1.) Degenerative Arthritis Flashcards
1
Q
What is the aka of Degenerative Joint Disease (DJD)?
A
Osteoarthritis
2
Q
What type of arthritis is degenerative joint disease?
A
Wear and tear
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
4
Q
Does degenerative joint disease create spurs?
A
No
5
Q
What are the 2 type of nodal osteoarthritis in the hands?
A
1.) Heberden’s Nodes 2.) Bouchard’s Nodes
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
7
Q
What are the 2 types of contracted toe positions caused by localized idiopathic osteoarthritis?
A
1.) Hammer toes 2.) Cock-up toes
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
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
10
Q
What is an aka for superior migration in the hip caused by localized idiopathic osteoarthritis?
A
Eccentric
11
Q
What is an aka for axial or medial migration in the hip caused by localized idiopathic osteoarthritis?
A
Concentric
12
Q
What is an aka for diffuse migration in the hip caused by localized idiopathic osteoarthritis?
A
Coxae senilis
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)
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)
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
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
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
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)
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
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
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
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
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
24
Q
Professional level athletes have an _____ incidence of osteoarthritis?
A
Increased
25
Former long distance runners and tennis players have a \_\_\_\_\_x increased risk of osteoarthritis in the knees and hips.
2-3x
26
Soccer athletes with an ACL tear have a \_\_\_\_\_x increased risk of osteoarthritis in the knee compared to athletes with an intact ACL.
3x
27
According to the Framingham study what is a strong predictor of later osteoarthritis?
Obesity as a young adult
28
It is estimated that elimination of obesity would reduce knee osteoarthritis by how much?
25-50%
29
It is estimated that elimination of obesity would reduce hip osteoarthritis by how much?
25% or more
30
What are the genetic risk factors of osteoarthritis?
Heberden's nodes
31
What are Heberden's nodes?
Nodal osteoarthritis in the distal interphalangeal joints
32
What are 6 risk factors for the progression (not onset) or osteoarthritis in the knee?
1.) Female 2.) Increased age 3.) Overweight 4.) Heberden's nodes 5.) Low dietary vitamin C 6.) Low dietary vitamin D
33
Do most individuals with x-ray demonstrable osteoarthritis have joint symptoms?
No
34
Who has an increased risk factor of osteoarthritis: men or women?
Women
35
Who has an increased risk factor of osteoarthritis: People in welfare or working people?
People on welfare
36
Who has in increased risk factor of osteoarthritis: Married people or divorced people?
Divorced people
37
What are 8 characteristics from the notes of the gross pathology of osteoarthritis?
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
38
Early osteoarthritis is characterized by a healing response with what 3 components?
1.) Thickening of the articular cartilage 2.) Increased water content 3.) Increased rate of proteoglycan synthesis
39
What are the 4 component in the progression of cartilage changes in osteoarthritis?
1.) Decreased proteoglycan concentration 2.) Cartilage thinning 3.) Vertical clefts (fibrillation) in cartilage 4.) Irregular fibrillated cartilage is worn away
40
Normal articular cartilage is avascular and separated from underlying bone by what?
A layer of calcified cartilage (tidemark)
41
When fibrocytes migrate into fissures in cartilage what do they produce?
Fibrocartilage
42
Which is more durable: Fibrocartilage or hyaline cartilage?
Hyaline cartilage
43
What are 4 bone changes from the notes in osteoarthritis?
1.) Remodeling and hypertrophy of subchondral bone occurs 2.) Eburnation of bone 3.) Subchondral cyst formation 4.) Osteophytes
44
How does remodeling and hypertrophy of subchondral bone present on radiographs?
Sclerosis
45
What is eburnation?
Smooth, polished appearance of exposed subchondral bone after articular cartilage has worn away
46
What is subchondral cyst formation?
Microfractures of the bone allows synovial fluid to penetrate subchondral bone
47
What bone changes that occur with osteoarthritis result in osteophytes?
Combined growth of cartilage and bone at joint margins
48
What are 3 synovial changes from the notes that result from osteoarthritis?
1. ) Chronic, patchy synovitis changes
2. ) Villous formation may occur
3. ) Fragments of artiular cartilage and bone may become embedded in synovial membrane
49
Chronic, patchy synovitis that occurs with osteoarthritis usually occurs with what 3 things?
1. ) Lining cell hyperplasia
2. ) Lymphocytic infiltration
3. ) Perivascular lymphoid aggregates
50
Villous formation which may occur with osteoarthritis is reminescent of rheumatoid arthritis, how does it differ?
1. ) No pannus formation
2. ) No erosion of cartilage
51
What surrounds the fragments of articular cartilage and bone when they become embedded in the synovial membrane?
