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* Cor T1 Sag PD * 47F 5Y increasing stiffness and decreased ROM. Initial presentation 4.

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Presentation on theme: "* Cor T1 Sag PD * 47F 5Y increasing stiffness and decreased ROM. Initial presentation 4."— Presentation transcript:

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2 *

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6 Cor T1 Sag PD

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8 47F 5Y increasing stiffness and decreased ROM. Initial presentation 4

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12 Ankylosing Spondylitis Dagger sign Bilateral hip inflammatory arthritis *

13 Ankylosing Spondylitis Young white men When fuse posteriorly, may spare anterior Scalloping of Cx spine Dagger + Bamboo = Tram tracks

14 19M increasing mass on hand, refused treatment 3

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17 Osteosarcoma *

18 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 Osteosarcoma

19 25M with wrist pain 3

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22 Osteopoikilosis *

23 Juxtaarticular bone islands ?AD, M>F, asymptomatic Ovoid 2-10mm Benign sclerosing bone dysplasia

24 95 M pain R hip 4

25 Cor T1

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28 Cor STIR Pagets disease Pathological Fx Asterix enhancement *

29 Pagets disease O. deformans 3% >40, northern latitudes, >M Lytic, vascular fibrous connective tissue Inactive, decreased turnover with sclerosis Mixed, common, both together

30 40M painful knee 4

31 Cor T1

32 Sag PD B thalassemia intermedia *

33 Major-Homozygous-Cooley anaemia lack of B Italian and Greek Skull, hair on end, widened diploic Porosis, thin cortex, Erlenmyer flask Arthropathy B thalassemia

34 23M knee pain 1

35 Distal MCL injury *

36 Ossification points to joint MHE points away from joint Distal MCL injury

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38 Sag T1 Sag PDFS

39 Sag T1 Sag PDFS

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43 C5

44 50M heel pain 2

45 Sag T1

46 Sag PDFS *

47 Involuting lipoma Any age, equal sex Calcaneus>Femur>Tibia>Fibula Can have central dystrophic calcification

48 13F painful foot No trauma

49 Sag T1

50 Sag PDFS *

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52 57M L hip pain 3

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55 Sandwich vertebrae Osteopetrosis *

56 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

57 Variable patients Same condition

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64 Pseudohypoparathyroidism 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

65 Variable patients Same condition 8

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69 Dermatomyositis 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

70 35M with recent trauma Flex / Ext

71 C5

72 C6 C6 Fx subluxation *

73 Signs of instability 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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80 *

81 10M painful neck

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83 Transient disc calcification of children *

84 Painful Pain lasts weeks Calcification lasts months Adjacent vertebrae flattened Transient disc calcification of children

85 28F pain in lumbar region

86 Anterior limbus with instability *

87 Limbus Vertebrae More often anterior and superior More significant posterior Disc herniates through ring apophysis Commonest lower lumbar

88 37F acute torticollis, stiffness and shortness of breath

89 Fibrodysplasia ossificans progressiva *

90 MOP / Stone man Rare, AD, sporadic Presents in childhood Stiffness, Heterotopic ossification Malformed fingers and toes Bone morphogenic protein (BMP) signaling pathway problem Fibrodysplasia ossificans progressiva

91 48M joint pains and dark pigmentation on ears

92 Alkaptonuria *

93 Alkaptonuria / Ochronosis Absence of homogentisic acid oxidase Pigmentation Arthropathy Osteoporotic with dense disc calcification Larger joints show DJD

94 6mM Calcareous nodules

95 Idiopathic calcinosis universalis *

96 Idiopathic calcinosis universalis Rare, unknown cause Infants - subcutaneous Children - spreads to muscles Calcium phosphate and carbonate Serum calcium and phosphorous normal DDx - DMS, HPT, Calcium gluconate

97 28BF mass in shoulder

98 Idiopathic Tumoral Calcinosis *

99 Periarticular calcified masses Shoulder, hip, elbow B>W, M=F Recur if resected Elevated phosphate, normal calcium Renal tubular phosphate resorption

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101 *

102 Ax PDFSAx T1 *

103 Cor T1 Cor T2 *

104 *

105 1518960 *

106 Sag T1 *

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108 81M shoulder pain

109 Chondrocalcinosis *

110 CPPD Hyperparathyroidism Hemochromatosis Acromegaly Gout Wilsons disease

111 45F swelling of arm with numbness of 2nd and 3rd fingers

112 Ax PDFSAx T1 Fibrolipomatous hamartoma of the median nerve with macrodystrophia lipomatosis *

113 Fibrolipomatous hamartoma of the median nerve with macrodystrophia lipomatosis Nerve territory directed macrodactyly Localised form of gigantism Median or Plantar nerves Possible relation with neurofibromatosis

