MSK review

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  1. What are the characteristic radiographic findings in osteoarthritis?


    Joint Space Narrowing
  2. What disorder is associated with osteophytes but no joint space narrowing or sclerosis?
    DISH (Diffuse Idiopathic Skeletal Hyperostosis)
  3. What are the characteristic radiographic findings of rheumatoid arthritis?
    Any synovial lined joint in the body:


    Marginal erosions

    Soft tissue swelling

    Joint space narrowing
  4. In what direction does the joint space narrowing occur in rheumatoid arthritis in the femoral head vs osteoarthritis
    Rheumatoid arthritis - In an axial direction

    Osteoarthritis - superior direction (towards weight bearing)
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    Syndesmophytes run vertically while osteophytes run horizontally
  6. Which spondyloarthropathies tend to have syndesmophytes which are MARGINAL and SYMMETRIC?
    Ankylosing Spondylosis

    Inflammatory Bowel Disease
  7. Which spondyloarthopathies tend to have syndesmophytes which are NONMARGINAL and ASYMMETRIC?
    Psoriatic arthritis

    Reiter's syndrome
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    Symmetric/bilateral SI joint involvement

    Ankylosing spondylitis

    Inflammatory Bowel Disease
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    Unilateral/asymmetric SI joint involvement

    Psoriatic arthritis

    Reiter syndrome
  10. What is the classic pattern of arthropathy seen in psoriatic small joint involvement?
    Distal joints

    Proliferative erosions

    Soft tissue swelling

  11. How long does it take for gout to manifest itself radiographically?
    Takes 4 to 6 years for gout to cause radiographically evident disease
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    Erosions with SCLEROTIC margins

    - Classic gout finding
  13. What is the classic triad in CPPD (pseudogout)?

    Cartilage calcification

    Joint destruction
  14. What are the classic locations for cartilage calcification (chondrocalcinosis)?
    Knee (medial and lateral compartments)

    Wrist (triangular fibrocartilage)

    Symphysis pubis
  15. What is the differential for soft tissue calcification of the rotator cuff of the shoulder?
    CPPD (pseudogout)

    CHA (HAD) (Hydroxyapatite deposition)
  16. What is the main difference between the joint destruction found in DJD versus CPPD (pseudogout)?
    CPPD has a proclivity for the upper extremity
  17. What disorders are highly associated with CPPD (pseudogout)?


  18. What are the characteristic radiographic findings in collagen vascular diseases?

    Soft tissue wasting
  19. What types of hand findings are noted in patients with lupus (SLE)?
    Severe ulnar deviation
  20. What types of radiographic changes are found in hemachromatosis?
    • Findings of DJD (joint space narrowing, sclerosis, osteophytes)
    • CPPD (pseudogout)
  21. What disease do these bony findings suggest?
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    "Drooping" osteophytes

    "Squaring" of the metacarpal heads due to large osteophytes
  22. What is the most commonly seen location of a Charcot joint?
    Diabetic foot

    First and second tarsometatarsal joint
  23. What are the classic findings for Juvenile Rheumatoid arthritis and hemophilia?
    Overgrowth of the ends of bones (epiphyseal enlargement)
  24. What is the pathogenesis of synovial osteochondromatosis?
    Metaplasia of the synovium with deposition of foci in joint cartilage
  25. What is the difference in pathophysiology between primary and secondary synovial osteochondromatosis?
    Secondary synovial osteochondromatosis - small bits of cartilage shed into joint at different times, grow as they are nourished by synovial fluid > loose bodies of different sizes
  26. What is pigmented villonodular synovitis?
    Chronic inflammation of the synovium that causes synovial proliferation
  27. What is another consideration on the differential if the deposits of cartilate do not ossify in the joint?
    Noncalcified synovial osteochondromatosis

    Pigmented villonodular synovitis
  28. What is the most reliable radiographic sign of a knee effusion?
    Distance between suprapatellar fat pad and the anterior femoral fat pad (> 10 mm)
  29. What are the radiographic stages of avascular necrosis?
    1. Joint effusion

    2. Patchy/mottled increase in density

    3. Subchondral lucency along articular surface

    4. Collapse of articular surface
  30. What is a smaller and more focal form of avascular necrosis?
    Osteochondritis dissecans
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    • Madelung deformity
    • - Positive ulnar variance
    • - Lateral/dorsal bowing of radius