1. ) Macrophages
2. ) Local inflammatory cells
52
Intervetebral osteochondrosis primarily affect what target tissue?
The nucleus pulposis
53
In intervetebral osteochondrosis dessication of the nucleus leads to what 2 things?
1. ) Vacuum phenomenon in IVD space
2. ) Decreased IVD height
54
What disorder is pictured?
Intervertebral osteochondrosis
55
What condition is pictured?
Intervertebral osteochondrosis
56
What condition is pictured?
Intervertebral osteochondrosis
57
What condition is pictured?
Intervertebral osteochondrosis
58
Spondylosis deformans primarily affects what target tissue?
Annular fibers of the disc
59
What are the key findings of spondylosis deformans?
Osteophytes on the vertebral endplates
60
What type of arthritis does a syndesmophyte typically imply?
Inflammatory arthritis
61
What is the typical location of spondylosis deformans?
Marginal location
62
What condition is pictured?
Spondylosis deformans
63
What condition is pictured?
Spondylosis deformans
64
What type of appearance is pictured in this cervical spine?
Pseudo-fracture appearance
65
What type of appearance is pictured in this cervical spine?
Pseudo-fracture appearance
66
What is visible on the uncinate processes?
Hypertrophic changes
67
What is visible on the uncinate processes?
Hypertrophic changes
68
What does uncinate hypertrophy create on radiographs?
Horizontal lucency
69
What is pictured?
Uncinate hypertrophy creating a horzontal lucency
70
What can be seen on the zygoaphyseal articulations and uncovertebral joints?
Sclerosis and osteophyte formation
71
What can be seen on the zygoaphyseal articulations and uncovertebral joints?
Sclerosis and osteophyte formation
72
What can be seen in the intervertebral foramina's?
Intervertebral foraminal encroachment poteriorly and anteriorly
73
What can be seen in the intervertebral foramina's?
Intervertebral foraminal encroachment poteriorly and anteriorly
74
What can be seen in the intervertebral foramina's?
Intervertebral foraminal encroachment posteriorly and anteriorly
75
What 3 things can be seen on the posterior joints?
1. ) Spondylosis
2. ) Osteochondritis dissecans
3. ) Osteophyte formation
76
What 3 things can be seen on the posterior joints?
1. ) Spondylosis
2. ) Osteochondritis dissecans
3. ) Osteophyte formation
77
What 3 things can be seen on the posterior joints?
1. ) Spondylosis
2. ) Osteochondritis dissecans
3. ) Osteophyte formation
78
What happens in degenerative spndylolisthesis?
The pars interarticularis is intact but the vertebra moves forward
79
In degenerative spondylolisthesis the vertebra moves forward, this is secondary to what?
Degenerative remodeling of the posterior joints
80
What condition is pictured?
Degenerative spondylolisthesis
81
What does the differential diagnosis include for blastic lesions in vertebral bodies?
Hemispherical sclerosis
82
Hemispherical sclerosis has what type of changes?
Type III Modic changes
83
What is hemispherical sclerosis?
Reactive sclerosis of the vertebral body adjacent to the degenerative disc
84
What is hemispherical sclerosis often seen with?
Schmorl's node
85
What type of changes for hemispherical sclerosis are visble on an MRI?
Type I and Type II Modic changes
86
What condition is pictured?
Hemispherical sclerosis
87
Is spinal stenosis congeital or acquired?
Both
88
What is acquired spinal stenosis most often due to?
Degenerative joint disease
89
What are 5 causes from the notes of spinal stenosis?
1. ) Degenerative joint disease
2. ) Paget's disease
3. ) Compression fracture
4. ) Neoplasm (bone or soft tissue)
5. ) Congenital anomaly
90
What condition is pictured?
Spinal stenosis
91
What is spinal stenosis?
Narrowing of the cord
92
What condition is pictured?
Spinal stenosis
93
What is there potential for in spinal stenosis of the cervical spine?
Chronic vascular compromise
94
What could result from spinal stenosis?
Myelomalacia
95
What part of the spine does the anterior spinal artery supply?
Anterior 2/3 of the cord
96
What are the 3 soft tissue elements from the notes that are present in spinal stenosis?
1. ) Ligamentum flavum thickening
2. ) Capsular thickening of zygopophyseal joints
3. ) Synovial cyst of zygopophyseal joints
97
What are 4 characteristics from the notes of degenerative spondylolisthesis?
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
How much is the displacement usually in degenerative spndylolisthesis?
Usually \< 5-6mm
99
What condition is pictured?
Degenerative spondylolisthesis
100
What condition is pictured?
Degenerative spondylolisthesis
101
What condition is pictured?
Degenerative spondylolisthesis
102
What is the most common pattern of degenerative joint disease in the hip?
