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Skeletal Radiology B > 1.) Degenerative Arthritis > Flashcards

1.) Degenerative Arthritis Flashcards

1
Q

What is the aka of Degenerative Joint Disease (DJD)?

A

Osteoarthritis

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2
Q

What type of arthritis is degenerative joint disease?

A

Wear and tear

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3
Q

What are 3 examples from the notes of confusing terminology in the spine?

A

1.) Intervertebral osteochondrosis 2.) Spondylosis deformans 3.) Discogenic spondylosis

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4
Q

Does degenerative joint disease create spurs?

A

No

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5
Q

What are the 2 type of nodal osteoarthritis in the hands?

A

1.) Heberden’s Nodes 2.) Bouchard’s Nodes

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6
Q

What are the 3 most common locations of localized idiopathic osteoarthritis in the hands?

A

1.) Nodes 2.) Erosive interphalangeal joints 3.) Carpal - 1st metacarpal joint

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7
Q

What are the 2 types of contracted toe positions caused by localized idiopathic osteoarthritis?

A

1.) Hammer toes 2.) Cock-up toes

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8
Q

What are the 3 most common locations of localized idiopathic osteoarthritis in the feet?

A

1.) Hallux valgus or rigidus 2.) Contracted toes 3.) Talonavicular joint

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9
Q

What are the 3 most common locations of localized idiopathic osteoarthritis in the knees?

A

1.) Medial compartment 2.) Lateral compartment 3.) Patellofemoral compartment

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10
Q

What is an aka for superior migration in the hip caused by localized idiopathic osteoarthritis?

A

Eccentric

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11
Q

What is an aka for axial or medial migration in the hip caused by localized idiopathic osteoarthritis?

A

Concentric

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12
Q

What is an aka for diffuse migration in the hip caused by localized idiopathic osteoarthritis?

A

Coxae senilis

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13
Q

What are the 3 most common locations of localized idiopathic osteoarthritis in the hip?

A

1.) Eccentric (superior) 2.) Concentric (axial, medial) 3.) Diffuse (coxae senilis)

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14
Q

What are the 4 most common locations of localized idiopathic osteoarthritis in the spine?

A

1.) Apophyseal joints 2.) Intervertebral discs 3.) Spondylosis (osteophytes) 4.) Ligamentous (DISH)

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15
Q

What are 4 other isolated joints from the notes that are common locations of localized idiopathic osteoarthritis?

A

1.) Sacroiliac (SI) joint 2.) Temporomandibular Joint (TMJ) 3.) Glenohumeral joint 4.) Tibiotalar joint

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16
Q

What are the 6 causes from the notes of secondary osteoarthritis?

A

1.) Trauma 2.) Congenital or developmental disorders 3.) Metabolic disorders 4.) Endocrine disorders 5.) Calcium deposition diseases 6.) Neuropathic disorders

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17
Q

What are the 5 examples from the notes of trauma that can result in secondary osteoarthritis?

A

1.) Acute trauma 2.) Chronic trauma (occupation, sports) 3.) Frostbite 4.) Caisson disease 5.) Hemoglobinopathies

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18
Q

What are 3 examples from the notes of localized congenital or developmental disorders that can result in secondary osteoarthritis?

A

1.) Legg-Calve-Perthes disease 2.) Developmental dysplasia of the Hip 3.) Slipped Femoral Capital Epiphysis (SFCE)

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19
Q

What are 3 examples from the notes of congenital or developmental mechanical factors that can result in secondary osteoarthritis?

A

1.) Varus/valgus 2.) Unequal leg length 3.) Hypermobility syndromes 4.) Bone dysplasias

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20
Q

What are 4 examples from the notes of metabolic disorders that can result in secondary osteoarthritis?

A

1.) Ochronosis 2.) Hemachromatosis 3.) Wilson’s disease 4.) Gaucher’s disease

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21
Q

What are 5 examples from the notes of endocrine disorders that can result in secondary osteoarthritis?

A

1.) Acromegaly 2.) Hyperparathyroidism 3.) Diabetes 4.) Obesity 5.) Hypothyroidism

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22
Q

What are 2 examples from the notes of calcium deposition diseases that can result in secondary osteoarthritis?

