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106 Cards in this Set

  • Front
  • Back
What are the hallmarks of djd?
-Joint space narrowing
-Sclerosis
-Osteophytosis
Which is the least specific finding in DJD?
Joint space narrowing—it is seen with lots of other joint problems
When wouldn’t sclerosis be present in DJD?
-In severe osteoporosis
-Osteophytosis may be diminished as well
What causes osteophytosis without DJD?
Diffuse idiopathic skeletal hyperostosis (DISH)
How can you tell DISH from DJD?
DISH doesn’t have joint space narrowing or sclerosis
What is primary osteoarthritis?
-Familial arthritis
-Affects middle-aged women
-Seen only in the hands
Which specific joints are affected by primary osteoarthritis?
Symmetric involvement of the DIP, PIP, and base of the thumb
What if primary osteoarthritis is not symmetric?
Find another diagnosis
What is Kellgren arthritis?
-Also called erosive osteoarthritis
-Just like primary osteoarthritis, but it is associated with diffuse, severe osteoporosis as well as erosions
Which joints tend to have erosions as a manifestation of OA?
The TMJ, SI, AC, and symphysis pubis
What is a geode?
Cystic formations that occur around joints in a variety of disorders
What disorders are associated with geode formation?
DJD, RA, CPPD disease, avascular necrosis
How are geodes formed?
#1: synovial fluid is forced into the subchondral bone, causing a cystic formation of joint fluid

#2: following bone contusion, when the contused bone forms a cyst
What are the hallmarks of RA?
-Soft tissue swelling
-Osteoporosis
-Joint space narrowing
-Marginal erosions—away from the weight-bearing portion
How does RA affect the hip?
The femoral head tends to migrate axially
How does OA tend to affect the hip?
The femoral head tends to migrate superolaterally
How does RA affect the shoulder?
The humeral head appears to be “high-riding”
What things can cause a high-riding shoudler?
-RA
-CPPD
-Torn rotator cuff
How does DJD in RA pts look different?
Sclerosis and osteophytosis are considerably diminished
Which diseases are grouped as the HLA-B27 spndyloarthropathies?
Ankylosing spondylitis, inflammatory bowel disease, psoriatic arthritis, Reiter syndrome
What are the hallmarks of the HLA-B27 spondyloarthropathies?
-Bony ankylosis
-Proliferative formation of new bone
-Predominantly axial skeleton involvement
What is a syndesmophyte?
-Paravertebral ossification that resembles an osteophyte, except that it runs vertically
-An osteophyte has a horizontal axis
How can you tell a syndesmophyte from an osteophyte if their orientation is in between?
Look at other levels to see what their ossifications look like

Sometimes you can’t tell
What does it mean for a syndesmophyte to be marginal?
It has its origin at the edge of a vertebral body and extends to the edge of the adjacent vertebral body

Non marginal syndesmophytes tend to be big and bulky
What diseases have symmetric, marginal syndesmophytes?
Ankylosing spondylitis and inflammatory bowel disease
What diseases have asymmetric, non-marginal syndesmophytes?
Psoriatic arthritis, Reiter’s syndrome
Which joint is typically involved in the HLA-B27 spondyloarthropathies?
The SI joint
Which diseases always have bilateral involvement of the SI joints?
Ankylosing spondylitis and inflammatory bowel disease
Which diseases sometimes have bilateral involvement of the SI joints, sometimes not?
Reiter syndrome and psoriatic arthritis
What should you think when you see unilateral erosive disease of an SI joint?
DJD, reiter’s or psoriatic arthritis, infection, maybe gout
What does the large joint involvement look like in HLA-B27 spondyloarthropathies?
It resembles rheumatoid arthritis
How many ankylosing spondylitis pts have hip disease?
Half
What the small joint involvement of psoriatic arthritis look like?
-Distal predominance
-Proliferative erosions
-Soft tissue swelling
-Periostitis
-Severe forms may have ankylosing across joints and arthritis mutilans deformities
What does a “proliferative” erosion look like?
They have fuzzy margins with wisps of periostitis emanating from them, as opposed to the normally seen clean-cut sharply marginated erosions
What is a common finding in small joint involvement of psoriatic arthritis?
Calcaneal heel spur with fuzzy margins, rather than sharp margins, like those seen in DJD or post-traumatic
How does Reiter syndrome differ from psoriatic arthritis?
It is identical, except it tends to affect the feet more, while psoriatic tends to affect the hands
Which joint is classically involved in Reiter syndrome?
The great toe interphalangeal joint
What are the crystal-induced arthritides?
-Gout
-Pseudogout
-Ochronosis
-Wilson disease
What is the crystal deposited in gout?
Monosodium urate
How long does it take for gout to show up on radiographs?
4-6 years
What are the classic signs of gouty arthritis?
Well defined erosions
-With sclerotic borders (Pretty specific for gout)
-With overhanging edges
(Not so specific)

