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MSK > Black and white > Flashcards

Black and white Flashcards

1
Q

What gives superolateral migration of the humeral head? Where does the osteophyte form and why?

A

OA

Medial cortex of femoral head due to shifting of weight bearing

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2
Q

What causes medial migration of the femoral head?

A

Secondary to acetabular fracture

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3
Q

What causes axial migration of the femoral head?

A

Inflammatory arthropathies, crystialline arthropathies

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4
Q

Give the disease for axially migrated femoral head based on the secondary chages:

osteoporosis with bilateral involvement, little if any subchondral sclerosis, no osteophytes

bilatreal, cuff of osteophytes ate femoral head and neck junction

asymmetric, calcified cartilage, indolent (degen rather than destruction), subchondral sclerosis and osteophytes (NOT the medial femoral neck as in OA)

Absence of white cortical line along extensive portion of femoral head

A

RA - can see acetabular protrusio

Ankylosing spondylitis

CPPD

Septic arthritis

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5
Q

What are two primary BONE disorders that cause AXIAL migration of the femoral heads

A

Pagets and renal osteodystrophy

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6
Q

What 4 conditions do NOT cause loss of hip joint space until late in the disease

A

Osteonecrosis, synovial chondromatosis, PVNS, TB

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7
Q

What is the imaging of osteonecrosis of the femoral head

A

Initially, there will be a smudginess of the normal trabecular pattern, followed by lytic and sclerotic areas. There will be a subchondral crescent shaped lucency indicating impending collapse

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8
Q

Differentiate osteonecrosis from late stage OA

A

Osteonecrosis will have far more extensive change in the femoral head

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9
Q

What is the best radiographic sign to diagnose synovial chondromatosis

A

scalloping defect along neck and femur

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10
Q

Differentiate PVNS from synovial chondromatosis

A

PVNS - asymmetric, well defined cysts on both sides of the joint, scalloping defects

SC - bilateral, no cysts

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11
Q

Total knee compartment loss is suggestive of what?

A

Inflammatory arthropathy

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12
Q

How does RA present in the knee

A

bilateral symmetric disease with uniform joint loss with generalized osteoporosis. LITTLE EVIDENCE of bone repair or osteophyte formation

can see large synovial cysts

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13
Q

What are the knee findings in psoriatic/reiters arthritis

A

bilateral ASYMMETRIC disease with maintained bone mineralization

Will see bony excrescences at ligamentous and tendinous attaachments

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14
Q

What are the knee findings in juvenile chronic arthritis

A

Unilateral but total knee involvement

OVERGROWTH of the femoral and tibial epiphyses with overgrowth of the patella

lucent metaphyseal band due to increased blood flow

widening of the intercondylar notch

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15
Q

What are the findings in the knee in hemophilia?

A

Overgrowth of the epiphyses and patella with widening of the intercondylar notch and a SQUARE patella

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16
Q

DDx for overgrowth of the epiphyses and patella with widening of the intercondylar notch in the knee

A

JRA, hemophilia

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17
Q

What are the features of a septic knee joint

A

UNILATERAL

Effusion, uniform cartilage loss, juxtaarticular osteoporosis, loss of white cortical line

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18
Q

What two processes show preferential joint space loss in the knee

A

OA, CPPD

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19
Q

Which joint space is preferentially affected in OA?

A

medial tibiofemoral due to mechanical stress

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20
Q

What are the findings in a neuropathic joint?

A

6 D’s

Dense (subchondral sclerosis)
Degeneration
Destruction of cartilage
Deformity
Dislocation
Debris
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21
Q

Which joint is preferentially involved in the knee in CPPD?

A

Patellofemoral

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22
Q

Scalloped defect in the femur superior to the location of the patella in the flexed position is suggestive of what arthropathy?

A

CPPD

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23
Q

What are the four common disorders that do not cause loss of the knee joint until late in the disease

A

Osteonecrosis, OCD, synovial osteochondromatosis, PVNS

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24
Q

AVN of the femoral condyle is associated with what two disease processes

A

Lupus, steroids

Also seen in SONK

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25
Q

How does osteonecrosis of the knee present radiographically

A

Ill defined areas of lucency and bone repair in the involved condyle - asymmetric

Subchondral lucency and displacement of the cortical fragment inward are pathognomonic

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26
Q

How does an OCD lesion in the knee develop?

