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51 Cards in this Set
- Front
- Back
Columns of the vertebrae
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- 3 total
- *Anterior: ant. longitudinal ligament and ant. 2/3 of vertebral body - *Middle: posterior 1/3 of vertebral body and post. longitudinal ligament (PLL) - *Posterior: everything past PLL |
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Mnemonic for cervical spine
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AABCDS
Adequate Film Alignment Bony Landmarks Cartilaginous Space Disc Space Soft tissues |
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Requirements for adequate cervical spine film
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- Should include all 7 vertebrae and C7-T1 junction. (C7 MUST be visualized on the lateral view)
- It should also have correct density and show the soft tissue and bony structures well. |
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Requirements for alignment of cervical spine film
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4 parallel lines
1. *Ant. vertebral line: ant margin of vertebral bodies 2. *Post vertebral line: post margin of vertebral bodies 3. *Spinolaminar line: post margin of spinal canal 4. *Post spinous line: tips of spinous processes - Lines should follow a slightly lordotic curve - Smooth, no step-offs - Any malalignment should be considered evidence of ligamentous injury or occult fx - C spine must be immobilized until dx made |
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Evaluating alignment on A-P view of C spine
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- *Use edges of vertebral bodies and articular pillars
- *Height of c-spine vertebral bodies should be approx. equal on AP view, and *equal @ all levels - *Spinous process should be midline and in good alignment. |
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On C-spine xray, vertebral bodies should be ___ in shape and roughly equal in size.
Exceptions |
- *Rectangular
- C1, 2 not rectangular - Height of C4 and C5 may be slightly less than C3 and C6 |
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*Pedicles on c-spine xray
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- Both R and L should superimpose on true lateral views.
- If fx is suspected, get oblique views or CT. |
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*Lamina on c-spine xray
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- Posterior elements are seen poorly on the lateral film.
- Best demostrated by CT. |
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Predental space - what is it and AKA...
Normal measurements in adults and children |
- Cartilaginous space b/w dens and anterior arch of C1
- AKA as ADI: Atlanto-dens Interval - *Adults = 3mm or less - *Children = 5mm or less |
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Causes of increased predental space
Next step? |
- Fx, then get a CT
- Ligamentous injury, then get an MRI |
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Odontoid view
- Should see - Alignment |
- *Entire odontoid and lateral borders of C1-C2
- *Occipital condyles should line up with the lateral masses and superior articular facet of C1 - distance from dens to lateral masses of C1 should be equal bilaterally - Tips of lateral mass of C1 should line up with the lateral margins of the superior articular facet of C2 - *Odontoid should have uninterrupted cortical margins blending w/ body of C2 |
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Nasopharyngeal space - location (on lateral xray) and normal measurement (adult)
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- Anterior to C1
- 10 mm (adult) |
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Retropharyngeal space- location (on lateral xray) and normal measurement
Decreased in ... |
- Anterior to C2-C4
– 6mm - Epiglotitis |
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Retrotracheal space
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- Anterior to C5-C7
- 14 mm in kids - 22mm in adults |
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*Jefferson cervical fx
MOI MC area fx'd |
- Fx of C1 (atlas)
- Typical MOI: *axial compression w/ or w/o ext force* - MC is posterior arch, result of hyperextension injury (diving into shallow water) |
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Presumptive evidence for _______ ligament disruption can be seen on a lateral xray if ADI > 3mm
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- Transverse ligament
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Hangman's cervical fx
MOI What can result? |
- Fx of C2 (axis) pars interarticularis
- MOI: *hyperextension with or without axial loading*, (MVA) - Anterior movement (spondylolisthesis) of C2 results and causes prevertebral soft-tissue swelling |
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Clavicle fracture MOI
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Typically due to a fall on the outstretched arm or fall onto the lateral shoulder.
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Acromioclavicular dislocation MOI
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Typically due to direct downward blow to the tip of the shoulder. (*football*, wrestling, hockey)
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Shoulder/Humerus fx locations
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1. Proximal
2. Midshaft 3. Distal – epicondyle (medial/lateral) |
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Shoulder/humerus dislocation MOI and location
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- External rotation abduction force on humerus, or posterior to postero-lateral blow.
- Typically anterior and inferior (MC is anterior) |
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Xray of osteoarthritic shoulder - views
What changes can you see? |
3 view X-ray: AP, Axillary, and Lateral
- Loss of joint space and bone spurs |
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Radial head fx
MOI Pain during what mvmts - why? |
- Typically d/t fall w/ outstretched hand
- Pain and difficulty supinating/pronating (bc of ligament damage) |
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Colle's fx - description, MOI, tenderness where?
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- Distal radius fx w/ dorsal displacement of the hand/wrist
- Fall on outstretched arm - very tender on distal radius |
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Ulnar fracture - MOI
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Mechanism is direct impact, as with fall
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Dislocation of the elbow - description, MOI, presentation
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- Usually caused by fall on the outstretched arm
-MC - posterior displacement of the olecranon to the humerus - Arm is shortened and held flexed |
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Pelvic fx- MOI and complications
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- Result of direct trauma
- Can cause nerve, blood vessel, bladder, or bowel complications |
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Hip/femur fx - MC over what age? MOI
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- MC > 50yo
- Fall |
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Femoral neck fx presentation
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The involved extremity is externally rotated and slightly shortened
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Femoral trochanteric fxs - 2 types, presentation, age compared to femoral neck fx
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- Intertrochanteric - the involved extremity may be internally rotated and slightly shortened
More common at later age then femoral neck - Greater trochanteric |
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Hip/femur dislocations - MC which direction, presentation
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- MC is posterior (and superior)
- Typically shortening, adduction, and internal rotation of the extremity is seen |
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Slipped capital femoral epiphysis (SCFE)- description, presentation
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- Adolescent disorder - fx of growth plate
- M>F - Overweight - Causes painful limp and limited hip internal rotation and ABDuction - Change in ROM usually diagnositc |
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Most bone tumors are...
