Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

KEVIN BURANT IV > Chapter 43 - Arthritis (CHERI NOTES) > Flashcards

Chapter 43 - Arthritis (CHERI NOTES) Flashcards

1
Q

______ or _____ ; is the most common arthritide. (p. 1043)

A

OSTEOARTHRITIS or DEGENERATIVE JOINT DISEASE

  • it is believed to be caused by trauma either overt or as an accumulation of microtrauma over years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A hereditary form of osteoarthritis that occur primarily in women. (p.1043)

A

PRIMARY OSTEOARTHRITIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Enumerate the three hallmarks of degenerative joint disease. (p.1043)

A
  1. Joint space narrowing
  2. Sclerosis
  3. Osteophytosis
  • if all three of these findings are not present on the radiograph; another diagnosis should be considered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Least specific finding out of the three hallmarks of degenerative joint disease (p.1043)

A

JOINT SPACE NARROWING

  • yet is it virtually always present in DJD
  • unfortunately; joint space narrowing is also seen in almost every other joint abnormality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TRUE OR FALSE?
Sclerosis should be present in varying amounts in all cases of DJD unless severe osteoporosis is present. (p.1043)

A

TRUE

  • Osteoporosis will cause the sclerosis to be diminished
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The only disorder that will cause osteophytes without sclerosis or joint space narrowing is ____. (p.1043)

A

DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS

  • a common bone-forming disorder that at first glance resembles DJD; except that there is no joint space narrowing (or disc space narrowing in the spine) and there is no sclerosis.
  • not believed to be caused by trauma or stress as is DJD and is not painful or disabling as DJD can be.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Osteoarthritis is divided into two types: ______. (p.1043)

A

PRIMARY OSTEOARTHRITIS; SECONDARY OSTEOARTHRITIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TRUE OR FALSE?

SECONDARY OSTEOARTHRITIS is what radiologist refer to when speaking of DJD. (p.1043)

A

TRUE

  • It is; as mentioned; secondary to trauma of some sort.
  • it can occur in any joint in the body but is particularly common
    in hands; knees; hips and spine.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

______ is a familial arthritis that affects middle-aged women
almost exclusively and is seen only in the hands. (p.1043)

A

PRIMARY OSTEOARTHRITIS

  • it affects the distal interphalangeal joints; the proximal interphalangeal joints; and the base of the thumb in a bilaterally symmetrical fashion.
  • if it is not bilaterally symmetrical; the diagnosis of primary osteoarthitis should be questioned.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A type of primary osteoarthritis that can be very painful and
debilitating is _____. (p.1043)
It has the identical distribution mentioned for primary
osteoarthritis but is associated with OSTEOPOROSIS OF THE
HANDS; as well as erosions.

A

EROSIVE OSTEOARTHRITIS

  • it is uncommon; and radiologists generally see little of this
    disorder.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Other name for EROSIVE OSTEROARTHRITIS? (p.1043)

A

KELLGREN ARTHRITIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Enumerate the 4 joints which also exhibit EROSIONS aside from the classic triad of degenerative joint disease. (p.1043)

A
  1. TEMPOROMANDIBULAR JOINT
  2. ACROMIOCLAVICULAR JOINT
  3. SACROILIAC JOINTS
  4. SYMPHYSIS PUBIS
  • when erosions are seen in one of these joints; DJD must be
    considered or inappropriate treament may be instituted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

TRUE OR FALSE?

A SUBCHONDRAL CYST or GEODE is often found in joints affected with DJD. (p.1043)

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

_____ are cystic formations that occur around joints in various
disorders (including; in addition to DJD; rheumatoid arthritis;
calcium pyrophosphate dihydrate crystal deposition disease
and avascular necrosis (AVN)).

