This disorder will cause osteophytes without sclerosis or joint space narrowing
Idiopathic skeletal hyperostosis
This condition affects the hands only.
It affects the distal/ proximal IPJ and the base of the thumb in a bilaterally symmetrical fashion.
It affects the distal interphalangeal joints (Heberden nodes): Distal IPJ
(Bouchard nodes): proximal IPJ
(mnemonic H-D, B-P)
This condition has identical distribution for primary OA and is associated with osteoporosis of the hands, as well as erosion.
Gull-wing appearance of DIP joint
Erosive OA aka Kellgren arthritis
Hallmarks of rheumatoid arthritis (6):
1. soft tissue swelling
3. joint Space narrowing
4. marginal erosions
5. bilaterally symmetrical
6. proximal distribution (Hands)
The femoral head migrates axially where as in OA it migrates superiolaterally.
Name the HLA B-27 positive spondyloarthropathies: (4)
- Ankylosing spondylitis
- Inflammatory bowel disease- IBD
- Psoriatic arthritis
- Reiter syndrome also called reactive arthritis
Paravertebral ossification that runs vertically is known as...
bamboo spine with a single central radiodense line related to ossification of supraspinous and interspinous ligaments which is called dagger sign. (Ank Spon)
Causes of high riding shoulder (3)
- Rheumatoid arthritis
- CPPD (aka Pseudogout)
- Torn rotator cuff
These 2 conditions may cause asymmetrical unilateral SI joint disease :
- Reiter syndrome
- Psoriatic arthritis
Hallmarks of gout
- Well defined erosions/ sclerotic margins
- Soft tissue nodules
- No osteoporosis
- Random distribution
Classic triad for CPPD/ Pseudogout:
2. cartilage Ca / aka chondrocalcinosis
3. Joint destruction
What are the most commonly affected locations for chondrocalcinosis in CPPD: (3)
- Medial and lateral compartment of the knee
- Triangular fibre cartilage of the wrists
- Pubic symphysis
Most common location of arthropathy in CPPD: (5)
- MCP joint in hand
- Radiocarpal joint
- Patellofemoral joint
Name three diseases with high associations with CPPD
- Primary Hyper PTH
What is the difference between soft tissue calcification in scleroderma and dermatomyositis
In scleroderma, Soft tissue calcification is subcutaneous where as in dermatomyositis it is intramuscular.
What is the diagnosis?
Lacelike appearance of the hands with associated skin Nodules
What is the diagnosis?
The metacarpal heads are square shaped, block like and there is Drooping appearance of the osteophytes
Classic triad for Charcot joint
- joint destruction,
- dislocation and
- heterotopic new bone (soft tissue calcification or clumps of ossification adjacent to the joint.)
What are the radiological findings in juvenile rheumatoid arthritis and the haemophilia?
Overgrowth of the ends of the bone (epiphyseal enlargement) associated with gracile diaphyses.
Characteristic appearance of PVNS on MRI
Low signal hemosiderin seen
Lining the synovium on both T1 and T2.
Blooming on GE
What is the Ddx for PVNS?
non calcified synovial osteochondromatosis
What is Sudeck atrophy?
Also named as shoulder hand syndrome, Reflex sympathetic dystrophy, And chronic regional pain syndrome.
It occurs after minor trauma to an extremity resulting in pain, swelling and dysfunction.
Severe patchy osteoporosis soft tissue swelling are seen radiologically.
Which part of the femoral head is affected in AVN?
Anterior Superior portion of the femoral head. If the anterior portion is not involved, The diagnosis should be questioned. Posterior AVN can happen post posterior dislocation
what is Kienbock malacia?
Avascular necrosis of lunate is called Kienbock malacia.
Frightening and sclerosis of the tarsal navicular in children due to AVN
Describe neuropathic joint:
Deformity with Debris and Dislocation and having Dense subchondral bone and Destruction of articular cortex
first spot in the foot affected by Rheumatoid arthritis
5th MT head
RA, splenomegaly and neutropenia
Felty syndrome high Rh factor titre weight loss, leg ulceration and brown skin pigmentation
RA and pneumoconiosis
Pencil sharpening effect
Name some BUZZWORDS associated with psoriatic arthritis
- Pencil in cup deformity
- Fuzzy appearance around the joint- Sausage digit
- Ivory phalanx
- Mouse ears
- Acral osteolysis
when i say ankylosis in hand, you say .... and ....
