Term
|
Definition
Congenital
Arthritis
Trauma
Blood (hematological)
Infection
Tumor
Endocrine, Nutritional, Metabolic
Soft tissue |
|
|
Term
|
Definition
Death of osseous cellular and marrow composition of bones.
Epiphyseal predisposition |
|
|
Term
|
Definition
Most common: spontaneous/idiopathic
Other common: alcoholism, corticosteroid |
|
|
Term
|
Definition
Pancreatitis, Pregnancy
Legg-Perthes disease, Lupus
Alchoholism, Atherosclerosis
Steroids
Trauma
Idiopathic (Legg-Perthes disease), Infection
Caisson disease, Collagen disease
Rheumatoid arthritis, Radiation treatment
Amyloid
Gaucher disease
Sickle cell disease/spontaneous |
|
|
Term
|
Definition
Blood vessels are obstructed.
Increased marrow space pressure
Time from initial infarct to healed 2-8 years |
|
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Term
|
Definition
Avascular (most severe)
Revascularization
Repair
Deformity |
|
|
Term
|
Definition
Epiphyseal blood supply sucks, leading to death of osteocyte and bone marrow cells.
Growth is altered; epiphyseal growth slows or stops, articular cartilage continues |
|
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Term
|
Definition
1. New Vessels grow into the necrotic bone, resulting in deposition and resorption.
2. New Bone is deposited directly on the dead bone, thickening the trabeculation and increasing bone density
3. New bone easily modeled relative to epiphyseal stresses (softer than normal)
4. Fracture under the articular cortex may occur (cresent sign)
5. Resorption is secondary to phagocytosis, fibrosis, and infiltration and produces bony fragmentation |
|
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Term
AVN
Repair and remodeling phase |
|
Definition
Bony resoprption is replaced by bony deposition
New bone is still easily modeled and deformity may be produced. |
|
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Term
|
Definition
Restitution of the epiphysis to its normal configuration, occurs in varying degrees
Residual deformity is due to how much compressive force is exerted on the necrotic bone during revascularization and repair phases |
|
|
Term
Epiphyseal Infarction
General Radiological Features |
|
Definition
Collapse of articular cortex
Fragmentation
Mottled trabecular pattern
Sclerosis
Subchondral cysts
Crescent sign |
|
|
Term
Epiphyseal Infarction
Collapse of articular cortex |
|
Definition
| generally at the region of max stress |
|
|
Term
Epiphyseal Infarction
Fragmentation |
|
Definition
| manifestation of resorption and weakening. Radiolucent clefts appear |
|
|
Term
| Mottled Trabecular pattern |
|
Definition
Reveals a thickened irregular pattern traversing necrotic areas.
Most likely seen during revascularization and repair phases |
|
|
Term
Epiphyseal Infarction
Sclerosis |
|
Definition
| Occurs with revascularization |
|
|
Term
Epiphyseal Infarction
Subchondral cysts |
|
Definition
| Patchy, well circumscribed areas of rarefaction identical to DJD cysts |
|
|
Term
Epiphyseal Infarction
Subchondral Fractures |
|
Definition
Results from weakened subchondral bone.
AKA Rim sign, Crescent sign |
|
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Term
| Metaphyseal/Diaphyseal Infarcts |
|
Definition
Usually medullary
Necrotic bone seen on revascularization seen as area of rerfaction (blackening)
Longer than wide |
|
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Term
|
Definition
Chandlers' disease
4:1 Male dominance
Bilateral, but asymetric 50% of the time
Vague symptoms: pain in the butt, groin, knee, thigh, or hip
Gradual increase in pain and decreased motion.
Limping gate
Necrotic area tends to be wedged or semilunar shaped (bite sign) |
|
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Term
|
Definition
AVN (adult femoral head) treatment
Remove core of bone from femoral neck and head.
