after partial meniscectomy?
Subchondral fx, OA, progressive cartilage loss
Which joint plays a role in maintaining talus in normal position?
Subtalar joint maintains talus in normal position relative to tibia.
When a menisus esp the medial side looks small or "funny" hwat should you consider?
Subtotal meniscecomtomy.
Name the knee bursa
Superficial infrapatellar, deep infrapatellar, suprapatellar bursa, MCL-semimemb bursa, pes anserine bursa
Subscaps?
Superior third fibers have a tendinous insertion on lesser tub; inferior 2/3rd fibers have a muscular attachment on LT.
What is tarsal tunnel release?
Surgical Procedure: An incision is made 10 cm to the tip of the medial malleolus and 2 cm posterior to the posterior margin of the tibia. During the proximal release, the flexor retinaculm is released from its proximal extent near the medial malleolus to the sustentaculum tali. The tunnel is followed distally, and release of the fascial arcade around the medial and lateral plantar nerve branches should be followed through to the abductor hallucis.
What should you suspect if a pt has symmetric insufficiency fx?
Suspect osteomalacia.
What is the angle of Gissane?
The "critical" angle of Gissane was devised on lateral radiographs to evaluate calcaneal fractures, as commonly the talar lateral process is driven downward into the adjacent relatively weak part of the calcaneus. The angle is measured using a line along the superior calcaneal cortex at the body and anterior calcaneal process, and another line along the posterior articular facet of the calcaneus; normally it measures around 130 degrees. The apex of the angle of Gissane is at the location of chronic talar impact with lateral hindfoot impingement, and this is the center of the bony changes, therefore the angle of Gissane, or "calcaneal angle" can be used as a term to identify the calcaneal location of pathology
Where does AOL attach?
The AOL, also known as the beak ligament, has its origin at the volar tubercle of the trapezium and attaches to the volar beak of the first metacarpal base, at the ulnar-volar aspect of the joint.
What are the stabilizing structures of the lateral ankle?
The ATFL, the CFL, PTFL
What is the accessory anterior tibiofibular lig called?
The Bassett ligament
What is the intermetatarsal ligament?
The IML is an extracapsular ligament that runs obliquely from the dorsoradial aspect of the second metacarpal to the volar-ulnar tubercle of the first metacarpal base. It is just radial and volar to the extensor carpi radialis longus tendon insertion on the second metacarpal base. It inserts on the first metacarpal base adjacent to the UCL and POL insertions and its fibers are interspersed with UCL fibers at the metacarpal insertion. It is an extracapsular ligament and restricts radial translation of the first metacarpal.
What is the Q angle?
The Q angle is an important indicator of biomechanical function in the lower extremity. This measurement reflects the effect of the quadriceps mechanism on the knee (hence the "Q" angle). -The Q angle of the knee is a measurement of the angle between the quadriceps muscles and the patella tendon and provides useful information about the alignment of the knee joint. -**When assessed correctly, it supplies very useful information concerning the alignment of the pelvis, leg and foot.**
What do you mean by modular junction?
The Rejuvenate Modular Dual Taper stems--the femoral component consists of three separate pieces (stem, neck and head), with modular junctions at both the head-neck (trunion) and neck-stem articulations.
What is the superficial peroneal nerve?
The SPN is a branch of the common peroneal nerve. The SPN pierces the deep fascia of the leg about 12.5 cm above the tip of the lateral malleolus. Before it divides into its terminal branches roughly 6 cm above the tip of the lateral malleolus, the SPN sends out collateral motor branches to the peroneal brevis and peroneal longus muscles. It provides sensory innervation to the dorsolateral aspect of the foot and ankle
What is most cmmon place to get fx in reverse TSA?
The acromion or clavicle
What are some dorsal accessory m?
The extensor digitorum brevis manus is found ulnar to the extensor tendon of the index finger.
What is the bicipitoradial bursa?
The bicipitoradial bursa is a synovial lined bursa consistently found between the distal biceps and bicipital tuberosity, and is normally collapsed and not visualized. The distended bursa can extend proximally and surround the distal biceps tendon1. The distal biceps tendon does not have a synovial lined tendon sheath.
The spring ligament is NOT the same as the bifurcate ligament.
The bifurcate ligament extends from the calcaneous to the navicular and cuboid bones at the lateral aspect of midfoot.
What tendon is at risk of injury in distal radius fractures involving Lister's tubercle?
The extensor pollicus longus (EPL)
What tendon does the central cord of the Plantar fascia envelope?
