Degenerative Arthritides-Part I PDF
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Uploaded by BeneficialGyrolite9754
National University of Health Sciences
Terry D. Sandman
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Summary
This document provides an overview of degenerative arthritides in radiology, emphasizing various aspects such as interpretation guidelines, frequency of conditions, age and sex predilection, classification, features, and common target sites. It includes detailed information on the cervical, thoracic, and lumbar spine, and sacroiliac features, along with relevant image interpretations and analyses.
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RA 6115 RADIOLOGY: ARTHRITIDES AND TRAUMA Degenerative Arthritides: Part I Terry D. Sandman, DC, MPH, DACBR Lecturer - Diagnostic Imaging College of Professional Studies Doctor of Chiropractic Medicine Department of Clinical Sciences National Universi...
RA 6115 RADIOLOGY: ARTHRITIDES AND TRAUMA Degenerative Arthritides: Part I Terry D. Sandman, DC, MPH, DACBR Lecturer - 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 Proper view selection Utilization of all available views Review previous studies Remember ABCs Remember Minimum Study: 2 Views, preferably at Right Angles to each other 2 10 year old just jumped out of a tree and found out he couldn’t fly like superman; His leg hurts………. …. should he go back out and play? 3 Maybe not ! Remember…2 views at right angles 4 Film Terminology 5 RELATIVE FREQUENCY OF ARTHRITIDES Very Common Less Common Least Common DJD AS Gout (osteoarthritis) CPPD Infection DISH SLE OCI Reiter’s PSOR Scleroderma RA SCM (SO) RELATIVE ONSET AGE OF ARTHRITIDES 0-20 20-40 Years 40 Years Years plus JRA AS DJD PVS OCI DISH SLE GOUT PSOR HOA REITER’S CPPD RA SCLERODERMA SCM SEX PREDILECTION OF ARTHRITIDES MALE FEMALE AS JRA GOUT SLE HOA OCI REITER’S PRIMARY DJD SECONDARY DJD 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 : Lower2/3 10 11 FEATURE INFLAM. DEGEN. METAB. Symmetry yes no no Number of poly mono Joints mono/pauci Joint uniform non-uniform uniform Narrowing Alignment abnormal abnormal normal Bone Density decreased Increased normal Erosions poorly absent sharply defined defined Osteophytosis absent present absent Periostitis present absent absent DEGENERATIVE JOINT DISEASE 13 Spondylosis ,Spondylosis Deformans- aka DJD vertebral centrum Spondylitis-inflammation of vertebra Spondylolysis – aka fracture of pars interarticularis, unilateral or bilateral Spondylolisthesis – any forward slipping of one verterbra on the one below (anterolisthesis) backward slip-Retrolisthesis Spondylosyndesis – surgically stabilization between two vertebrae Spondyloptosis - 100% slippage of vertebra off the level below Spondylopathy-any disorder of the spinal column Arthrosis-DJD posterior facet joints Osteoarthritis—historical synonym for DJD 14 Target Sites of Primary DJD 15 Sites Where Primary DJD Are Uncommon 1. Atlanto-occipital 2. Atlanto-axial 3. Tibio-talar 4. Metatarsophalangeal (2-5) 5. Glenohumeral 6. Elbow 7. Metacarpophalangeal 16 CARDINAL FEATURES ASYMMETRY WITH LOCALIZED ORIGIN NON-UNIFORM SPACE NARROWING SUBCHONDRAL SCLEROSIS OSTEOPHYTOSIS ARTICULAR DEFORMITY SUBCHONDRAL CYST FORMATION MALALIGNMENT OSTEOCARTILAGENOUS LOOSE BODIES 17 18 Cervical Spine Features 19 Normal C-Spine: Neutral Lateral 20 21 Normal C-Spine: AP 22 23 Normal C-Spine: APOM 24 25 Normal C-Spine: LAO 26 27 Oblique Terminology Arrows indicate proper marker placement With laterals and obliques, always mark the side of the body CLOSEST to the film 28 Which IVF? Right IVFs 29 Film RPO 30 RPO 31 CERVICAL SPINE FEATURES C4-5-6 APOPHYSEAL JOINTS OSTEOPHYTES, SCLEROSIS, SUBLUXATION UNCOVERTEBRAL (VON LUSCHKA) JOINTS OSTEOPHYTES, FORAMINAL NARROWING INTERVERTEBRAL DISC NARROWING, VACUUM, OSTEOPHYTES 32 Atlas/Axis Arthrosis 33 Early Uncinate Arthrosis 34 35 Degenerative Anterolisthesis 36 Foraminal Encroachment 37 Foraminal Encroachment CT Scan 38 What do you see? 39 What do you see? 40 What do you see? 41 THORACIC SPINE FEATURES T6-T12 Costovertebral joints: Narrowing, sclerosis and osteophytosis Intervertebral disc space narrowing, sclerosis, hyperkyphosis and osteophytosis, mainly right sided. Why are anterior osteophytes likely to be more prominent on the right? 42 Case 1 - What do you see? 43 Case 2 - What do you see? 44 Case 3 - What do you see? 45 DISK INFECTION Don’t get lazy! 46 47 48 49 Vacuum Disk Sign What is this? 50 Lumbar Spine Features 51 Normal AP Lumbar 52 Normal Lateral Lumbar 53 Normal Oblique Lumbar 54 Scotty Dog Identification Posterior Oblique = Homo-lateral Anterior Oblique = Contra-lateral 55 Normal L-Spine: LAO Which pedicle is this? 56 Normal L-Spine: AP Lumbosacral Junction Spot 57 LUMBAR SPINE FEATURES L4-S1 Apophyseal Joints: Narrowing, subchondral sclerosis, osteophytosis, subluxation. Intervertebral Disc Narrowing, vacuum sign, osteophytosis, sclerosis, canal stenosis 58 Types of Degenerative Disc Disease Spondylosis Deformans Near normal disc height Large osteophytes Intervertebral Osteochondrosis Significant loss of disc height Small osteophytes Irregular endplates Vacuum clefts 59 Osteophytes 60 Vacuum Disk Sign 61 Degenerative Spondylolisthesis 62 63 “Claw Spurs” 64 Hemispherical Spondylosclerosis 65 Facet Arthrosis 66 Vacuum Sign on CT 67 Marked Facet Hypertrophy CT Scan 68 Advanced Facet Degeneration CT Scan 69 Capsular Calcification 70 Degenerative Canal Stenosis 71 Baastrup’s Disease “Kissing Spinous Processes” 72 Vertebral Outgrowths 73 What do you see? 74 What do you see? 75 SACROILIAC FEATURES LOSS OF JOINT SPACE SUBCHONDRAL SCLEROSIS OSTEOPHYTOSIS CHANGES LIMITED TO LOWER TWO- THIRDS OF JOINT 76 77 End of Part I 78