A

Chronic repetitive trauma to an area of normal irregular ossification during growth

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27
Q

What joint is most commonly involved in PVNS?

A

Knee

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28
Q

Most common cause of bilateral oasteoarthritic changes in the shoulders?

A

CPPD

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29
Q

What is the cutoff for subacromial narrowing? What does it indicate?

A

7mm

Chronic rotator cuff tear, impingement

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30
Q

Bony excrescence under the acromion, flattening and sclerosis of the humeral head, and bony proliferation of the greater tuberosity suggest waht in the shoulder?

A

Impingement

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31
Q

What are the causes of distal clavicular osteolysis?

A

SHIRT Pocket

Scleroderma
Hyperparathyroidism
Infection
RA
Trauma 
Progeria
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32
Q

Total compartmental involvement (GH, AC, Subacromial) in the shoulder suggest what kind of process?

A

Inflammatory

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33
Q

What findings suggest psoriatic over RA in the shoulder?

A

Preserved mineralization
ossification at the rotator cuff attachment and CC ligament
less prominent erosive disease

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34
Q

A Hatchet deformity, or large erosion of the superolateral aspect of the humeral head, suggests what?

A

Ankylosing spondylitis

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35
Q

Inferolateral displacement of the humeral head with subchondral cysts suggest what?

A

Hemophilia

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36
Q

What two diseases do not cause joint space loss in the shoulder

A

HADD, osteonecrosis

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37
Q

What is the most common cause of shoulder pain?

A

HADD, or calcific tendinitis

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38
Q

What is hadd?

A

Amorphous calcification in one of the tendons surrounding the joint

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39
Q

What are the two types of joint in the SI joint?

A

True synovial - anteroinferior 1/3

Diarthrodal cartilaginous - posterior 2/3

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40
Q

Where do disease processes usually affect first in the SI joint?

A

Iliac side due to the relative thinness of the overlying cartilage

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41
Q

With regards to the SI joint, what causes widening? narrowing? irregularity in the width?

A

Widening: infection, inflammatory
Narrowing: RA
irregular: crystalline arhtropathies, OA

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42
Q

What separates an erosion in the SI joint involved with gout vs inflammatory arthropathy?

A

Gout will have a sclerotic well-defined border

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43
Q

Where is the sclerosis seen in osteitis condensans ilii

A

wedge shaped on the iliac side

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44
Q

Anterior osteophyte formation of the SI joint is seen in what two diseases

A

Crystalline arthropathy and OA

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45
Q

Calcified abscess in front of the SI joint is suggestive of what?

A

TB

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46
Q

Where is the tophi in SI gout

A

anterior inferior aspect

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47
Q

Osteitis condesans ilii is associated with what other pelvic ring abnormality? Which view demonstrates it?

A

Pubic symphisis instability

Flamingo view - shifting weight

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48
Q

What are sharpeys fibers?

A

The outermost fibers of the annulus fibrosus, that not covered by the endplate cartilaginous cap

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49
Q

What is the difference between the PLL and ALL in terms of attachment to the vertebral body?

A

The ALL pulls away from the vertebral body approximately 3mm from the end of the body. The PLL is closely adhered the entire length of the body.

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50
Q

What is a syndesmophyte? What condition is it seen in?

A

Vertical ossification bridging two adjacent vertebral bodies; it is the ossification of sharpeys fibers

Ankylosing spondylitis

Can be seen in psoriatic/reiters/IBD

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51
Q

What is a marginal osteophyte? What condition is it seen in?

A

Horizontal bone extension of the vertebral endplate with contiguous cortex and medulla

Seen with degenerative disc disease and spondylosis deformans

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52
Q

What is a nonmarginal osteophyte? What condition is it seen in?

A

horizontal extension or osteophyte observed 2-3 mm away from the actual vertebral endplate.

