Joint Degeneration Flashcards
What are the radiographic signs of facet joint degeneration?
- osteophytosis
- subchondral sclerosis
- loss of jt space
- synovial cysts
- degenerative hypertrophy (foraminal encroachment, spinal stenosis, lateral recess stenosis)
Name 2 secondary effects of facet joint degeneration
- ligamentum flavum hypertrophy
- synovial cysts
Where are synovial cysts most common with facet joint degeneration?
L4-L5 facet joints
(continuous w/ facet jts)
What does ligamentum flavum hypertrophy secondary to facet joint degeneration lead to?
central canal & lateral (subarticular) recess stenosis
How are ligamentum flavum hypertrophy and synovial cysts secondary to facet joint degeneration visualized?
only on MRI
What can synovial cysts secondary to facet joint degeneration lead to?
spinal canal or neural foramen (IVF) stenosis
What can synovial cysts secondary to facet joint degeneration mimic clinically?
disc herniation SSx
What finding is correlated with ligamentum flavum hypertrophy secondary to facet joint degeneration and suggests a poor prognosis?
fatty infiltration of multifidi mm
Describe the appearance of uncovertebral degeneration.
“pseudoFx” appearance: osteophytes create horizontal lucency overlapping superior vertebral body, seen on lat view
What is the leading cause of cervical spine neural foraminal encroachment?
uncovertebral degeneration (with facet arthrosis)
Uncovertebral degeneration with neural foraminal encroachment predisposes the patient to ____
radiculopathy
(may or may not have)
What secondary effect of spinal degeneration is a contraindication to adjusting?
myelopathy
What should you suspect if you see atlantoaxial degeneration?
transverse ligament compromise:
- trauma
- inflammatory arthritis
- instability
(stable jt, should not have degeneration)
What is your next step before treating a patient with atlantoaxial degeneration?
flexion/extension radiographs
What joints of the thoracic spine commonly degenerate?
- costovertebral
- costotransverse
What alignment changes may be radiographically visible with spinal degeneration?
- anterolisthesis
- retrolisthesis
- laterolisthesis
- rotations (beware of crooked SPs)
- abnormal disc & facet wedging (scoliosis)
What is Baastrup disease?
narrowing of the interspinous space in the lower lumbar spine
What are the characteristics of Baastrup disease?
- worse w/ hyperlordosis
- flattening & sclerosis of SPs
- accessory bursa seen on MRI
- source of LBP worse on extension
What should you suspect if you see SI joint degeneration?
- trauma
- inflammatory arthritis
- instability
(stable jt, should not have degeneration)
What are the characteristics of hip joint degeneration?
- non-uniform jt space loss (superior-lateral aspect)
- subchondral cysts
- osteophytes
What is the term for severe hip degeneration?
Malum coxae senilis
(may require hip replacement)
What are the characteristics of femorotibial joint degeneration?
- non-uniform jt space loss (med > lat)
- leads to genu varus deformity
- osteophytes
- subchondral cysts
- subchondral sclerosis
What are the characteristics of patellofemoral joint degeneration?
- usually more pronounced on lateral side
- Patellar tooth sign
What is patellar tooth sign?
degenerative enthysopathic changes leading to irregular appearance of anterior surface of patella
What view is best to see patellar tooth sign?
sunrise view
(merchant view)
What is chondromalacia patellae?
early softening of retropatellar cartilage in adolescents & teenagers
What imaging modality is used to visualize chondromalacia patellae?
MRI
(radiographically absent)
What is a better diagnosis for chondromalacia patellae?
patellofemoral pain syndrome
What may cause chondromalacia patellae?
trauma, tracking abnormalities, etc.
What is a common symptom of chondromalacia patellae?
“movie theater sign”
What signs of degeneration may be seen in the foot and ankle?
- ankle mortise (rare except post-trauma)
- plantarcalcaneal or achilles enthesopathy
- hallux valgus
- hallux rigidus
What is the most common joint in the shoulder to degenerate?
AC joint
What is the second most common joint in the body to degenerate?
AC joint
What is of particular concern with AC joint degeneration?
downward osteophytes narrow subacromial space causing supraspinatus tear and impingement
What may cause glenohumeral joint degeneration?
- trauma
- endocrine/metabolic anomalies
What may cause elbow joint degeneration?
secondary to trauma or inflammatory arthropathy
(^ in carpenters d/t repetitive trauma/stress)
What is the most common joint in the wrist to degenerate?
1st carpometacarpal joint (thumb, d/t opposition)
What joints in the wrist are uncommon to see degeneration in?
- DRUJ
- radiocarpal
- intercarpal
- 2-5 carpometacarpal
Where do Heberden nodes occur?
DIP joints
Where do Bouchard nodes occur?
PIP joints
Where do Haygarth nodes occur?
MCP joints
What degenerative nodes are more common signs of degeneration?
Heberden (DIP)
Bouchard (PIP)
Haygarth nodes may indicate what type of cause?
inflammatory
(MCP degeneration unusual)
