Bone And Joint: Lecture Exam Ii (Arthritis)

Front 1

Degeneration: Spondylosis Deformans

Back 1

Annulus Fibrosis

Front 2

Degeneration: Intervertebral Osteochondrosis

Back 2

Nucleus Pulposes

Front 3

Loss of disc space: Spondylosis Deformans

Back 3

Minimal

Front 4

Loss of disc space: Intervertebral Osteochondrosis

Back 4

Prominent

Front 5

Osteophytes: Spondylosis Deformans

Back 5

Prominent

Front 6

Osteophytes: Intervertebral Osteochondrosis

Back 6

Minimal

Front 7

Vacuum: Spondylosis Deformans

Back 7

Annular

Front 8

Vacuum: Intervertebral Osteochondrosis

Back 8

Nuclear

Front 9

What is highly specific for painful annular tears?

Back 9

High Intensity Zone (HIZ)

Front 10

Inflammatory Modic Change

Back 10

Type I

Front 11

Decreased signal intensity on T1
Increased signal intensity on T2

Back 11

Type I Modic Change

Front 12

Fatty Modic Change

Back 12

Type II

Front 13

Increased signal intensity on T1 and T2
Decreased signal intensity with fat suppression

Back 13

Type II Modic Change

Front 14

Decreased signal intensity on T1 and T2

Back 14

Type III Modic Change

Front 15

Which is the only Modic Change that can be seen on xray

Back 15

Type III

Front 16

< or = to 2 mm of endplate margin; asymptomatic

Back 16

Normal discs

Front 17

> 2 mm away from endplate margins; 50% of circumference
Most are asymptomatic

Back 17

Disc Bulge

Front 18

Base exceeds AP dimension; < 50% of circumference; most are asymptomatic

Back 18

Disc Protrusion

Front 19

Disc Protrusion that is <25% of circumference

Back 19

Focal Disc Protrusion

Front 20

Disc Protrusion that is >25% of circumference

Back 20

Broad Based Disc Protrusion

Front 21

AP dimension exceeds base; superior or inferior margin

Back 21

Disc Extrusion

Front 22

Which disc sequestration has an umbilicus?

Back 22

Extrusion

Front 23

Which disc sequestration has no connection?

Back 23

Sequestration
Not responsive to conservative management

Front 24

90% of focal lumbar disc abnormalities are ______ and _____?

Back 24

Central and paracentral

Front 25

90$ of disc contour abnormalities occur where in the lumbar spine? where in the cervical spine?

Back 25

- L4/L5 and L5/S1 in the lumbar spine
- C5/C6 and C6/C7 in the cervical spine

Front 26

Cervical disc herniations hit which roots?

Back 26

Exiting nerve roots
- The nerve root below

Front 27

Lumbar central and paracentral disc herniations hit which roots?

Back 27

Transient/Descending nerve roots
- The nerve root below

Front 28

Lumbar foraminal disc herniations hit which roots?

Back 28

Exiting nerve roots
- The nerve root above

Front 29

Synovial cysts are most common where?

Back 29

L4/L5 facet joints

Front 30

Narrowing of the interspinous space in the lower lumbar spine

Back 30

Baastrup's Disease
(Kissing Spinous disease)

Front 31

Osteoarthritis: Femoroacetabular Joint

Back 31

- Non-uniform decrease in joint space; most prominent at superior lateral aspect
- Subchondral cysts
- Osteophytes
- Severe cases may require hip replacement surgery
- Malux coxae senilis

Front 32

Where is osteoarthritis of the femoroacetabular joint most prominent?

Back 32

Superior lateral aspect

Front 33

Osteoarthritis: Femorotibial Joint

Back 33

- Non-uniform decrease in joint space
- Medial > Lateral
- Better seen with weigh-bearing views
- Osteophytes
- Subchondral cysts
- Subchondral sclerosis

Front 34

Osteoarthritis of the femorotibial joint is most common where?

Back 34

Medial side

Front 35

Osteoarthritis: Patellofemoral Joint

Back 35

- Usually more pronounced on lateral side
- Patellar Tooth Sign

Front 36

Patellar Tooth Sign

Back 36

Osteoarthritis of Patellofemoral Joint
- Degenerative enthysopathic changes leading to irregular appearance of anterior surface of the patella

Front 37

Patellar Tooth Sign is best seen on what view?

