The Wizard's potion
These are some of Don's interesting comments
from the Friday morning case conferences. Any errors in this section are
solely the poor recording of otherwise accurate comments, due to the pressure
of the quantity of interesting comments. This section is updated weekly.
To see the cases
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This page last updated on
05/06/2003 09:56:57 PM
Friday Conference 11/22/02: from
- The pattern of ACL injury and medial
femorotibial edema is often associated with a medial meniscal tear.
Similarly, proximal fibular edema is often associated with injury to the
- In distinguishing an infected disk vs
mechanical/degenerative disk: less than 10 % of cases with a vacuum disk
phenomenon will have an infection in the disk. A pre-existing vacuum disk
can lose the gas in the disk when it becomes infected. If there is a
question of spondylolisthesis due to degenerative facet disease vs
infection, a hyperextension lateral fim of the spine can draw gas into the
disk, effectively excluding infection. If this fails, an MRI is a good next
- Septic arthritis in the presence of
rheumatoid arthritis: staph is common. Look for large effusions, ill-defined
bone destruction, and rapid rate of distruction as signs of infection.
- Dermatomyositis in the region of the knee on
plain film: results in sheet-like calcifications in the soft tissues
anteriorly and posteriorly. The differential includes scleroderma (more
tuftal, or tumor-like calcification), and lupus (globular calcification).
- C-spine fusions: the "wasp-waist" appearance
of vertebral body fusion is indicative of fusion occurring early in life. If
the spinous processes are not fused, then the process is not developmental.
- Deforming nonerosive arthropathy: the
differential includes Jacoud’s arthropathy (from rheumatic fever) with a
clinical pattern of ulnar-sided arthritis in the hand involving the 4th
and 5th fingers, ulnar deviation and Boutineer’s deformities,
Ehlers-Danlos, and probably disuse with resultant joint space loss and
chronic deforming arthritis.
- HAD (hydroxyapatite deposition): affects the
ulnar side of the wrist most commonly (can involve the flexor carpi ulnaris
tendon). Pain and swelling over the pisiform and distal ulna can also be
present. It is associated with collagen/vascular diseases or chronic renal
failure. The calcification and swelling can go away, and when aspirated, the
deposits have a toothpaste-like consistency. The tophaceous deposits of gout
and those of CPPD look different. HADD has different appearances according
to srage—it may have a fluid level, which is good for determining whether it
is amenable for aspiration. It also has a more organized form and can erode