Radiology: Degenerative Arthritides Part I

Radiology: Arthritides and Trauma - Degenerative Arthritides: Part I

• Course Title: Radiology: Arthritides and Trauma
• Course Part: Degenerative Arthritides: Part I
• Lecturer: Terry D. Sandman, DC, MPH, DACBR
• Lecturer's Title: Diagnostic Imaging, College of Professional Studies, Doctor of Chiropractic Medicine, Department of Clinical Sciences, National University of Health Sciences

Basic Rules of Interpretation of Joint Films

• Best Quality Image Production: Crucial for accurate interpretation
• Proper View Selection: Choosing the right X-ray views for a joint is important
• Utilization of all Available Views: Analyzing all relevant X-rays for complete picture
• Review Previous Studies: Examining prior imaging reports for context and comparison
• Remember ABCs: A critical element in interpreting images (likely refers to airway, breathing, circulation)
• Minimum Study: At least 2 X-ray views are needed, ideally at right angles to each other

Case Study - 10-Year-Old with Leg Pain

• A 10-year-old fell out of a tree and can't fly like Superman.
• His leg hurts.
• Should he go back outside and play?
• The answer is probably no.
• This highlights the need for proper X-ray views (at least 2, at right angles).

Film Terminology

• Anteroposterior (AP): X-ray view with the beam traveling from the front to the back of the body.
• Posteroanterior (PA): X-ray view with the beam traveling from the back to the front of the body.
• Left Lateral: X-ray view with the beam from left side to the right, patient's side close to or touching the film.
• Right Lateral: X-ray view with the beam from right to the left, patient's side close to or touching the film.
• Left Anterior Oblique (LAO): X-ray view from the left side, inclined toward the front or the body, oblique
• Right Anterior Oblique (RAO): X-ray view from the right side, inclined toward the front or body, oblique
• Left Posterior Oblique (LPO): X-ray view from the left side, inclined towards the rear or back of the body, oblique
• Right Posterior Oblique (RPO): X-ray view from the right side, inclined towards the rear or back of the body, oblique

Relative Frequency of Arthritides

• Very Common: DJD (Osteoarthritis)
• Less Common: Ankylosing Spondylitis (AS), CPPD, DISH, OCI, Psoriatic Arthritis (PSOR), Rheumatoid Arthritis (RA), SCM (SO)
• Least Common: Gout, Infection, SLE, Reiter's, Scleroderma

Relative Onset Age of Arthritides

• 0-20 Years: Juvenile Rheumatoid Arthritis (JRA), Systemic Juvenile Arthritis (SJA)
• 20-40 Years: Ankylosing Spondylitis (AS), OCI, SLE, Psoriatic Arthritis (PSOR), Rheumatoid Arthritis (RA), SCM (SO)

Sex Predlection of Arthritides

• Male: Ankylosing Spondylitis (AS), Gout, HOA, Reiter's, Secondary DJD
• Female: Juvenile Rheumatoid Arthritis (JRA), SLE, OCI, Primary DJD, Rheumatoid Arthritis (RA), Scleroderma

Joint Classification

• Fibrous: Cranial Sutures, Syndesmoses (tib/fib, rad/ulna)
• Cartilaginous: Symphysis Pubis, Intervertebral Disc, Manubriosternal Junction
• Synovial: Fingers, Toes, Knee, Hip, Apophyseal Joints, Sacroiliac Joint (Lower 2/3)

Joint Structure (diagrammed)

• The image shows the components of a joint: Hyaline Cartilage, Subchondral Cortex, Bare Area, Synovium, and Joint Capsule.