Reduces marrow pressure and vascular perfusion and promotes healing? |
|
|
Term
| Signs of avascular necrosis |
|
Definition
snowcap sign
crescent/rim sign
mushroom deformity
hanging rope sign
Bite sign |
|
|
Term
|
Definition
May have:
Articular deformity
Early DJD
Acetabular displasia
Hanging rope sign
Trochanteric overgrowth |
|
|
Term
|
Definition
MRI scans demonstrate a loss of marrow signal, particularly on T1 weighted scan
Often bilateral
Demonstrate joint efusion |
|
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Term
| Legg-Calve-Perthes disease |
|
Definition
AVN of the femoral capital epiphysis before closure
Self limiting (2-8 years)
Patients 4-8 years of age |
|
|
Term
Legg-Calve-Perthes disease
Avascular Stage |
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Definition
| Capsular distortion, increased joint space, increased TDD, small epiphysis |
|
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Term
Legg-Calve-Perthes disease
Revascularization |
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Definition
| Flattened,small epiphysis, fragmentation, homogenous sclerosis (snow cap), increased cortical density, metaphyseal cysts, patchy schlerosis, crescent sign, wide short neck |
|
|
Term
Legg-Calve-Perthes disease
Repair and remodeling |
|
Definition
reconstruction of density and configuration
Coxa vera
enlarged femoral head (coxa magna)
Flattened head (mushroom deformity)
large greater trochanter |
|
|
Term
Legg-Calve-Perthes disease
Radiologic Findings |
|
Definition
Soft tissue swelling
small epiphysis
lateral displacement of ossification ctr
flattening, fissuring and fracturing of ossification center
Metaphyseal widening and foreshortened
Widened irregular physis
Intrapiphyseal gas |
|
|
Term
| Soft tissue signs of hip joint disease |
|
Definition
Capsular swelling
Small obturator (hip flexion)
Increased tear drop distance |
|
|
Term
Legg-Calve-Perthes disease
Prognosis |
|
Definition
Depends on:
early diagnosis (poorer in advanced disease)
Age (younger better)
Sex (poorer in females) |
|
|
Term
| Osteochondrosis dissecans |
|
Definition
Represents a focal subchondral infarction of subarticular bone
Necrotic bone may heal spontaneously or become a free floating fragment |
|
|
Term
Osteochondrosis dessicans
Clinical |
|
Definition
Children and adolecents
Males more prevelent
Unually in the knee
assymptomatic
clicking, locking, limitation of motion
swelling, pain aggravated by movement
Predisposes to DJD |
|
|
Term
Osteochondritis dissecans
Location |
|
Definition
Knee!
Medial Femoral Condyle (85%) bilateral 20-30%)
humeral head
Capitullum of elbow
talus |
|
|
Term
Osteochondritis dissecans
Radiology |
|
Definition
lesion at the lateral aspect of the medial femoral condyle
Joint mouse (osteiochondral fragment)
Soft tissue swelling |
|
|
Term
| Spontaneous osteonecrosis |
|
Definition
Diagnostic term applied to the aged knee
associated with medial meniscal lesions. Black triangles |
|
|
Term
| Osgood Schlatter's Disease |
|
Definition
Fragmentation of the apophysis of the tibial tuberosity
11-15 years of age
Self limiting, painful
Pain, tenderness, soft tissue swelling over tibial tubercle |
|
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Term
|
Definition
Avascular necrosis (usually the MTP 2)
More common in females (high heel shoes) |
|
|
Term
|
Definition
Avascular necrosis of lunate
Associated with manual labor
20-40 year olds
75% have short ulna (ulna minus)
pain and swelling of wrist
Lunate increases density-fragments and collapses
sclerosis, radiolucent, flattening
Precipitates DJD |
|
|
Term
|
Definition
Tarsal Navicular
Vascular insufficiency or normal variant?
Navicular patchy, homogenous sclerosis, collapse fragmentation. |
|
|
Term
|
Definition
AKA Juvenile discogenic disease JDD
abnormality of the discovertebral junction
Probably does not represent a necrosis
Usually in teens
Chronic back pain, deformity, early DDD
Etiology: failure of embryologic vascular channels, centrum defects, and notochord clefts |
|
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Term
|
Definition
T and L
3 contiguous vertebra
5 degree anterior body wedging
Increased Kyphosis
Schmorl's nodes |
|
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Term
|
Definition
Not a necrosis!