A

GEODES

  • One method of geode formation; is that synovial fluid is forced into the subchondral bone; causing a cystic collection of joint fluid
  • Another etiology is following a bone contusion in which the contused bone forms a cyst
  • they rarely cause problems themselves but are often misdiagnosed as something more sinister.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

_____ is a connective tissue disorder of unknown etiology that can affect any synovial joint in the body. (p.1044)

A

RHEUMATOID ARTHRITIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Enumerate the *6 Radiographic hallmarks of RHEUMATOID ARTHRITIS. (p.1044)

*prev 4 (corrected)

A
  1. SOFT TISSUE SWELLING
  2. OSTEOPOROSIS
  3. JOINT SPACE NARROWING
  4. MARGINAL EROSIONS
  5. BILATERAL SYMMETRICAL
  6. PROXIMAL
    • in the hands; it is classically a proximal process that is bilaterally symmetrical
  • smoon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In the hip (with Rheumatoid Arthritis); the femoral heads
tends to migrate _____; whereas in osteoarthritis;
it tends to migrate _______. (p.1044)

A

HIP: femoral heads migrate….
RHEUMATOID ARTHRITIS - AXIALLY;
OSTEOARTHRITIS - SUPEROLATERALLY.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In the shoulder (with Rheumatoid Arthritis); the humeral

head tends to be “________”. (p.1044)

A

HIGH-RIDING

  • other things to think of when confronted with a high-riding shoulder are a torn rotator cuff and CPPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A group of diseases that was formerly known as rheuma-
toid variants is now known as the seronegative; _____.
(p.1047)

A

HUMAN LEUKOCYTE ANTIGEN B27 (HLA-B27)-
POSITIVE SPONDYLOARTHROPATHIES

  • these disorders are all linked to the HLA-B27 histocompatibility antigen
  • included in this group of diseases are:
    1. Ankylosing spondylitis
    2. Inflammatory bowel disease
    3. Psoriatic Arthritis
    4. Reiter syndrome (also called REACTIVE ARTHRITIS)
  • they are characterized by bony ankylosis; proliferative new-bone formation; and predominantly axial (spinal) involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

One of the more characteristic findings in HLA-B27 Spondyloarthropathies disorders. (p.1047)

A

SYNDESMOPHYTES IN THE SPINE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A ______ is a paravertebral ossification that resembles

an osteophyte; except that is runs VERTICALLY. (p.1047)

A

SYNDESMOPHYTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Osteophyte has its orientation in a ___ axis. (p.1047)

A

HORIZONTAL axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

TRUE OR FALSE?
Sometimes it can be difficult to decide whether a particular paravertebral ossification is an osteophyte or a syndesmophyte based on its orientation alone. (p.1047)

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

TRUE OR FALSE?
Bridging osteophytes and large syndesmophytes can have
a similar appearance; with both having an orientation halfway between vertical and horizontal. (p.1048)

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Two classifications of syndesmophytes? (p.1048)

A
  1. MARGINAL and SYMMETRICAL

2. NONMARGINAL and ASYMMETRICAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

A ____ syndesmophyte has its origin at the edge or margin of a vertebral body and extends to the margin of the adjacent vertebral body and extends to the margin of the adjacent vertebal body. (p.1048)

A

MARGINAL syndesmophyte

  • invariably bilaterally symmetrical as viewed on an AP spine film.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

TRUE OR FALSE?
ANKYLOSING SPONDYLITIS classically has marginal;
symmetrical syndesmophytes. (p.1048)

A

TRUE

  • Inflammatory bowel disease has an identical appearance when the spine is involved.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

_______ syndesmophyte are generally large and bulky.

p.1049

A

NONMARGINAL; ASYMMETRICAL SYNDESMOPHYTES

  • they emanate from the vertebral body away from the endplate or margin and are unilateral or asymmetrical as viewed on an AP spine film.
  • PSORIATIC ARTHRITIS and REITER SYNDROME classically
    have this type of syndesmophyte.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

TRUE OR FALSE?

Involvement of the SI joints is common in the HLA-B27 spondyloarthropathies. (p.1049)

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

TRUE OR FALSE?
ANKYLOSING SPONDYLITIS and INFLAMMATORY BOWEL DISEASE typically cause bilaterally symmetrical SI joint disease; which is initially erosive in nature and progresses to sclerosis and fusion. (p.1049)

A

TRUE

  • it is extremely unusual to have asymmetrical or unilateral SI joint disease in these two disorders.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

TRUE OR FALSE?
REITER SYNDROME and PSORIATIC ARTHRITIS can exhibit
unilateral or bilateral SI joint involvement. (p.1049)