The central cord envelopes the flexor digitorum brevis.
What is difference between edema pattern of pivot shift and patellar dislocation?
The contusion of the lateral femoral condyle after lateral patellar dislocation should be differentiated from the contusion pattern involving the lateral femoral condyle after a pivot shift injury. With lateral patellar dislocation, edema of the lateral femoral condyle is located more anteriorly and peripherally, whereas with pivot shift injury the contusion is more centrally or posteriorly located on the lateral femoral condyle. The exact location of the femoral edema after a pivot shift injury depends on the degree of flexion of the knee at injury. With less flexion, the femoral edema will be located more anteriorly, but it will be associatedwith edema of the posterior tibial plateau rather than with edema of the inferomedial patella.
What is the name of the fibro-osseous tunnel that the peroneus longus tendon travels in?
The cuboid tunnel
What are the deep and superficial fibers of Deltoid ligament called?
The deep (anterior and posterior tibiotal) and superficial (tibiocalcaneal, tibionavicular, tibiospring, and tibiotalar) fibers.
How many ligaments make up the dorsal deltoid ligaments?
The dorsal deltoid ligament consists of three ligaments that are, from radial to ulnar, the dorsoradial ligament (DRL), the dorsal central ligament (DCL) and the posterior oblique ligament (POL).4 Each originates from the dorsal tubercle of the trapezium and, together, they form a broad insertion on the dorsal edge of the first metacarpal base. The DRL originates on the radial side of the dorsal trapezial tubercle and inserts on the radial-dorsal side of the metacarpal. The DCL and POL are purely dorsal structures, ulnar to the DRL. The DCL is the shortest and thickest and the POL is the longest of these ligaments. The DRL courses subjacent to and is reinforced by the abductor pollicis longus tendon. The DCL is directly beneath the extensor pollicis brevis (EPB) tendon.
What does the dorsal ligament of the radioulnar ligament do?
The dorsal ligament prevents volar displacement in supination.
What is a common site for dorsal ganglion cysts?
The dorsal radiotriquetral ligament. dorsal radiocarpal joint recess
What is the triceps surae?
The gastrocnemius, Achilles and plantaris are referred to triceps surae.
What are the 3 subtypes of hereditary sclerosis dsyplasia?
The hereditary sclerosing bone dysplasias can be categorized as dysplasias of (a) endochondral bone formation, (b) intramembranous bone formation, or (c) both.
What is the significance of Hoffa's fat pad?
The main function of HFP is to reduce friction between the patella, patellar tendon and deep skeletal structures. Moreover, it prevents pinching of the synovial membrane and it facilitates vascularisation of adjacent structures
What does the tibial nerve branch into?
The medial and lateral plantar nerve and a smaller medial calcaneal nerve.
What are midcarpal joints?
The midcarpal joint is formed laterally by the scaphotrapeziotrapezoid (STT) space and the scaphocapitate space, centrally by the lunocapitate space, and medially by the triquetral-hamate space.
What is stage II adhesive capsulitis?
The only adhesive capsulitis they will do something about.
PQ?
The peroneus quartus (PQ) arises from the peroneus brevis muscle (PB) and courses medial and posterior to the peroneus longus (PL) and peroneus brevis (PB) muscles and tendons before inserting on the retroctrochlear eminence of the calcaneus
What are the three most common entrapment sites for the posterior tibila nerve?
The posterior tibial nerve has three main entrapment sites: proximal at the flexor retinaculm, and distally at the medial and lateral plantar nerve (branches from the tibial nerve located at the distal ends of the tarsal tunnel).
What is a scarf osteotomy?
The scarf osteotomy is performed for hallux valgus deformity. -It is a way of dividing the 1st metatarsal in a Z-shape fashion (metartarsal is cut in 3 planes) to allow the metatarsal to be accurately moved medially, then fixed stably, thus correcting the bunion.
Sciatic nerve
The sciatic nerve originates from lumbosacral plexus L4-S3 tibial division orginates from anterior preaxial branches of L4,L5,S1,S2,S3 peroneal division originates from from postaxial branches of L4,L5,S1,S2
What is the sinus tarsi?
The sinus tarsi is a lateral space located between the talus and the calcaneus. It contains the cervical ligament, interosseous talocalcaneal ligaments, the medial roots of the inferior extensor retinaculum, neurovascular structures, and fat. -
What are the components of the spring ligament?
The spring ligament is the calcaneonavicular ligament. The components are superomedial, medioplantar, inferoplantar calcaneonavicular ligaments.
