normal joint normal articular cortex - university of babylon
TRANSCRIPT
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Normal articular cortex Normal joint
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Joint disease
1-degenerative disease (osteoartheritis )
2- inflammatry disease (still disease ,RA)
3-infective disease (septic artheritis ,TB artheritis )
4-malignant disease (synovioma )
5-traumatic disease
6-congenital disease (displacement hip)
7-abnormal trabecular patteran (behejet disease)
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Classification
Hypertrophic
Hallmarks
Bone production
Sclerosis
Infectious
Hallmark
Destruction of articular cortex
Erosive
Hallmark
Erosions
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Hypertrophic Arthritis
Degenerative arthritis(osteoartheritis)
Primary
Secondary
Charcot arthropathy
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1º Degenerative Arthritis
Intrinsic degeneration of articular
cartilage
Excessive wear and tear
Most commonly hips and knees
Less commonly shoulders and elbows
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1º DJD of knees affects medial,
weight-bearing surface
1º DJD of hips affects superior,
weight-bearing surface
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2º Degenerative Arthritis
Another process destroys articular
cartilage
Degenerative changes supervene
How to recognize
Atypical locations (knee)
Atypical appearance (Marked DJD of 1 hip)
Atypical age (DJD in 20 year-old)
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2º Degenerative Arthritis Causes
Trauma
Infection
Avascular necrosis
CPPD
RA
Hemophilia
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Osteoartheritis (degenerative
joint disease):
RADIOLOGICAL SIGN :
1-normal bone density(no osteoporosis)
2-narrowing of the joint space maximal at weight
bearing site
3- subchondral sclerosis and cyst may be seen
4-osteolytic lesion
5-sclerosis of the bone is a prominent feature
6-osteophyte formation
7-loose bodies
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2º DJD of right ankle following fracture
R3
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Charcot’s Arthropathy General
Disturbance in sensation leads to multiple microfractures
Pain sensation intact from muscles and soft tissue
Causes
Shoulders – syrinx, spinal tumor
Hips – tertiary syphilis, diabetes
Feet – diabetes
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Charcot’s Arthropathy Findings
X-ray findings
Fragmentation
Soft tissue swelling
Destruction of joint
Sclerosis
Osteophytosis
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Charcot’s Knees-Diabetes
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Infectious Arthritis
More common in adults
Usually from local trauma-surgery or accident
Children get osteomyelitis
Destruction of articular cartilage & cortex
Tends to affect one joint (DDx from gout)
Fingers from human bites
Feet from diabetes
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Infectious Arthritis Causes
Usually staph - “early” destruction of articular cortex
Rapid course (unlike most arthritides)
TB spreads via bloodstream from lung
More protracted course
In children, spine most common; in adults, knee
Severe osteoporosis
Healing with ankylosis common in both
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Septic arthritis of hip with
pathologic fracture
R3
Normal hip
Acetabular white line
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Erosive Arthritis Types
Rheumatoid arthritis
Gout
Hemophilia
Erosive osteoarthritis
Rheumatoid variants
Psoriatic arthritis
Reiter's
Ankylosing spondylitis
Inflammatory bowel disease
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Gout General
Long latent period between onset of
symptoms and bone changes
Asymmetric and monoarticular
More common in males
Most common at 1st MT-P joint
Tophi rarely calcify
Olecranon bursitis is common
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Gout Findings
Juxta-articular erosions
Sharply marginated with sclerotic rims
Overhanging edges (rat-bites)
No joint space narrowing until later
Little or no osteoporosis
Soft tissue swelling
Tophi not calcified
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Gout
R3
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Rheumatoid artheritis
RADIOLOGICAL SIGN :
1-generalzed osteopenia
2-swelling of the soft tissue around
3-articular erosion
4- sometime the joint ligment may undergo
softening or complete cut
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Rheumatoid Arthritis General
Bilaterally symmetrical
Earliest change: MCP, PIP, ulnar styloid
Radiocarpal jt most commonly narrowed
Periarticular demineralization
Begins MCP jts of 1st and 2nd fingers
Large joints usually no erosions
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Rheumatoid Arthritis General
Can lead to 2º DJD
Marked narrowing of joint space with intact
articular cortex, think of RA
Little or no sclerosis
Especially, hips and knees
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RA of Hips – Marked narrowing, little
sclerosis
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RA of Foot
RA usually
involves 5th
MT-P joint
first
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Psoriatic Arthritis
Almost always accompanies skin
disease, especially nail changes
Involves DIP joints of hands > feet
Cup-in-pencil deformity
Resorption of terminal phalanges
No osteoporosis
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Psoriasis of hands
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Reiter’s Syndrome
Urethritis, arthritis (50%) & conjunctivitis
Periostitis at sites of tendinous insertion
Whiskering
Like DISH, ankylosing spondylitis
Affects feet more than hands .
Resembles RA
Reiter’s also has osteoporosis
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Reiter’s Syndrome
R3
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Ankylosing Spondylitis
HLA-B27 positive
B/L SI arthritis
Squaring of vertebral bodies
Bamboo-spine from continuous
syndesmophytes
Peripheral large joint erosive arthritis
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Ankylosing Spondylitis
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Inflammatory Bowel Disease
Can occur with either Crohn’s or UC
More common with UC
Looks like AS in spine
Asymmetric sacroiliitis
Like psoriasis, TB
Peripheral joint STS without erosions
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Hemophilia General
Usually seen in large joints
Hemorrhage produces synovitis
which leads to pannus
Incites hyperemic response
Bone resorption and remodeling
Especially in open epiphyses
DDx: JRA
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Hemophilia Findings
Overgrowth of epiphyses
Resorption of secondary trabeculae
Longitudinal striations
Widening of interconylar notch of knee
Joint effusion
Hemosiderin deposit around joint
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Hemophiliac Arthropathy
R3
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Arthritis or Not
AVN DJD
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hyperparathyrodium
Generalzed decrease in bone density
Subperiosteal bone resorption
Soft tissue calcification
Brown tumours
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