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JOINT & SOFT TISSUE DISEASES (METABOLIC (Osteoporosis (pencil thin…

- - - - Spondylosis Deformans
      - DISH
      - Baastrup's Disease
      - Neurotrophic
        
        Hypertrophic (Charcot Joints)
        
        Atrophic
      - Erosive Arthritis
    - - Osteitis Condensans Ilii / Pubis?
      - Idiopathic Chrondrolysis of Hip?
  - - - OPLL
    - - Extremities
        
        Thumb Basilar
      - Spines
        
        CostoTransverse
        
        CostoVertebral
        
        UncoVertebral
        
        Facet Joints
- - - - Synovial involvement --> capsular distention --> cartilage death and destruction
      - Loss of cartilage causes joint & bone destruction
      - proximal femoral metaphysis may show signs of osteomyelitis ( neonates)
    - - Femur Epiphysis, Metaphysis
        
        common route of infection: blood, direct implantation, contiguous spread from one bone to the other, iatrogenic
        
        fat plane displacement
        
        moth-eaten pattern of bone destruction
        
        solid / laminated periosteal reaction
        
        sequestrum, involucrum
      - Spinal: sacroilitis, visceral infection, oedema, abscess
  - - - Rheumatoid Arthritis
        
        Radiographic Features
        – Soft tissue swelling
        – Intra-articular effusion
        – Periostitis
        – Uniform loss of joint space
        – Articular marginal erosions (rat bites)
        – Growth disturbances
        – Periarticular/juxtaarticular Osteoporosis
        – Displaced fat pad planes – meaning??
      - Juvenile Chronic Arthritis (JCA)
        
        Radiographic Features
        – Periostitis
        – Uniform loss of joint space
        – Articular erosions
        • Increased blood flow results in:
        – Growth disturbances (increased or decreased)
        – Osteoporosis
        • Ankylosis common in hands and feet
    - - Ankylosing Spondylitis 90% HLA-B27 + young 15-35 yo adult M:F = 15:1, pseudowidening, erosion (Rosary bead sign), ankylosis (SIJ Star sign), Destruction inf & sup corner of VBs (Romanus lesion), reactive sclerosis (Shiny corner), squaring of VB, marginal syndesmophyte, bamboo spine, Trolley Track & Dagger signs
      - Reiter's clinical triad = urethritis, conjunctivitis, polyarthritis; skin lesions (keratoderma blenorrhagicum); 75% HLA-B27 + anaemia males 18-40, M:F = 50:1
      - Psoriatic Hand
        
        • nail changes in DIPs and PIPs
        
        • Uncommon in MCP, wrist involved vs. RA
        
        • 3 Joints single digit (ray pattern) different from RA
        
        • Asymmetric, sausage digits due to tenosynovitis
        
        • Joint widening, erosion, fibrous deposition
        
        • Marginal erosions, “mouse ears”
        
        • Whittling of phalanx
        
        erosion into articular surface “pencil in cup
        
        • Severe deformity, arthritis mutilans
        
        • intraarticular ankylosis
      - Enteropathic **10% HLA-B27 - Ulcerative colitis, Crohn's
    - - Systemic Lupus Erythematosus
        
        • Reversible ulnar deviation, boutonniere, swan neck deformities
        • Generalised osteoporosis
        – Mechanical erosions, repeated dislocations
        – Changes in joint space
        – Calcification subcutaneous tissues/vessels
      - Progressive Systemic Sclerosis (ScleroDerma)
- - - - in Tendons & Ligaments
    - - in Cartilage
- - - - rhizomelic limb shortening
      - • large cranium with prominent forehead
      - • small foramen magnum (hydrocephalus)
      - • “bullet vertebra” at T/L junction -> protuberant abdomen, acute kyphosis
      - • increase lumbar lordosis -> protuberant buttocks, horizontal sacrum
      - • short, thick pedicles
      - • decreasing interpedicular distance caudally -> canal stenosis
      - • posterior vertebral body scalloping
      - • shallow acetabulum, dysplastic femoral heads -> early arthritis
      - • champagne glass pelvis
  - - - diffuse osteosclerosis
      - • **bone within bone
      - • sandwich vertebrae**
      - • sclerotic skull base
      - • bones appear strong, they’re weak -> fractures, spondylolysis