A

1.) Calcium Pyrophosphate Deposition Disease (CPPD) 2.) Apatite arthropathy

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23
Q

What are 4 risk factors of occupational trauma that are associated with increased incidences of osteoarthritis in the knee?

A

1.) Kneeling 2.) Squatting 3.) Bending 4.) Heavy lifting

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24
Q

Professional level athletes have an _____ incidence of osteoarthritis?

A

Increased

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25
Q

Former long distance runners and tennis players have a _____x increased risk of osteoarthritis in the knees and hips.

A

2-3x

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26
Q

Soccer athletes with an ACL tear have a _____x increased risk of osteoarthritis in the knee compared to athletes with an intact ACL.

A

3x

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27
Q

According to the Framingham study what is a strong predictor of later osteoarthritis?

A

Obesity as a young adult

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28
Q

It is estimated that elimination of obesity would reduce knee osteoarthritis by how much?

A

25-50%

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29
Q

It is estimated that elimination of obesity would reduce hip osteoarthritis by how much?

A

25% or more

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30
Q

What are the genetic risk factors of osteoarthritis?

A

Heberden’s nodes

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31
Q

What are Heberden’s nodes?

A

Nodal osteoarthritis in the distal interphalangeal joints

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32
Q

What are 6 risk factors for the progression (not onset) or osteoarthritis in the knee?

A

1.) Female 2.) Increased age 3.) Overweight 4.) Heberden’s nodes 5.) Low dietary vitamin C 6.) Low dietary vitamin D

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33
Q

Do most individuals with x-ray demonstrable osteoarthritis have joint symptoms?

A

No

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34
Q

Who has an increased risk factor of osteoarthritis: men or women?

A

Women

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35
Q

Who has an increased risk factor of osteoarthritis: People in welfare or working people?

A

People on welfare

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36
Q

Who has in increased risk factor of osteoarthritis: Married people or divorced people?

A

Divorced people

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37
Q

What are 8 characteristics from the notes of the gross pathology of osteoarthritis?

A

1.) Softening, fibrillation and loss of articular cartilage 2.) Eburnation of exposed bone/bone remodeling 3.) Osteophytes 4.) Subchondral cysts 5.) Synovitis 6.) Thickening of joint capsule 7.) Meniscus degeneration 8.) Periarticular muscle atrophy

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38
Q

Early osteoarthritis is characterized by a healing response with what 3 components?

A

1.) Thickening of the articular cartilage 2.) Increased water content 3.) Increased rate of proteoglycan synthesis

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39
Q

What are the 4 component in the progression of cartilage changes in osteoarthritis?

A

1.) Decreased proteoglycan concentration 2.) Cartilage thinning 3.) Vertical clefts (fibrillation) in cartilage 4.) Irregular fibrillated cartilage is worn away

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40
Q

Normal articular cartilage is avascular and separated from underlying bone by what?

A

A layer of calcified cartilage (tidemark)

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41
Q

When fibrocytes migrate into fissures in cartilage what do they produce?

A

Fibrocartilage

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42
Q

Which is more durable: Fibrocartilage or hyaline cartilage?

A

Hyaline cartilage

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43
Q

What are 4 bone changes from the notes in osteoarthritis?

A

1.) Remodeling and hypertrophy of subchondral bone occurs 2.) Eburnation of bone 3.) Subchondral cyst formation 4.) Osteophytes

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44
Q

How does remodeling and hypertrophy of subchondral bone present on radiographs?

A

Sclerosis

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45
Q

What is eburnation?

A

Smooth, polished appearance of exposed subchondral bone after articular cartilage has worn away

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46
Q

What is subchondral cyst formation?

A

Microfractures of the bone allows synovial fluid to penetrate subchondral bone

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47
Q

What bone changes that occur with osteoarthritis result in osteophytes?

A

Combined growth of cartilage and bone at joint margins

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48
Q

What are 3 synovial changes from the notes that result from osteoarthritis?

A
  1. ) Chronic, patchy synovitis changes
  2. ) Villous formation may occur
  3. ) Fragments of artiular cartilage and bone may become embedded in synovial membrane
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49
Q

Chronic, patchy synovitis that occurs with osteoarthritis usually occurs with what 3 things?

A
  1. ) Lining cell hyperplasia
  2. ) Lymphocytic infiltration
  3. ) Perivascular lymphoid aggregates
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50
Q

Villous formation which may occur with osteoarthritis is reminescent of rheumatoid arthritis, how does it differ?

