Chapter 43 - Arthritis (CHERI NOTES) Flashcards
(94 cards)
1
Q
______ or _____ ; is the most common arthritide. (p. 1043)
A
OSTEOARTHRITIS or DEGENERATIVE JOINT DISEASE
- it is believed to be caused by trauma either overt or as an accumulation of microtrauma over years
2
Q
A hereditary form of osteoarthritis that occur primarily in women. (p.1043)
A
PRIMARY OSTEOARTHRITIS
3
Q
Enumerate the three hallmarks of degenerative joint disease. (p.1043)
A
- Joint space narrowing
- Sclerosis
- Osteophytosis
- if all three of these findings are not present on the radiograph; another diagnosis should be considered
4
Q
Least specific finding out of the three hallmarks of degenerative joint disease (p.1043)
A
JOINT SPACE NARROWING
- yet is it virtually always present in DJD
- unfortunately; joint space narrowing is also seen in almost every other joint abnormality
5
Q
TRUE OR FALSE?
Sclerosis should be present in varying amounts in all cases of DJD unless severe osteoporosis is present. (p.1043)
A
TRUE
- Osteoporosis will cause the sclerosis to be diminished
6
Q
The only disorder that will cause osteophytes without sclerosis or joint space narrowing is ____. (p.1043)
A
DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS
- a common bone-forming disorder that at first glance resembles DJD; except that there is no joint space narrowing (or disc space narrowing in the spine) and there is no sclerosis.
- not believed to be caused by trauma or stress as is DJD and is not painful or disabling as DJD can be.
7
Q
Osteoarthritis is divided into two types: ______. (p.1043)
A
PRIMARY OSTEOARTHRITIS; SECONDARY OSTEOARTHRITIS
8
Q
TRUE OR FALSE?
SECONDARY OSTEOARTHRITIS is what radiologist refer to when speaking of DJD. (p.1043)
A
TRUE
- It is; as mentioned; secondary to trauma of some sort.
- it can occur in any joint in the body but is particularly common
in hands; knees; hips and spine.
9
Q
______ is a familial arthritis that affects middle-aged women
almost exclusively and is seen only in the hands. (p.1043)
A
PRIMARY OSTEOARTHRITIS
- it affects the distal interphalangeal joints; the proximal interphalangeal joints; and the base of the thumb in a bilaterally symmetrical fashion.
- if it is not bilaterally symmetrical; the diagnosis of primary osteoarthitis should be questioned.
10
Q
A type of primary osteoarthritis that can be very painful and
debilitating is _____. (p.1043)
It has the identical distribution mentioned for primary
osteoarthritis but is associated with OSTEOPOROSIS OF THE
HANDS; as well as erosions.
A
EROSIVE OSTEOARTHRITIS
- it is uncommon; and radiologists generally see little of this
disorder.
11
Q
Other name for EROSIVE OSTEROARTHRITIS? (p.1043)
A
KELLGREN ARTHRITIS
12
Q
Enumerate the 4 joints which also exhibit EROSIONS aside from the classic triad of degenerative joint disease. (p.1043)
A
- TEMPOROMANDIBULAR JOINT
- ACROMIOCLAVICULAR JOINT
- SACROILIAC JOINTS
- SYMPHYSIS PUBIS
- when erosions are seen in one of these joints; DJD must be
considered or inappropriate treament may be instituted
13
Q
TRUE OR FALSE?
A SUBCHONDRAL CYST or GEODE is often found in joints affected with DJD. (p.1043)
A
TRUE
14
Q
_____ are cystic formations that occur around joints in various
disorders (including; in addition to DJD; rheumatoid arthritis;
calcium pyrophosphate dihydrate crystal deposition disease
and avascular necrosis (AVN)).
A
GEODES
- One method of geode formation; is that synovial fluid is forced into the subchondral bone; causing a cystic collection of joint fluid
- Another etiology is following a bone contusion in which the contused bone forms a cyst
- they rarely cause problems themselves but are often misdiagnosed as something more sinister.
15
Q
_____ is a connective tissue disorder of unknown etiology that can affect any synovial joint in the body. (p.1044)
A
RHEUMATOID ARTHRITIS
16
Q
Enumerate the *6 Radiographic hallmarks of RHEUMATOID ARTHRITIS. (p.1044)
*prev 4 (corrected)
A
- SOFT TISSUE SWELLING
- OSTEOPOROSIS
- JOINT SPACE NARROWING
- MARGINAL EROSIONS
- BILATERAL SYMMETRICAL
- PROXIMAL
- in the hands; it is classically a proximal process that is bilaterally symmetrical
- smoon
17
Q
In the hip (with Rheumatoid Arthritis); the femoral heads
tends to migrate _____; whereas in osteoarthritis;
it tends to migrate _______. (p.1044)
A
HIP: femoral heads migrate….