Small ones are seen with DDD and spondylosis deformans and are calles “traction” osteophytes and signify instability

When large enough, can turn vertically and form bridging nonmarginal syndesmophytes, these are seen with psoriatic and reiters

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53
Q

What are paraspinal phytes? What are they seen in?

A

ossification of the soft tissue structures that surround the vertebral body,

PLL in DISH

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54
Q

What is the definition of disc height loss?

A

Disc height equal to or less than the preceding level

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55
Q

What are the radiographic findings in DDD

A

Disc height loss, vaccuum phenomenon, calcification, marginal/nonmarginal osteophytes, subchondral bone repair

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56
Q

What are the spine findings in acromegaly?

Ochronosis (alkaptonuria)?

Neuropathic spine?

A

A - DDD with increased AP diameter of the vertebral body

O - DDD with calcs/vaccuum and ABSENCE of osteophytes

N - extreme DDD with reparative bone, massive osteophytes, bony fragmentation

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57
Q

What is spondylosis deformans?

A

Small marginal and or nonmarginal osteophytes WITHOUT disc space loss or DDD

Degeneration of sharpeys fibers

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58
Q

What is ankylosing spondylitis?

A

Ossification of sharpeys fibersand deep ALL

ascends from lumbar to cervical leading to bamboo spine

disc spaces are maintained

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59
Q

how do psoriatic and reiters appear in the spine

A

Asymmetrical and exuberant

Usually bridging nonmarginal osteophytes with preservation of disc space

Indistinguishable, but psoriasis tends to affect spine much more than reiters

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60
Q

How does DISH present in the spine?

A

Excessive ossification anterior to the vertebral bodies

DOESNT ossifiy sharpeys fibers unlike AS, so there will be a lucent Y or T shaped configuration where the ALL pulls away from the vertebral body

Must affect at least 4 contiguous vertebral segments

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61
Q

How does one differentiate between DISH and inflammatory spondyloarthropathy?

A

DISH will not affect the SI joints

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62
Q

What are the common radiographic findings in RA?

A 
Periarticular soft tissue swelling
Juxtaarticular/generalized osteoporosis
Uniform joint space loss
Lack of bone formation
Marginal erosions
Synovial cysts
Subluxations
Symmetrical distribution
Hands > feet > knees > hips > cervical spine > shoulders > elbows
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63
Q

What are the earliest radiographic changes in RA?

A

soft tissue swelling and juxtaarticular osteoporosis

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64
Q

Where are RA erosions first seen in the hand? Where do they occur in the wrist?

A

radial aspect of base of proximal phalanges

navicular waist, capitate waist, articulation of hamate with base of fifth metacarpal, first CMC, radial/ulnar styloid

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65
Q

What is the distribution of ankylosis in late stage RA?

A

CMC only, will not see bony ankylosis distal to the carpals

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66
Q

Where do erosions affect the feet first? lateR?

A

Lateral aspect of fifth metatarsal head, followed by other metatarsal head medial aspect then lateral aspect

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67
Q

What are the hip findings in RA?

A

Acetabular protrusion, erosions, osteoporosis

ABSCENCE of osteophytes and bony remodeling

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68
Q

What are the knee findings in RA?

A

Uniform joint space loss, subchondral cysts,

LACK of erosions, bone reparation, osteophytes

69
Q

What is unique about RA in the ankle?

A

Formation of periosteal reaction along the posterior tibia

must be distiguished from stress fracture

70
Q

What is the most frequent finding in the spine in RA?

A

Atlantoaxial instability - laxity of the transverse ligament holding the odontoid in place

71
Q

Where in the head does RA commonly affect?

A

TMJ

72
Q

What are the common radiographic findings in psoriatic arthritis?

A 
Fusiform soft tissue swelling (sausage digit)
Normal bone mineralization
Joint space loss
Bone proliferation
Pencil in cup erosions
Asymmetry
Hands > feet > SI joint > spine
73
Q

What is the main radiographic difference between RA and psoriatic arthritis?

A

Psoriatic has bone proliferation

74
Q

Where does bone proliferation with psoriatic arthritis occur in the hand? How does it appear?