A

TRUE

  • it seems that it is bilateral about 50% of the time.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

TRUE OR FALSE?
If there is bilateral; symmetrical SI joint disease; it could be caused by any of the four HLA-B27 spondyloarthropathies. (p.1049)

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

TRUE OR FALSE?
If there is unilateral (or clearly asymmetrical) SI joint involvement; one can exclude ankylosing spondylitis and inflammatory
bowel disease and consider REITER SYNDROME or PSORIATIC DISEASE. (p.1049)

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

TRUE OR FALSE?
Small joint involvement; specifically in the hands and the feet; is not common in ANKYLOSING SPONDYLITIS and INFLAMMATORY BOWEL DISEASE. (p.1050)

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

____ causes a distinctive arthropathy that is characterized
by its distal predominance; proliferative erosions; soft
tissue swelling and periostitis. (p.1050)

A

PSORIASIS

  • proliferative erosions are different from the clean-cut; sharply marginated erosions seen in all other erosive arthritides in that they
    have fuzzy margins with wisps of periostitis emanating from them.
  • the severe forms are often associated with bony ankylosis across jonts and arthritis mutilans deformities.
  • a fairly common finding is a calcaneal heel spur that has fuzzy margins as opposed to the well-corticated heel spur seen in DJD or
    post-trauma.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

The ______ is a commonly affected location in Reiter disease. (p.1050)

A

INTERPHALANGEAL JOINT OF THE GREAT TOE

  • causes identical changes in every respect to psoriasis; with the exception that the hands are not as commonly involved as the feet and Reiter diseae occurs almost exclusively in MEN.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

The ____ arthritides include primarily gout and pseudo-

gout. (p.1050)

A

CRYSTAL-INDUCED ARTHRITIDES

  • Ochronosis and Wilson Disease are so rare that they are not covered in this chapter.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

____ is a metabolic disorder that results in hyperuricemia
and leads to monosodium urate crystals being deposited
in various sites in the body; especially joints. (p.1050)

A

GOUT

  • the actual causes of the hyperuricemia are myriad and
    include heredity.
  • the arthropathy caused by gout is very characteristic
    radiographically.
39
Q

It takes __ to __ years for gout to cause radiographically evident disease. (p.1050)

A

4 to 6 years

  • most patients are treated successfully long before the destructive arthropathy occurs; therefore; gouty arthritis is not commonly encountered.
40
Q

Enumerate the 4 Classic Radiographic findings in gout. (p.1052)

A
  1. WELL-DEFINED EROSIONS
    - often with sclerotic borders or overhanging edges;
  2. SOFT TISSUE NODULES
    - that calcify in the presence of renal failure
  3. RANDOM DISTRIBUTION
    - in the hands
  4. NO MARKED OSTEOPOROSIS
41
Q

TRUE OR FALSE?
Even though erosions with overhanging edges occur
with gout; they can occur in other disorders as well and
are by no means pathognomonic. (p.1052)

A

TRUE

  • the sclerotic margins of the erosions are rarely seen in any other arthritide; therefore; this is a very useful differential point.
42
Q

Gout typically affects the ___ of the great toe. (p.1052)

A

METATARSOPHALANGEAL JOINT OF THE GREAT TOE

  • in the advanced stages; it can be very deforming
43
Q

Patients with gout often have chondrocalcinosis because

they have a predisposition for ____. (p.1052)

A

PSEUDOGOUT (CPPD)

  • as many as 40% of patients with gout concomitantly
    have CPPD
44
Q

Classical triad of PSEUDOGOUT (Calcium Pyrophosphate

Dihydrate Crystal Deposition Disease-CPPD). (p.1052)

A
  1. PAIN
  2. CARTILAGE CALCIFICATION
  3. JOINT DESTRUCTION
  • the patient may have any combination of one or more of this triad at any one time.
  • each of these is addressed individually
    in some detail in this chapter; but note that two
    of the three are radiographic findings.
  • this is a disorder that is best diagnosed
    radiographically.
45
Q

TRUE OR FALSE?
The pain of CPPD is nonspecific.
It can mimic that of gout (hence the term “pseudogout”)
or infection or just about any arthritis. (p.1052)