Feature Comparison of Inflammatory, Degenerative, and Metabolic Arthritis

• Symmetry: Inflammatory - yes, Degenerative - no, Metabolic - No
• Number of Joints: Inflammatory - poly, Degenerative - mono. Metabolic - mono/pauci
• Joint Alignment: Inflammatory - uniform, Degenerative - non-uniform, Metabolic - uniform
• Bone Density: Inflammatory - decreased, Degenerative - increased, Metabolic - normal
• Erosions: Inflammatory - poorly defined, Degenerative - absent, Metabolic - sharply defined
• Osteophytosis: Inflammatory - absent, Degenerative - present, Metabolic - absent
• Periositis: Inflammatory - present, Degenerative - absent, Metabolic - absent

Degenerative Joint Disease (DJD)

• Defined as joint disease characterized by gradual loss of cartilage.

Definitions (Spine Conditions)

• Spondylosis: Degenerative condition involving vertebral centrum
• Spondylosis Deformans: another name for Degenerative Disc Disease.
• Spondylitis: Inflammation of vertebrae
• Spondylolysis: Fracture of pars interarticularis, unilateral or bilateral.
• Spondylolisthesis: Forward slipping or backward slip of one vertebra on another
• Spondylosyndesis: Surgical stabilization of vertebrae
• Spondyloptosis: Full slippage of vertebra
• Spondylopathy: Any condition affecting the spinal column
• Arthrosis: Degenerative changes in joints, similar to DJD.
• Osteoarthritis: Historically a synonym for DJD.

Target Sites of Primary DJD (Diagrammed, body)

• The diagram shows different regions where Primary DJD commonly occurs. Locations illustrated would include neck, shoulder, and legs.

Sites Where Primary DJD is Uncommon

• Atlanto-occipital, atlanto-axial, tibio-talar, metatarsophalangeal (2-5), glenohumeral, and elbow, metacarpophalangeal joint.

Cardinal Features of Degerative Joint Diseases (DJD)

• Asymmetry with localized origin of joint changes
• Non-uniform changes in space narrowing.
• Subchondral sclerosis.
• Osteophytes or bone spurs.
• Articulation deformity.
• Subchondral formations of cysts.
• Malalignment or abnormal alignment in the joints
• Osteo-cartilaginous loose bodies

Radiographic Images and Descriptions for Spinal Conditions

• Numerous images are included and described (normal C-spine, normal lumbar, types of spinal conditions such as degenerative condition, infections, and so on).
• The images aid comprehension of normal anatomy and specific pathologies. 

Additional Features and Diagnoses for Spinal Conditions 

• C4-6 Apophyseal Joints, Osteophytes, Sclerosis, Subluxation in Cervical spines
• Uncovertebral (Von Luschka) Joints, Osteophytes, and Foraminal Narrowing in Cervical spine
• Intervertebral Disc Narrowing, Vacuum and Osteophytes in Cervical Spine
• Cervical, Thoracic, and Lumbar Features: Multiple features and images illustrated include osteophytosis, narrowing, and sclerosis
• Disk Infections are covered including images of CT scans with arrows indicating the location of abnormalities
• Images illustrating various views of vertebrae and joint abnormalities in the lumbar and thoracic areas

Scotty Dog Identification and Other Topics

• Posterior Oblique view shows corresponding (same-side) structures; Anterior Oblique shows the opposite structure on the X-ray.
• Lumbar imaging also discussed (normal views) 
• Various other images describe various points on body regions

Lumbar Spine Features

• L4-S1 apophyseal joints: narrowing, subchondral sclerosis, osteophytosis, subluxation.
• Intervertebral discs: described as narrowing, vacuum sign, osteophytosis, sclerosis, canal stenosis
• Different types of degenerative disc disease
  • Spondylosis Deformans
  • Intervertebral Osteochondrosis

Specific Imaging Terminology 

• Descriptions of important terms, concepts, and radiographic images that may be helpful to learn about or focus to assess a condition
  • Various types of calcification and bone growth,
  • Other specific degenerative conditions of joints, and so on, are described.

Test your knowledge on the key principles of interpreting joint films in degenerative arthritides. This quiz covers essential rules including best quality image production, view selection, and the importance of reviewing previous studies. Enhance your understanding of radiological practices in the context of arthritis and trauma.