Soft tissue nodules (These calcify with renal failure)

Random distribution

No marked osteoporosis
Which joint is classic for gout?
The first MTP
Why do gout pts get chondrocalcinosis?
Because they are predisposed to pseudogout
How many gout pts go on to develop pseudogout?
40%
What is the classic triad of pseudogout?
-Pain
-Cartilage calcification
-Joint destruction
What are the crystals deposited in pseudogout?
Calcium pyrophosphate dihydrate
What crystals are deposited in calcific tendonitis?
Calcium hydroxyapatite
Which cartilages are typically affected by pseudogout?
-Knee (medial and lateral compartments)
-Triangular fibrocartilage of the wrist
-Symphysis pubis

Chondrocalcinosis in these joints is virtually diagnostic of CPPD
How can you tell calcific tendinitis from CPPD deposition?
Calcification of soft tissues can be either CPPD or calcific tendinitis

BUT, calcific tendinitis does not affect joint cartilages
Why do joints get destroyed in CPPD disease?
CPPD crystals erode the cartilage, and DJD occurs
How can you tell plain DJD from CPPD DJD?
By which joints are involved
Which joints are involved in CPPD DJD?
-Shoulder
-Elbow
-Radiocarpal joint
-Patellofemoral joint
-MCP joints of the hand
Which joints are involved in plain DJD?
-Medial compartment of the knee
-DIP of hand
-Hip
What is a pseudo-charcot joint?
-Looks like a neuropathic joint, but has sensation
-Can be caused by advanced CPPD destruction
Which three disease have a strong association with CPPD?
-Primary hyperparathyroidism
-Gout
-Hemochromatosis
What diseases are grouped under the collagen-vascular diseases?
-SLE
-Dermatomyositis
-Mixed connective tissue disease
What is the hallmark of joint involvement in collagen-vascular diseases?
-Osteoporosis
-Soft tissue wasting
-No bony erosions
What is characteristic of lupus joint involvment?
Ulnar deviation of the phalanges
What are characteristic of dermatomyositis and scleroderma joint involvement?
Soft tissue calcifications
How can you tell joint involvement of dermatomyositis from scleroderma?
Scleroderma has subcutaneous calcifications

Dermatomyositis has intramuscular calcifications
What does sarcoid involvement of joints look like?
-Lytic destructive lesions of the cortex
-“lace-like” appearance
Which joint is typically involved in sarcoid?
The hands
How many hemochromatosis pts have arthropathy?
20-50%
What is the characteristic finding of joint involvment of hemochromatosis?
-DJD involving the 2nd-4th MCPs
-“squaring” of the metacarpal heads and “drooping” osteophytes
-Also, many of these pts have CPPD disease, so look for chondrocalcinosis
Why do neuropathic joints get so messed up?
-The joint is rendered unstable by inaccurate muscle action and is unprotected by nerve reflexes
-There is repeated microtrauma
What is the classic triad of findings in a neuropathic joint?
-Destruction (severe)
-Dislocation
-Heterotopic new bone (debris)
What is the most common neuropathic joint?
Diabetic foot
What is characteristic about diabetic charcot feet?
-1st and 2nd tarsometatasal joints are affected
-Looks like a lisfranc fx.
What are classic bone x-ray findings in jRA and hemophilia?
-Overgrowth of the ends of bones associated with gracile diaphyses
-You might see widening of the intercondylar notch of the knee
Why are the ends of the bones overgrown in jRA and hemophilia?
Hyperemia and disuse
What is synovial osteochondromatosis?
-Metaplasia of the synovium that results in deposition of foci of cartilage in the joint
-These foci calcify and are seen on x-rays
What joints are typically affected in osteochondromatosis?
Knee, hip, elbow
What do you see if these foci of osteochondromatosis don’t calcify?
Only a joint effusion
How does osteochondromatosis cause symptoms?
The foci shed off into the joint space where they are free fragments, “joint mice”
How is osteochondromatosis treated?
Synovectomy
What is tumefactive osteochondromatosis?
When loose bodies are tightly packed into a joint, giving the appearance of tumor
Why is tumefactive osteochondrosis a tricky diagnostic situation?
It can look like tumor on MR

