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It may be lowed by ossification of the outer fibers of the annulus fi- widened or narrowed with pronounced bone destruction proven oxytrol 5 mg. It represents boring vertebral bodies forming syndesmophytes oxytrol 2.5mg without prescription, which pseudoarthrosis due to trauma or stress and extends from are typical of ankylosing spondylitis order oxytrol 2.5 mg with visa. The ra- phytes are delicate and symmetric, and connect the ver- diological differentiation between type A and type B dis- tebral-body margins (marginal syndesmophytes). They covertebral lesions is of practical importance since are different from the parasyndesmophytes (or nonmar- pseudoarthrosis may require spinal stabilization. It has been shown that on Gd-DTPA MRI atic arthritis, pronounced erosive changes may cause ver- seronegative spondylitis has a variable signal pattern and tical subluxation of the axis with basilar invagination of degree of contrast enhancement, which may reflect the the odontoid. MRI studies clearly demonstrate the degree evolutionary stages of discovertebral enthesitis in anky- of compression of the medulla oblongata. At an early stage of spinal enthesitis, the discovertebral junctions are of low signal intensity on T1-weighted spin echo images. High signal intensity on References T2-weighted images and marked contrast enhancement on T1-weighted post-contrast images surrounding bone 1. Resnick D, Niwayama G (1995) Diagnosis of bone and joint erosion reflect inflammatory edema and hyperemia. Saunders, Philadelphia may identify early erosive changes in radiographically 2. Modic TM, Masaryk TJ, Ross JS (1992) Magnetic resonance MR studies show high-signal-intensity vertebral-body imaging of the spine. Year book Medical, St Louis corners on T1-weighted and T2-weighted images without 4. Moll JMH, Haslock I, Mac Rae IF, Wright V (1974) Associa- fatty marrow transformation. Medicine (Baltimore) 53:343-364 lations with potentially life-threatening complications is 6. Jevtic V, Kos-Golja M, Rozman B, McCall I (2000) Marginal ligamentum transversum is present. Widening of the pre- erosive discovertebral “Romanus” lesions in ankylosing dental space by more than 3 mm in adults and 5 mm in spondylitis demonstrated by contrast enhanced Gd-DTPA children during flexion may be demonstrated by radi- magnetic resonance imaging. Skeletal Radiol 29:27-33 IDKD 2005 Degenerative Diseases of the Spine D. McCall2 1 Department of Radiology, University Hospital, Zurich, Switzerland 2 Department of Diagnostic Imaging, The Robert Jones & Agnes Hunt Hospital, Shropshire, UK Introduction cytes and has ground substance. Therefore, the inner ring has high signal intensity on T2-weighted images. Degenerative disease of the spine, in particular low back The second component of the intervertbral disk is the pain (LBP), is one of the most common causes of work dis- nucleus fibrosus. Back pain is a pervasive problem that affects two- gen and hydrophilic proteoglycans.

