Transcript No Slide Title

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Cor T1
Sag PD
*
47F 5Y increasing stiffness and
decreased ROM. Initial
presentation
4
Ankylosing Spondylitis
Dagger sign
Bilateral hip inflammatory arthritis
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Ankylosing Spondylitis
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•
•
•
Young white men
When fuse posteriorly, may spare anterior
Scalloping of Cx spine
Dagger + Bamboo = Tram tracks
19M increasing mass on hand,
refused treatment
3
Osteosarcoma
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Osteosarcoma
• Most common primary malignant bone
tumor in young adults and children
• Second to MM in older
• Osteoid immature bone
• Bimodal
• Close to knee, away from elbow
• Young-cylindrical, Old-flat
25M with wrist pain
3
Osteopoikilosis
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Osteopoikilosis
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•
•
•
Juxtaarticular bone islands
?AD, M>F, asymptomatic
Ovoid 2-10mm
Benign sclerosing bone dysplasia
95 M pain R hip
4
Cor T1
Cor STIR
Pagets disease
Pathological Fx
Asterix enhancement
*
Pagets disease
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•
•
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•
O. deformans
3% >40, northern latitudes, >M
Lytic, vascular fibrous connective tissue
Inactive, decreased turnover with sclerosis
Mixed, common, both together
40M painful knee
4
Cor T1
Sag PD
B thalassemia intermedia
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B thalassemia
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•
•
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Major-Homozygous-Cooley anaemia
lack of B
Italian and Greek
Skull, hair on end, widened diploic
Porosis, thin cortex, Erlenmyer flask
Arthropathy
23M knee pain
1
Distal MCL injury
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Distal MCL injury
• Ossification points to joint
• MHE points away from joint
Sag T1
Sag PDFS
Sag T1
Sag PDFS
C5
50M heel pain
2
Sag T1
Sag PDFS
*
Involuting lipoma
• Any age, equal sex
• Calcaneus>Femur>Tibia>Fibula
• Can have central dystrophic calcification
13F painful foot
No trauma
Sag T1
Sag PDFS
*
57M
L hip pain
3
Sandwich vertebrae
Osteopetrosis
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Osteopetrosis
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•
•
•
•
•
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Marble bone, Defective osteoclasts
AR, Infantile, Systemic, Leukaemia
AD, Adult, Fxs, anaemia, CN palsy
Sclerotic, peri and endosteal
Erlenmyer flask
Bone in bone, sandwich vertebrae
Calvaria and mandible spared
Variable patients
Same condition
*
Pseudohypoparathyroidism
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•
•
•
•
X-linked, renal and skeletal resistance to PTH
Short, retarded,
Decreased Ca, normal/increased PTH
Brachydactyly 1,4,5 MC
Ca basal ganglia, skin, SubQ
Variable patients
Same condition
8
Dermatomyositis
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•
•
•
•
•
Damaged chondroitin sulfate
Atrophy, oedema, necrosis of muscle
30-60, F>M
Calcification extremities and girdles
Pointing of tufts
Ass. Malignancy, lung, kidney, ovary, breast
35M with recent trauma
Flex / Ext
C5
C6 Fx subluxation
C5
C6
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Signs of instability
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•
•
•
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Spinous process fanning
Widening of disk space
Horizontal displacement >3.5mm
Angulation >11 degrees
Disruption of facets
Multiple fractures at one level
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10M painful neck
*
Transient disc calcification of children
Transient disc calcification of
children
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•
•
•
Painful
Pain lasts weeks
Calcification lasts months
Adjacent vertebrae flattened
28F pain in lumbar region
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Anterior limbus with instability
Limbus Vertebrae
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•
•
•
More often anterior and superior
More significant posterior
Disc herniates through ring apophysis
Commonest lower lumbar
37F acute torticollis, stiffness and
shortness of breath
