pathology

Osteoblastoma

Epidemiology

 

Uncommon

 

< 1% Primary bone tumour

 

Young boys

- second decade

 

Location

 

Similar to OO

 

Spine 30%

- especially posterior elements

 

Long bones 35%

 

Clinical

 

Back or limb pain

- pain less severe than OO

Sternoclavicular Pathology

 

Condensing Osteitis

 

Epidemiology

- seen in women over 40

 

Xray

- sclerotic and overgrown

 

Condensing Osteitis Xray

 

CT

 

Congenital Vertical Talus

Definition

 

Rockerbottom foot / Persian Slipper Foot

 

Epidemiology

 

Uncommon

 

50% bilateral

 

Doesn't delay walking

- may present in toddler with callus under talus head

 

Associations

 

Congenital anomalies

- CNS disorders

- spina bifida & diastematomyelia ~10%

- arthrogryposis

- neurofibromatosis 

Subtalar Dislocation

Epidemiology

 

Rare

 

Types

 

Medial

- 80%

- calcaneum dislocated medially

 

Lateral

- 20%

- higher energy injury

 

Central Cord Syndrome

Epidemiology

 

Most common pattern cord injury

 

Hyper-extension injury in middle aged man with osteoarthritic spine

 

Usually C3/4 and C4/5

 

Mechanism

 

Most common type / in older patient with pre-existing spondylosis / OPLL

- hyperextension injury

- compression of the cord

- anteriorly by osteophytes

- posteriorly by infolded ligamentum flavum

 

Dislocation

Epidemiology

 

Uncommon

- dancers

- athletes

 

Aetiology

 

Hyperdorsiflexion of the MTPJ

 

Pathology

 

MT head dislocates plantar

- may buttonhole through capsule

- can prevent closed reduction

 

Blocks to Reduction

 

1.  Sesamoids

2.  Conjoint tendon

3.  Intersesamoid Ligament

 

Flexor Tendon Background

Anatomy

 

Fascicles of long, spiraling bundles

- tenocytes & Type I collagen

- synovial cells & fibroblasts present

 

Endotenon 

- surrounds the individual collagen bundles

 

Epitenon

- fine fibrous outer layer, highly cellular, continuous with endotenon

- contains most of the blood vessels & capillaries

 

Sportsman's Hernia

Definition

 

Groin pain in athletes

- secondary to tear in external oblique fascia

 

Epidemiology

 

Sports with aggressive adduction

- hockey / soccer

 

Pathology

 

Tears in external oblique fascia

- tend to be central

- around spermatic cord and ilioinguinal nerve

- pain may be from nerve entrapment

 

DDx

 

Adductor Longus Tear

Posterolateral Rotatory Instability

Definition

 

Radius rotates externally in relation to the ulna

- posterior displacement of the radial head relative to the capitellum

- in flexion

 

Posterolateral rotatory Instability

 

Anatomy LCL

 

LCL Elbow

 

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