Intro, degenerative part 1 Flashcards
General description of inflammatory joint disease
Soft tissue swelling, edema, uniform loss of joint space, erosions juxta-articular osteoporosis
Monoarticular or para-articular
Systemic pattern
Greater predisposition to ankylosis
General description of degenerative joint disease
Nonuniform loss of joint space, osteophytes, subchondral sclerosis, cysts
Asymmetric
Describe T1 MR
Short time repitition, short time echo
Black CSF, white bone marrow
Describe T2 MR
Long time repitition, long time echo
White CSF, black bone marrow
General description of metabolic joint disease
Noteable soft tissue masses within periarticular soft tissues
Well marginated bone lesions
Relative preservation of joint space
Overlapping degenerative and inflammatory changes is common
AKA lumpy bumpy arthritis
General description of infectious/septic joint disease
Known cause of grossly destroyed and disintegrated joints
Greatest incidence below 30
Monoarticular moat common
Bloodborne pathogens and direct implantation
Staphylococcus aureus most common organism
Radiographic findings lag behimd clinical
ABCDs pf joint doseases
Alignment Bone Cartilage Distribution Soft tissue
Generalized age onset of each joint disease
0-20 JRA
20-40 seronegative, seropositive
>40 degwnerative, DISH, gout, CPPD
What joints are usually affected in degnerative arthritis?
Weight bearing articulations of the spine, hips and knees
1st MTP, 1st MC trapezium
DIP
How do you get degenerative arthritis? What are some symptoms?
Insidious onset, intermittent exacerbations, aching pain, stiffness, environmental
Changes such as cold and lowered barometric pressure as it may aggravate symptoms
underlying etiology of primary osteoarthritis
no evidence of underlying etiology
underlying etiology of secondary osteoarthritis
abnormal forces including obesity, trauma, and joint deformity
pre-existing cartilage pathology such as RA, fractures and meniscal damage
collapse of subchondral bone, such as avascular necrosis and osteoporosis
risk factors of DJD
age (increased DJD with age) gender (females) obesity trauma (most significant local factor) physical activity (higher impact) inactivity or excessive activity
clinical features of DJD
poor radiographic-clinical correlation stiffness, especially with rest normal blood work spinal stenosis vertebrobasilar ischemia
osteophytes have a _____ cortex and internal structure continuous with the parent bone and capped with____.
distinct
cartilage
general radiology features of DJD
asymmetric distribution asymmetric loss of joint space osteophytes subchondral sclerosis subchondral cysts (geodes) subluxation (midalignments) intra-articular loose bodies entheseopathy ankylosis (rare)
osteophyte definition
bony outgrowths in the locality of capsular insertion. bony excrescences with internal trabeculation and cortex, with a cartilage cap pathologically from carilage metaplasia and ligamentous traction and infrequently will create ankylosis
subchondral sclerosis definition
increased mechanical stresses cause thickened existing trabeculation and formation of new ones, localized compensatory increase in bone mass
subchondral cysts definition
focal regions of bone loss within the subchondral bone. they are ovoid or rounded cysts often with a sclerotic border due to intraosseous synovial fluid intrusion through exposed articular plate
how are intraarticular loose bodies made?
from cartilage degradation, flaking, and fragmentation and occasionally include subchondral bone
articular deformity results form what?
time and continued repetitive stress deforms secondary to trabecular remodeling, fracture and collapse
joint subluxations from (1,2,3,4) render the joint prone to displacement
- progressive loss of joint space
- capsular laxity
- ligamentous laxity
4 joint deformation
entheseopathy definition
pathological change of an enthesis
degeneration of hands is common among what?
middle-aged postmenopausal women
DIP soft tissue nodes
Heberden’s nodes
PIP soft tissue nodes
Bouchard’s nodes
gull wing sign
bilateral DJD with central joint erosions
target locations on hands for DJD
DIP
PIP
1st MCP
osteophytes, sclerosis, cystic changes, loss of joint space, misalignment
radiographic changes in DJD
osteophytes decreased joint space sclerosis lateral displacement cystic changes
describe erosive osteoarthritis
variant of DJD
appears unusually inflammatory
not to be confused with RA
symptoms/signs of erosive osteoarthritis
gull wing sign
pain, redness, swelling and decreased motion
middle aged females
describe degeneration of feet
common in first MTP joint
known as hallux rigidus when present with symptoms of pain and stiffness
metatarsal varus, hallux valgus joint misalignment is common
bunion
where are heel spurs specifically?
on the inferior part of the calcaneous on the posterior side of it
spurs are an _______change
enthesopathic
which joint of the shoulder is most commonly associated with DJD?
AC joint
how does DJD affect the AC joint?
osteophytes extend inferiorly and may impinge on rotator cuff tendons leading to tendon calcification and superior migration of the humerus
how does CPPD affect the glenohumeral joint?
osteophytes and joint misalignment and arouse suspicion of significant previous trauma or CPPD
what is shoulder impingement syndrome?
elevation of the humeral head
degenerative enthesopathic changes of the humeral head
spurring of the AC joint
rotator cuff degeneration
where does the supraspinatus tendon ususally insert? where does it break and why?
inserts on the greater tuberosity of the humeral head
usually tears about an inch from the tuberosity because that’s where there is less blood flow
how does a supraspinatus tnedon tear show up on MR?
increased whiteness (the tendon is usually black)
what is HADD?
deposition of calcium within tendons and bursa
wherre is HADD commonly seen?
shoulder, elbow, rist, hip, knee, ankle, spine
where is HADD most common?
supraspinatus tendon
what age range usually experiences HADD?
40-70 years old
what are the signs and symptoms of HADD?
pain, tenderness, localized swelling, reduced ROM
calcification of soft tissue on radiograph
what are the 3 parts of the knee?
medial tibiofemoral
lateral tibiofemoral
retropatellar
what are radiographic signs of DJD of the knee?
asymmetric loss of joint space
subchondral sclerosis
articular deformity and iregularity
hypertrophic changes of the intercondylar spines
enthesopathy of the anterior non-articular surface of the patella
what part of the knee most commonly experiences DJD?
medial compartment causing genu varus
pelligrini-steida calcifications
calcification of medial tibial collageral ligament (HADD)
post-traumatic dystrophic changes
what do you need to differentiate for pelligrini-steida?
fabella
what are intraarticular fragments?
fragments of cartilage, meniscus or synovium within the joint
heterogeneously dense, popcorn ball looking
what is synovial osteochondrometaplasia?
laminated, stippled, concentric calcific densities
