Congenital degenerative and infective bone and joint diseases Flashcards
Imaging modalities fo skeleton
Convential X-ray in two planes
CT imaging for trauma and complex bone lesions.
MRI is used to visualize inflammatory diseases or microfractures of the bones.
MRI also for the joints, ligaments, tendons, menisci.
What is used for bone scintigraphy
Tc-MDP, Bisphosphonate.
Bisphosphonate uptake indicates bone turnover.
Fracture types not actually a topic.
Linear fracture
Incomplete fracture
Comminuted fracture - fragmented
Impacted fracture - telescoped fracture, one bone smashed into theo other
Stress fracture - may not be visible on X-Ray. evident later by increased bone density or callus formation
Chip fractures
Avulsion fractures - small peice of bone ripped off the rest of the bone, by a tendon or ligament.
Pathologic fracture
Articular fracture - a fracture through a joint surface
Greenstick fracture - in children, with a bend like a green stick.
Fractures through the epiphyseal growth plate - in children.
Degenerative joint diseases, list
Osteoarthritis
Rheumatoid arthritis
Psoriatic arthritis
Ankylosing Spndylitis
Reiter’s syndrome
Osteoarthritis characteristics and cause
Results from the age/stress related breakdown of cartilage bewteen joints.
Involves the large weight bearing joints - Knees, Hip joints.
In the upper extremity, involves the distal interphalangeal joints and spares the more proximal hand joints.
The facet joints of the spine are also affected.
Sacroilliac joint is also affected.
Osteophytes - aka new bone growth spurs - are the major sign of osteoarthritis.
Rheumatoid arthritis, what joints are affected, what are the major pathological signs.
Predominantly affects the small proximal interphalangeal joints and the metacarpal-phalangeal joints of the hands and feet.
Also affects the cervical spine commonly.
The hands and feet are the most common sites but it can affect any synovial joint.
Erosions and inflammation are present in the joints.
PANNUS formation inflammatory proliferation of the synovium.
Erosions of the cartilage and underlying bone.
The earliest erosions appear at the “bare areas” of the joints. which do not articulate directly and are not covered by cartilage.
Ankylosing Spondylitis, what joints are affected
Affects several joint types: Synovial joints Cartilaginous joints (vertebral discs, symphsis)
Also affects ligament and tendon attachment sites.
Sacroilliac joint is affected early and often, and sacroiliitis is the hallmark of ankylosing spondylitis. Always eventually affects bilaterally and symmetrically, which is important diagnostically.
Strongly affects the axial skeleton.
Sacroiliac, Vertebral Discs, vertebral articular joints ‘apophyseal joints’
Costovertebral joints.
What imaging is used to diagnose Ankylosing Spondylitis.
Joint changes: seen best by MRI, STIR imaging can show the inflammation and edema well at the sacroilliac joint.
Synovial inflammation
Suchondral edema
Other characteristics of Ankylosing Spondylitis.
Osteoporosis is usually prominent in ankylosing spondylosis.
Fusion of the sacroilliac joints and vertebral and permanent scoliosis/spinal deformity.
Sharpeys fibers due to vertebral annulus fibrosus.
Paravertebral ossification
Psoriatic arthritis
Very similar to Rheumatoid arthritis, but with less symmetrical changes, also……..it specifically occurs in people with psoriasis!
More involvement of the distal interphalangeal joints.
About half have sacroiliac joint changes, but they are not always symmetric.
Erosions and sclerosis occur, and the joint can become either widened or ankylosed.
Reiter’s syndrome
Reactive arthritis, is a classic triad of conjunctivitis, urethritis, and arthritis occurring after an infection, particularly those in the urogenital or gastrointestinal tract.
Asymmetric arthritis of the legs, sacroilliac joint and feet, Sometimes with spondylitis. Spares the upper extremity.
Osteomyelitis, how is it best visualized
What are the signs of acute v chronic osteomyleitis
Infection of the bone.
MRI provides earliest detection.
X-ray signs take longer. They are:
Lytic lesion
Loss of cortical margins
New bone formation under the periosteum
Chronic:
Altered bone architeture
Areas of lytic lucency, surrounded by sclerosis
Areas of irregular cortical thickening.
Characteristics of senile osteoporosis
Loss of bone (osteopenia) with age.
Especially in postmenopausal women.
Thinning of the spongy bone.
Pathologic compression fractures
Common sites:
Vertebral bodies
Neck of the femur
Signs of osteoperosis on X-ray
Anterior wedging and increased concavity of vertebral bodies, esp in the lumbar.
Other causes of osteoperosis besides age
Cushings syndrome, especially iatrogenic cushings or prolonged steroid treatment
Hyperthyroidism
Acromegaly
Pregnancy
Disuse osteoporosis - diffuse osteopenia throughout the specific bone, with prolonged immobilization. Reversible
Osteomalacia definition and causes
Inadequate mineralization of the bone.
Vitamin D deficiency,
Renal tubular phosphate wasting.
Osteomalacia characteristic X ray signs
Decreased bone density, and subsequent increased contrast and visualization of the trabecular pattern.
Cortical thinning with cortical striations.
Looser’s zones aka Milkman lines - Pseudofractures or insufficiency fractures going perpendicularly to the bone cortex, lucent.
Hyperparathyroidism bone changes
Generalized osteopenia.
SUBPERIOSTEAL RESORPTION specifically, is pathognomonic for hyperPTH.
Specifically! Occurs first on the Radial aspect of the Middle and Distal phalanges of the index and middle fingers.
Congenital disorders mentioned
Achondroplasia - autosomal dominant, but not severe, long life span.
Selectively shortened extremities and mostly normal growth of spine and skull.
Impaired endochondral bone growth, impairing the growth of epiphyseal plates of long bones.
The facial bones are smaller however, and can cause prominent neurological problems due to small foramina for the cranial nerves.
Osteogenesis imperfecta
Autrosomal dominant as well.
Caused by mutations to Collagen 1 gene.
Severely impaired collagen formation
Affects ligaments, bones, skin, sclera, teeth.
Blue sclera, malformed teeth.
Multiple fractures during birth or even before birth.
Renal failure in many patients
Growth retardation and easy to fracture.
Congenital hip dysplasia:
More frequent in girls 9:1
Acetebular rim development, ligament looseness, muscles contrating, or intrauterine subluxation all can contribute. Children should be screened for this, and it is done by Ultrasound. Is fixed by reduction and/or hip harnesses.