Narrowing of the superolateral portion of the joint
103
Is degenerative joint disease in the hip unilateral or bilateral?
Either
104
What condition is pictured?
DJD of the Hip
105
What condition is pictured?
DJD of the Hip
106
What are geodes?
Large subchondral cysts
107
What is the most common joint for geodes?
Hip joint
108
What condition is pictured?
DJD of the Hip
109
What condition is pictured?
Secondary DJD of the Hip
110
What condition is pictured?
Secondary DJD of the Hip
111
Where is the secondary DJD of the hip seen?
DJD is present bilaterally, but more marked on the left
112
What condition is pictured?
Secondary DJD of the Hip
113
What are the 4 most visible abnomalities pictured?
1. ) Sclerosis
2. ) Irregularity of joint space
3. ) Joint space narrowing
4. ) Atypical number of coccygeal segments
114
Osteophyte formation at the AC joint can create impingement on the available space for what tendon?
Supraspinatus tendon
115
What condition is pictured?
DJD of the AC joint
116
What condition is pictured?
DJD of the AC joint
117
What are 3 characteristics of secondary DJD of the wrist?
1. ) Wrist is not a common location for primary DJD
2. ) Ligamentous injury may predispose
3. ) Volar intercalated segment instability (VISI)
118
What indicates the volar intercalated segment instability (VISI)?
Volar rotation of lunate and abdominal scapho-lunate angle and capitolunate angle
119
What condition is pictured?
Secondary DJD of the wrist
120
What condition is pictured?
Secondary DJD of the wrist
121
What condition is pictured?
Secondary DJD of the wrist
122
What condition is pictured?
Secondary DJD of the wrist
123
What condition is pictured?
Bouchard's nodes
124
What condition is pictured?
Bouchard's nodes (PIP)
125
What condition is pictured?
Heberden's nodes
126
Where are Heberden's nodes?
DIP
127
Where are Bouchard's nodes?
PIP
128
What can be seen ont he medial side of the right knee?
1. ) Narrowing
2. ) Subchondral cysts
3. ) Sclerosis
129
What can redistribute weightbearing for temporary improvement of symptoms?
Tibial osteotomy
130
What is visible in this case of DJD of the knee?
Marked asymetrical joint narrowing with osteophyte formation and sclerosis
131
What is DISH?
Diffuse Idiopathic Skeletal Hyperostosis
132
What is the typical onset age of DISH?
5th-6th decade
133
DISH is associated with what other clinical findings?
1. ) Diabetes mellitus
2. ) Heel Spurs and Tennis Elbows
3. ) OPLL may result in symptoms of cord compression
134
135
What are 7 x-ray charachteristics of DISH?
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
What condition is pictured?
DISH
137
What is Diffuse Idiopathic Skeletal Hyperostosis (DISH)?
Diffuse, thick calcification of the ALL
138
What are the characteristics of DISH in the thoracic spine?
Involvement of the thoracic spine may be thinner and mimic anklosing spondylitis
139
What is structural formation is pictured on the radiograph of DISH with peripheral involvement?
Calcaneal hyperostosis
aka
Heel spur
140
What can be see in this radiograph of DISH?
Hypertrophic change along the margin of glenoid fossa
141
What can be seen in this radiograph of DISH?
Hypertrophic change along the margin of glenoid fossa
142
What condition is pictured?
DISH
143
What condition is pictured?
DISH
144
What condition is pictured?
DISH
145
What condition is pictured?
DISH
146
What are 4 characteristics of ossification of posterior longitudinal ligament?
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
What condition is pictured?
Ossifcation of posterior longitudinal ligament (OPLL)
148
A cervical cord compression may result in what upper motor neuron findings?
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
What condition is pictured?
Ossifcation of posterior longitudinal ligament (OPLL)
150
What condition is pictured?
Ossifcation of posterior longitudinal ligament (OPLL)
151
What condition is pictured?
Ossifcation of posterior longitudinal ligament (OPLL)
152
What condition is pictured?
Ossifcation of posterior longitudinal ligament (OPLL)
153
What condition is pictured?
Ossifcation of posterior longitudinal ligament (OPLL)
154
What condition is pictured?
Ossifcation of posterior longitudinal ligament (OPLL)
155
What are 5 clinical findings of osteitis condensans illi?
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
What condition is pictured?
Osteitis condensans illi
157
What are 6 characteristics of osteitis condensans illi?
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
What condition is pictured?
Osteitis condensans illi
159
What condition is pictured?
Osteitis condensans illi
160
What condition is pictured?
Osteitis condensans illi
161
What condition is pictured?
Osteitis condensans illi
162
What condition is pictured?
Osteitis condensans illi
163
What condition is pictured?
Osteitis condensans illi
164
What condition is pictured?
Osteitis condensans illi