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Based on their relative locations in the spinal cord buy 5 mg oxytrol, which of the following tracts or fiber bundles would most likely be involved in (A) Abducens a lesion located in the immediate vicinity of the lateral corti- (B) Arcuate cospinal tract? The loss of pain and thermal sensations experienced by this woman (D) Medial longitudinal fasciculus would most likely correlate with a lesion involving which of the (E) Rubrospinal tract following structures? The examination reveals a drowsy somewhat stuporous stem; CT confirms this generic 2.5 mg oxytrol amex. Damage to which of the following within the brain medial to the internal medullary lamina purchase oxytrol 5 mg mastercard. Which of tracts or fiber bundles in the pons or medulla would most likely the following structures is most likely involved in this lesion? In addition to the medial and lateral geniculate nuclei, which of the of the posterior spinal artery at spinal cord levels C4-T2. Which following structures is also served by the thalamogeniculate of the following structures are in the territory served by this ves- artery, a branch of P? She explains that he suddenly became weak in his left group of cells, which of the following combinations of structures lower extremity. She immediately rushed him to the hospital, appear to be the same shade of grey in a T1- weighted MRI? The examination reveals an alert (A) Dorsomedial nucleus and Globus pallidus man who is obese and hypertensive. He has no cranial nerve (B) Globus pallidus and Caudate deficits, is slightly weak on his left side, and has no sensory (C) Globus pallidus and Putamen deficits. An MRI (D) Putamen and Caudate nucleus obtained the following day shows no lesions. Which of the fol- (E) Putamen and Pulvinar lowing most specifically describes this man’s medical experi- ence? Which of the following portions of the trigeminal nuclear complex (A) Central cord syndrome is found in lateral areas of the brainstem between the level of the (B) Small embolic stroke obex and the spinal cord-medulla junction and is the source of (C) Small hemorrhagic stroke trigeminothalamic fibers conveying pain and thermal information (D) Syringobulbia originating from the face and oral cavity? The examination reveals a weakness (hemiplegia) and a loss of vibratory sensation and discriminative touch 26. Which of the following structures is located within the territory all on the left lower extremity, and a loss of pain and thermal sensa- served by branches of the posterior inferior cerebellar artery tions on the right lower extremity. Damage to which of the following fiber bundles or tracts would (C) Medial lemniscus most likely explain the loss of vibratory sensation in this man? Space-occupying lesions within the posterior cranial fossa, or (D) Gracile fasciculus on the left events that increase pressure within this infratentorial region, may (E) Gracile fasciculus on the right result in herniation of a portion of the cerebellum through the foramen magnum.

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P1 Proximal phalanx Musculoskeletal Sonography 163 In loosening of a hip prosthesis discount 2.5mg oxytrol mastercard, the capsule to bone distance which is normally less than 3 buy discount oxytrol 5mg on line. US can detect different hypoechoic bursae around the hip: the trochanteric bursa generic oxytrol 5 mg with amex, the ischiogluteal bursa, and the iliopsoas bursa, of which the latest may communicate with the joint. The cause is most often mechanical, less frequent inflammatory, and rarely infectious or tu- moral. The complete spectrum of changes associated with tendinosis may occur at the insertion of the gluteus medius and minimus tendons. The diagnosis of hamstring or adductor insertion ten- donitis requires a comparison of the thickness and echo texture of the involved structures (Fig. US can demonstrate the extraarticular origin of a painful snapping hip by a dynamic evaluation of the il- iopsoas, gluteal and tensor fascia lata tendons. Hyperechoic crystal deposition (arrow) proximal in the rectus Different types of hernias in the groin region can also femoris tendon surrounded by edema be differentiated and diagnosed by US. In sports injuries, US detects hematoma and disconti- nuity in tendon or muscle tears of the hamstrings, adduc- tor, and rectus femoris muscles, or, apophyseal avulsions in patients 14-25 years of age. In chronic or repetitive lesions, muscular fibrosis and Knee Sonography calcifications are found. The US evaluation of hip dysplasia allows evaluation Ultrasound can detect small effusions of various of the cartilage components of the femoral head and ac- echogenicity (depending on the etiology), loose bodies, etabulum in multiple planes, both at rest and with move- and synovial proliferations (Fig. In tendinosis of the proximal patellar tendon (jumper’s knee), the spectrum of focal hypoechoic tendon enlarge- ment (areas of fibromyxoid degeneration), fissures, par- tial tears, focal hypervascularization, and calcifications can be monitored by US, and can easily be differentiated from peritendonitis or bursitis [46, 47]. Microavulsions of cartilage in Osgood-Schlatter or Sinding Larson Johansson disease are seen as hyperehoic calcified foci accompanied by hypoechoic focal tendon thickening and, occasionally, mild bursal effusion. US differentiates quadriceps tendon lesions from in- juries to the distal quadriceps muscle bellies. In iliotibial band friction syndrome, hypoechoic thick- ening and fluid collection in the soft tissues between the lateral femoral condyle and the ilotibial tract should be looked for in a comparative study completed by a dy- namic evaluation. Different types of bursitis, chronic, metabolic, infec- tious, and hemorrhagic, generally have a distinct clinical and sonographic presentation. Right and left compara- ovial- (bursa, joint space) or peritendinous tissue can be de- tive study of the hamstring’s insertion in a transverse plane at the ischial tuberosity. The right hamstring’s insertion appears marked- tected and monitored by power Doppler.

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