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Name Malignant Neoplasm
- Multiple Myeloma
- Metastisis- Lytic and Blastic
- Hodgkins
- Pagets
- Osteo Sarcoma
- Chondrosarcoma and Fibrosarcoma
- Ewings Sarcoma
- Chordoma
-
Multiple Myeloma's AKA
Plasma Cell Sarcoma
-
Multiple Myeloma/ Plasma Cell Sarcoma
- Primary Malignance of Bone
- proliferation od plasma cells infiltrating bone marrow
- can cause pathological collapse (vertebral Plana)
- Associated with "rain drop skull"
- will spare pedicle
-
Multiple Myeloma/ Plasma Cell sarcoma
Labs
Special Test
- Labs: M spike on the immunuElectroPhoresis
- Reversal of Albumin/ Globulin Ratio (Screen Test)
- Bense Jones Proteinuria, Elevated ESR
- Special Test: Bone Scan - COLD
-
Types of Metastatic Disease
- Lytic and Blastic
- Most common malignant tumor of bone
- * Multiple Myeloma is the MC primary malignancy*
-
Lytic Metastasis
- > 40 yo
- recent unexplained weight loss
- skeletal pain worse at night
- Moth eaten or permeative pattern
- "EATS" pedicle
- has swiss cheese appearance in skull
-
Lytic Mets LABS/ Special test
- LABS Increased Alk Phos
- Speacial Test: Bone Scan- HOT
-
Hodgkin's Disease
- MC ages 20-40 - seen even more in <30 yo males (CAUCASION)
- Ivory White Vertabrae with Anterior Scalloping
- Biopsy is needed - Reed Sternberg cell
- Does not cause bone enlargement
-
Blastic Metastasis
- >40 yo
- ivory white vertabrae (OJO: does not have anterior scalloping like in Hodgkins)
- MC cause from prostatic carcinoma
- may cause pathological collapse
- Metastisizes to lumbars
- Does not cause bione enlargement
-
Blastic Mets
Labs/ Special test
- LABS: Increased Alk Phos
- Special Test: Bone scan- HOT
-
Paget's AKA
Osteitis Deformans
-
Paget's / Osteitis Deformans
- > 50 yo Males
- Cortical Thickening
- Bone expansion
- picture frame vertrbrae (1st stage)
- bowing deformities
-
Paget's/ Osteitis Deformans
Labs
- Increased Alk Phose
- Increased Urinary Hydroxyproline
Speacial Test: Bone Scan- HOT
-
Osteosarcoma
- MC BONE Malignancy in CHILDREN
- 10-30yo
- Spiculated/ radiating/ sunburst - radiates at 90 degrees
-
Osteosarcoma Labs and Special Test
- Labes: Increased Alkaline Phos
- Special Test: Bone scan- HOT
-
Chondrosarcoma and Fibrosarcoma
- >40yo
- creates spiculated/ radiating/sunburst periosteal reaction of bone
-
Ewings Sarcoma
- 10-25+/- yo
- MC in Diaphysis of long bones
- multiparalleled onion skin (laminated) - Periosteal reaction
- bone expansion
- Codmans Triangle
-
what will Ewings Sarcoma mimic
an Infection
-
Chordoma
- >40 yo
- Aberrant notochord cell tumor.
- MC in Sacrum
- 2nd MC location- Skull
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Who most commonly has a scoliosis
females 13-19
-
whohow is a scoliosis named
by major convexity
-
what is a rotatory scoliosis
spinous deviate the concavity
-
what is a simple scoliosis
spinoues deviate to the convexity
-
1. what are the lines of Mensuration for scoliosis?
2. which is best
- 1. Cobs and Rissers Ferggusons
- 2. Cobs is the best
-
MC scoliosis
females - Right thoracic convexity
-
in refrence to scoliosis what does UNDER 20 degrees means
adjust and monitor
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In refrence to scoliosis what does 21-40 degrees
send to orthepist for bracing - Milwaukee
-
Scoliosis measurement over 40 degrees mean what
surgical consult
-
scoliosis measurement over 50 degrees means what
cardiopulmonary compromise
-
what are the stages of Pagets/ Ostositis Deformans
- 1. Lytic or Destructive
- 2. Combined
- 3. Sclerotic
- 4. Malignant (Osteosarcoma)
-
Pagets/ Osteitis Deformans MC causes
Basilar Impression
-
Pagets/ Osteitis Deformans lines of mensuration
- for Basilar Invagination
- McGregor's Line - Best line
- Chamberlain's Line
-
How do you monitor Scoliosis
- 1. Riessors Sign - look at secondary growth centers at the iliac crest (lateral to medial)
- 2. Wrist Films - Best way
- 3. tanner Stages (pubertal devolpment; looks at external changes; early puberty leads to increased liklihood of curve progression
-
if patient over 25 yo comes in with scoliosis what do you do
evaluate and adjust
-
What is the best way to monitor scoliosis
radiographing the Left Wrist.