114 35M 8w post injury

115 Cor T1 Cor T2 Post traumatic myositis ossificans *

116 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

117 25M Blocker

118 Myositis ossificans *

119 Sport related myositis ossificans Single direct blow Repeated minor trauma –Adductor longus-Riders bone –Brachialis-Fencers bone –Soleus-Dancers bone –Blockers arm

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121 48M Alcohol ++

122 1518960 *

123 Grading of AVN Steinberg modification of Arlet/Ficat 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

124 Causes of AVN Trauma Steroids Alcohol Pancreatitis Protease inhibitors Gauchers Sickle cell Caisson Perthes / Idiopathic

125 34M Developing lump anterior to knee

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127 Ax T1 Ax PDFS

128 Sag T1 *

129 Soft tissue chondroma Rare 20-40Y Hands and feet Well demarcated and lobulated Curvilinear, ringlike or nodular calcification High signal T2

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131 PDFS *

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135 1171948 *

136 1999621 *

137 35M Knee injury

138 PDFS *

139 ACL/MCL Empty lateral gutter

140 86M Stiffness and Locking

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142 Multiple bodies in Popliteal recess Primary Vs secondary osteochondromatosis Multiple similar size Origin

143 62M Fullness in suprapatella region

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145 Body growing in joint Laminated Slow growing

146 30M Outdoors man

147 *

148 Snake bite Venom not infection Due to proteases

149 36M Prior trauma

150 1171948 *

151 Florid reactive periostitis BPOP Bizarre parosteal osteochondromatous proliferation Manifestation of PTMO in hands Periosteal proliferation > ST ossification

152 50M Trauma Whiplash injury 1

153 1999621 *

154 Extension tear drop Fx Small fragment Usually more superior Cx spine

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157 0850849 1 *

158 *

159 2W earlier2W later

160 1927160 *

161 2001785 *

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163 36M Trauma 3Y ago MVA Now myelopathy 3

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165 2001176

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167 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

168 42M Fall 1

169 0850849 1 *

170 Anterior shoulder dislocation Hill Sachs lesion (Hatchett ) –Stryker view Bony or soft tissue Bankart –Westpoint view Posterior dislocation –Trough Fx –Bennets lesion Bony

171 21M Injury weeks ago Recent surgery 1

172 *

173 Volkmanns ischaemic contracture Soft tissue contractures –Volkmanns –Burns –Neurologic conditions –RhA, SLE –Arthrogryposis multiplex congenita

174 40M Known medical condition Recent trauma 2

175 2W earlier2W later

176 2003485 2W later *

177 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

178 75F Lifelong limp 1

179 1927160 *

180 DDH Adults

181 DDH Infants Acetabular angle Lateral shift Superior shift Shentons Perkins Hilgenreiners Center Edge

182 40M Waterskier 1

183 2001785 *

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185 Old ischial avulsion Avulse bone < 25Y Waterskier, Hurdler, Sprinter

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188 1806380 *

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190 2003226 *

191 1995690

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194 54F Fall 2

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196 1777100 *

197 Transverse Patella FX Direct or indirect Transverse 70%, indirect Longitudinal, stellate or comminuted Bipartite - superolateral Dorsal defect - superolateral –Direct

198 63F Longstanding decrease ROM 1

199 1806380 *

200 Chronic anterior shoulder dislocation, with neoglenoid Failure to diagnose May have increased ROM

201 19F Slowly growing (1Y) lump on thigh 3

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204 1998078 *

205 Alveolar Soft Part Sarcoma 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

206 19F MVA 20032261

207 *

208 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

209 65M Neck pain Myelopathy 19956903

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213 CPPD arthropathy Deposited in transverse ligament Associated –Tumor like masses may compress cord –Atlanto axial subluxation –Spontaneous odontoid Fx

214 35M Deformity

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216 Maffucci syndrome Multiple enchondromas ST Hemangiomas Malignant potential close to 100% –Olliers enchondromatosis 25-30% Developmental, not hereditary Growth deformities

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225 12M Deformity

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227 Noonans Short Metacarpal –Idiopathic –Post trauma Iatrogenic, Fx, Growth plate inj, Thermal, Electrical –Turners, 4 th +/- 3 rd or 5 th –Pseudo- and pseudopseudohypoparathyroidism 4 th and 5 th

228 14M Deformity

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230 Carpal osteolysis Onset childhood Carpals, Tarsals, elbows Associated nephropathy

231 29F FOOSH

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233 Scaphoid Fx on lateral view Many scaphoid fractures are best seen on lateral

234 68M Wrist instability

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236 VISI Suggests lunotriquetral ligament tear DISI- scapholunate ligament tear Angle between scaphoid and lunate < 30 Pie shaped lunate