Where does the Spring ligament lie in relation to the PTT?`````````````````````````````````````````````````````````````````````
The spring ligament lies deep to the PTT and contributes to supporting the longitudinal arch of the foot.
Which muscles make up the common flexor tendon?
The superficial group (pronator teres, flexor carpi radialis, plamaris longus and flexor carpi ulnaris) arises mostly from a common flexor tendon that attaches to the anterior part of the medial epicondyle of the humerus, and from adjacent fascia. -supplied chiefly by the median nerve.
What is the most important component of spring ligament?
The superomedial calcaneonavicular ligament (SM-CNL) is the strongest component of the spring ligament complex and extends from the sustentaculum tali to the dorsal aspect of the medial navicular.
What is the tarsal tunnel?
The tarsal tunnel is a fibro-osseous tunnel created by the tibia anteriorly, posteriorly by the talus, and laterally by the calcaneus. The flexor retinaculum (laciniate ligament) overlays the contents of the tarsal tunnel, which includes the posterior tibialis, flexor digitorum, flexor hallucis longus, posterior tibial artery/vein, and the tibial nerve.
Osteoporosis plus multiple compression fractures that isn't sickle cell
Think Goucher's. Sickle cell doesn't normally give you osteoporosis so if you see it you have to think of Goucher's -Goucher's gives thickened bilateral femoral necks (in patient without hx of MHE).
What does the volar ligament of the radioulnar ligament do?
The volar ligament prevents dorsal displacement in pronation
Destruction of multiple hinge joints in a MALE that looks like RA
Think Hemophilia, hint is that pt is male (x-linked dz)
isolated subluxation 1st CMC
Think Lupus
Causes of a suprapatella joint effusion without fx or other cause like OA?
Think Rheumatoid, CPPD, gout
Scarring of biceps pulley, interval and IGHL?
Think multidirectoin instability
How many different knee fat pads are there?
There are three anterior knee fat pads
What happens to older pts who have an anterior dislocation of shoulder (the don't get hillsachs or bankarts).
They blow out their subscapularis instead.
What happens in old pts who dislocate the shoulder anteriorly?
They typcially rip their subscapularis instead of getting a bankart or hillsachs lesion
Describe psoriatic arthritis
This arthropathy has five presentations: distal interphangeal joint polyarthritis, arthritis mutilans, rheumatoid arthritis-like symmetric, polyarthritis, monoarthritis or asymmetric oligoarthritis, and sacroiliitis and spondylitis mimicking ankylosing spondylitis. The arthropathy may antedate skin changes in 20% of cases. The radiographic hallmark of this dis- ease is bone proliferation, distinguishing it from rheumatoid arthritis (the prototypical non-bone-forming synovial inflammatory arthropathy). The joints of the hands and feet are common target sites. Key observa- tions include soft tissue swelling that sometimes involves the entire digit (sausage finger), normal miner- alization, bony erosions that begin at the margins of the joint and progress centrally, destroying the entire artic- ular surface area ("pencil-in-cup" deformity), and resorption of the tufts of the distal phalanges. Bony pro- liferative changes may occur adjacent to these erosions but may also occur in the form of periostitis, joint anky- losis, and enthesopathy. In the axial skeleton, bilateral sacroiliitis is more frequent than unilateral involvement, spine, asymmetric or unilateral paravertebral ossifica- tions affect the lower thoracic and upper lumbar spine.
Anterior impingement
This condition involves a beaklike prominence at the anterior rim of the tibial plafond, usually associated with a corresponding area over the opposed margin of the talus proximal to the talar neck, well within the anterior ankle joint capsule (Fig. 5). These osteophytes can impinge on each other, especially with ankle dorsiflexion, and soft tissues can become entrapped. -Pain with dorsiflexion
What is Hoffa's fat pad impingement syndrome?
This is edema in the infrapatella (Hoffa's) fat pad. -Specifically occurs in superolateral Hoffa's fat pad. - It is thought to be due to patella maltracking or imbalance of the forces between medial and lateral vastus muscles causing impingement of the superolateral aspect of Hoffa fat pad between the inferior patella and the lateral femoral condyle. -Pt's with patella tendinopathy get it so pt's with patella alta are prone to it. -Pts present with anterior knee pain exacerbated by hyperextension; point tenderness at inferior pole of patella -Associated findings include lateral patellar subluxation and patella alta (Insall-Salvati ratio greater than 1.2) which are found in around 90% of cases. 1,2
L5
Tib ant, tib post, foot extensors
What are terminal branches of sciatic n?