RHEUMATOID ARTHRITIS - AXIALLY;
OSTEOARTHRITIS - SUPEROLATERALLY.
18
Q
In the shoulder (with Rheumatoid Arthritis); the humeral
head tends to be “________”. (p.1044)
A
HIGH-RIDING
- other things to think of when confronted with a high-riding shoulder are a torn rotator cuff and CPPD
19
Q
A group of diseases that was formerly known as rheuma-
toid variants is now known as the seronegative; _____.
(p.1047)
A
HUMAN LEUKOCYTE ANTIGEN B27 (HLA-B27)-
POSITIVE SPONDYLOARTHROPATHIES
- these disorders are all linked to the HLA-B27 histocompatibility antigen
- included in this group of diseases are:
1. Ankylosing spondylitis
2. Inflammatory bowel disease
3. Psoriatic Arthritis
4. Reiter syndrome (also called REACTIVE ARTHRITIS) - they are characterized by bony ankylosis; proliferative new-bone formation; and predominantly axial (spinal) involvement
20
Q
One of the more characteristic findings in HLA-B27 Spondyloarthropathies disorders. (p.1047)
A
SYNDESMOPHYTES IN THE SPINE
21
Q
A ______ is a paravertebral ossification that resembles
an osteophyte; except that is runs VERTICALLY. (p.1047)
A
SYNDESMOPHYTE
22
Q
Osteophyte has its orientation in a ___ axis. (p.1047)
A
HORIZONTAL axis
23
Q
TRUE OR FALSE?
Sometimes it can be difficult to decide whether a particular paravertebral ossification is an osteophyte or a syndesmophyte based on its orientation alone. (p.1047)
A
TRUE
24
Q
TRUE OR FALSE?
Bridging osteophytes and large syndesmophytes can have
a similar appearance; with both having an orientation halfway between vertical and horizontal. (p.1048)
A
TRUE
25
Two classifications of syndesmophytes? (p.1048)
1. MARGINAL and SYMMETRICAL
| 2. NONMARGINAL and ASYMMETRICAL
26
A ____ syndesmophyte has its origin at the edge or margin of a vertebral body and extends to the margin of the adjacent vertebral body and extends to the margin of the adjacent vertebal body. (p.1048)
MARGINAL syndesmophyte
- invariably bilaterally symmetrical as viewed on an AP spine film.
27
TRUE OR FALSE?
ANKYLOSING SPONDYLITIS classically has marginal;
symmetrical syndesmophytes. (p.1048)
TRUE
- Inflammatory bowel disease has an identical appearance when the spine is involved.
28
_______ syndesmophyte are generally large and bulky.
| p.1049
NONMARGINAL; ASYMMETRICAL SYNDESMOPHYTES
- they emanate from the vertebral body away from the endplate or margin and are unilateral or asymmetrical as viewed on an AP spine film.
- PSORIATIC ARTHRITIS and REITER SYNDROME classically
have this type of syndesmophyte.
29
TRUE OR FALSE?
| Involvement of the SI joints is common in the HLA-B27 spondyloarthropathies. (p.1049)
TRUE
30
TRUE OR FALSE?
ANKYLOSING SPONDYLITIS and INFLAMMATORY BOWEL DISEASE typically cause bilaterally symmetrical SI joint disease; which is initially erosive in nature and progresses to sclerosis and fusion. (p.1049)
TRUE
- it is extremely unusual to have asymmetrical or unilateral SI joint disease in these two disorders.
31
TRUE OR FALSE?
REITER SYNDROME and PSORIATIC ARTHRITIS can exhibit
unilateral or bilateral SI joint involvement. (p.1049)
TRUE
- it seems that it is bilateral about 50% of the time.
32
TRUE OR FALSE?
If there is bilateral; symmetrical SI joint disease; it could be caused by any of the four HLA-B27 spondyloarthropathies. (p.1049)
TRUE
33
TRUE OR FALSE?
If there is unilateral (or clearly asymmetrical) SI joint involvement; one can exclude ankylosing spondylitis and inflammatory
bowel disease and consider REITER SYNDROME or PSORIATIC DISEASE. (p.1049)
TRUE
34
TRUE OR FALSE?
Small joint involvement; specifically in the hands and the feet; is not common in ANKYLOSING SPONDYLITIS and INFLAMMATORY BOWEL DISEASE. (p.1050)
TRUE
35
____ causes a distinctive arthropathy that is characterized
by its distal predominance; proliferative erosions; soft
tissue swelling and periostitis. (p.1050)
PSORIASIS
- proliferative erosions are different from the clean-cut; sharply marginated erosions seen in all other erosive arthritides in that they
have fuzzy margins with wisps of periostitis emanating from them.
- the severe forms are often associated with bony ankylosis across jonts and arthritis mutilans deformities.
- a fairly common finding is a calcaneal heel spur that has fuzzy margins as opposed to the well-corticated heel spur seen in DJD or
post-trauma.