Sclerosis and fragmentation of the calcaneal apophysis represents normal anatomy |
|
|
Term
| Calcified medullary infarct |
|
Definition
Serpiginous regions of calcification within the bone medula
Associated with arteriosclerosis
Differential Diagnosis: tumor,(enchondroma (no symptoms) chondrosarcoma (pain)) |
|
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Term
|
Definition
Hemolytic anemia
Pain and swelling in hands and feet
Infarct of bowel
Osseous changes related to infarction, avascular necrosis, marrowhyperplasia, and retarted growth
Predisposition to salmonella osteomyelitis |
|
|
Term
Sickle cell anemia
Radiology |
|
Definition
Marrow hyperplasia
Osteopenia
Hair on end skull
H shaped vertebrae (lincoln log)
Avascular necrosis |
|
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Term
|
Definition
AKA Cooley's anemia
RBC blood disorders
Abnormal hemoglobin
Fatigue (chronic anemia), gallstones, cardiomegaly, splenomegaly
Features: Marrow hyperplasia, extramedullary hematopoiesis, maxillary overgrowth ("rodent facies") "hair on end skull"
Coarsened trabeculation (honeybomb)
Osteopenia
Erlenmyer flask deformity |
|
|
Term
|
Definition
X chromosome linked bleeding disorder
Female the carrier usually manifest in males |
|
|
Term
|
Definition
| Intra-articular soft tissue swelling, radiodense effusion, osteopenia, square femoral condyles, degeneration, epiphyseal overgrowth, erosions, wide intercondylar nitch, irregular articular surfaces |
|
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Term
|
Definition
| joint pain/hemophilic arthropathy |
|
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Term
|
Definition
| malignant proliferation of WBC |
|
|
Term
|
Definition
Radiolucent submetaphyseal bands
Osteopenia
Osteolytic destruction of long bone metaphysis and diaphysis
Periosteal reactions
Growth arrest lines |
|
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Term
|
Definition
| feve, malaise, joint pain, easily bruised, spontaneous bleeds |
|
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Term
|
Definition
| Infection of skin, subcutaneous fat, or connective tissue (tendons/ligaments/muscle) |
|
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Term
|
Definition
| Infection of bone (marrow spaces) |
|
|
Term
Musculoskeletal Infections
At risk groups |
|
Definition
Immunosupressed
Diabetics
Post-surgical
vascular infection
Sickle-cell anemia
IV drug users
Anyone under the right conditions |
|
|
Term
|
Definition
Prone to infections by unusual organisms at unusual sites:
"the S joints" Spine, sacroiliacs, symphysis pubis, sternoclavicular |
|
|
Term
Muskuloskeletal Infections
Organisms |
|
Definition
Staphylococcus Aureus (90%)
Mycobacterium Tuberculosis
Neisseria Gonorrhea
Pseudomonas
Fungus
Streptococcus pyogenes |
|
|
Term
|
Definition
Trauma/Post surgical
Urinary tract infaction
Pneumonia
Skin Infections
Open wound of cellulitis
Heel sticks in infants |
|
|
Term
|
Definition
Hematogenous*
Direct extension
Direct implantation
Postoperative |
|
|
Term
|
Definition
Hematogenous spread.