A

adjacent to erosions, along the shaft, at insertions of tendons and ligaments

Can be exuberant and fluffy or resemble periostitis

75
Q

What is the distribution of psoriatic arthritis in the hand? How does it differ from RA?

A

DIP/PIP involvement&raquo_space; MCP or carpal

Skip involvement of PIP/MCP (RA will be uniform) and bone proliferation

76
Q

Differentiate psoriatic from ankylosing involvement in the spine?

A

Psoriatic will have bulky bony outgrowtsh unilateral/asymmetric

AS will have symmetric, with (1) squaring of the vertebral body and (2) involvement of the apophyseal joint

77
Q

What is the key feature that differentiates psoriatic from RA and from ankylosing spondylitis?

A

RA - bony proliferation and normal mineralization

AS - erosion

78
Q

What are the classic radiographic findings in Reiters? How is it differentiated from psoriatic?

A

Fusiform soft tissue swelling
Early osteoporosis with late normalization
Uniform joint space loss
Bone proliferation
Ill defined erosions
Asymmetric
Feet > ankles > knees> SI joints > hands > hips

Distribution is key differentiating feature from psoriatic

79
Q

Most common joint involved in reiters?

A

small joints of foot and calcaneus

80
Q

Foot distribution of reiters vs psoriatic

A

R - MTP and 1st IP

P - PIP and DIP

81
Q

What are the early foot findings in reiters? late?

A

Early - juxta articular osteoporosis, periostitis

Late - uniform joint space loss, marginal erosions

82
Q

What is unique about calcaneal spurring in psoriatic and reiters?

A

Will angle up towards calcaneus

83
Q

Fluffy periostitis of the distal fibula and tibia suggest which arthritis?

A

Reiters

84
Q

What is the key feature differentiating reiters from psoriatic?

A

Distribution

lower extremity in reiters

85
Q

What are the classic radiologic findings in ankylosing spondylitis?

A

Normal mineralization prior to ankylosis/osteoporosis after ankylosis
Subchondral bone formation
Small erosions
NO subluxation or cysts
Ankylosis
symmetric
SI and spine > hips > shoulders > knees > hands > feet

86
Q

What is the “star” refer to in AS SI involvement?

A

Ossification of the posterior superior ligaments can resemble a star

87
Q

Where is initial spine involvement in AS?

A

T12 - L1

88
Q

What are the changes associated with early AS in the spine?

A

Romanus lesions - small erosions of the corners of the vertebral body

Shiny corner - secondary reactive sclerosis

Squaring of the vertebral body

89
Q

Earliest finding in the spine in AS?

A

Lack of motion on flexion and extension views

90
Q

What are the c spine findings in AS? What is the danger?

A

erosion of the odontoid and atlanto axial subluxation

can fracture during intubation

91
Q

What are the two types of AS involvement in the SI joint?

A

Destructive - unilateral, less common, destruction of femoral head and irregularity leading to ankylosis

Nondestructive - more common, younger, bilateral, few erosions with a collar of osteophytes preceeding ankylosis

92
Q

Excessive ossification of the coracoclavicular ligament is seen in what disease?

A

AS

93
Q

What are the classic radiographic findings in OA?

A 
Normal mineralization
Nonuniform joint space loss
Absence of erosions
Subchondral new bone formation
Osteophytes
Cysts
Subluxations
Asymmetrical
Hands > feet > knees > hips
94
Q

Differentiate primary from secondary OA

A

Primary joint space loss is nonuniform

Secondary is uniform

95
Q

What is a heberden node? bouchard?

A

heberden is soft tissue swelling surrounding the DIP

bouchard is soft tissue swelling surrounding the PIP

96
Q

What is the difference between the osteophyte in OA and the periostitis in RA and the overflanking in psoriatic

A

OA - extension of a normal articular surface

RA - development of new bone

Psoriatic - false appearance of overhanging due to erosion

97
Q

The wrist findings in OA are very specific. Describe them.

A

JS narrowing, osteophytosis, subchondral sclerosis and cyst formation

Involves only the 1st CMC and trapezium-navicular articulations. If other carpal involvement, likely another process

Radial subluxation of 1st metacarpal on trapezium

98
Q

Who gets erosive arthritis usually?

