Radiographic Presentation Of Pathologies Of The Upper Limb

Question 1

How do we interpret x-rays?

Answer 1

ABCS approach

Question 2

What is the ABCS approach?

Answer 2

Alignment and joint space

Bone texture

Cortices

Soft tissues

Question 3

What are things to consider when interpreting x-rays?
(4)

Answer 3

Don’t forget to review all views

Compare both sides

Previous imaging

If you spot one abnormality, don’t lose focus until you have reviewed all areas of the image, otherwise, you might miss important pathology

Question 4

What do changes in alignment and joint space (ABCS) suggest?
(4)

Answer 4

Fracture

Subluxation

Dislocation

(When describing the displacement, the position of the fragment distal to the fracture site is always described)

Question 5

What changes can we identify by looking at the joint space?
(4)

Answer 5

Joint space narrowing due to cartilage loss

Cartilage calcification

New bone formation

Subchondral sclerosis (increased bone density)

Question 6

Which synovial joint can osteoarthritis affect?

Answer 6

Any synovial joint

Question 7

Are erosions a feature of osteoarthritis?

Answer 7

No but if they’re seen, it should raise the suspicion of inflammatory arthritis such as rheumatoid arthritis

Question 8

Which age group is osteoarthritis normally found in?

Answer 8

The older population (around 65)

Question 9

What can osteoarthritis be divided into?
(2)

Answer 9

Primary/concentric osteoarthritis

Secondary/eccentric osteoarthritis

Question 10

What is primary/concentric arthritis?

Answer 10

Arthritis that can be genetic, family-based or related to activities carried out in the patient’s life

Question 11

What is secondary/eccentric osteoarthritis?

Answer 11

Arthritis that’s caused as a result of other diseases, such as as fractures, joint instability or injuries

Question 12

What type of arthritis does rheumatoid arthritis become?

Answer 12

A symmetrical arthritis

Question 13

Which imaging modality can be used to look for erosions, synovitis and tenosynovitis?

Answer 13

Ultrasound

Question 14

What are the key features of rheumatoid arthritis?
(4)

Answer 14

Erosions

Synovitis/pannus

Deformity

Symmetrical pattern

Question 15

Where is rheumatoid arthritis most common?

Answer 15

In the hands/feet.

Question 16

Why is it important to look at the bone texture (ABCS)?

Answer 16

Altered density or disruption to the bony trabeculae within the substance of the bone, and the bony cortex may indicate pathology

Question 17

What are the 3 categories that osteomyelitis is classified into?

Answer 17

A bone infection that has spread through the blood stream

Osteomyelitis caused by bacteria that gain access to bone directly from an adjacent focus of injection (seen with trauma or surgery)

Osteomyelitis that is the result of diabetic foot infection or any other reason for diminished blood supply to the bones

Question 18

What are the radiographic features of osteomyelitis?
(11)

Answer 18

Radiographic appearances may be subtle and can take from 10-14 days post infection to show up

Osteomyelitis must extend at least 1cm and compromise 30-50% of bone mineral content to produce noticeable changes on radiographs

Osteopenia

Periosteal reaction/thickkening

May appear aggressive, including the formation of a codman’s triangle

Focal bony lysis or cortical loss

Enddoseal scalloping

Loss of trabecular bone architecture

New bone apposition

Eventual peripheral sclerosis

Gas within soft tissue

Question 19

What do bone metastases lead to?
(2)

Answer 19

Bone loss

Bone formation

Question 20

What 3 patterns can bone metastases take?

Answer 20

Lytic (osteolytic) metastases

Sclerotic (osteoblastic) metastases

Mixed lytic and sclerotic metastases

Question 21

What morphological characteristics can bone metastases have?
(3)

Answer 21

Diffuse

Focal

Expansile

Question 22

Which primary tumours commonly metastasize to bone?
(6)

Answer 22

Prostate cancer (most common in males)

Breast cancer (most common in females)

Non-small cell lung cancer

Hepatocellular carcinoma

Renal cell carcinoma

Thyroid cancer

Question 24

What do we use to describe bone lesions?

Answer 24

CAMPS

Question 25

What does CAMPS stand for?

Answer 25

Cortical response

Age

Margins, matrix

Pattern of destruction, periosteal reaction

Site, soft tissue involvement

Question 26

What’s another way to remember CAMPS when describing bone lesions?

Answer 26

All- age (maturity of skeleton)

Sensible- site (bone name and location within bone) and size

People- pattern of destruction (lytic lesions)

Must- margins (transition zone)

Make- matrix

Clear/- cortical response

Proper- periosteal reaction

Sense- soft tissue involvement