A

TRUE

  • it is typically intermittent for a large number of years
    until DJD occurs and becomes the main cause of pain.
46
Q

Cartilage calcification; known as ______; can occur in any
joint but tends to affect a few select sites in most
patients. (p.1052)

A

CHONDROCALCINOSIS

  • the few select sites of chondrocalcinosis are the following:
    1. medial and lateral compartments of the knee
    2. the triangular fibrocartilage of the wrist
    3. symphysis pubis
  • chondrocalcinosis in these areas is virtually diagnostic of CPPD
47
Q

TRUE OR FALSE?
When CPPD crystals occur in the soft tissues; such as in the
rotator cuff of the shoulder; a radiograph cannot differentiate between CPPD and calcium hydroxyapatite; which occurs in CALCIFIC TENDINITIS. (p.1052)

A

TRUE

  • Calcium hydroxyapatite does not occur in the joint cartilage except in extremely unusual cases; therefore; all chondrocalcinosis can be considered to be secondary to CPPD.
48
Q

TRUE OR FALSE? (in PSEUDOGOUT)

- The joint destruction or arthropathy is virtually indisinguishable from degenerative joint disease.(p.____)

A

TRUE

  • it is caused by CPPD crystals eroding the cartilage.
49
Q

The degenerative joint disease of CPPD has a proclivity

for the following:_______ (give 5). (p.1053)

A
  1. SHOULDER
  2. ELBOW
  3. RADIOCARPAL JOINT in the wrist
  4. PATELLOFEMORAL JOINT of the knee
  5. METACARPOPHALANGEAL (MCP) joints in the hand
  • these are areas not normally involved by DJD of
    wear and tear (such as in the distal interphalangeal joints
    of the hand; the hip; and the medial compartment of the
    knee.)
50
Q

Occasionally; the arthropathy of CPPD causes such severe
destruction that a neuropathic or Charcot joint is mimicked on
radiograph. This has been termed a _____ joint. (p.1054)

A

PSEUDO-CHARCOT JOINT

  • it is not a true charcot joint because of the presence of sensation.
51
Q

Enumerate the 3 diseases that have a high degree of association with CPPD. (p.1054)

A
  1. PRIMARY HYPERPARATHYROIDISM
  2. GOUT
  3. HEMOCHROMATOSIS

***(Mnemonic: CPPD P-G-H)
- these are diseases that tend to occur at the same time that CPPD occurs.
- if the patient has one of these three disorders; he or she
is more likely to have CPPD than is a nonaffected person
- there is probably no good reason to work-up every
patient with chondrocalcinosis for one of the three
associated diseases because they are so uncommon
and CPPD is extremely common.

52
Q

Scleroderma; SLE; Dermatomyositis and mixed connective tissue disease are all grouped together as ______. (p.1054)

A

COLLAGEN VASCULAR DISEASES

53
Q

The striking abnormality in the hands of patients with

collagen vascular diseases is ____ and ____. (p.1054)

A
  1. OSTEOPOROSIS
  2. SOFT TISSUE WASTING
  • erosions are generally not a feature of these disorders
54
Q

TRUE OR FALSE?
SYSTEMIC LUPUS ERYTHEMATOSUS characteristically has
severe ulnar deviation of the phalanges. (p.1054)

A

TRUE

55
Q

TRUE OR FALSE?

Soft tissue calcifications are typically present in __ and ____. (p.1054)

A

SCLERODERMA and DERMATOMYOSITIS

56
Q

Identify the soft tissue calcification location for the following:

(p. 1054)
a. Scleroderma
b. Dermatomyositis

A

A. SCLERODERMA - SUBCUTANEOUS

B. DERMATOMYOSITIS - INTRAMUSCULAR

57
Q

______ disease is an overlap of scleroderma; SLE; polymyositis and rheumatoid arthritis. (p.1054)

A

MIXED CONNECTIVE TISSUE DISEASE

  • it has myriad of radiographic findings
58
Q

______ is a disease that causes depostion of granulomatous
tissue in the body; primarily in the lungs; but also in the
bones. (p.1054-1056)

A

SARCOIDOSIS

59
Q

In the skeletal system (SAROCOIDOSIS); it has predilection
for the _____; where it causes lytic destructive lesions
in the cortex. (p.1056)