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Osteolytic
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Most important determinates in the analysis of a potential bone tumor are...
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- Morphology of the bone lesion on a plain radiograph (Well-defined osteolytic? ill-defined osteolytic? Sclerotic?)
- Age of pt - Plain xray is the most useful examination for differentiating these lesions - CT and MRI are only helpful in selected cases. |
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Periosteal rxn - def, types
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- Non-specific rxn that occurs when periosteum is irritated by a malignant tumor, benign tumor, infection, or trauma
- Types: benign and aggressive |
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Benign periosteal rxn seen in...
Appearance |
- Benign lesions such as bone tumors and following trauma
- AKA Solid periosteal rxn - Rxn appears as a *thick, wavy and uniform callus resulting from chronic irritation* - In the case of benign, slow growing lesions, the periosteum has time to lay down thick new bone and remodel it into a more normal-appearing cortex |
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Aggressive periosteal rxn seen in
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- Malignant tumors
- Also can be seen in benign lesions with an aggressive behavior (ie: infections and eosinophilic granuloma) |
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*Small zone of transition on bone lesions results in ...
Sign of ... |
- Results in a sharp, well-defined border
- Is a sign of slow growth. |
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A sclerotic border especially indicates ...
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poor biological activity
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Regarding bone lesions - An ill-defined border w/ a *wide zone of transition* is a sign of...
It is a feature of ... |
- Aggressive growth
- Malignant bone tumors |
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Two tumor-like bone lesions that may mimic a malignancy and must be included in the DDx when the lesion has a wide zone of transition
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- Infections
- Eosinohpilic granuloma |
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Lamellated periosteal rxn AKA
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- "Onion-skinning"
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Types of aggressive periosteal rxns
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- Lamellated or multilayered
- Spiculated/ interrupted/ "Hair on end"/ "Sunburst" - Codman's triangle |
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Codman's triangle
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Refers to elevation of the periosteum away from the cortex, forming an angle where the elevated periosteum and bone come together
- Tumor breaks cortex layer - In aggressive periostitis, the periosteum doesn't have time to consolidate |
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Osteoid osteoma - def, MC location, xray appearance
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- Unknown etiology
-Benign bone tumor composed of osteoid and woven bone - Usually < 1.5cm in diameter - Can occur in any bone, MC in appendicular skeleton - Focal bone pain @ site of tumor, worse @ night and increases with activity - Pain relieved by aspirin - Xray typically shows round lucency containing a dense SCLEROTIC central nidus |
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Osteochondroma - def, age, and appearance
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- Benign bone tumor that develops during childhood or adolescence.
- Abn growth that forms on the surface of a bone near the growth plate - Outgrowth of the growth plate and is made up of both bone and cartilage |
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Enchondroma - def, MC age, appearance on xray
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- Benign bone tumor composed of intramedullary catilaginous cysts
- MC in small bones of hands and feet - Grow in childhood, then stop growing but remain present throughout adulthood - Often found in pts 10-20yo - Xray: small < 5cm, lobe-shaped or oval, well-defined margins. In larger lesions, the lucent defect has endosteal scalloping (erosion) and cortex is expanded and thinned. Calcifications throughout lesion range from punctate to rings - "Bubbles w/in bones" |
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Aneurysmal bone cyst (ABC) - def, age, appearance
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- Benign bone tumor
- Usually 20s and 30s - Upper surface of bone as well as epiphysis or metaphysis - Xray shows expansile lesion w/ internal septae of longitudinal striations, expansile nature can make bone appear much larger than normal - Can be well-defined or appear sclerotic if healed - If highly expansile and @ end of bone - "Finger in a ballon" |
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Osteosarcoma - def, age, location, appearance
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- Malignant bone tumor
- Peak age: 18 or 20yo, although all ages can be affected - M> F - Typical presentation - pain and mass near joint (MC knee) - MC in metaphysis of long bones, 50% seen about knee joint - Appears as mixed sclerotic and lytic lesions causing periosteal rxn - "Sunburst rxn" |
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Chondrosarcoma - def, age, location, appearance
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- Malignant, bone tumor that produces cartilaginous matrix
- Slower growing than osteosarcomas - MC location = metaphysis of long bones - MC in > 60 yo - Presents w/ pain and swelling in bone - Fusiform, lucent defect w/ scalloping of inner cortex and periosteal rxn - Extension into soft tissue may be present - Usually ill-defined |
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Ewing's sarcoma
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- Malig. bone tumor
- MC in pelvis, femur, tibia, and humerus (usually long bones) - M> F - MC presents in childhood - Lamellated or "onion-skin" rxn. - caused by splitting and thickening of the cortex by tumor cells, followed by "moth-eaten" or mottled appearance and ext into soft tissue - Lesion is usually ill-defined lytic and central - Endosteal scalloping is often present |