Tibial and common peroneal n
How do you define the tibial slope?
Tibial slope angle is defined as angle formed between line drawn parallel to lateral tibial slope and vertical line bisecting diaphysis of femur.
Which ankle and foot joints communicate?
Tibiotalar--posterior subtalar jt (FHL tendon sheath) Talonavicular--calcaneocuboid Anterior subtalar--navicularcuneiform Anterior subtalar--calcaneocuboid Naviculocuneiform--Tarsometatarsal
When do you give contrast for a cystic mass?
To determine if a mass is truly a cyst and not a T2-bright mass (like myxoid sarcoma), give contrast. If a cyst is near a join, ligament or tend, and is homogenously high T2 signal, you can likely assume is a ganglion rather than a cystic mass.
What is role of imaging in ganglion cyst?
To identify a stalk or where cyst arises from so that it can resected to prevent recurrence.
What is a false profile used for?
To look at anterior acetabulum-for example to more optimally evaluate coverage of femoral head in pt with FAI
Where does the UCL attach?
To sublime tubercle
Which tendon is used for Tommy John procedure?
Tommy John surgery is done for ulnar collateral lgament tears where a the UCL is replaced with a tendon, usu the palmaris longus tendon in hand.
What is a common complic of labral repair?
Torn capsule. So always comment on iliofem lig whether intact, scarred etc
Spinal accessory
Trapezius and SCM
What is Triple arthodesis?
Triple arthodesis is used to address many types of foot deformity and pain. This procedure fuses three joints in the back of The talonavicular (blue arrow), subtalar (red arrow) and calcaneocuboid (green arrow) joints the foot. These joints, shown in the image to the right, are the talonavicular (blue arrow), subtalar (red arrow) and calcaneocuboid (green arrow
What is the name of the bare area over the central portion of the glenoid which mimic a cartilage defect?
Tubercle of Ozaki
What is Schatzker classification?
Type I Lateral split fracture Type II Lateral Split-depressed fracture Type III Lateral Pure depression fracture Type IV Medial plateau fracture Type V Bicondylar fracture Type VI Metaphyseal-diaphyseal disassociation
What is a type II lunate?
Type II lunate bones have an "extra" facet that articulates with the hamate bone, which frequently leads to arthritis.
What sequence can you use to help you ID PVNS if you didn't do a gradient?
Use the localizer sequence
Whihc way does the radius normally tilt?
Ventral
Vertical talus
Vertical oriented talus
What is the most common MOI with the peroneus brevis tears?
When related to trauma, the mechanism of injury is forceful dorsiflexion with inversion of the foot.
When do you consider epidural lipomatosis in spine?
When the dorsal epidural fat covers the spinous process instead of just the interspinous area.
4th and 5th metatarsal joints communicate?
Yes, 4th and 5th metatarsal joints communicate, but these do not communicate with the 1st. The 1st does not communicate with the rest.
Horizontal meniscal tear?
_indicates degenerative tear -Usu assoc with parameniscal cyst
Calcified cartilage layer
calcified cartilage layer - contains the tidemark layer; - tidemark is basophilic line which stradles the boundry between calcified and uncalcified cartilage; - separates hyaline cartilage from subchondral bone; - much of hyaline cartilage in non articular areas of the body ultimately calcifies w/ maturation; - when calcification occurs, chondrocytes die & matrix disintegrates; - articular cartilage is unique in that its more superficial zones do not calcify, except in states such as pseudogout
DDX for ischiogluteal bursa?
hamstring tear, peri-rectal or buttock abscess, hematoma, epidermoid cyst, dermoid cyst or hydatid cyst. - The common hamstring tendon is typically located lateral to the inflamed ischiogluteal bursa, and it possibly acts as a barrier to prevent the extension of the bursitis
Describe forefoot deformities
metatarsal adductus metatarsal abduction forefoot inversion forefoot eversion
What are the two borders of the Greater troch?
superficial--ITBand Deeep--gluteus medius tendon -US injection: Aim is for hitting bone with needle--put hand on plunger and slowly pull needle back while keeping hand on plunger. Should feel loss of resistance when needle is in potential space/GT bursa and watch for fluid plane to be created and for fluid to flow posteriorly on image.
What is tx for ankle OA due to malalignment?
supramalleolar osteotomy
Where does the peroneus brevis and longus tendons split?
the Peroneal tubercle (bony protuberance of calcaneous)