A

HANDS

  • these often have a so-called lace-like appearance;
    which is characteristic.
  • it can have associated skin nodules in the hands
60
Q

___ is disease of excess iron depostion in tissues
throughout the body leading to fibrosis and eventual
organ failure. (p.1056)

A

HEMOCHROMATOSIS

  • 20 to 50% of patients with hemochromatosis have a
    characteristic arthropathy in the hands that should suggest
    the diagnosis.
61
Q

The classic radiographic changes in HEMOCHROMATOSIS;

are essentially DJD; which involves the______ MCP joints. (p.1056)

A

SECOND THROUGH THE 4th MCP JOINTS

  • up to 50% of patients with hemochromatosis also have CPPD
  • a search should be made for chondrocalcinosis
  • another finding that is often seen in hemochromatosis
    is called SQUARING OF THE METACARPAL HEADS.
  • they appear enlarged and block-like as a result of the large osteophytes commonly seen in this disorder
62
Q

The osteophytes in HEMOCHROMATOSIS are often said to
be _____ because of the unusual way they hang off the
joint margin. (p.1056)

A

“DROOPING”

63
Q

A classic triad has been described (in NEUROPATHIC OR

CHARCOT JOINT) that consists of _____. (p.1056)

A
  1. JOINT DESTRUCTION
  2. DISLOCATION
  3. HETEROTOPIC NEW BONE
  • the radiographic findings for a CHARCOT JOINT are characteristic and almost pathognomonic
64
Q

TRUE OR FALSE?
Progressive joint destruction occurs in a neuropathic joint
because the joint is rendered unstable by inaccurate
muscle action and is unprotected by intact nerve reflexes.
(p.1056)

A

TRUE

65
Q

Heterotopic new bone has also been termed ______
and consists of soft tissue calcification or clumps of
ossification adjacent to the joint.(p.1057)

A

DEBRIS or DETRITUS

  • it too can be present in varying amounts
66
Q

The most commmonly seen Charcot joint today is in ___.

p.1057

A

FOOT OF A DIABETIC

67
Q

Charcot joint typically affects the _____ tarsometatarsal

joints in a fashion similar to a Lisfranc fracture. (p.1057)

A

FIRST and SECOND TARSOMETATARSAL joints

68
Q

TRUE OR FALSE?

Tabes Dorsalis from syphilis is rarely seen today. (p.1057)

A

TRUE

  • more commonly seen is a Charcot Joint in a patient with paralysis who continues to use the affected limb for support
  • a Charcot joint that is also seen on occasiion is the so-called PSEUDO-CHARCOT JOINT IN CPPD.
69
Q

The classic findings for Juvenile Rheumatoid Arthritis

JRA) and Hemophilia are ______. (p.1057

A

OVERGROWTH OF THE ENDS OF THE BONES (epiphyseal enlargement) associated with GRACILE DIAPHYSES.

  • joint destruction might or might not be present
70
Q

A finding that is purported to be classic for JRA and hemophilia is _______. (p.1057)

A

WIDENING OF THE INTERCONDYLAR NOTCH OF THE KNEE

  • this sign can be quite variable and difficult to use
  • it is rarely present when the other classic signs are not also present and obvious
71
Q

TRUE OR FALSE?
Another process that can mimic the findings in JRA and hemophilia is a joint that has undergone disuse from paralysis.
(p.1057)

A

TRUE

72
Q

It has always been said that the reason the epiphyses
are overgrown in JRA and hemophilia is because of the
______. (p.1057)

A

HYPEREMIA

  • however; many other things cause hyperemia without
    affecting the size of the epiphyses (such as Rheumatoid
    Arthritis and infection)
73
Q

The common denominator shared by JRA; hemophilia and

paralysis is ____. (p.1057)

A

DISUSE

  • This is most likely what causes the overgrowth of the ends of the bones seen in all three of these disorders
74
Q

______ is a relatively common disorder caused by a
METAPLASIA OF THE SYNOVIUM resulting in deposition
of foci of cartilage in the joint. (p.1057)