Back 37

Sunrise view

Front 38

Early softening of retropatellar cartilage in adolescents and teenagers

Back 38

Chondromalacia Patella

Front 39

Radiographic Presentation: Chondromalacia Patella

Back 39

Usually radiographically absent, requires MRI

Front 40

Osteoarthriis: Ankle and Foot

Back 40

Ankle: Rare (except for post-trauma)
Calcaneus: enthesophytes

Front 41

Osteoarthritis: Shoulder and Elbow

Back 41

- AC Joint (common): leads to impingement and supraspinatus tear, can narrow subacromial space
- GH joint, elbow (rare)

Front 42

Osteoarthritis of the wrist is most common where?

Back 42

First carpal-metacarpal joint

Front 43

Osteoarthritis of the hand is most common where?

Back 43

Interphalangeal joints

Front 44

What (2) nodes are associated with osteoarthritis of the hand? Where are they?

Back 44

- Heberdeen's nodes: DIP joints
- Bouchard's nodes: PIP joints

Front 45

Erosive Osteoarthritis

Back 45

- Inflammatory variant of OA
- Middle aged females
- Bilateral, symmetric, DIP and PIP involement

Front 46

Gull Wing Deformity

Back 46

Erosive Osteoarthritis
- Combination of lateral osteophytes and central intra-articular erosions with surface invagination

Front 47

Ossification of the anterior longitudinal ligament

Back 47

DISH

Front 48

What percentage of DISH patients also have Diabetes Mellitus?

Back 48

20%

Front 49

DISH is most common where?

Back 49

T7 - T11
(2nd most common: cervical spine)

Front 50

Diagnostic Criteria for DISH

Back 50

- Flowing hyperostosis
- 4 contiguous segments
- Absence of facet DJD
- NO SI INVOLVEMENT

Front 51

What does DISH look like in SI joints?

Back 51

IT DOES NOT INVOLVE THE SI's!!!!!

Front 52

Ossification of the posterior longitudinal ligament is most common where?

Back 52

C2 - C4

Front 53

OPLL can cause what?

Back 53

Spinal canal stenosis

Front 54

Syringomyelia

Back 54

Neuropathic Arthropathy
- Large, fluid filed cyst in spinal cord; look for cloak like distribution of pain in shoulders

Front 55

Licked candy stick appearance

Back 55

Atrophic Neuropathic Arthropathy
- Bones become atrophied and taper down

Front 56

Patterns of Hypertrophic Neuropathic Arthropathy

Back 56

6 D's (3 Di's, 3 De's)
- Distended joint
- Dislocation
- Disorganization
- Density increase- Debris
- Destruction

Front 57

Age: Synoviochondrometaplasia (SCM)

Back 57

30 - 50

Front 58

Primary SCM

Back 58

- Idiopathic
- loose bodies are the same size

Front 59

Secondary SCM

Back 59

- Secondary to trauma/degeneration
- Loose bodies are different sizes

Front 60

Clinical Features of SCM

Back 60

Pain, swelling, crepitus, locking, grinding sounds

Front 61

Age: Rheumatoid Arthritis

Back 61

20 - 60s
(20 - 30s onset, diagnosis usually 10 years later)

Front 62

Systemic Findings of Rheumatoid Arthritis

Back 62

- Carpal tunnel syndrome
- Sjogren's syndrome (patient dries out)
- Vasculitis (Raynauds)
- Pleuropulmonary (pericardial disease)

Front 63

Diagnostic Criteria for Rheumatoid Arthritis

Back 63

1. Morning stiffness in and around joints lasting for at least one hour before maximal improvement
2. Soft tissue swelling of three or more joint areas observed by a physician
3. Swelling of the PIPs, MCPs or wrist joints
4. Symmetric swelling

Front 64

Rat bite lesions

Back 64

Rheumatoid Arthritis
- At the very edge of the bare area where there is no cartilage

Front 65

Target Sites of Rheumatoid Arthritis

Back 65

- Hand (MCPs, intercarpal joints, ulnar styloid)
- Foot
- Cervical Spine (atlantoaxial instability)

Front 66

What nodes are present in Rheumatoid Arthritis? Where?

Back 66

Haygarth's nodes in the MCPs