MSKINTERESTING CASE PRESENTATION

18th June 2020

Case 1

■ 73 years-old/F

■ Medical history of poorly controlled DM; Fatty liver; Congenital Lt eye blindness

■ Admitted to ORT for #Rt NOF

■ Repeated falls

■ Concomitant infection of the left foot

Case 1

■ USG-Guided Right hip synovial biopsy

■ Negative for bacterial or TB growth

■ Negative for malignancy

■ Normal WCC and CRP

Rapid Destructive Osteoarthropathy of Hip

■ Rapidly chondrolysis to complete osteolysis of femoral head/neck

■ Unknown etiology; postulated to be interplay of mechanical stress, cartilage

degeneration and bone response

■ Rapid bone loss can mimic septic arthritis, inflammatory or neuropathic arthritis

■ No clinical or laboratory evidence to suggest otherwise

Case 2

■ 64 years-old/M

■ Medical history: Severe OSA on CPAP, hypertension, BPH, ischaemic heart disease

■ Presented to ORT for bilateral lower limb weakness and numbness

■ Extensive work-up in private

■ CT Brain, MRI Brain+MRA, MRI T+L+S Spine, MRA Lower limb arteries

Spinal Dural Arteriovenous Fistula

■ Incidence peak at 5th to 6th decades; Males are more common

■ Abnormal AF shunting between radicular artery and vein at the nerve root sleeve

■ Cord venous hypertension and cord edema

■ Insidious and progressive lower limb weakness, sensory changes and sphincter

disturbance

■ Haemorrhage is very rare

Case 3

■ 58 years-old/F

■ Hostel resident

■ Intellectual disability; Psychotic disorder; Adrenal insufficiency

■ Admitted for chest infection and right hip pain

■ CXR – RLZ consolidation

■ Pelvis X-ray and Right Hip USG

Case 3

■ Negative for bacterial culture, AFB and fungus

Gouty Hip Effusion

■ Articular manifestations occur in different stages

■ - Acute arthritis

■ - Chronic tophaceous gout

■ Chronic setting – imaging features are characteristic

■ Acute setting – Imaging signs are often non-specific and final diagnosis relies on

analysis of the synovial fluid

Case 4

■ F/39

■ Insidious onset of bilateral hip pain starting pregnancy at 37 weeks

■ No injury

■ Increasing pain severity

■ Post-delivery; pain improved with analgesics

■ Walk with quadripod indoor and wheelchair outdoor

Pregnancy-related Bilateral Femoral Head AVN

■ Traumatic vs non-traumatic

■ Non-traumatic cases; 40% are bilateral

■ Causes:

■ Chronic steroid therapy, alcoholism, autoimmune disease (SLE), chronic renal

failure, haemoglobinopathy, pregnancy

■ Pregnancy-related Hip AVN is rare

■ Unknown pathogenesis; proposed as multifactorial including hormonal, mechanical

and coagulation changes.

Companion Case: Global AVN

Case 5

■ 79/F

■ Sudden onset 4 limbs weakness and numbness

■ P/E shows unsteady gait and brisk reflexes

■ LL power 4/5

■ CT angiogram of the brain, neck and aorta are unremarkable

■ MRI C-Spine with Contrast

Intervertebral Disc Extrusion

■ A defect in the annulus fibrosus

■ It allows herniation of the nucleus pulposus

beyond the disc confines

■ Extruded disc can migrate superiorly or

inferiorly

■ A common cause for extrinsic spinal cord

compression

Case 6

■ 53 years old/F

■ Fall with contusion to the knees with both knee pain

■ Very occasional right knee give-way; no knee locking

■ Referred to private MRI Knee

Cyclops Lesion

■ Known as localized anterior arthrofibrosis

■ Often arise as a complication of ACL reconstruction; can also happen in patients

with ACL injuries

■ Can present with pain during knee extension

■ Exact etiology uncertain

■ Gradual fraying/bunching up of remnant ACL or graft fibers, excessive fibrosis

Case 7

■ 22 years-old/F

■ Medical student

■ Insidious onset of left knee pain

■ No trauma

■ P/E: Left effusion, negative McMurrary, ACL/PCL/MCL/LCL stable

Case 7.5

■ 22 years-old; Rugby player

■ History of right knee ACL tear and meniscus injury, with ACL reconstruction and

meniscus repair

■ Presented right anterior knee pain and vague swelling

■ ROM full; Ligaments stable

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Patella Alta

■ High-riding patella; May be

idiopathic or secondary to patella

tendon rupture

■ Associated with: recurrent patella

dislocation, chondromalacia

patellae and knee joint effusion

■ Insall-Salvati ratio>1.5

Patella Baja

■ Abnormally low patella

■ Usually symptomatic

■ Retropatellar pain, crepitations, restricted range of movement

■ Insall-Salvati ratio <0.75

Case 8

■ M/47

■ Left foot pain (mid plantar pain);

■ Mass felt at the popliteal fossa;

■ Tinel +ve

■ History of multiple spinal schwannoma; completely excised

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