A

Post menopausal females

99
Q

What is the main difference between OA and erosive OA?

A

Erosive OA has on overlying inflammatory component

100
Q

What is the difference between erosive OA and psoriatic?

A

EOA - central erosions (seagull), osteophytes

P - marginal erosions, no psteophytes

101
Q

Where is osteophyte/new bone formation in the hip in OA?

What is the mechanism

A

Ophyte - medial femoral head

New bone - medial cortex

Due to incongruity of femoral head stress secondary to superolateral migration

102
Q

What are the two cysts in OA?

A

Inclusion - immediately subchondral

Contusion - far from joint, completely enclosed in bone

103
Q

Within the knee in OA, where does the tibia sublux relative to the femur? Where is the most common site of osteophyte formation

A

Lateral

Medial aspect medial condyle

104
Q

What do bony excrescences in the knee in OA represent?

A

areas of cartilage loss

105
Q

What are the spine findings in OA?

A

Affects the apophyseal joints only; joint space loss, bony sclerosis

106
Q

Disc height loss, osteophyte formation and subchondral bone sclerosis in adjacent vertebral bodies in the spine in the setting of OA should be called what?

A

Degenerative disc disease

the disc is not a synovial joint, and OA is a synovial process

107
Q

What are the radiologic findings in a hypertrophic joint? (chronic)

A 
dissolution of the articulation
severe subluxation/dislocation
new bone formation
mammoth osteophytes
fragmentation and osseous debris
asymmetric involvement
foot > ankle > knee
108
Q

What is the most common finding of neuropathic osteoarthropathy in the foot

A

long standing lisfranc fracture-dislocation with extensive eburnation and fragmentation around the TMT joints

109
Q

What joints are involved most commonly neuropathic in tabes dorsalis

A

knee and hip

110
Q

What are the radiographic features in an atrophic joint? (acute)

A

extensive bone resorption
sharp edges resembling surgery
normal mineralization in adjacent bone
absence of bone repair

surgical joint with bony debris in the soft tissues

111
Q

What is the most common cause of neuropathic OA in the shoulder

A

syringomyelia

112
Q

What are the characteristic findings in DISH?

A 
normal mineralization
flowing ossification of at least 4 contiguous vertebral bodies
preservation of disc spaces
appendicular ligamentous ossification
absence of joint abnormality
113
Q

whiskered iliac crests, ischial tuberosities, and femoral trochanters suggests what?

A

Extraspinal DISH

114
Q

Ossification of the pubis symphysis and posterosuperior SI joint (nonsynovial) suggests what

A

DISH

115
Q

Where does DISH affect the knee?

A

Inferior and superior attachment of the patellar tendon

116
Q

What is the main difference between OA and DISH?

A

OA will have joint changes (space loss, vaccuum disc, subchondral sclerosis)

DISH (1) doesnt affect the joint itself and (2) affect ligamentous and tendinous attachments

117
Q

Where does DISH affect the humerus and hand?

A

Humerus - deltoid protuberance

Hand - phalangeal shafts

118
Q

What are the two types of gout? What is the difference radiographically

A

Primary - inborn error of metabolism
Secondary - increased production/decreased excretion

Secondary has no radiographic changes

119
Q

What are the radiographic findings in gout?

A 
Tophi
normal mineralization 
joint space preservation
punched out erosions with sclerotic borders
overhanging cortex
asymmetric
feet > ankles > knees > hands
120
Q

What is a tophus?

A

soft tissue mas created by deposition of urate crystals. Urate is not radiographically opaque, but they can precipitate calcium

121
Q

What is the mechanism behind the gouty erosions?

A

Tophi erode bone in an indolent course. Due to slow process, erosions usually have a sclerotic border, giving a punched out or mouse bite apprearance. As the erosion is progressing the proximal edge of cortex is remodeled in an outward direction creating an overhanging margin

122
Q

Are the changes in gout reversible?

A

No, but the urate crystals can disappear with treatment, so the tophi can be missing with the osseous findings intact

123
Q

Which aspect of the joint does gout affect?