    Congenital or traumatic distubrance of distal ulnar side of epiphyseal growth plate leading to shortening of the radius and overgrowth of the ulna
  32. What is the mnemonic for benign lytic bone lesions?
    • F - Fibrous dysplasia
    • E - Enchondroma/Eosinophilic Granuloma
    • G - Giant Cell Tumor
    • N - Nonossifying Fibroma
    • O - Osteoblastoma
    • M - Metastatic disease
    • A - Aneurysmal Bone Cyst
    • S - Solitary Bone Cyst
    • H - Hyperparathyroidism
    • I - Infection
    • C - Chondroblastoma/Chondromyxoid fibroma
  33. How can one rule out fibrous dysplasia?
    Fibrous dysplasia will not have periostitis

    Fibrous dysplasia looks like almost anything

    Often "ground glass" appearance
  34. Where does one typically find fibrous dysplasia?
    Pelvis (proximal femur invariably)


  35. What else should you consider if you are considering fibrous dysplasia in the tibia?
    Adamantinoma (malignant tumor)
  36. What is the syndrome if one notes polyostotic (affecting more than one bone) lesions in conjunction with cafe au lait spots and precocious puberty?
    McCune-Albright syndrome
  37. What is the most common benign cystic lesion of the phalanges?
  38. What are the typical findings in an enchondroma?
    Calcified chondroid matrix (except in phalanges)

    No periostitis
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    • Bone infarct -
    • well defined, serpentiginous, densely sclerotic border
    • No endosteal scalloping
  40. How to differentiate enchondroma vs Chondrosarcoma?
    Pain is more commonly associated with chondrosarcoma
  41. What syndrome is associated with multiple enchondromas?
    Ollier's disease
  42. What syndrome is associated with multiple enchondromas and soft tissue hemangiomas?
    Maffucci's syndrome
  43. What entities have been described to have bony sequestra?
    Eosinophilic granuloma



  44. What is the approximate age cutoff for patients with eosinophilic granuloma?
    EG is much more rare in patients above 30
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    1. Closed epiphyses

    2. Epiphyseal lesion abutting articular surface

    3. Eccentric location

    4. Sharp, non-sclerotic border
  46. What is the difference between a fibrous cortical defect and a non-ossifying fibroma?
    Fibrous cortical defects are typically shorter than 2 cm in length
  47. What is the differential diagnosis for expansile, lytic lesions in posterior aspect of spine?
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    Aneurysmal Bone Cyst

  48. What types of cancers can cause expansile, lytic metastases?
    Thyroid CA

    Renal CA
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    Aneurysmal bone cyst - multiple fluid-fluid levels
  50. What is the typical age range of an aneurysmal bone cyst?
    Less than 30 years old
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    Unicameral(solitary) bone cyst

    Fallen fragment sign (from fracture)

    • Central location
    • Proximal humerus and femur often
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    Subperiosteal bone resorption - resorption of radial(lateral) aspects of proximal/middle phalanges (often 2nd/3rd)

    Can also be seen in distal clavicles
  53. What is the differential diagnosis for a lytic lesion in the EPIPHYSIS in a patient under age 30?
    • 1. Infection (osteo)
    • 2. Chondroblastoma
    • 3. Giant Cell Tumor
  54. What rare lesion can mimic a non-ossifying fibroma?
    Chondromyxoid fibroma
  55. What disease is eosinophilic granuloma a benign form of?
    Langerhans Cell Histiocytosis
  56. How do thalassemias affect bone?
    Cause extramedullary hematopoeisis > hairy skull, thickened bone
  57. What is C2 called?
  58. What is the mechanism of a Jefferson fracture?
    Axial loan injury leading to burst fracture of C1 (atlas) ring
  59. What is the most common type of dens fracture?
    Type II - fracture through base of odontoid process
  60. What can structures can be injured with an MVA in which the chin hits the dashboard and causes hyperextension?
    Bilateral pars interarticularis fracture
  61. What is the name of the fracture in which chin strikes dashboard leading to bilateral pars interarticularis fractures?
    Hangman's fracture
  62. What structures can get injured with a hyperflexion injury?
    Anterior compression fracture

    Disruption of posterior ligament
  63. What is the name of the fracture associated with severe hyperflexion injury?
    Flexion teardrop fracture
  64. What can be fractured with hyperflexion of the neck associated with shoveling against fixed resistance?
    Spinous process
  65. What is the fracture called in which the spinous process is fractured associated with hyperflexion of the neck during shoveling against fixed resistance?
    Clay Shoveler's fracture
  66. What is the difference in mechanism between unilateral and bilateral facet joint dislocations?
    Unilateral - rotational injury

    Bilateral - extreme hyperflexion
  67. What fracture can occur a motor vehicle accident in which someone's back hyperflexes with a lap belt in place?
    Horizontal splitting of posterior elements extending anteriorly
  68. What is the difference between spondylolysis and spondylolisthesis?
    Spondylolysis - defect or fracture of pars interarticularis