Path can be interpreted as chondrosarcoma

BUT, there is no such thing as a malignant tumor arising from the joint space
Describe Pigmented villonodular synovitis (PVNS):
Pigmented villonodular synovitis (PVNS) is a rare chronic inflammatory process of the synovium that causes synovial proliferation. A swollen joint with lobular masses of synovium occurs and causes pain and joint destruction. It rarely, if ever, calcifies.
What does PVNS look like on x-rays?
Joints with PVNS look radiographically identical to noncalcified synovial osteochondromatosis, yet they are much less common. Therefore, whenever PVNS is a consideration, synovial chondromatosis should be mentioned.
What does PVNS look like on MR?
PVNS has a characteristic appearance on MR, with low-signal hemosiderin seen lining the synovium on both T1WIs and T2WIs
What else is Sudek atrophy called?
Also known as shoulder-hand syndrome and reflex sympathetic dystrophy
Describe Sudek atrophy:
Sudeck atrophy is a poorly understood joint affliction that typically occurs after minor trauma to an extremity, resulting in pain, swelling, and dysfunction. It typically affects the distal part of an extremity, such as a hand or foot, yet intermediate joints such as the knee and hip are believed by some to be occasionally involved.The pain usually subsides, but the osteoporosis may persist. With time, the swelling will subside and the skin may become atrophic.
What is reflex sympathetic dystrophy also known as?
Sudek atrophy
What should you look for in Sudek's atrophy?
It is important for the radiologist to recognize the aggressive osteoporosis in this disorder and differentiate it from disuse osteoporosis so that the treating physician can begin aggressive physical therapy.
What is most reliable way to tell if there's a knee effusion?
The radiographic sign for a knee effusion that seems to be the most reliable is the measurement of the distance between the suprapatellar fat-pad and the anterior femoral fat-pad. A distance between these two fat-pads of more than 10 mm is definite evidence for an effusion. A distance of less than 5 mm is normal.
What kinds of things can cause AVN?
Avascular necrosis (AVN), or osteonecrosis, can occur around almost any joint for a host of reasons, including steroid use, trauma, a variety of underlying disease states, and even idiopathically. It is often seen in renal transplant patients.
What is the earliest sign of AVN?
The earliest sign of AVN is a joint effusion. This often is not visible radiographically or is so nonspecific that it does not help with the diagnosis unless the clinical setting had already raised suspicion for AVN.
Describe early and late findigns of AVN:
The earliest sign of AVN is a joint effusion. The next sign for AVN is a patchy or mottled density. Next, a subchondral lucency often develops that forms a thin line along the articular surface. The final sign in AVN is collapse of the articular surface and joint fragmentation. I must stress that these changes all occur on only one side of a joint, which makes for an easy diagnosis because almost everything else around joints involves both sides of the joint.
What is the most useful study for ruling out AVN?
MR is extremely useful in evaluating AVN. It is the most sensitive imaging study available, often showing AVN when plain films or radionuclide scans are normal
What does AVN of the hip look like on MR?
In the hip, AVN typically has an area of low or mixed signal on T1WIs that is located in the anterosuperior portion of the femoral head. If the anterior portion of the femoral head is not involved, the diagnosis of AVN should be questioned, as it is uncommon for this condition to present otherwise. Posterior femoral head AVN can occasionally be found after posterior dislocation of the hip because of impaction of the femoral head on the posterior column of the acetabulum.
What is osteochondritis dissecans?
A form of AVN that is smaller and more focal than that just described is osteochondritis dissecans. Osteochondritis dissecans frequently leads to a small fragment of bone being sloughed off and becoming a free fragment in the joint, i.e., a “joint mouse.”
Where does osteochondritis dissecans tend to occur?
It occurs most often in the knee at the medial epicondyle. It also is frequently seen in the dome of the talus and occasionally in the capitellum.
What four diseases can have an essentially normal joint with subchondral cysts or geodes?
Osteochondritis dissecans, rheumatoid arthritis, DJD, and CPPD.
What is Kienböck malacia?
AVN of the lunate
What is Köhler disease?
AVN of the tarsal navicular
What is Freiberg infraction?
AVN of the metatarsal heads
What is Legg-Calve-Perthes disease?
AVN of the femoral head
What is Scheuermann disease?
AVN of ring epiphyses of the spine
What is AVN of the lunate called?
Kienböck malacia
What is AVN of the tarsal navicular called?
Köhler disease
What is AVN of the metatarsal heads called?
Freiberg infraction
What is AVN of the femoral head called?
Legg-Calve-Perthes
What is AVN of ring epiphyses of the spine called?
Scheuermann disease
What is Osgood-Shlatter disease?
AVN of the tibial tubercle
What does AVN look like on T1WIs?
It shows diffuse low signal on T1WIs that involves the entire area of AVN
What is AVN of the tibial tubercle called?
Osgood-Shlatter disease