237 33F No history of trauma

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239 Keinbocks Ulna minus Trauma Osteonecrosis

240 45F Hand pain

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242 Acroosteolysis Tuft –CVD- Scleroderma, CREST, Raynauds –Psoriasis –Neuropathic DM, Leprosy, Myelomeningocele, Syrinx, Cong indifference to pain (Leesch Nyan) –Trauma Thermal, Burns, frostbite electrical –Hyperparathyroidism –Epidermolysis bullosa –Porphyria, Subungal exostosis, –Snake and scorpion venom –Phenytoin toxicity in infants

243 40M Knife injury

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245 Flexor tendon laceration Displaced sesamoid Sesamoid useful marker of tendon

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250 *

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254 20M Hurt hand catching ball

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256 Dislocations Need 2 views for trauma

257 22F Deformity

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259 Boutonnierre Rupture of middle slip of extensor tendon as it passes over PIPJ Lateral slips migrate volarly Occasionally avulsion Needs early Dx

260 76F RhA

261 *

262 Cranial Settling Atlantoaxial settling Erosion of lateral masses Different from basilar invagination

263 57M Bilateral shoulder pain

264 *

265 DDx Unilateral –Amyloid, TB Bilateral –Crystal –Occupational OA –Syrinx - neuropathic –Previous inflammatory arthritis Clavicles normal –Hemophilia

266 24M FOOSH

267 *

268 Trans scaphoid/triquetrum perilunate Fx dislocation Pie shaped lunate

269 31M Blow to flexed thumb

270 *

271 Rolando Fx Axial blow More difficult to anatomically reduce

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273 March 01

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277 *

278 *

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280 57M Right hip pain

281 March 01

282 May 01

283 Dec 02 *

284 Hepatic metastases Rare to bone Similar to other hypervascular mets

285 50M MVA

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288 Anterior hip dislocation 5% of hip dislocations Can have associated impaction injuries Leg externally rotated

289 32M Bilateral chronic hip pain

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291 *

292 Perthes White boys 4-7y Younger onset – better outcome DDx for bilateral –MED, Morquios, SCD, Gauchers, –Hypothyroid, CDP, Warfarin embryopathy

293 17F Mechanical symptoms

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296 Osteochondroma Point away from joint Cartilage cap is hyaline Cap thickness > 1cm concerning Pain important to dx malignancy

297 75M Knee locking

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299 *

300 Primary synovial osteochondromatosis Metaplasia of synovium May not be visible on X-ray Primary similar size Synovial hemangiomas have lucent centers

301 55M 1Y post trauma

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303 Dystrophic calcification in Quadriceps tear Calcification –Metastatic –Dystrophic –Tumoral

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309 LeftRight *

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312 46M Previous trauma Chronic bowel problems

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316 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

317 16M Slowly increasing pain in tibia

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320 T1FSGd *

321 Osteosarcoma Conventional Telangiectatic Parosteal Periosteal Multicentric Soft tissue

322 14M Pain with running

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324 1m later *

325 Stress Fracture Fatigue Insufficiency Pathologic

326 54M Twisting injury

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330 Maisonneuve Fx Transverse fracture of medial malleolus without distal fibula Fx, ask for proximal fibula

331 31F Arthritis

332 Left

333 Right *

334 RhA noeostosis Reiters is more plantar and less symmetric

335 53M Pain lower back

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337 Ankylosing Spondylitis Enthesopathy

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345 *

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347 42F Foot stiffness

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349 Compartment syndrome ossification Extensive sheet like ossification Dystrophic

350 24F Fall

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352 Fracture blisters DDx pseudoaneurysm

353 8M Swelling of toe

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355 Digital fibroma Recurring digital fibroma of infancy Can become large Painless Fingers and toes DDx –Enchondroma, Epidermoid inclusion, Digital fibroma, Subungal lesions, Glomus

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358 Melorrheostosis A benign sclerosing bone dysplasia Osteopathia striata Osteopoikilosis Dripping candle wax Sclerotomes

359 43M Trauma

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361 Osteoma (Ivory) Gardeners syndrome –Adenomatous polyps, Dental lesions, ST tumors, osteomas

362 67F Lump

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365 Fibrous Dysplasia Common Hamartomatous fibro-osseous metaplasia 70% monoostotic Polyostotic tends to be unilateral Usually expansile Shepherds crook, ground glass Any bone, but spine unusual

366 33M Tackled at rugby

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368 Anterior dislocation Hill sachs Bony Bankart Stryker for Hill Sachs Westpoint for bony Bankart Can occur after one dislocation

369 56F Lump and pain

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371 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

372 42M Mechanical symptoms

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374 *

375 Sessile osteochondroma Anterior at knee Also have mechanical symptoms


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