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key muscles attaching to the iliac crest
abs
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key muscles attaching to the ASIS
- sartorius
- tensor fascia latae
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key muscle attaching to the AIIS
rectus femoris
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key muscle attaching to the greater trochanter
hip rotators
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key muscle attaching to the lesser trochanter
iliopsoas
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key muslces attaching to the IT
hamstrings
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key muscles attaching to body of pups and inf pubic ramus
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classic appearance of stress fractures
condesnation of cancellous bone (like sclerosis) perpendicular to the long bone
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2 types of stress fractures and their descriptions
- fatigue: normal bone undergoing abnormal stress
- insufficiency: abnormal bone undergoing normal stress
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where are stress fractures most common in the femoral neck, and why? who?
- inf more common than sup bc inf has "compressive trabeculae" while the sup is the "tensile side"
- runners and military trainees
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the big deal about a femoral neck fracture?
the blood supply runs thru the neck, so disruption may lead to avascular necrosis of the femoral head
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best way to view a fem neck stress fx?
bc plain films are often neg, get an MRI or bone scan (they're more sensitive)
(and if you suspect a stress fracture and the plain films are neg, tell the pt to be non-wt-bearing til there's an MRI)
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lipohemarthrosis - def, appearance on a film
mixture of fat & blood in a joint following a trauma (intra-articular fracture)
if the area is horizontal the fat will float above the fluid (blood) and there'll be a straight line in between
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looking at a knee joint in the lateral view, how/where will you see the ACL
it's visible when you're looking more at the lateral side - as you get more medial it fades, and now you see the PCL
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what kind of contraction is most likely to rupture the quad/patellar tendon
how will the patella appear
- eccentric
- it'll be elevated (pat tend rupt)
- tilted (quad tend rupt)
<you ninny, quad tendon is sup, pat tendon is inf>
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4 most common sites of stress fractures
- 2nd & 3rd metatarsals
- calcaneus
- distal tib
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periosteal reaction def
- formation of new bone in response to injury or other stimuli of the periosteum surrounding the bone
- it is most often identified on X-ray films of the bones.
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how will a stres fx look in metatarsal vs calcaneus & distal tibia?
- metatarsals: periosteal reaction (bone growth surrounding the fx
- calc & distal tib: linear sclerosis
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4 non-mechanical ways to get stress fxs
- infection
- arthritsi
- metabolic (hyperparathyroidism)
- neoplastic
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2 things to look for in bones for infection
- periosteal reaction
- destruction
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in bones infection gives a periosteal reaction or destruction. Other signs of infection?
- soft tissue swelling
- ulcers
- subuctaneous air
- skin thickening
- cellulitis
- abscesses fistulas
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what do you call an infection when it involves a joint (as opposed to bone)
septic arthritis
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name of infection when it involves bone
osteomyelitis (it's septic arthritis if it's at a joint)
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what kind of scan to use when looking for infection?
- radiographs first, but it's often negative until at least 7 days
- MRI - more sensitive
- nuclear medicine bone scan, dunno when
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what to look for on an MRI if you're looking for infection
abnormal fluid collections and marrow edema (bright on fat-sat T2, dark on T1 ... it's fluid...)
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degenerative arthritis = secondary arthritis = osteoarthritis ... what's the basic progression
loss of articular cartilage --> joint space narrowing --> osteophyte formation
then there's sclerosis, subchondral cysts
on a film it's bone-on-bone at the joint, and the bone around there looks fuzzy
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where gets hit most by degenerative arthritis / secondary arthritis / osteoarthritis
hips and knees
- hands are less common, but when there it's in DIPs & PIPs & CMCs
- rarely shoulders
- ... it goes after wt bearing jts
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rheumatoid arthritis
- chronic autoimmune inflammatory disease
- char by jt swelling, pain, destruction
- synovial inflammation
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arthritises -
1) which has a swollen inflamed synovium --> bone erosion
2) which has cartilage erosion --> bone ends rubbing
- 1) rheumatoid (tho it seems you get eroded cartilage and bone rubbing here too - it's just not the primary issue)
- 2) osteoarthritis
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7 diagnostic criteria for RA (need 4/7 to have it)
- morning stiffness at least an hour
- swelling of 3 or more jts
- swelling of wrist MCP, or PIP jts
- symmetric involvement
- typical radiographic changes
- rheumatoid nodules
- positive serum rheumatoid factor
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the american college o rheumatology/euorpean league against rhumatism made a classification for pts w at least one joint w synovitis that isn't better explained by some other pathology. what are the 5 things looked at on this scale?
- number of joints involved
- serology (for ACPA)
- acute phase reactants (whether there's abnormal C-reaction protein CRP or erythrocyte sedimentation rate ESR)
- duration of symptoms (more or less than 6 weeks)
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5 radiographic findings for RA
- soft tissue swellign
- osteoporosis
- jt space narrowing
- marginal erosions (away from wt-bearing portion of the joint)
- in hands, proximal process that is bilat & symmetrical
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basically what's happening in gout
hyperuricemia --> deposition of monosodium urate crystals
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primary vs secondary gout (the usual diff)
- primary: congenital 2/2 inborn error of metabolism
- secondary: 2/2 other disorders affecting urate metabolism (alcoholism...)
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presentation of acute vs chronic gout
- acute: jt swelling & pain mimicking septic arthritis (films show soft tissue changes, no bony changes)
- chronic: Tophi eroding into bone --> bony changes
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tophus def
- nodular mass of uric acid crystals.
- characteristically deposited in different soft tissue areas of the body in chronic (tophaceous) gout,
- commonly found as hard nodules around the fingers, at the tips of the elbows, and around the big toe, they can appear anywhere in the body. They have been reported in unexpected areas such as in the ears, in the vocal cords, and around the spinal cord.
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common sites for gout
- 1st MTP joint involve 90% of the time
- metatarsotarsal jts
- olecranon bursits
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radiographic findings for gour
- eccentric soft tissue swelling (tophi)
- erosiongs w overhanging edges (reactive bone around tophus)
- jt space preserved
- can be near or far from jt
- no jt space narrowing
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why is the jt space preserved in gout?
bc deposition in articular cartilage is focal, so narrowing only occurs late
so basically, no jt narrowing!
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