Discover and read the best of Twitter Threads about #MSKRad

Most recents (19)

Heads up to followers on twitter, will be virtually attending the #ESASRBANZBMS conference this week (21-24th Nov) so expect a bunch of tweets with a particularly heavy science bend. Disclaimer: this is by no means an extensive coverage & usually includes personal reflections. /1
So before continuing, I will try to...
- keep everything here in this thread
- share what I snippets I can
- add a number to keep tweets in some order
- respond where possible (but am also engaging in the conference spaces)
- link to papers when I can /2
Now a bunch of # in case relevant to these folks: #MedTwitter #Science #anzbms #biology #pharmatwitter #ortho #rheum #immunology
#arthritis #pathology #physicaltherapy
#pt #MSKRad #OccupationalTherapy
#physiotherapy

Anyone is most welcome to add relevant tags :D /3
Read 35 tweets
7yo girl
Chronic wrist pain
X-ray = not available
Previous trauma = not clear

???

#MSKrad #radiology #orthotwitter #PedRad #radiologia
What do you think?
Since the're over 100 votes in the poll, I'll give the answer. Looking at the MRI, there's a diffuse edema of the scaphoid: trauma? , avascular necrosis? (Preiser) /3 #MSKrad
Read 8 tweets
Rare case‼️A 7 yo boy with neck pain, muscle spasms and torticollis (his head was tilted to the left side) for 10 days. Her mother reported a fever and a presumed throat infection 1week prior to the onset of pain. No recent trauma was reported. 1/4 #mskrad #radres #orthotwitter ImageImageImage
👉Grisel syndrome - non-traumatic rotational atlantoaxial subluxation following an infection in the head and neck region (upper respiratory tract infection is most common). 2/4 #radres #orthotwitter #MSKRad
✍️The pediatric population has the highest incidence of Grisel syndrome, likely bc of the greater ligamentous laxity of the cervical region (inflammation may increase the laxity of ligaments). Diagnosis is based on clinical and rad criteria. 3/4 #MSKRad #radres #orthotwitter
Read 4 tweets
#Wetread Case 17

Hx: Wrist pain

Professionally appropriate gif responses only please. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #MSKRad #orthorad

Social media breaks are a good thing!😁 ImageImage
#Wetread Case 18 Answer: Trans-scaphoid Perilunate dislocation

-lunate still "normal" position while other carpal bones dislocate dorsally
++ assoc scaphoid fx! ⭐️⭐️ (count the proximal row 😁)

#FOAMrad #FOAMed #mskrad #errad #orthorad Image
Perilunate Dislocation:

Mechanism: high-energy trauma (MVA) or FOOSH (fall on outstretched hand)

Injury: torn radioscaphoid, scapholunate & lunotriquetral ligaments

👀 for the scaphoid fx!
Read 5 tweets
#WetreadCoW Case 15

Hx: Fall. Back Pain

Professionally appropriate gif responses only please. Extra points for not using the obvious answer. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #MSKRad #NeuroRad
Silly Twitter, lets keep it together now 🤣

ER went ahead and ordered the CT CAP. Does this help?😏

Turns out the patients pain was more T/L junction and L-spine. 🤔
#WetreadCoW Case 15 Answer: Butterfly vertebra

Vertebral anomaly from lack of fusion of the 2 sides of a vertebral segment (?due to persistent notochordal tissue) ➡️ bowtie appearance on frontal or 2 wedges connected at their tips.#FOAMed #FOAMrad #Neurorad #MSKRad #radres
Read 6 tweets
#WetreadCoW Case 12

Hx: heel pain

Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #FOAMrad #FOAMed #radres #errad #mskrad #orthorad Image
#WetreadCoW Case 12 Answer: Haglund's Syndrome

Haglund's deformity= post-sup calcaneal spur (red)="pump bump"

Haglund's syndrome= deformity +Kager's fat pad edema (blue)+thick Achilles @ insertion & retroAchilles bursitis (green) #FOAMrad #FOAMed #radres #mskrad #orthorad Image
Haglund's deformity/syndrome is assoc w use of rigid heel shoes, ex high heels (aka "pumps")➡️ irritation @ Achilles insertion & retroAchilles bursitis➡️ deformity+ edema+pain

US & MR show same thing!

Deformity(spur) alone ❌=symptoms (like plantar spur ❌=plantar fasciitis sx)
Read 3 tweets
#WetreadCoW Case 10

Hx: trauma survey exam. Fall, pain

Dx? Anything else you may want to consider given the history?

Please answer with professionally appropriate gif responses only. No spoilers. #FOAMrad #FOAMed #radres #errad #orthorad #MSKRad Image
#WetreadCoW Case 10 Answer: Ankylosing Spondylitis

-fused SI jts
-fused pubic symphysis
- interspinous ligament ossification = "dagger spine"
-fused Lspine?

