joint disease

Question 1

what are the 4 categories of joint disease

Answer 1

1. degenerative
2. inflammatory
3. metabolic / deposition
4. infection

Question 2

What are the features of degenerative process? (5)

Answer 2

• asymmetric distribution
• non-uniform loss of joint space
• osteophytes
• subchondral sclerosis
• subchondral cysts

Question 3

What are the features of inflammatory processes? (4)

Answer 3

• symmetric distribution
• uniform loss of joint space
  -bone erosion
  -juxta-articular osteoporosis

Question 4

what are the features of metabolic /deposition process? (5)

Answer 4

• soft tissue masses
• calcification (depositions)
• well marginated bone lesions
• relative preservation of joint space
• may cause degenerative change

Question 5

What are the features of infectious process?

Answer 5

• monoarticular
• changes occur very rapidly (days - weeks)
• soft tissue swelling
• cortical destruction
• periosteal reaction

Question 6

Degenerative articular disorders: clinical features:

Answer 6

• m/c pathological joint affliction
• changes cartilage and joint components
• typically sm joints in hand & lgr weight bearing joints
• insidious onset - aching, swelling, stiffness goes away with activity
• pathological process: force causes loss of ground substances, cartilage degrades, synovium thickens, osteophytes form, subchondral thickening (sclerosis), synovial fluid enters subchondral bone (cysts)

Question 7

what 4 joints are involved in spinal degeneration?

Answer 7

• intervertebral disc
• facet joints
• uncovertebral joints
• costal (costovertebral & costotransverse)

Question 8

Cervical disc degeneration

Answer 8

• m/c C5/6
• loss of disc height, osteophytes, sclerosis
• lge anterior osteophytes may cause dysphagia
• posterior osteophytes may cause stenosis
• calcium deposits in annular fibres (intercalary bones) may be early sign

Question 9

cervical facet arthrosis

Answer 9

• usually lower cervical spine
• best seen on AP or oblique views
• AP shows hypertrophy of normally smooth lateral border
• oblique view may show osteophyte growth
• lateral view can show loss of joints space, subchondral sclerosis, osteophyte and anterolisthesis

Question 10

cervical uncinate arthrosis

Answer 10

• usually lower cervical spine
• best seen on AP view - shows blunting and hypertrophy
• normal uncinate processes “cat ears”
• lateral view may show pseudofracture

Question 11

thoracic disc degeneration

Answer 11

• less pronounced than other regions
• disc heights smallest at T2 to T4 then inc below
• most prominent finding is osteophytes (not on left side due to aorta)
• minimal loss of disc height and sclerosis

Question 12

thoracic costotransverse & costovertebral arthrosis

Answer 12

• m/c lower segments T9/10
• bony hypertrophy, osteophytes, sclerosis, loss of joint space

Question 13

thoracic facet arthrosis

Answer 13

• uncommon in t spine - more common in lower segments
• best seen on AP view
• loss of joint space and sclerosis

Question 14

lumbar disc degeneration

Answer 14

• m/c L4/5 and L5/S1
• best seen on lateral view
• loss of disc height, sclerosis, osteophytes, vacuum, altered alignment
• traction osteophytes - earlier in degen process, small, horizontal
• claw osteophytes - lgr, starts horizontal turns vertical

Question 15

lumbar spondylosis deformans

Answer 15

• lge claw osteophytes,
• normal disc height

Question 16

lumbar intervertebral osteochondrosis

Answer 16

• sm traction osteophytes
• severe loss of disc height
• severe end plate sclerosis
• vacuum typically seen

Question 17

lumbar facet arthrosis

Answer 17

• m/c L4/5 & L5/S1
• loss of joint space
• subchondral sclerosis,
• hypertrophy,
• osteophytes
• anterolisthesis

Question 18

advanced imaging of disc degeneration/modic changes

Answer 18

• disc degen: loss of signal on T2 due to loss of water; first seen on anterior 2/3 disc
• disc bulge: circumferential, broad based displacement - part of normal aging with disc degeneration
• disc protrusion: focal & contained by outer annulus; max width of herniation is no greater than at base of herniation
• disc extrusion: max width > base of herniation; disc material attached but may (outer annulus walls of herniation) /not be contained by annulus (herniation extends through outer annulus)
• disc sequestration: frag of herniation breaks free; can migrate up or down within canal; maybe resorbed by body
• cauda equina syndrome: back/leg pain, urinary bladder incontinence, saddles paresthesia, impotency, SURGICAL EMERGENCY

Question 19

Diffuse Idiopathic Skeletal hyperostosis

Answer 19

• spinal and extraspinal lig ossification/calcification
• ANTERIOR LONGTITUDINAL LIG
• morning stiffness, bone/joint pain
• 20% dysphagia
• inc kyphosis, dec lordosis
• correlated with DM
  RADIOGRAPHIC:
• mc t spine, esp lower segments
• slowing hyperstosis 4 contiguous vertebral levels
• inv midpoint of vertebral bodies
• relative preservation of disc height
• Right side in t spine due to aorta
• peripheral skeleton may have enthesopathy/sig lig or tendon ossification
• may see OPLL