-
How would you monitor scoliosis
1.Risser's sign 2. Wrist films 3. Tanner Stages (pubertal dev't; looks at external changes; early puberty leads to increased liklihood of curve progression)
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what are they types of arthritides
Inflammatory and Degenerative
-
Name the types of Inflammatory Arthritides
- Rheumatoid Arthritis
- Ankylosing Spondylitis
- Enterpathic Arthropathy
- Enteropathic Arthropathy
- Psoriatic Arthritis
- Reiters
- Systemic Lupus Erythematosus
- Scleroderma
- Osteitis Condensans Ilia
-
Name the Degenerative Arthritides
- Degenerative Joint Disease
- Diffuse Idiopathic Hyperostosis
- Neurogenic Arthropathy
- Synoviochondrometaplasia
-
Rheumatoid Arthritis AKA in refrence to kids
Still's Disease
-
what are some characteristics of RA
- Bilateral uniform loss of joint space
- rat bite erosions
- symetrical
- atlanto axial instability
- Bouchards (PIP)
- Haygarth (MCP)
- DIPs are spared
- Swan nech and boutiniere deformity
- ulnar deviation
- Bakers cyst
-
What is commonly seen with RA
- Bilateral Protrusio Acetabuli,
- swann neck boutinniere deformaty
-
what is a boutinniere deformity
- Hyperextension with DIP
- Hyperflexion with PIP
-
What is a Swann Neck Deformity
- DIP Hyperflexion
- PIP Hyperextension
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what is a Bakers Cyst
benign swelling of the semimembranous bursa
-
what are the labs for RA
+RA latex, +FANA, +ESR, +CRP and normocytic normochromic anemia
-
What is Sjorgens
- Dry mouth and eyes
- seen in RA
-
What is Ankylosing Spondylitis AKA
MarieStrumpell Disease
-
Ankylosing Spondylitis/ Marie Strumpell Disease
- Also considered Autoimmune condition
- males 15-35yo
- starts in the SI joints
- lbp
- AM stiffness
-
Ortho's test AS
- Chest Expansion
- Foresters Bowstring
- Lewins supine
- Iritis
-
MC places for AS
- Bilateral SI joint fusion
- 2nd mc location T12-L1
-
what is commonly seen with AS
- Shiny Corner Sign, Bilateral marginal (syndesmophytes)
- squaring of vertebral bodies
- bamboo spine
- dagger sign
- trolley track sign
-
AS Labs
+ HLA B27 and +ESR
-
Enteropathic Arthropathy
- Identical to AS with GI dysfunction
- -All signs are the same
-
Psoriatic Arthritis
- Males 20-50, silver scaly lesions on extensors
- pitted nails
- cocktail sausage fingers
- Increased in joint space
- pencil in cup deformity, mouse ear deformity
- ray sign
- atlantoaxial instability
- non-marginal syndesmophytes
-
Psoriatic Arthritis Labs
+HLA B27
-
Reiters
- Males 20-30+/-
- urethritis
- conjunctivitis
- arthritis
- calcaneal spur
- non marginal syndesmophytes
-
-
Systemic Lupus Erythematosus
- Females, photosensitive, skin rash (malar/butterfly rash)
- alopecia
- Raynoauds Phenomenon
- can cause ulnar deviation of phalanges
- non erosions of joints
-
Systemic Lupus Erythematosus
- +LE prep
- +FANA
- +RA latex
- +ESR
-
1. what conditions will cause have ulnar deviation
2. how are the different
1. SLE and RA
- 2. In SLE when a patient presents with Ulnar deviation and they place hand on flat surface and if it returns to normal = SLE
- In RA patient this is not true
-
Scleraderma aka
Progressive Systemic Sclerosis
-
Scleraderma
- females 30-50yo
- CREST Syndrome
- erosions from distal tufts
-
Labs for Scleraderma
+FANA, +RA latex (30%)
-
Osteitis Condensans Ilia aka
Osteitis Triangularis
-
Osietis Condensans Ilia
- Multiparous females 20-40yo
- bilateral and symetrical triangular sclerotic areas on the lower half of the ilium.