- Erosive OA
Bamboo spine and shiny corners
Gout on MRI (2)
1. Juxta articular soft tissue mass (low on T2)
2. Tophus will typically enhance
Earliest sign of Gout
" Punched out lesion with overhanging edges"
Gout mimickers (5)
- Reticular histiocytosis
Degenerative change in an unusual joint
CPPD can cause ...... wrist by degenerating the SL ligament
Milwaukee shoulder, or destructive shoulder arthropathy, usually affects elderly women, associated with the deposition of ........ with joint effusion and rotator cuff tear.
This condition usually affects elderly women, associated with the deposition of hydroxyapatite crystals with joint effusion and rotator cuff tear.
Name some signs associated with hyperPTH
1. subperiosteal bone resorption- radial aspect of 2/3rd fingers ]
2. Rugger Jersey spine
3. Brown tumours
4. Terminal tuft erosion
Superior and inferior rib notching- bone resorption pelvis wit narrowing of femoral neck and wide SI joint
Causes of cervical spine fusion (2)
1. congenital (Klippel Feil)
2. juvenile rheumatoid arthritis
Causes of erosions of dens (2)
Reducible deformity of joints without articular erosion.
Hand X-ray : reversible ulnar subluxation at the MCP on Norgaard view and PA view
Post-rheumatic fever the hand X-ray shows non erosive arthropathy with ulnar deviation of fingers. Findings are very similar to SLE
How to differentiate between DISH and AS
There is no sacroiliitis in DISH
OPPL is associated with... (3)
2. ossification of ligament flavuum.
This condition is associated with patients on renal dialysis, And it most commonly affects the cervical spine.
RNP antibody is positive
Mixed connective tissue disease
Proximal distribution and premature fusion of growth plates.
Enlargement of epiphysis and widened intercondylar notch
Juvenile idiopathic arthritis
Findings in juvenile idiopathic arthritis is similar to…
Haemophilia- you also get blooming artefact secondary to haemosiderin (DDX: PVNS)
Bilateral involvement of shoulders, Hips, carpals and knees Carpal tunnel syndrome is a clinical manifestation. The Joint space is typically preserve until later in the disease
Double line sign is best seen on this sequence? what is it a sign of?
seen on T2 osteonecrosis/AVN
elevated level of serum trytase and osteosclerosis and thickening of SB folds
Where is Baker's cyst located?
Medial head of gastrocnemius and semimembranosis.
Most common location for hydroxyapatite deposition
Secondary causes of calcific tendonitis
- Chronic renal disease
- Collagen vascular disease
- Tumoral calcinais
- Hypervitaminosis D
This is a progressive diaphysial dysplasia (PDD).
It causes fusiform bone enlargement with sclerosis of the long bones. It starts in childhood.
- This is a progressive diaphysial dysplasia (PDD).
It causes fusiform bone enlargement with sclerosis of the long bones.
- bilateral and symmetrical
- hot on bone scan
- can you involve the skull and cause optic nerve compression
Widening of the joint space in an adult hip
This is typically found in hand (palmer tendons).
Can cause erosion on the underlying bone.
Will be soft tissue density and T1 and T2 dark
Giant cell tumour of the tendon sheath (PVNS tendon)
Giant cell tumour of the tendon sheath versus glomus tumour
Glomus tumour is T1 dark and T2 bright and will enhance uniformly
Frond like deposition of fatty tissue affecting the synovial lining of the joints and bursa
AVN of the hip usually affects the .... articular border
Causes of hip AVN (4)
- Perthes -
- Sickle cell -
- Gauchers -
Which one obliterates sinuses
Thalassaemia or sickle-cell?
Erlenmeyer flask - Causes:
1. anaemias (thalassaemia, SCD),
2. storage disorders (Gaucher’s, Niemann–Pick), and
3. skeletal dysplasias (Pyle’s disease, craniometaphyseal dysplasia, Melnick–Needles syndrome).
Gracile Bone causes:
- N: neurofibromatosis
- I: immobilisation/paralysis
- M: muscular dystrophy, e.g. Duchenne muscular dystrophy
- R: rheumatoid arthritis (juvenile RA)
- O: osteogenesis imperfecta
- D: dysplasia, e.g. Marfan syndrome, homocysteinuria
female in 3rd trimester of pregnancy with hip pain
transient osteoporosis of the hip
Findings in transient osteoporosis of the hip
X ray: Osteopenia
NM: Increased uptake on bone scan.
AVN of calcanea apophysis
AVN of capitulum