A

SYNOVIAL OSTEOCHONDROMATOSIS

  • most of the time; these cartilaginous deposits calcify and are readily seen on a radiograph.
  • it is most commonly seen in the knee; hip and elbow.
  • up to 30% of the time; the cartilaginous deposits do not calcify
  • In these cases; all that is seen on the radiograph is a JOINT EFFUSION; unless erosion or joint destruction occur.
75
Q

_________ is an uncommon; chronic; inflammatory process of the synovium that causes synovial proliferation. (p.1059)

A

PIGMENTED VILLONODULAR SYNOVITIS (PVNS)

  • a swollen joint with lobular masses of the synovium occurs and causes pain and joint destruction
  • it rarely; if ever; calcifies.
76
Q

Term given for pigmented villonodular synovitis when it occurs in a tendon sheath; which is not unusual.(p.1059)

A

GIANT CELL TUMOR OF TENDON SHEATH and

TENDON SHEATH XANTHOMA

77
Q

TRUE OR FALSE?
Joints with PVNS look radiographically identical to noncalcified synovial osteochondromatosis; yet they are much less commmon.
(p.1059)

A

TRUE

  • therefore; whenever PVNS is a consideration; SYNOVIAL CHONDROMATOSIS should be mentioned.
  • PVNS has a characteristic appearance on MR with low-signal hemosiderin seen lining the synovium on both T1WI and T2WI
78
Q

______ aka as SHOULDER-HAND SYNDROME; REFLEX SYMPATHETIC DYSTROPHY, and CHRONIC REGIONAL
PAIN SYNDROME;
- a poorly understood joint affliction that typically occurs after minor trauma to an extremity; resulting in pain; swellling and dysfunction (p.1060)

A

SUDECK ATROPHY

  • Severe; patchy osteoporosis and soft tissue swelling are seen radiographically
  • typically affects the distal part of an extremity such as hand or foot; yet; intermediate joints such as the knee and the hip are believed by some to be occasionally involved.
  • the pain usually subsides; but the osteoporosis may persist
  • the swelling; with time; will subside and the skin may become atrophic
  • it is important of the radiologist to recognize the aggressive osteroporosis in this disorder and differentiate it from disuse osteoporosis so that the treating physician can begin aggresive
    physical therapy
79
Q

TRUE OR FALSE?
In the setting of trauma to the elbow; an effusion indicates
a fracture. (p.1061)

A

TRUE

80
Q

The only fat pad around the hip that gets displaced with
an effusion is the ________; and it is uncommonly seen.
(p.1061)

A

OBTURATOR INTERNUS

81
Q

The radiographic sign for a knee effusion that seems to be
the most reliable is the measurement of the _______.
(p.1061)

A

DISTANCE BETWEEN THE SUPRAPATELLAR FAT PAD and
the ANTERIOR FEMORAL FAT PAD

  • a distance between these two fat pads of MORE THAN
    10 MM is definite evidence for an EFFUSION
  • a distance of LESS THAN 5 MM is NORMAL
  • a distance of 5 TO 10 MM is EQUIVOCAL
  • it does not make any difference if there is an effusion
    in the knee - regardless; the patient gets treated the same
  • if it were vital to the patient; one could aspirate the joint
    or perform an MR study to find out
  • I should point out that an MR should never be performed
    just to seen whether there is fluid in the joint
82
Q

TRUE OR FALSE?
Shoulder effusions are very difficult to detect unless they
are massive enough to displace the humeral head inferiorly;
as with a fracture and hemarthrosis. (p.1061)

A

TRUE

  • fortunately; as with most other joints;treatment is not based solely on the presence of absence of an effusion; so it hardly matters.
  • the same is true in the ankle; wrist and smaller joints.
83
Q

_______ can occur around almost any joint for a host of
reasons including steroids; trauma; various underlying
disease states; and even idiopathically.
- it is often seen in renal transplant patients (p.1061)

A

AVASCULAR NECROSIS (AVN) or OSTEONECROSIS

84
Q

The hallmark of AVN is________. (p.1061)

A

INCREASED BONE DENSITY AT AN OTHERWISE NORMAL JOINT

  • increased density at a narrowed joint usually indicates DJD; however; if either osteophytes or joint space narrowing are absent; another disorder should be considered
85
Q