- JOINT SPACE IS NORMAL
-
In Osteitis Condensans Ilia what can be seen on film
Para glenoid sulci - notches on the inf borders of ilia (bilateral)
-
Degenerative Joint Disease aka
Osteoarthritis
-
DJD
- Non-Inflammatory
- MC involves finger and weight bearing joints
- usually stiffens with rest and improves with activity; complication include spinal stenosis and IVF enchroachment
- Asymetrical Distribution, non uniform loss of space
-
-
DJD in the spine
- IVD narrowing
- osteophytes
- endplate sclerosis
-
DJD in the Hand
- Heberden (DIP)
- Bouchards (PIP) nodes
-
Heberden Node
- hard or bony swellings that can develop in the distal interphalangeal joints (DIP)
- Sign of Osteoarthritis
-
Bouchard Node
- hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (the middle joints of fingers or toes.)
- Sign of Osteoarthritis
-
Diffuse Idiopathic Hyperostosis (DISH) AKA
Forestiers Disease
-
DISH/ Forestiers Disease
- Males >40yo
- associated with Diabetes Mellitus
- ossification of Posterior Longitudinal Ligament (OPLL)
- flowing hyperostosis, candle wax drippings, 4 contiguous segments
-
Neurogenic Arthropathy aka
Charcots Joint
-
Charcots/ Neurogenic Arthropathy
- Secondary to impaired sensory function in the joints
- seen with diabetes, tabes dosalis, syphulis and syringomyelina
-
what are the 6 D's and what Disease are they associated
- seen most commonly in Neurogenic Arthropathy
- Distension,
- Density of Subchondral sclerosis,
- Debris within joint,
- Dislocation, and
- Destruction of bone
-
Synoviochondrometaplasia
- MC joint affected is the knee
- Results in Multiple loose bodies within the joint that are round or ovoid in shape
-
Gout
- males >40yo due to overproduction of uric acid (foods in high purines)
- Recurrent Episodes of a painful, monoarticular, red hot, and swollen joint
- Overhanging margins: Juxta-articulation erosions (above and below joint space)
-
gout mc seen in
- MTP of the big toe (Podagra)
- Tophi Crystals maybe seen
-
1. Labs for Gout
2. Special Tests
- 1. Increased uric acid
- +ESR
- 2. Joint Aspiration
-
Pharmacology for Gout
- Acute-Colchinicine
- Chronic Allopurinol
-
Calcium Pyrophosphate Dihydrate Crystals Deposition (CPPD)/ Psuedogout
- Thin linear calcification parallel to the articular cortex within the joint space called Chondrocalcinosis when affecting cartilage.
- MC seen in the knee
-
Hydroxyapatite Deposition Disease (HADD)
- MC affects the shoulder joint
- round oval calcificationsnear insertion of bursa or tendon
-
Septic Arthritis
Pt presents with a fevor, chill, history of trauma/ surgery and a warm tender, swollen joint
-
-
Avascular Necrosis aka
Osteonecrosis/ Osteochondrosis
-
Avascular Necrosis
- All AVN's are self resolving taking 8months-12years
- all major cause is due to trauma
-
AVN
Labs?
Special Tests?
- No labs
- Special tests" Bone scan or MRI
-
Name AVN's
- Preisers
- Scherermanns
- Legg Calves Perthes
- Kohler
- Keinbochs
- Servers
- Blounts
- Freinbergs
- Osteochondritis Dessicans
- Panners
-
Preisers
Carpal Scaphoid - 90% thru middle MC fx of carpal
-
Osgood Schlatters
- no longer on AVN list
- Tibial Apophisitis
- Location: Tibial Tuberosity
-
How does Osgood Schlatters present
- kids 8-16 yo
- pin point pain and swelling
- usually sport playing (soccer)\hip felxion and extension
- Cho pat brace
- must stop all sports for 3-5weeks
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Location of Scheuermann's
Vertebral End Plate Epiphysis
-
Legg Calves Perhes location
femoral Epiphysis
-
Kohlers location
Tarsal Navicular
-
Keinbochs location
Carpal Lunate
-
Servers location
Calcaneus
-
Blounts location
Medial Tibial Condyle
-
Freinbergs location
Head of 2nd Metatarsal
-
Osteochondritis Dessicans location
Articular surface of the medial femoral condyle (mc laterally)
-
Panners location
Capitellum
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