A
  1. ) No pannus formation
  2. ) No erosion of cartilage
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51
Q

What surrounds the fragments of articular cartilage and bone when they become embedded in the synovial membrane?

A
  1. ) Macrophages
  2. ) Local inflammatory cells
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52
Q

Intervetebral osteochondrosis primarily affect what target tissue?

A

The nucleus pulposis

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53
Q

In intervetebral osteochondrosis dessication of the nucleus leads to what 2 things?

A
  1. ) Vacuum phenomenon in IVD space
  2. ) Decreased IVD height
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54
Q

What disorder is pictured?

A

Intervertebral osteochondrosis

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55
Q

What condition is pictured?

A

Intervertebral osteochondrosis

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56
Q

What condition is pictured?

A

Intervertebral osteochondrosis

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57
Q

What condition is pictured?

A

Intervertebral osteochondrosis

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58
Q

Spondylosis deformans primarily affects what target tissue?

A

Annular fibers of the disc

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59
Q

What are the key findings of spondylosis deformans?

A

Osteophytes on the vertebral endplates

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60
Q

What type of arthritis does a syndesmophyte typically imply?

A

Inflammatory arthritis

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61
Q

What is the typical location of spondylosis deformans?

A

Marginal location

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62
Q

What condition is pictured?

A

Spondylosis deformans

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63
Q

What condition is pictured?

A

Spondylosis deformans

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64
Q

What type of appearance is pictured in this cervical spine?

A

Pseudo-fracture appearance

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65
Q

What type of appearance is pictured in this cervical spine?

A

Pseudo-fracture appearance

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66
Q

What is visible on the uncinate processes?

A

Hypertrophic changes

67
Q

What is visible on the uncinate processes?

A

Hypertrophic changes

68
Q

What does uncinate hypertrophy create on radiographs?

A

Horizontal lucency

69
Q

What is pictured?

A

Uncinate hypertrophy creating a horzontal lucency

70
Q

What can be seen on the zygoaphyseal articulations and uncovertebral joints?

A

Sclerosis and osteophyte formation

71
Q

What can be seen on the zygoaphyseal articulations and uncovertebral joints?

A

Sclerosis and osteophyte formation

72
Q

What can be seen in the intervertebral foramina’s?

A

Intervertebral foraminal encroachment poteriorly and anteriorly

73
Q

What can be seen in the intervertebral foramina’s?

A

Intervertebral foraminal encroachment poteriorly and anteriorly

74
Q

What can be seen in the intervertebral foramina’s?

A

Intervertebral foraminal encroachment posteriorly and anteriorly

75
Q

What 3 things can be seen on the posterior joints?

A
  1. ) Spondylosis
  2. ) Osteochondritis dissecans
  3. ) Osteophyte formation
76
Q

What 3 things can be seen on the posterior joints?

A
  1. ) Spondylosis
  2. ) Osteochondritis dissecans
  3. ) Osteophyte formation
77
Q

What 3 things can be seen on the posterior joints?

A
  1. ) Spondylosis
  2. ) Osteochondritis dissecans
  3. ) Osteophyte formation
78
Q

What happens in degenerative spndylolisthesis?

A

The pars interarticularis is intact but the vertebra moves forward

79
Q

In degenerative spondylolisthesis the vertebra moves forward, this is secondary to what?

A

Degenerative remodeling of the posterior joints

80
Q

What condition is pictured?

A

Degenerative spondylolisthesis

81
Q

What does the differential diagnosis include for blastic lesions in vertebral bodies?

A

Hemispherical sclerosis

82
Q

Hemispherical sclerosis has what type of changes?

A

Type III Modic changes

83
Q

What is hemispherical sclerosis?

A

Reactive sclerosis of the vertebral body adjacent to the degenerative disc

84
Q

What is hemispherical sclerosis often seen with?

A

Schmorl’s node

85
Q

What type of changes for hemispherical sclerosis are visble on an MRI?

A

Type I and Type II Modic changes

86
Q

What condition is pictured?

A

Hemispherical sclerosis

87
Q

Is spinal stenosis congeital or acquired?

A

Both

88
Q

What is acquired spinal stenosis most often due to?