Blood vessels do not penetrate physis in children, preventing epiphysis and joint infection. Adults and infants are succeptable. |
|
|
Term
| Most common locations for Infection |
|
Definition
Knee
Hip
Ankle (distal tibia)
shoulder
Spine |
|
|
Term
| 2 categories of infection |
|
Definition
Suppurative (pus)
staph
Non-Suppurative (TB) |
|
|
Term
| Suppurative Osteomyellitis |
|
Definition
| Bone marrow infection (by anything but TB) |
|
|
Term
Supperative Osteomyelitis
clinical features of acute Infection |
|
Definition
Edema
Lymphadenopathy
Warm skin
Cellulitis
Joint Pain |
|
|
Term
Suppurative Osteomyelitis
4 Radiographic Stages |
|
Definition
Latent (hidden) Stage (1-10 days)
Early Stage (10-21 days)
Middle Stage (weeks)
Late Stage (months) |
|
|
Term
Suppurative Osteomyelitis
Early Stage |
|
Definition
Radiographic Stage>10days
Spinal lesion may approach 3 weeks
Soft tissue edema
Osteopenia |
|
|
Term
Suppurative Osteomyelitis
Middle Stage |
|
Definition
Permeative or Lytic moth-eaten destruction
Periosteal response; solid, laminated, codman's triangle |
|
|
Term
Suppurative Osteomyelitis
Late Stage |
|
Definition
Cortical destruction
Draining sinus
Involucrun
Cloaca
Sequestrum
Sclerosis
Debris
Loss of joint space
Ankylosis |
|
|
Term
|
Definition
Chalky, white area: isolated dead bone
Cortical and medullar infactrs |
|
|
Term
|
Definition
"Bony collar"
Chronic periosteal response
Pus lifts the periosteum and causes new bone formation, trying to wall off the infection. |
|
|
Term
|
Definition
Draining sinus
More common with chronic disease
Rare complication is to develop a squamous cell carcinoma within the channel of the cloaca; the ulcerative channel with malignant transformation has been called Marjolin's Ulcer |
|
|
Term
| Brodie's Abscess Formation |
|
Definition
Localized, abortive form of supperative osteomyelitis
Localized pain that worsens at night
Lesions may be sterile
Chronic osteomyelitis
Reactive sclerosis |
|
|
Term
|
Definition
<20 years of age: disc is still vascular, if begins there it spreads to adjacent bodies
Adult: Starts in Anterior Vertebral Endplates, then goes to disc with vertebral collapse
Lumbar most common |
|
|
Term
|
Definition
Joint Effusion
Juxtaarticular osteoporosis
Lytic destruction that crosses the joint space |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
Spine infection
Early radiographic features |
|
Definition
rapid disc space loss
Endplate destruction |
|
|
Term
Spine Infection
Radiographic Features |
|
Definition
Endplate destruction
Disc destruction
Pre-vertebral ST swelling
SOL |
|
|
Term
| LImitations of Plain Films |
|
Definition
Not very sensitive
Must have significant loss in bone density before it is detected
Other imaging studies are better for detection of early infection. |
|
|
Term
| Sensitivity of Plain Films for osteomyelitis |
|
Definition
<5% are abnormal on presentation
<33% are positive for findings at 1 week
90% sensitivity at 3-4 weeks |
|
|
Term
|
Definition
Can detect infection within hours of infection.
Utilizes Technetium (non specific)
Galium tags RBC
Indium tags WBC
Very sensitive
Often followed by MRI to evaluate soft tissue |
|
|
Term
|
Definition
Advantages: earlier detection than plain film
Good for hard to see image areas (spine, pelvis, sternum)
Findings are more specific and suggestive for osteomyelitis
Increased marrow density
Sclerosis, demineralization, periosteal reaction |
|
|
Term
|
Definition
Better than CT and Plain Film
More sensitive for bone marrow paths
Direct view of intramedullary disorders
May precede bone scan findings
Multiple slices visualized
Better soft tissue contrast
Better anatomic definition |
|
|
Term
| Osteomyelitis findings on MRI |
|
Definition
Decreased signal intensity on T1
Increased signal intensity on T2 |
|
|
Term
Suppurative Osteomyelitis
Key Points |
|
Definition
Main Cause: Staph Aureus
Radiographic latency period of 10 days
Lytic destruction of bone that crosses anatomical barriers (vs. tumor)
Joint/extremity involvement classic
Disc space loss with endplate destruction classic in the spine
Effective treatment requires early diagnosis |
|
|
Term
|
Definition
Nonsuppurative osteomyelitis (Pott's disease)
Main cause of infection related death worldwide. |
|
|
Term
|
Definition
1-3% of TB cases
Usually involves weight bearing joints
Secondary form of TB |
|
|
Term
|
Definition
Typically begins in anterior endplate region
Disc space narrowing=earliest radiographic finding
Vertebral collapse
Decreased T1 and increased T2 |
|
|
Term
TB
Comparison to osteomyelitis |
|
Definition
Similar, but add: Multiple levels
Paraspinal cold abcesses with Ca+ |
|
|
Term
TB (non suppurative)
Comparison to Suppurative |
|
Definition
| similar, but much slower and indolent |
|
|
Term
|
Definition
Sign of Tuberculosis Septic Arthritis
Juxtarticular osteoporosis
Marginal erosions
Slow joint space loss |
|
|
Term
| Hormones inhibiting bone production |
|
Definition
Parathyroid hormone (PTH)
Cortisol |
|
|
Term
| Hormones and nutrients that stimulate bone production |
|
Definition
Growth hormone
Thyroid hormone
Calcitonin
Vitamin D
Vitamin C |
|
|
Term
|
Definition
All encompassing definition for increased radiolucency of bone.