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Fibrodysplasia ossificans progressiva
Fibrodysplasia ossificans
progressiva
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•
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MOP / Stone man
Rare, AD, sporadic
Presents in childhood
Stiffness, Heterotopic ossification
Malformed fingers and toes
Bone morphogenic protein (BMP) signaling
pathway problem
48M joint pains and dark
pigmentation on ears
Alkaptonuria
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Alkaptonuria / Ochronosis
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•
•
•
•
Absence of homogentisic acid oxidase
Pigmentation
Arthropathy
Osteoporotic with dense disc calcification
Larger joints show DJD
6mM
Calcareous nodules
Idiopathic calcinosis
universalis
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28BF mass in shoulder
Idiopathic Tumoral Calcinosis
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*
Ax PDFS
*
Ax T1
Cor T2
Cor T1
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*
1518960
*
Sag T1
*
81M shoulder pain
*
Chondrocalcinosis
Chondrocalcinosis
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•
•
•
•
•
CPPD
Hyperparathyroidism
Hemochromatosis
Acromegaly
Gout
Wilsons disease
45F swelling of arm with
numbness of 2nd and 3rd fingers
Ax PDFS
*
Ax T1
Fibrolipomatous hamartoma of the median nerve
with macrodystrophia lipomatosis
Fibrolipomatous hamartoma of the
median nerve with macrodystrophia
lipomatosis
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•
•
•
Nerve territory directed macrodactyly
Localised form of gigantism
Median or Plantar nerves
Possible relation with neurofibromatosis
35M
8w post injury
Cor T2
Cor T1
Post traumatic myositis ossificans
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Post traumatic myositsis ossificans
• 4/52 Faint peripheral Ca
– Periosteal reaction
• 8/52 Circumscribed cortex
– Central lacy pattern
• 5/12 Maturity
• >6/12 Regression
– Separate from bone
• 1 year Usually disappears
– Periosteal reaction remains
25M
Blocker
*
Myositis ossificans
Sport related myositis ossificans
• Single direct blow
• Repeated minor trauma
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–
–
–
Adductor longus-Rider’s bone
Brachialis-Fencer’s bone
Soleus-Dancer’s bone
Blocker’s arm
48M
Alcohol ++
1518960
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Grading of AVN
Steinberg modification of
Arlet/Ficat
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0 - Abnormal MRI no symptoms
1 - Abnormal MRI, pain
2 - Mixed sclerosis and lucency on x-ray
3 - Subchondral collapse
4 - Marked collapse
5 - Secondary acetabular OA
Causes of AVN
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Trauma
Steroids
Alcohol
Pancreatitis
Protease inhibitors
Gauchers
Sickle cell
Caisson
Perthes / Idiopathic
34M
Developing lump anterior to knee
Ax PDFS
Ax T1
*
Sag T1
Soft tissue chondroma
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Rare
20-40Y
Hands and feet
Well demarcated and lobulated
Curvilinear, ringlike or nodular calcification
High signal T2
PDFS
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*
*
1171948
*
*
1999621
35M
Knee injury
PDFS
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ACL/MCL
• Empty lateral gutter
86M
Stiffness and Locking
Multiple bodies in
Popliteal recess
• Primary V’s secondary osteochondromatosis
• Multiple similar size
• Origin
62M
Fullness in suprapatella region
*
Body growing in joint
• Laminated
• Slow growing
30M
Outdoors man
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Snake bite
• Venom not infection
• Due to proteases
36M
Prior trauma
1171948
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Florid reactive periostitis
• BPOP
• Bizarre parosteal osteochondromatous
proliferation
• Manifestation of PTMO in hands
• Periosteal proliferation > ST ossification
50M
Trauma
Whiplash injury
1
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1999621
Extension tear drop Fx
• Small fragment
• Usually more superior Cx spine
0850849
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1
*
2W earlier
2W later
1927160
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2001785
*
36M
Trauma 3Y ago
MVA
Now myelopathy
3
2001176
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Chronic non-union of C2 Fx