⭐️Need to look for spine fx!

Too easy? or maybe everyone is distracted by #ASER2020
#FOAMed #radres #mskrad #orthorad ImageImage
Ank Spon:

-seroneg spondyloarthropathy (neg Rheum factor) ➡️ fusion of the spine, SI jts, pubic symphsysis, and sometimes other jts
- assoc w HLA B27 gene
-M>F
-usually presents 3rd-4th decade
-trt: NSAIDS, motion/exercise, TNF-alpha blockers
Read 5 tweets
#WetreadCow Case 4

Hx: MVA, neck pain

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #Neurorad #MSKRad ImageImage
#WetreadCow Case 4

Answer: Unilateral Facet Dislocation

Normal L & R superior articular facets overlap/aligned to the C6-C7 where 1 is shifted anterior(red dash)

-Ant & post vertebral lines (green) ?ok
-Spinolaminar line (orange)=broken ❌
-Post spinous line (purple) = gap ❌
Perched facet = subluxed joint with tip of inferior facet resting on tip of super facet of lower body

Dislocated/jumped/locked facet = complete dislocation with inferior tip ANTERIOR to superior facet of lower body (thus "locked")

Get the CT and ALWAYS 👀 for the fracture!
Read 5 tweets
#WetreadCoW Case 2

Hx: Fall, pain

Anyone know my name?

Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #FOAMrad #FOAMed #radres #errad #mskrad #orthorad ImageImage
#WetreadCow Answer: Barton Fracture

Distal radial fx but only involves dorsal aspect of the distal radius (volar aspect is intact). Radial styloid ok on oblique?🤔

Barton fx=shear fx of dorsal distal radius

Shear off volar aspect=reverse Barton fx
#mskrad #orthorad #FOAMrad ImageImage
This fx is not too displaced, but as the fx fragment displaces more, the carpal bones often dislocate with it. If we cone in tightly we can see the scaphoid/lunate are starting to migrate with the dorsal fragment

W/o proper trt, this can cause long term wrist pain/instability Image
Read 4 tweets
Wetread Summer Series Case 8

Hx: shoulder pain

Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #orthorad #MSKrad Image
#WetreadCow SS Case 8

Answer: Septic joint + osteomyelitis (humerus + glenoid)

+RTC tear or two on MRI 😮

-Cortical destruction w/ ⬆️⬆️osteopenia
-large jt effusion
- ⬆️ soft tissue swelling

These go bad VERY fast! Aspiration is key!
#FOAMrad #radres #errad #orthorad #MSKrad ImageImageImage
This was literally a Friday 5PM walking out the door case. To this day it reminds me:

1) Provided Hx can be useless (your 👀 >> indication)
2) Cortex, Cortex, Cortex - examine all the cortical margins
3) Soft tissues are your friend!
4) Beware first and last case of the day 😉
Read 3 tweets
Wetread SS Case 4

Hx: hip dislocation

Initial and post reduction films. Thoughts? 🤔 There may be a CT coming 😉

Professionally appropriate gif responses only. No spoilers! wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #MSKRad Image
@AdamSingerMD @StefanTigges @ER_Rad_Hanna @RyanBPetersonMD Pt still had pain and limited ROM so CT was ordered. Anything wrong here? Image
#WetreadCow Answer: dislocated arthroplasty liner

Femoral head component does not sit centrally in the acetabular component because the radiolucent liner has dislocated into a communicating fluid collection (ie circular lucency lateral to troch!)#FOAMed #radres #MSKrad #orthorad Image
Read 3 tweets
Wetread Case 40

Hx: elbow swelling.

Diagnosis(es)?

Clinician inquires about aspiration. Thoughts?

Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad #orthorad ImageImage
Wetread Case 40 Answer

Answer: Olecranon Bursitis secondary to Gout

We have focal mass-like soft tissue density posterior to the olecranon with o/w minimal soft tissue edema. Add on some soft tissue Ca+ and this is classic picture of gouty olecranon bursitis
Etiologies for olecranon bursitis:

-trauma
-repeated or continued pressure/irritation (aka “student’s", “baker’s” or Popeye elbow)
-infection
-inflammation (classically gout, although RA and CPPD as well)
Read 7 tweets
Wetread Case 36

Hx: Several weeks of worsening wrist pain

How specific can you be?