The earliest sign of AVN is a ______. (p.1061)

A

JOINT EFFUSION

  • this often is not visible radiographically or is so nonspecific that it does not help with the diagnosis unless the clinical setting had already raised suspicion for AVN.
  • the next sign for AVN is a patchy or mottled density
86
Q

In AVN or OSTEONECROSIS:
In the knee; this density increase can occur throughout
an entire _____;
whereas in the hip; it often involves the entire ______.
(p.1062)

A

entire CONDYLE; entire FEMORAL HEAD

87
Q

The final sign in AVN is ______. (p.1062)

A

COLLAPSE OF THE ARTICULAR SURFACE and
JOINT FRAGMENTATION

  • I must stress that these changes all occur on only one side of a joint; which makes for an easy diagnosis because almost everything else around joints involves both sides of the joint
88
Q

TRUE OR FALSE?
MR is extremely useful in evaluating AVN. It is the most
sensitive imaging study available; often showing AVN when plain films or radionuclide scans are normal. (p.1062)

A

TRUE

89
Q

In the hip; AVN typically has an area of low signal or
mixed signal on T1WIs; which is located in the _____.
(p.1062)

A

ANTEROSUPERIOR PORTION OF THE FEMORAL HEAD

  • if the anterior portion of the femoral head is not involved;
    the diagnosis of AVN should be questioned; as it is uncommon
    to present otherwise
  • posterior femoral head of AVN can occasionally be found after
    posterior dislocation of the hip because of impaction of the
    femoral head on the posterior column of the acetabulum
90
Q

A form of AVN that is smaller and more focal than that

just described is ______. (p.1062)

A

OSTEOCHONDRITIS DISSECANS

  • it is most likely caused by trauma; however; this is controversial; with one school of thought believing the cause is idiopathic.
  • it occurs most often in the KNEE at the MEDIAL EPICONDYLE
  • it also is frequently seen in the DOME OF THE TALUS (foot) and occasionally in the CAPITELLUM (elbow)
91
Q

Osteochondritis dissecans frequently leads to a small fragment of bone being sloughed off and becoming a free fragment in the joint; a “ _____”. (p.1064)

A

“JOINT MOUSE”

92
Q

TRUE OR FALSE?

AVN is one of the disorders around joints in which subchondral cyst or geodes can occur. (p.1064)

A

TRUE

  • it is the only one of the 4 disorders (rheumatoid arthritis; DJD; and CPPD being the others) that can have an essentially normal joint and have a geode.
  • the other abnormalities will have any or a combination of joint space narrowing; osterophytes; osteoporosis;chondrocalcinosis or other findings
93
Q

____ - a host of names have been ascribed to certain bones
with AVN usually with the eponym being the first person
to describe the disorder. (p.1064)

A

OSTEOCHONDROSES

  • they are believed to be idiopathic for the most part but can also occur secondary to trauma.
94
Q 
A few of the more common epiphyses involved in 
osteochondroses are the following:
(Identify their eponyms):
1. CARPAL LUNATE - \_\_\_\_\_\_\_\_\_\_\_\_\_
2. TARSAL NAVICULAR - \_\_\_\_\_\_\_\_\_\_
3. METATARSAL HEADS - \_\_\_\_\_\_\_\_\_
4. FEMORAL HEAD - \_\_\_\_\_\_\_\_\_\_\_\_\_
5. RING EPIPHYSES OF THE SPINE: _
6. TIBIAL TUBERCLE: \_\_\_\_\_\_\_\_\_\_\_\_\_
A
  1. CARPAL LUNATE - Kienbock Malacia
  2. TARSAL NAVICULAR - Kohler disease
  3. METATARSAL HEADS - Freiberg infraction
  4. FEMORAL HEAD - Legg-Perthes disease
  5. RING EPIPHYSES
    OF THE SPINE: - Scheuermann disease
  6. TIBIAL TUBERCLE: - Osgood-Schlatter disease
    (also called SURFER KNEES)
  • MR can be very useful in identifying AVN in these sites
  • it shows diffuse low signal on T1WIs; which involves the
    entire area of AVN

KEVIN BURANT IV (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions