2: Degenerative Joint Disease Flashcards
Give me some general info on DJD
959
- progressive, non-inflammatory
- the changes are in cartilage and joint components
- typically larger weight bearing joints or small joints of the hand
- Spine, hips, knees, AC, 1st CMC/MTP, DIP’s
What are the clinical features of DJD
-more Male than F up to 45 yrs then reverse
-most common type of joint disease
-the clinical findings are disproportionate to observed x-ray findings
-any joint can develop DJD
-insidious onset of symptoms (proceeding in a gradual, subtle way, but with very harmful effects.)
-aching, swelling, stiffness goes away with activity
-Environment: temp, humidity may aggravate –> cold and lower pressures may aggravate
-history may reveal repetitive motions or chronic injury.
pg 7
What are the Pathological features of DJD
- initially degeneration begins as a focal process, gradually spreading to involve a greater proportion of the joint surfaces.
- once process is initiated degenerative changes appear to be irreversible, but rate of change may be modified.
- the cartilage consisting of ground substance (chondroitin) supply support for collagen. DJD is abnormal articular forces that promote loss of Chondroitin by limiting normal chondrocyte function.
- once ground substance is altered exposed collagen fibres destruct. starts with cartilage then to subchondral bone
- synovium thickens
- osteophyte formation
- subchondral thickening (sclerosis)
- synovial fluid enters subchondral bone -sub cartilage (cysts)
What are the radiographic features of DJD in the hip
pg 7
- Non-unifrom loss of joint space -tends to be in regions of greatest intra-articular stress especially in weight bearing structures like spine, hip and knee
Non-uniform Loss of Joint Space
− Superior migration, most common
− Waldenstrom’s sign, wide medial joint space, in association with superior
− Medial migration, less common
− Axial migration, rare 2. 2.Osteophytes
− Outer supraacetabular margin
− Collar type around femoral neck, seen at the lateral and inferomedial surface of femur
3. Subchondral Cysts
− Often large, near site of reduced joint space
− Occur on either side of the joint 4. Subchondral Sclerosis
− Area where stress is greatest, usually supra-acetabular (were there is the most cartilage loss)
5. Buttressing
− Cortical thickening, medial femur − Stress related, altered mechanics J
6. Joint Deformity
− Flattening superior femoral head
What are the radiographic features of DJD in the knee
pg 8
knee:
- spiking of the tibial eminences
- loose bodies
- chondrocalcinosis in menisci
Medial Tibiofemoral Joint
- deacreased joint space
- sclerosis more evident on the tuba
- osteophytes are small
- cysts are rare here
- deformity late stages, Varus
Lateral Tibiofemoral joint:
- late stages of DJD
- usually see with patellofemoral involvement
- usually see with other underlying disease i.e. CPPD
- Isolated here is uncommon, if it is consider CPPD
- loss of joint space, osteophytes, sclerosis, anterior erosion of femur.
What is Chondromalacia Patellae?
a) Criteria for diagnosis
b) Radiographic Signs
- Criteria for Diagnosis
− Anteromedial pain w/, crepitus, buckling, locking, stiffness, swelling − Aggravated by walking up stairs
− Patellar compression painful - Radiographic Signs
− Plain films are normal, unless late stage of patellofemoral DJD
− CT air arthrography can detect loss of cartilage
− MRI most sensitive to focal loss of cartilage
DJD in the Ankle/tarsals
− The ankle is an uncommon site for DJD, unless prior trauma exists − First tarsometatarsal joint may show signs
− If you see DJD in mid/hind foot think about coalition of the tarsals
DJD in the Foot
− First MTP most common site
− Osteophytes seen along the dorsal and medial surface of joint − Bunion deformity seen as lateral angulation of phalanx
− Hallux Rigidus seen at late stage of disease
Shoulder
Acromioclavicular Joint
− DJD more common in A-C than G-H
− Loss of joint space, sclerosis, osteophytes, small cysts
− Complication: impingement syndrome, rotator cuff disease associated with inferior osteophytes
Glenohumeral Joint
− Any significant DJD at this location, think previous trauma/occupational trauma − Osteophytes inferior humeral head
− Cysts at rotator insertion
− Rotator disruption seen as sup. migration of humeral head
DJD Elbow
− Very rare and secondary to trauma, occupation
− Loose bodies and osteophytes, olecranon spur at triceps insertion
DJD Wrist
− Usually limited to 1st CMC
− Disarticulation, sclerosis, osteophyte, loose bodies
− Radiocarpal DJD seen secondary to trauma or underlying disease (CPPD) − Cysts can be seen in carpals