A

Degenerative joint disease

89
Q

What are 5 causes from the notes of spinal stenosis?

A
  1. ) Degenerative joint disease
  2. ) Paget’s disease
  3. ) Compression fracture
  4. ) Neoplasm (bone or soft tissue)
  5. ) Congenital anomaly
90
Q

What condition is pictured?

A

Spinal stenosis

91
Q

What is spinal stenosis?

A

Narrowing of the cord

92
Q

What condition is pictured?

A

Spinal stenosis

93
Q

What is there potential for in spinal stenosis of the cervical spine?

A

Chronic vascular compromise

94
Q

What could result from spinal stenosis?

A

Myelomalacia

95
Q

What part of the spine does the anterior spinal artery supply?

A

Anterior 2/3 of the cord

96
Q

What are the 3 soft tissue elements from the notes that are present in spinal stenosis?

A
  1. ) Ligamentum flavum thickening
  2. ) Capsular thickening of zygopophyseal joints
  3. ) Synovial cyst of zygopophyseal joints
97
Q

What are 4 characteristics from the notes of degenerative spondylolisthesis?

A
  1. ) Posterior elements not separated form body (no spondylosis)
  2. ) Secondary to DJD of posterior joints
  3. ) Most common level L4/5
  4. ) Typically mild displacement
98
Q

How much is the displacement usually in degenerative spndylolisthesis?

A

Usually < 5-6mm

99
Q

What condition is pictured?

A

Degenerative spondylolisthesis

100
Q

What condition is pictured?

A

Degenerative spondylolisthesis

101
Q

What condition is pictured?

A

Degenerative spondylolisthesis

102
Q

What is the most common pattern of degenerative joint disease in the hip?

A

Narrowing of the superolateral portion of the joint

103
Q

Is degenerative joint disease in the hip unilateral or bilateral?

A

Either

104
Q

What condition is pictured?

A

DJD of the Hip

105
Q

What condition is pictured?

A

DJD of the Hip

106
Q

What are geodes?

A

Large subchondral cysts

107
Q

What is the most common joint for geodes?

A

Hip joint

108
Q

What condition is pictured?

A

DJD of the Hip

109
Q

What condition is pictured?

A

Secondary DJD of the Hip

110
Q

What condition is pictured?

A

Secondary DJD of the Hip

111
Q

Where is the secondary DJD of the hip seen?

A

DJD is present bilaterally, but more marked on the left

112
Q

What condition is pictured?

A

Secondary DJD of the Hip

113
Q

What are the 4 most visible abnomalities pictured?

A
  1. ) Sclerosis
  2. ) Irregularity of joint space
  3. ) Joint space narrowing
  4. ) Atypical number of coccygeal segments
114
Q

Osteophyte formation at the AC joint can create impingement on the available space for what tendon?

A

Supraspinatus tendon

115
Q

What condition is pictured?

A

DJD of the AC joint

116
Q

What condition is pictured?

A

DJD of the AC joint

117
Q

What are 3 characteristics of secondary DJD of the wrist?

A
  1. ) Wrist is not a common location for primary DJD
  2. ) Ligamentous injury may predispose
  3. ) Volar intercalated segment instability (VISI)
118
Q

What indicates the volar intercalated segment instability (VISI)?

A

Volar rotation of lunate and abdominal scapho-lunate angle and capitolunate angle

119
Q

What condition is pictured?

A

Secondary DJD of the wrist

120
Q

What condition is pictured?

A

Secondary DJD of the wrist

121
Q

What condition is pictured?

A

Secondary DJD of the wrist

122
Q

What condition is pictured?

A

Secondary DJD of the wrist

123
Q

What condition is pictured?

A

Bouchard’s nodes

124
Q

What condition is pictured?

A

Bouchard’s nodes (PIP)

125
Q

What condition is pictured?

A

Heberden’s nodes

126
Q

Where are Heberden’s nodes?

A

DIP

127
Q

Where are Bouchard’s nodes?

A

PIP

128
Q

What can be seen ont he medial side of the right knee?

A
  1. ) Narrowing
  2. ) Subchondral cysts
  3. ) Sclerosis
129
Q

What can redistribute weightbearing for temporary improvement of symptoms?

A

Tibial osteotomy

130
Q

What is visible in this case of DJD of the knee?

