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

Sag PD Cor T1

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

* Ankylosing Spondylitis Dagger sign
Bilateral hip inflammatory arthritis *

Ankylosing Spondylitis
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 *

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 *

Osteopoikilosis 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 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 *

B thalassemia 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 *

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

Sag T1 Sag PDFS

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 *

Osteopetrosis 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
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 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

C6 Fx subluxation C5 C6 *

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

10M painful neck

* Transient disc calcification of children

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

28F pain in lumbar region

* Anterior limbus with instability

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

37F acute torticollis, stiffness and shortness of breath

Fibrodysplasia ossificans progressiva
*

Fibrodysplasia ossificans progressiva
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 *

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

6mM Calcareous nodules

Idiopathic calcinosis
universalis *

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

28BF mass in shoulder

Idiopathic Tumoral Calcinosis
*

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

Ax PDFS Ax T1 *

Cor T2 Cor T1 *

Sag T1 *

81M shoulder pain

* Chondrocalcinosis

Chondrocalcinosis 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
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 *

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 Adductor longus-Rider’s bone Brachialis-Fencer’s bone Soleus-Dancer’s bone Blocker’s arm

48M Alcohol ++

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

Causes of AVN 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 Rare 20-40Y Hands and feet
Well demarcated and lobulated Curvilinear, ringlike or nodular calcification High signal T2

PDFS *

35M Knee injury

PDFS *

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

Snake bite Venom not infection Due to proteases

36M Prior trauma

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

50M Trauma Whiplash injury
1

Extension tear drop Fx Small fragment Usually more superior Cx spine

2W earlier 2W later

36M Trauma 3Y ago MVA Now myelopathy

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

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

Volkmann’s ischaemic contracture
Soft tissue contractures Volkmann’s Burns Neurologic conditions RhA, SLE Arthrogryposis multiplex congenita

40M Known medical condition Recent trauma
2

2W earlier 2W later

* 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

DDH Adults

DDH Infants Acetabular angle Lateral shift Superior shift Shenton’s
Perkin’s Hilgenreiner’s Center Edge

40M Waterskier 1

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

54F Fall 2

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

63F Longstanding decrease ROM
1

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

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

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

19F MVA 1

Odontoid Fx Type 1 - Steep oblique Type 2 - Neck
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

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 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 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

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

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

57M Bilateral shoulder pain

DDx Unilateral Bilateral Amyloid, TB 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

Rolando Fx Axial blow More difficult to anatomically reduce

March 01

57M Right hip pain

March 01

May 01

Dec 02 *

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

17F Mechanical symptoms

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

75M Knee locking

Primary synovial osteochondromatosis
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
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 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 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 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

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

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