Lecture no 4 Prepared by Dr.Salah Mohammad Fatih MBChB,DMRD,FIBMS(radiology)
OA RA•Joint space narrowed max. at •Joint space narrowing uniform.wt bearing site•Erosion do no occur. •Erosion is characteristic feature.•Subchondral sclerosis may •Subchondral sclerosis is not abe seen. feature.•Sclerosis is a prominent •Sclerosis not a feature unlessfeature. there is secondary OA.•No osteoporosis. •Osteoporosis often present•No peri articular soft tissue •Peri articular soft tissue swellingswelling
Most often due to pyogenic bacterial infection or TB. Usually only one joint affected. Synovial biopsy or exam. of the joint fluid is necessary for identification of infecting organism
Usually due to staph. Aureus. Rapid destruction of the articular cartilage followed by destruction of the subchondral bone & cause peri articual soft tissue swelling. Earliest radiological finding is joint effusion, do US, you can do US guided aspiration of the joint fluid. If Dx is still in doubt , then MRI advisable
There is decrease in cartilage width in theleft hip, and cortical indistinctness in theleft acetabulum with subarticular cystformation.
Hip& knee are the most commonly affected peripheral joints. Spine involved in 50% of cases.
Localized osteoporosis. Cartilage erosion usually occur late for that resion , at 1st joint space is preserved. Margional errosion. At late stage there may be gross disorganization of the joint with calcified debris near the joint.
Radiological features• classic picture of a Charcot joint. It demonstrates the five Ds:• increased or normal density,• joint distension (effusion),• bony debris.• joint disorganization• joint disassociation.
•lateral translation of the tibia relative tothe femur;• a destructive arthropathy with loss ofcartilage width and fragmentation,especially of the medial tibial plateau;•large effusion containing bony debris.
• Changes seen in the feet in the pt with diabetic neuropathy.• Prominent feature is Resorption of the bone ends & calcification of the arteries in the feet often present
complete obliteration of thecartilage width anddestruction with veryabundant fragmentation atthis joint.
• Also known as osteonecrosis, is where there is death of bone due to interruption of the blood supply.• It occur most commonly in the intra-articular portions of bones & is associated with numerous underlying condition including.• Steroid therapy.• Collagen vascular diseases.• Radiation therapy.• Sickle cell disease.• Exposure to the high pressure environment e.g. deep- see divers
X-ray finding• Increased density of the subchondral bone with irregularity of the articular contour or even fragmentation• A charactristic lucent line may be seen just beneath the articular cortex.• The cartilage space may be preserved until secondary OA changes occur.
left hip joint;increaseddensitycentrally andflattening ofthe femoralhead in theweight-bearingregion, aswell as thecrescent signorsubchondralfracture.
MRI• Is imaging modality of choice.• It can show abnormality when the X-ray is normal & signal pattern allow specific Dx to be made.
• Is a group of condition in which no associated cause for avascular necrosis can be found.• Osteochondritis now regarded as being due to impaired blood supply associated with repeated trauma.
Perthe’s disease• Is avascular necrosis of the femoral head in children.• seen generally between ages 4 and 8, when the vascular supply to the femoral head is most at risk.• Males are affected more than females.• Bilateral in 10 percent of patients.
X-ray finding• The first radiographic sign may be effusion.• Later, increased density, fragmentation and flattening of the ossification center & lucent areas within it•• Metaphyseal irregularity & short wide femoral neck.
The left femoralcapital epiphysis isdense, has lucent areaswithin it, and isflattened. This left hipis laterally subluxated,
Other forms of osteochondritis
• Kienbock’s disease = avascular necrosis of lunate bone.• Freiberg’s disease = avascular necrosis of metatarsal head.• Kohler’s disease = avascular necrosis of navicular bone of the foot.
There isincreaseddensity andcollapse ofthe lunate Kienbocks disease
Osgood-schlatter’s disease = avascular necrosis of tibial tuberosity . Fragmentation of tibial tuberosity
Kohler’s disease = avascular necrosis of navicular bone of the foot.Increaseddensity withirregularity inthe out line
Slipped femoral epiphysis
.• age range (10 to 16 years of age)• Males are more commonly affected than females.• bilateral 20 percent of the time, but rarely symmetric.• Slipped epiphyses almost always are directed posteromedially.
Radiological finding • The epiphysis itself appears shorter due to the posterior slippage. • The epiphyseal plate itself appears wider, with less distinct margins • The epiphysis is also slightly more medially placed, it can be demonstrated by drawing a line along the lateral femoral neck. This line should intersect a portion of the femoral head in the normal individual. In a slipped epiphysis, the line will either not intersect the femoral head, or will intersect a smaller portion of it. • The slip is best appreciated in lateral film of the hip
The left femoral capital epiphysis appears slightly shorter than does the right,with an apparent widening of the epiphyseal plate
Developmental dysplasia of the hips (DDH or CDH)
developmental dysplasia of the hips (CDH or DDH)• female: male = 6:1• 70% occur on the left side, Bilateral involvement occur in 5%