    Spondylolisthesis - Anterior displacement of the involved vertebral body with respect to inferior vertebral body
  69. What is grade II spondylolisthesis?
    Displacement of 25 to 50% of the vertebral body's AP dimension
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    Jaccoud/lupus arthropathy

    Non erosive

    Marked ulnar subluxation at MCP joints
  71. What is the major complication of multiple hereditary exostoses?
  72. What are the characteristic imaging findings in multiple hereditary exostoses?
    Widening of metaphyses

    Sessile or pedunculated exostoses
  73. What are characteristic MSK findings of neurofibromatosis type I?
    • S-shaped scoliosis
    • Posterior vertebral body scalloping
    • Ribbon Ribs
    • Severe bowign
    • Pseudoarthroses
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  74. What is the primary defect in osteopetrosis?
    Defective osteoclast activity
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    Sever disease - Inflammation/sclerosis of calcaneal apophyses

    Often seen in young children (jumping) and is self limited
  76. What is the difference between lunate and perilunate dislocation?
    Perilunate dislocation > lunate maintains normal position with respect to distal radiusImage Upload 16

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  77. What is the difference between a trans-scaphoid perilunate dislocation and a perilunate dislocation?
    Transcaphoid perilunate dislocation > includes fracture of the scaphoid
  78. What are the most common tarsal bone coalitions?
    Calcaneus and navicular (most common)

    Talus and calcaneus
  79. What nerves and muslces are typically involved in Parsonage-Turner syndrome?
    Suprascapular nerve

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    • Supraspinatus and infraspinatus
  80. What nerves and muscles are involved with quadrilateral space syndrome?
    Axillary nerve

    Deltoid and teres minor
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    Particle disease -

    • Multifocal lucencies
    • Do not conform to prosthesis
    • No associated sclerotic reaction
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    Double PCL sign - band anterior to intact PCL

    Suggests bucket handle meniscal tear
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    Metadiaphyseal lesion

    Lytic lesion, sclerotic, scalloped

    Non-ossifying fibroma
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    Myositis Ossificans - peripheral calcifications in patient with history of trauma
  85. What is the difference between gigantism and acromegaly?
    Gigantism - stimulation of endochondral ossification before growth plate closure

    Acromegaly - growth hormone hypersecretion in the skeletally mature patient leading to intramembranous bone formation resulting in periosteal new bone formation and widening of osseous structures
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    Blount disease - lack of growth of the medial proximal tibial physis
  87. What is typically the first ligament to be injured in an ankle inversion?
    Anterior talofibular ligament (ATFL)

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    Tug lesion - minimal smooth periosteal thickening at medial aspect of distal femur (most likely secondary to vastus medialis insertion)
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    Humeral pseudocyst - area of decreased cancellous bone in the greater tuberosity due to disuse or osteoporosis

    Not a lytic lesion
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    Supracondylar process of the humerus
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    Bipartite patella

    Accessory ossification center at superolateral aspect of patella
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    Os odontoideum

    Unrecognized fracture through growth plate before age 6 - lack of fusion of dens

    Abnormal mobility of the dens with respect to C2
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    Dysplasia Epiphysealis Hemimelica (Trevor's disease)

    Osteochondromas arising from the epiphysis
  94. What is the differential diagnosis for a cystic lesion of the TERMINAL phalanx?
    Epidermal inclusion cyst (associated with history of trauma)

    Glomus tumor

    Enchondroma (rare)
  95. Teenager pitcher with shoulder pain
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    • Little league shoulder - Salter 1 injury with widened proximal humeral lateral physis
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  96. Where do labral variants tend to occur?
    • At the 11 to 3 o'clock position - 
    • Sublabral foramen
    • Sublabral recess
    • Buford complex
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    Luxatio erecta (inferior shoulder dislocation)

    Arm appears held upward or behind head in fixed abduction.
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    Macrodystrophia lipomatosa - localized form of giantism

    Usually affects 2nd or 3rd digit of hand or foot
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    Peroneus brevis split tear

    C-shaped appearance around peroneus longus
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    Nail patella syndrome (Fong disease)
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    Iliotibial band syndrome

    Ill-defined signal abnormality interposed between the iliotibial band and femoral condyle (low T1, high T2)
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    Jumper's knee -

    Injury of proximal patellar tendon where it inserts onto inferior pole of the patella

    • Pediatric form - similar to:
    • Sinding-Larsen-Johansson disease
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MSK review

MSK review
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