A

Dorsal with preservation of the plantar

124
Q

What differentiates gout from OA at the first MTP

A

The presence of a tophus and bony erosions indicates gout

125
Q

What joint in the hand is preferentially involved in gout

A

CMC

126
Q

Olecranon bursitis is suggestive of what process?

A

Gout

127
Q

What are the two diseases that have an association with CPPD

A

primary hyperparathyroidism and hemachromatosis

128
Q

What three areas should be imaged in suspicion for CPPD

A

knee, wrist, and pubic symphysis

129
Q

What are the characterisitic features of CPPD

A 
Chondrocalcinosis
Normal mineralization
Uniform joint space loss
Subchondral new bone formation
Osteophyte formation
Cysts (moreso than OA)
Bilateral
Knees > hands > hips
130
Q

Preferential patellofemoral joint space loss with a scalloped defect in the anterior aspect of the femoral condyles is indicative of what process

A

CPPD

131
Q

Where in the wrist is CPPD most common

A

TFCC

132
Q

Where in the hand does cPPD affect

A

MCP joints, spares IP

133
Q

What is the step ladder configuration related to CPPD?

A

occurs with dissociation between navicular and lunate with accompanying joint space loss between lunate and capitate.

134
Q

Uniform joint space loss of the hip with suchondral sclerosis and cyst formation without osteophyte suggests what

A

CPPD

135
Q

With regards to distribution, what is the main difference between OA and cPPD

A

CPPD affects nonbearing joints, such as shoulder and elbow

136
Q

What are the characteristic radiographic findings in HADD

A 
Periarticular calcification 
Soft tissue swelling
Normal adjacent bone and joint
Occasional effusion
Occasional osteoporosis
Single joint distribution
Shoulder > hip > wrist > elbow > neck
137
Q

Where does most HADD occur in the shoulder

A

Supraspinatus

138
Q

What is the milwaukee shoulder

A

HADD in the rotator cuff may eventually rupture into the bursa leading to severe secondary arthropathy

139
Q

Where does HADD occur in the hip? elbow? wrist?

A

Hip - gluteal attachments in the greater trochanter
Elbow - medial and lateral condyle of humerus, olecranon bursa
Wrist - FCU which shows as calcification adjacent to pisiform

140
Q

Where does HADD affect the spine

A

longus colli muscle anterior to C2 vertebral body just inferior to atlas

141
Q

What is the physiology behind CPPD in the setting of hemachromatosis

A

Iron blocks pyrophosphatase activity in cartilage, leading to precipitation of CPPD

142
Q

What are the characteristic radiographic findings in hemachromatosis

A 
Osteoporosis
Chondrocalcinosis (hyaline > fibrous (CPPD)
Uniform joint space loss
Subchondral sclerosis
Subchondral cysts
Beak like osteophytes
Symmetric
hand/wrist
143
Q

Where in the hand does hemachromatosis predominantly affect? what are the characteristic features

A

2nd and 3rd MCP

beak osteophyte on medial aspect of 2nd and 3rd metacarpal

Flattening or collapse of metacarpal heads too

144
Q

Which arthropathy has a paint brush appearance?

A

Wilsons

145
Q

What is ochronosis

A

Homogentisic acid oxidase deficiency

Deposits homogentisic acid which precipitates calcium hydroxyapatite

146
Q

What are the characteristic features of ochronosis

A 
Osteoporosis
Disc degeneration
Uniform joint space loss
Extensive subchondral sclerosis
Absence of osteophytes
Intraarticular loose bodies
Symmetric
Spine > knee > hip > shoulder
147
Q

Differentiate ochronosis from AS in the spine

A

Ochronosis has loss of disc space with vaccuum phenomenon

Also, in the SI joint the changes in ochronosis are more related to OA without erosion or ankylosis

148
Q

What are the radiographic changes in SLE

A 
Soft tissue swelling
Juxta articular osteoporosis
Subluxation and dislocations
absence of erosions and joint space loss
Calcification
Osteonecrosis
Symmetric
149
Q

What is the hallmark of SLE arthritis?