• Type 1 steep oblique
– Due to alar ligament
• Type 2 neck of odontoid process
– Prone to non-union
• Type 3 extends into body
– Often heal with conservative Rx
42M
Fall
1
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1
0850849
Anterior shoulder dislocation
• Hill Sach’s lesion (Hatchett )
– Stryker view
• Bony or soft tissue Bankart
– Westpoint view
• Posterior dislocation
– Trough Fx
– Bennet’s lesion
• Bony
21M
Injury weeks ago
Recent surgery
1
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Volkmann’s ischaemic contracture
• Soft tissue contractures
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Volkmann’s
Burns
Neurologic conditions
RhA, SLE
Arthrogryposis multiplex congenita
40M
Known medical condition
Recent trauma
2
2W earlier
2W later
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2003485
2W later
Hemophilic pseudotumor
• Uncommon manifestation of Hemophilia
• Femur > Pelvis > Tibia > Small bones of
hands and feet
• Intraosseous or subperiosteal
• Lytic, expansile, can look aggressive, ST
mass
75F
Lifelong limp
1
1927160
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DDH
Adults
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DDH
Infants
Acetabular angle
Lateral shift
Superior shift
Shenton’s
Perkin’s
Hilgenreiner’s
Center Edge
40M
Waterskier
1
2001785
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Old ischial avulsion
• Avulse bone < 25Y
• Waterskier, Hurdler, Sprinter
1806380
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2003226
1995690
54F
Fall
2
1777100
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Transverse Patella FX
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Direct or indirect
Transverse 70%, indirect
Longitudinal, stellate or comminuted
Bipartite - superolateral
Dorsal defect - superolateral
– Direct
63F
Longstanding decrease ROM
1
*
1806380
Chronic anterior shoulder
dislocation, with neoglenoid
• Failure to diagnose
• May have increased ROM
19F
Slowly growing (1Y) lump on
thigh
3
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1998078
Alveolar Soft Part Sarcoma
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Malignant granular cell myoblastoma
Young adult females
Thigh muscles
Slow growth, calcifcation, invade bone
Metastasizes late
Vascular, may have flow voids
Path - similar to paraganglioma
19F
MVA
1
2003226
*
2003226
Odontoid Fx
• Type 1 - Steep oblique
– Sometimes tip Fx also called type 1
• Type 2 - Neck
– Prone to non-union
• Type 3 - Involves body
– Usually heal conservatively
65M
Neck pain
Myelopathy
3
1995690
1995690
1995690
1995690
**
CPPD arthropathy
• Deposited in transverse ligament
• Associated
– Tumor like masses may compress cord
– Atlanto axial subluxation
– Spontaneous odontoid Fx
35M
Deformity
Maffucci syndrome
• Multiple enchondromas
• ST Hemangiomas
• Malignant potential close to 100%
– Olliers enchondromatosis 25-30%
• Developmental, not hereditary
• Growth deformities
12M
Deformity
Noonans
• Short Metacarpal
– Idiopathic
– Post trauma
• Iatrogenic, Fx, Growth plate inj, Thermal, Electrical
– Turners, 4th +/- 3rd or 5th
– Pseudo- and pseudopseudohypoparathyroidism
• 4th and 5th
14M
Deformity
Carpal osteolysis
• Onset childhood
• Carpals, Tarsals, elbows
• Associated nephropathy
29F
FOOSH
Scaphoid Fx on lateral view
• Many scaphoid fractures are best seen on
lateral
68M
Wrist instability
VISI
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•
Suggests lunotriquetral ligament tear
DISI- scapholunate ligament tear
Angle between scaphoid and lunate < 30
Pie shaped lunate
33F
No history of trauma
Keinbocks
• Ulna minus
• Trauma
• Osteonecrosis
45F
Hand pain
Acroosteolysis
• Tuft
– CVD- Scleroderma, CREST, Raynauds
– Psoriasis
– Neuropathic
• DM, Leprosy, Myelomeningocele, Syrinx, Cong indifference
to pain (Leesch Nyan)
– Trauma
• Thermal, Burns, frostbite electrical
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–
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Hyperparathyroidism
Epidermolysis bullosa
Porphyria, Subungal exostosis,
Snake and scorpion venom
Phenytoin toxicity in infants
40M
Knife injury
Flexor tendon laceration
Displaced sesamoid
• Sesamoid useful marker of tendon
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*
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*
20M
