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Differential Diagnosis of Musculoskeletal Disorders

Premature Epiphyseal Ossification!!navigator!!

@ Proximal femoral and humeral epiphyses

  1. Jeune asphyxiating thoracic dysplasia
  2. Ellis-van Creveld chondroectodermal dysplasia

Epiphyseal / Apophyseal Lesion!!navigator!!

  1. Chondroblastoma
  2. Brodie abscess
  3. Fungal / tuberculous infection
  4. Langerhans cell histiocytosis
  5. Osteoid osteoma
  6. Chondromyxoid fibroma
  7. Enchondroma
  8. Bone cyst
  9. Foreign-body granuloma

mnemonic: ICEBAGS

  • Infection
  • Chondroblastoma (age <40)
  • Eosinophilic granuloma
  • Brown tumor
  • Aneurysmal bone cyst
  • Giant cell tumor
  • Subchondral cyst

Subarticular Lesion

  1. T2 hypo- to isointense matrix
    1. Giant cell tumor
  2. T2 hyperintense matrix
    1. Solitary subchondral cyst
    2. Intraosseous ganglion
    3. Brodie abscess
    4. Clear cell chondrosarcoma

Stippled Epiphyses!!navigator!!

  1. Normal variant
  2. Avascular necrosis
  3. Hypothyroidism
  4. Chondrodysplasia punctata
  5. Multiple epiphyseal dysplasia
  6. Spondyloepiphyseal dysplasia
  7. Hypoparathyroidism
  8. Down syndrome
  9. Trisomy 18
  10. Fetal exposure to warfarin / hydantoin
  11. Homocystinuria (distal radial + ulnar epiphyses = PATHOGNOMONIC)
  12. Zellweger cerebrohepatorenal syndrome

Physeal / Metaphyseal Widening & Irregularity!!navigator!!

  1. Rickets
  2. Hypophosphatasia
  3. Metaphyseal chondroplasia

Epiphyseal Overgrowth!!navigator!!

  1. Juvenile rheumatoid arthritis
  2. Hemophilia
  3. Healed Legg-Perthes disease
  4. Tuberculous arthritis
  5. Pyogenic arthritis (chronic)
  6. Fungal arthritis
  7. Epiphyseal dysplasia hemimelica
  8. Fibrous dysplasia of epiphysis
  9. Winchester syndrome

Epiphyseolysis!!navigator!!

= SLIPPED EPIPHYSIS

(zone of maturing hypertrophic cartilage affected, NOT zone of proliferation)

  1. Idiopathic / juvenile epiphyseolysis
    Age: 12–15 years (? puberty-related hormonal dysregulation)
    • adiposogenital type; tall stature
  2. Renal osteodystrophy
  3. Hyperparathyroidism in chronic renal disease
  4. Hypothyroidism
  5. Radiotherapy

Outline