Many etiologies |
|
|
Term
| Plain film detection of osteopenia |
|
Definition
| 30-50% of bone mass loss needed before it can be detected on pain film |
|
|
Term
|
Definition
Qualitatively normal but quantitatavely deficient bone.
Gradual reduction in skeletal mass
Compression fractures
Increasing thoracic kyphosis |
|
|
Term
|
Definition
Senile osteoporosis
Postmenopausal
transient/regional osteoporosis |
|
|
Term
|
Definition
corticosteroids
Infection
Disuse
RDS
Arthritides |
|
|
Term
|
Definition
| Allows early diagnosis of fracture. |
|
|
Term
| Risk factors for osteoporosis |
|
Definition
Female sex
Early onset of menopause
Inactivity
Smoking
Alchohol
Caffeine
Excessive protein
Low calcium intake
No sunlight or vitamin D |
|
|
Term
Osteoporosis
Radiographic features (spine) |
|
Definition
Osteopenia and radiolucenc
Cortical thinning "pencil thin"
Wedge shaped vertebrae
codfish deformity
Schmorl's nodes |
|
|
Term
|
Definition
Thinned cortices
Endosteal scalloping
Loss of secondary trabeculae
Risks of fractures |
|
|
Term
|
Definition
| Compressive and tensile trabeculae at head of femur. Strong. |
|
|
Term
| Pathological causes of osteoporosis/osteopenia |
|
Definition
plasma cell (multiple) myeloma
metastasis
anemia
nutritional deficiencies
diabetes mellitus
immunodeficiency states
chronic liver disease |
|
|
Term
|
Definition
Osteopenia (esp. in patient too young for osteoporosis)
Compression fractures
Punched out lesions |
|
|
Term
| Dual Energy X-ray Absorptiometry |
|
Definition
DEXA scan
Evaluate osteoporosis
low energy x-rays measure mineral content of bone
Determined Bone Mineral Density |
|
|
Term
|
Definition
Predicts fracture risk.
For every -1 SD the risk doubles
0=normal risk for 40 year old
-1 for about every -10% of bone loss |
|
|
Term
| WHO defines oseoporosis on basis of: |
|
Definition
T-scores
below -2.5=osteoporosis |
|
|
Term
|
Definition
Immobility and disuse
Reflex sympathetic dystrophy syndrome |
|
|
Term
|
Definition
| Inhibits osteoblast activity |
|
|
Term
|
Definition
Reflex sympathetic dystrophy syndrome
Acute pain following trivial trauma.
Especialy hand
Reflex hyperactivity of the SNS
Skin atrophy
pigmentation abnormalities |
|
|
Term
|
Definition
Too nonspecific to make the diagnosis without clinical information.
Soft tissue swelling
regional osteoporosis
Joints are OK
Osteoporosis may be patchy |
|
|
Term
| Transient osteoporosis of the hip |
|
Definition
Middle aged adults
May be related to pregnancy
More common in men and usually bilateral in men
left hip usually involved in women.