Hurt hand catching ball
Dislocations
• Need 2 views for trauma
22F
Deformity
Boutonnierre
• Rupture of middle slip of extensor tendon as
it passes over PIPJ
• Lateral slips migrate volarly
• Occasionally avulsion
• Needs early Dx
76F
RhA
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Cranial Settling
• Atlantoaxial settling
• Erosion of lateral masses
• Different from basilar invagination
57M
Bilateral shoulder pain
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DDx
• Unilateral
– Amyloid, TB
• Bilateral
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–
–
–
Crystal
Occupational OA
Syrinx - neuropathic
Previous inflammatory arthritis
• Clavicles normal
– Hemophilia
24M
FOOSH
*
Trans scaphoid/triquetrum
perilunate Fx dislocation
• Pie shaped lunate
31M
Blow to flexed thumb
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Rolando Fx
• Axial blow
• More difficult to anatomically reduce
March 01
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*
*
57M
Right hip pain
March 01
May 01
Dec 02
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Hepatic metastases
• Rare to bone
• Similar to other hypervascular mets
50M
MVA
Anterior hip dislocation
• 5% of hip dislocations
• Can have associated impaction injuries
• Leg externally rotated
32M
Bilateral chronic hip pain
*
Perthes
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•
•
•
White boys
4-7y
Younger onset – better outcome
DDx for bilateral
– MED, Morquios, SCD, Gauchers,
– Hypothyroid, CDP, Warfarin embryopathy
17F
Mechanical symptoms
*
Osteochondroma
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•
•
•
Point away from joint
Cartilage cap is hyaline
Cap thickness > 1cm concerning
Pain important to dx malignancy
75M
Knee locking
*
Primary synovial
osteochondromatosis
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•
•
•
Metaplasia of synovium
May not be visible on X-ray
Primary similar size
Synovial hemangiomas have lucent centers
55M
1Y post trauma
*
Dystrophic calcification
in Quadriceps tear
• Calcification
– Metastatic
– Dystrophic
– Tumoral
Left
*
Right
46M
Previous trauma
Chronic bowel problems
*
Hypertrophic Osteoarthropathy
• Pulmonary
– CA bronchus, Lymphoma, Abscess, Bronchiectasis,
Metastases
• Pleural
– LFTP (highest association), Mesothelioma
• Cardiovascular
– CCHD
• GI
– UC, Crohns, Dysentry, Lymphoma, Whipples, Coeliac,
Cirrhosis, Nasopharnygeal CA, Juvenile polyposis
16M
Slowly increasing pain in tibia
T1FSGd
*
Osteosarcoma
•
•
•
•
•
•
Conventional
Telangiectatic
Parosteal
Periosteal
Multicentric
Soft tissue
14M
Pain with running
1m later
*
Stress Fracture
• Fatigue
• Insufficiency
• Pathologic
54M
Twisting injury
*
Maisonneuve Fx
• Transverse fracture of medial malleolus
without distal fibula Fx, ask for proximal
fibula
31F
Arthritis
Left
Left
*
Right
RhA noeostosis
• Reiters is more plantar and less symmetric
53M
Pain lower back
Ankylosing Spondylitis
• Enthesopathy
*
42F
Foot stiffness
Compartment syndrome
ossification
• Extensive sheet like ossification
• Dystrophic
24F
Fall
Fracture blisters
• DDx pseudoaneurysm
8M
Swelling of toe
Digital fibroma
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•
•
•
•
Recurring digital fibroma of infancy
Can become large
Painless
Fingers and toes
DDx
– Enchondroma, Epidermoid inclusion, Digital
fibroma, Subungal lesions, Glomus
Melorrheostosis
•
•
•
•
•
A benign sclerosing bone dysplasia
Osteopathia striata
Osteopoikilosis
Dripping candle wax
Sclerotomes
43M
Trauma
Osteoma (Ivory)
• Gardeners syndrome
– Adenomatous polyps, Dental lesions, ST
tumors, osteomas
67F
Lump
Fibrous Dysplasia
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•
•
•
•
•
•
Common
Hamartomatous fibro-osseous metaplasia
70% monoostotic
Polyostotic tends to be unilateral
Usually expansile
Shepherds crook, ground glass
Any bone, but spine unusual
33M
Tackled at rugby
Anterior dislocation
Hill sachs
Bony Bankart
• Stryker for Hill Sachs
• Westpoint for bony Bankart
• Can occur after one dislocation
56F
Lump and pain
GCT
• Multinucleated giant cells in fibroid stroma
• Knee, distal radius, proximal humerus
• Lytic, subarticular, narrow zone of transition
without sclerosis
• Can look aggressive
• After epiphyseal fusion
42M
Mechanical symptoms
*
Sessile osteochondroma
• Anterior at knee
• Also have mechanical symptoms