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad #orthorad
Yeah! We have a lot of widened scapholunate distance references, aka:

Terry Thomas Sign
David Letterman Sign
Michael Strahan Sign
Madonna Sign

referring to their diastema (or increased gap between their front teeth)
Answer: Dorsal Intercalated Segment Instability (DISI)

Findings:
1) Widened scapholunate distance from full thickness tear
2) Abnormal scaphoid - old fx perhaps? (m/c carpal fx goes with prior injury) 🤔
3) Dorsal rotation of the lunate on the lateral exam
Read 10 tweets
Wetread Case 34

Hx: palpable mass (No X-rays. 🤷‍♂️)

Diagnosis? Any relevant medical history you can think of?

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad #orthorad
Answer: Calcinosis of Chronic Renal Failure (ie Secondary Tumoral Calcinosis)

Yes, Dialysis/renal failure is the key!

#WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad #orthorad

Different patient:
True Tumoral Calcinosis (TC) is ususally reserved for the hereditary dysfunction of phosphate regulation yielding large, painless, periarticular Ca+.

Here we have the exact same finding except secondary to chronic renal failure, thus “secondary” or “uremic” tumoral calcinosis.
Read 6 tweets
Wetread Case 30

Hx: foot pain

How about something, anything outside of the chest 😂

Feel free to answer with professionally appropriate gif responses only. No spoilers.
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad #orthorad and no 🤔 or 🤭! 🤣
Answer: Intraosseous lipoma of the calcaneous

but I bet everyone knew that!

Classic appearance = a well circumscribed lytic lesion in the calcaneal body with central Ca++ (aka cockade sign)
Whats a cockade?

= a rosette - a knot of ribbon rolled into a badge.

So central density surrounded by well circumscribed low density area
Read 6 tweets
Wetread Case 28

Hx: Trauma 3 weeks ago with new knee pain

Diagnosis? And be specific!

Feel free to answer with professionally appropriate gif responses only. No spoilers.
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad #orthorad Image
Answer: Pellegrini-Stieda Syndrome

Here's the X-ray and CT from 3 weeks ago.

New X-ray shows development of calcification/ossification near femoral attachment of MCL and the CT 3 wks ago shows thickening/injury to the MCL. This is all c/w the classic Pellegrini-Stieda lesion ImageImage
So we have 2 entities:

1) Pellegrini-Stieda lesion = the post-traumatic calcification/ossification classically near the femoral attachment of the MCL

2) Pellegrini-Stieda Syndrome = Pain @ a developing P-S lesion. Typically seen about 3-6 wks post injury.
Read 4 tweets
Wetread Case 26

Hx: traumatic pain

Feel free to answer with professionally appropriate gif responses only. No spoilers.
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad ImageImage
@StefanTigges @RyanBPetersonMD @ER_Rad_Hanna @AdamSingerMD Answer: Anterior calcaneous process fx

I was convinced this was going to be an avulsion fx of the extensor digitorum brevis from the lateral calcaneous (kinda big fragments but good location on AP ankle). Unfortunately the CT had other ideas.

#WetreadCow #FOAMrad #errad #mskrad Image
@StefanTigges @RyanBPetersonMD @ER_Rad_Hanna @AdamSingerMD Teaching point: EDB avulsion and ant calcaneous process fx can look similar on ankle X-rays (with similar clinical presentation and inversion injury). Proper foot X-rays with obliques to look at the ant calc process should really be considered in this situation.
Read 4 tweets
Wetread Case 23

Hx: DVT study for leg swelling and pain

Feel free to answer with professionally appropriate gif responses only. No spoilers.
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad ImageImage
@StefanTigges @RyanBPetersonMD @ER_Rad_Hanna Answer: "Tennis leg" -more specifically here a tear of the medial head of the gastrocnemius muscle

Seen a few times on DVT studies. Swollen, painful leg w not the best physical exam. Hx of acute pain with abrupt movement is classic.

#WetreadCow #FOAMrad #radres #errad #mskrad Image
@StefanTigges @RyanBPetersonMD @ER_Rad_Hanna Awesome drawings are my tribute to @StefanTigges 😀
Read 3 tweets
1/ Musings of an #MSKRad post-#AAOS2018 meeting. Attended nearly the whole meeting – very impressive presentations, exhibitor booths, educational offerings – a vast meeting similar to #RSNA. @UMichRadiology @jjacobsn @morrisonMSK @SoteriosGyft @danortizmd
2/ More MSK Rads should consider this mtg – lots of relevant material and opps for collaboration. Imaging is so central to orthopaedics – we each get better by reviewing this content and conversing. Orthopaedics most frequent referrer for MSK imaging - ajronline.org/doi/abs/10.221…
3/ I attended mostly sports sessions. Some hot topics: Ongoing issues in joint preservation (excellent sessions in both knee and hip joint preservation), orthobiologics, earlier and earlier identification of “cartilage at risk”.
Read 11 tweets

Related hashtags

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!