Joint space remains normal
Decreased T1, Increased T2
Self limiting over 3-12 months |
|
|
Term
|
Definition
Altered bone quality
Lack of calcium
High ratio of osteoid |
|
|
Term
Osteomalacia
2 main causes |
|
Definition
Vitamin D deficiency
Renal tubular phosphate loss (Fanconi's syndrome) |
|
|
Term
|
Definition
|
|
Term
|
Definition
Osteopenia (less dense)
Coarsened trabeculation (thicker)
Looser zones (pseudofractures)
Basilar invagination
Acetabular protrusion. |
|
|
Term
| Best diagnostic procedure for osteomalacia |
|
Definition
|
|
Term
|
Definition
"Rachitic rosary" of chest due to cartilage overgrowth
Paintbrush metaphysis
Bow legs |
|
|
Term
|
Definition
Barlow's disease
Long term deficiency of Vit C
Capillary fragility
Mistaken for child abuse
osteopenic bones |
|
|
Term
| Scurvy radiological features |
|
Definition
Osteopenia
Widened mataphysis
Beak like metaphyseal outgrowths (Pelken's spurs)
Wimberger's sign
Scorbutic zone |
|
|
Term
|
Definition
sign of scurvy
Radiodence slcerosis around epiphysis, rediolucent centrally |
|
|
Term
|
Definition
| radiolucent band visible directly beneath zone of provisional calcification. |
|
|
Term
Primary
Hyperparathyroidism |
|
Definition
Parathyroid gland adenoma
Most common type
Major cause of hypercalcemia |
|
|
Term
| Secondary hyperparathyroidism |
|
Definition
Compliation of chronic renal disease
Stimulates PTH release |
|
|
Term
|
Definition
| Seen in dialysis patients. |
|
|
Term
|
Definition
Osteopenia
Suboperiosteal Resorption
Brown tumors
Soft tissue calcification |
|
|
Term
|
Definition
Most definitive radiographic sign of HPT
Esp at radial margins middle and proximal phalanges of the 2nd and 3rd digits
Widened SI joints |
|
|
Term
|
Definition
Rugger jersey spine
Subperiosteal resorption at SI joints
Salt and pepper skull |
|
|
Term
|
Definition
feature of HPT
Hemorage causes hemosiderin producing brown color |
|
|
Term
|
Definition
Bone disorder occuring when the kidneys fail to maintain proper levels of calcium and phosphorus in blood.
Affects patients on dialysis |
|
|
Term
| % of population with small pituitary adenomas |
|
Definition
|
|
Term
|
Definition
Headaches
Visiual disturbances (optic chiascm)
discomfort in extremities. |
|
|
Term
|
Definition
Oversecretion of growth hormone from pituitary adenoma.
Occurs after growth centers close
Coarse facial features
Enlarged jaw, hands, feet, head (no increase in height) |
|
|
Term
Acromegaly
radiographic features |
|
Definition
spade like distal tufts (fingers)
Heel pad thickness >23mm |
|
|
Term
|
Definition
AKA Cushings
MC: Exogenous corticosteroid administration |
|
|
Term
|
Definition
Obese, especially upper thorax
moon face
Buffalo hump
Purple striae on abdomen
Hypertension
Rib and vertebra fractures |
|
|
Term
Cushings
Radiografic features |
|
Definition
osteopenia
compression fractures
avascular necrosis
atherosclerotic plaquing |
|
|
Term
|
Definition
Dwarfis
Trident hands (all fingers same length)
bullet vertebrae
Arnold Chiari malformation (skull)
Champagne glass pelvis |
|
|
Term
|
Definition
defect of intramembranous bone growth
Skull, clavicle, and midline defects
Inverted pear shape skull
aplasio or hypoplastic clavicles |
|
|
Term
|
Definition
Collagen disorder fails to produce normal collagen
Tall stature, arachnodactly, heart valve defects, aortic aneurysm, lens dislocation |
|
|
Term
|
Definition
Scoliosis
Acetabular protrusion
Pectus excavatum |
|
|
Term
| Osetogenesis Imperfectica |
|
Definition
Type 1 collogen disorder
skeletal fragility
may be lethal at birth
Confused with abuse
Blue sclera
abnormal dentition (rotten teath)
Premature otosclerosis (earbone thickening) |
|
|
Term
Osteogenesis Imperfectica
Imaging |
|
Definition
Osteopenia
Bowed long bones
Thin corticles
Multiple fractures
Kyphoscoliosis |
|
|
Term
|
Definition
Sclerosing bone disease (more white)
Decreased osteoclast activity |
|
|
Term
|
Definition
Bone within bone "endobone, sandwich vertebra"
Erlenmeyer flask deformity |
|
|