A

Subluxation WITHOUT erosion (RA)

150
Q

How does osteonecrosis show up on imaging

A

The necrosis doesnt show up, its the reparative changes that are visualized

Increased smudgy density (dead or repair bone)
Subchondral lucency (impending collapse)
151
Q

What are the characteristic radiographic findings in scleroderma

A

Resoprtion of the soft tissue of the finger tip
Subcutaneous calcification
Erosion of the distal tuft
Acrosclerosis/amorphous calcification of the distal phalanx

152
Q

How does dermatomyositis present radiographically?

A

Soft tissue calcification along intermuscular fascial planes

153
Q

How does polyarteritis nodosa present radiographically?

A

Periosteal new bone formation limited to the tibia and fibula in a symmetric fashion

154
Q

Preferential ankylosis of the trapezoid in the wrist suggests what?

A

MCTD

155
Q

How does JRA differ from adult RA?

A

(1) periostitis in metaphyses of phalanges, metacarpals, and metatarsals
(2) significant erosive change WITHOUT joint space loss

156
Q

What are the three presentations of stills disease

A

1 - systemic disease without radiographic changes
2 - polyarticular disease with less severe systemic manifestations
3- pauciarticular or monoarticular disease with infrequent systemic manifestations

157
Q

What are the radiographic manifestations of stills disease

A 
Periarticular soft tissue swelling
Osteoporosis
Periostitis
Overgrown or balloon epiphyses
Advanced skeletal maturation
Late joint space and erosion
Ankylosis
Symmetric
158
Q

What are the hand findings in stills disease

A

MCP, PIP, and DIP involvement (vs RA, no DIP)

Periarticular soft tissue swelling and juxtaarticular osteoporosis

Overgrowth and ballooning of the epiphyses with premature closure of the growth plate leading to brachydactyly

Can have epiphyseal compression fractures leading to flattening of the metacarpal heads and cupping of the proximal phalangeal ossification center

159
Q

How does stills affect the wrist

A

Acceleration of growth maturation in the carpals with leads to bony irregularity

leads to ankylosis

usually involves 2/3 compartments (spares radiocarpal)

160
Q

How does stills affect the ankle mortise

A

Tibiotalar tilt secondary to overgrowth of the epiphyses and premature closure of the epiphyseal plate

161
Q

In mono or pauciarticular JRA, which joint is most commonly affected? How?

A

Knee

ST swelling, juxtaarticular osteoporosis

Metaphyseal lucent band (increased blood flow to the synovium)

Overgrowth of the femoral and tibial epiphyses, leads to widened intracondylar notch

squaring of the patella

162
Q

What are the hip findings in stills? what about the c spine

A

Enlargement of the femoral head with acetabular protrusio and flattening of the femoral head due to compression fractures

Ankyloses of the apophyseal joints
What are the mandibular findings

163
Q

What are the mandibular findings in stills

A

shortening of the body and vertical rami of mandible

164
Q

What are the articular changes in hemophilia

A 
Radiodense soft tissue swelling
Osteoporosis
Overgrown/ballooned epiphyses
Subchondral cysts
Late joint space loss and secondary OA
Asymmetric
Knee > elbow > ankle > hip > shoulder
165
Q

What are the hemophilia findings in the knee

A

Dense soft tissue swelling and joint effusion with overgrowth of the femoral and tibial epiphyses causing widening of the intracondylar notch

Squaring and ballooning of the patella inferiorly

166
Q

What is the finding in the ankle mortise in hemophilia

A

Tibiotalar slant

167
Q

What are the shoulder findings in hemophilia

A

Widened GH space with inferior displacement of the humeral head

Soft tissue swelling with subchondral cyst formation

168
Q

How does a pseudotumor in the bone associated with hemophilia appear

A

Radiolucent lesion with well defined border +/- sclerosis. Septated with varying degrees of cortical destruction and periosteal bone formation

169
Q

What are the main differentiating features between JRA and hemophilia

A

Hemophilia will have radiodense soft tissue secondary to blood as well as SUBCHONDRAL CYSTS

MSK (8 decks)

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