A

Marked asymetrical joint narrowing with osteophyte formation and sclerosis

131
Q

What is DISH?

A

Diffuse Idiopathic Skeletal Hyperostosis

132
Q

What is the typical onset age of DISH?

A

5th-6th decade

133
Q

DISH is associated with what other clinical findings?

A
  1. ) Diabetes mellitus
  2. ) Heel Spurs and Tennis Elbows
  3. ) OPLL may result in symptoms of cord compression
134
Q
A
135
Q

What are 7 x-ray charachteristics of DISH?

A
  1. ) At least 4 contiguous levels involved
  2. ) Thick, flowering anterior and/or lateral calcification or ossification
  3. ) No posterior joint ankylosis
  4. ) Relative preservation of IVD height
  5. ) No SI joint erosion
  6. ) No sclerosis
  7. ) No ankylosis
136
Q

What condition is pictured?

A

DISH

137
Q

What is Diffuse Idiopathic Skeletal Hyperostosis (DISH)?

A

Diffuse, thick calcification of the ALL

138
Q

What are the characteristics of DISH in the thoracic spine?

A

Involvement of the thoracic spine may be thinner and mimic anklosing spondylitis

139
Q

What is structural formation is pictured on the radiograph of DISH with peripheral involvement?

A

Calcaneal hyperostosis

aka

Heel spur

140
Q

What can be see in this radiograph of DISH?

A

Hypertrophic change along the margin of glenoid fossa

141
Q

What can be seen in this radiograph of DISH?

A

Hypertrophic change along the margin of glenoid fossa

142
Q

What condition is pictured?

A

DISH

143
Q

What condition is pictured?

A

DISH

144
Q

What condition is pictured?

A

DISH

145
Q

What condition is pictured?

A

DISH

146
Q

What are 4 characteristics of ossification of posterior longitudinal ligament?

A
  1. ) May be isolated phenomenon or may be associated with DISH
  2. ) Cervical spine most often involved (thoracics more than lumbars)
  3. ) May see on plain flim
  4. ) Multiplanar imaging necessary for assessment of cord space
147
Q

What condition is pictured?

A

Ossifcation of posterior longitudinal ligament (OPLL)

148
Q

A cervical cord compression may result in what upper motor neuron findings?

A
  1. ) Positive Hoffman sign in hand
  2. ) Postitive Babinski sign
  3. ) Clumsiness of hand
  4. ) Patient may have difficulty walking on uneven ground due to leg spasticity
149
Q

What condition is pictured?

A

Ossifcation of posterior longitudinal ligament (OPLL)

150
Q

What condition is pictured?

A

Ossifcation of posterior longitudinal ligament (OPLL)

151
Q

What condition is pictured?

A

Ossifcation of posterior longitudinal ligament (OPLL)

152
Q

What condition is pictured?

A

Ossifcation of posterior longitudinal ligament (OPLL)

153
Q

What condition is pictured?

A

Ossifcation of posterior longitudinal ligament (OPLL)

154
Q

What condition is pictured?

A

Ossifcation of posterior longitudinal ligament (OPLL)

155
Q

What are 5 clinical findings of osteitis condensans illi?

A
  1. ) May or may not have symptoms
  2. ) Typically uni- or multi-parous female patient
  3. ) Child bearing age range
  4. ) Self-limiting condition that resolves with age
  5. ) May be unilateral or bilateral (but more often bilateral)
156
Q

What condition is pictured?

A

Osteitis condensans illi

157
Q

What are 6 characteristics of osteitis condensans illi?

A
  1. ) Affects the iliac side fo the SI joint, usually bilateral
  2. ) Affects lower 1/2 of joint
  3. ) Trianglular pattern of reactive sclerosis
  4. ) SI joint will not be fused
  5. ) No need for referral
  6. ) Unusal to see in the elderly
158
Q

What condition is pictured?

A

Osteitis condensans illi

159
Q

What condition is pictured?

A

Osteitis condensans illi

160
Q

What condition is pictured?

A

Osteitis condensans illi

161
Q

What condition is pictured?

A

Osteitis condensans illi

162
Q

What condition is pictured?

A

Osteitis condensans illi

163
Q

What condition is pictured?

A

Osteitis condensans illi

164
Q

What condition is pictured?

A

Osteitis condensans illi

Skeletal Radiology B (17 decks)

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