36
The ______ is a commonly affected location in Reiter disease. (p.1050)
INTERPHALANGEAL JOINT OF THE GREAT TOE
- causes identical changes in every respect to psoriasis; with the exception that the hands are not as commonly involved as the feet and Reiter diseae occurs almost exclusively in MEN.
37
The ____ arthritides include primarily gout and pseudo-
| gout. (p.1050)
CRYSTAL-INDUCED ARTHRITIDES
- Ochronosis and Wilson Disease are so rare that they are not covered in this chapter.
38
____ is a metabolic disorder that results in hyperuricemia
and leads to monosodium urate crystals being deposited
in various sites in the body; especially joints. (p.1050)
GOUT
- the actual causes of the hyperuricemia are myriad and
include heredity.
- the arthropathy caused by gout is very characteristic
radiographically.
39
It takes __ to __ years for gout to cause radiographically evident disease. (p.1050)
4 to 6 years
- most patients are treated successfully long before the destructive arthropathy occurs; therefore; gouty arthritis is not commonly encountered.
40
Enumerate the 4 Classic Radiographic findings in gout. (p.1052)
1. WELL-DEFINED EROSIONS
- often with sclerotic borders or overhanging edges;
2. SOFT TISSUE NODULES
- that calcify in the presence of renal failure
3. RANDOM DISTRIBUTION
- in the hands
4. NO MARKED OSTEOPOROSIS
41
TRUE OR FALSE?
Even though erosions with overhanging edges occur
with gout; they can occur in other disorders as well and
are by no means pathognomonic. (p.1052)
TRUE
- the sclerotic margins of the erosions are rarely seen in any other arthritide; therefore; this is a very useful differential point.
42
Gout typically affects the ___ of the great toe. (p.1052)
METATARSOPHALANGEAL JOINT OF THE GREAT TOE
- in the advanced stages; it can be very deforming
43
Patients with gout often have chondrocalcinosis because
| they have a predisposition for ____. (p.1052)
PSEUDOGOUT (CPPD)
- as many as 40% of patients with gout concomitantly
have CPPD
44
Classical triad of PSEUDOGOUT (Calcium Pyrophosphate
| Dihydrate Crystal Deposition Disease-CPPD). (p.1052)
1. PAIN
2. CARTILAGE CALCIFICATION
3. JOINT DESTRUCTION
- the patient may have any combination of one or more of this triad at any one time.
- each of these is addressed individually
in some detail in this chapter; but note that two
of the three are radiographic findings.
- this is a disorder that is best diagnosed
radiographically.
45
TRUE OR FALSE?
The pain of CPPD is nonspecific.
It can mimic that of gout (hence the term "pseudogout")
or infection or just about any arthritis. (p.1052)
TRUE
- it is typically intermittent for a large number of years
until DJD occurs and becomes the main cause of pain.
46
Cartilage calcification; known as ______; can occur in any
joint but tends to affect a few select sites in most
patients. (p.1052)
CHONDROCALCINOSIS
- the few select sites of chondrocalcinosis are the following:
1. medial and lateral compartments of the knee
2. the triangular fibrocartilage of the wrist
3. symphysis pubis
* chondrocalcinosis in these areas is virtually diagnostic of CPPD
47
TRUE OR FALSE?
When CPPD crystals occur in the soft tissues; such as in the
rotator cuff of the shoulder; a radiograph cannot differentiate between CPPD and calcium hydroxyapatite; which occurs in CALCIFIC TENDINITIS. (p.1052)
TRUE
- Calcium hydroxyapatite does not occur in the joint cartilage except in extremely unusual cases; therefore; all chondrocalcinosis can be considered to be secondary to CPPD.
48
TRUE OR FALSE? (in PSEUDOGOUT)
| - The joint destruction or arthropathy is virtually indisinguishable from degenerative joint disease.(p.____)
TRUE
- it is caused by CPPD crystals eroding the cartilage.
49
The degenerative joint disease of CPPD has a proclivity
| for the following:_______ (give 5). (p.1053)
1. SHOULDER
2. ELBOW
3. RADIOCARPAL JOINT in the wrist
4. PATELLOFEMORAL JOINT of the knee
5. METACARPOPHALANGEAL (MCP) joints in the hand
- these are areas not normally involved by DJD of
wear and tear (such as in the distal interphalangeal joints
of the hand; the hip; and the medial compartment of the
knee.)
50
Occasionally; the arthropathy of CPPD causes such severe
destruction that a neuropathic or Charcot joint is mimicked on
radiograph. This has been termed a _____ joint. (p.1054)
PSEUDO-CHARCOT JOINT
- it is not a true charcot joint because of the presence of sensation.
51
Enumerate the 3 diseases that have a high degree of association with CPPD. (p.1054)
1. PRIMARY HYPERPARATHYROIDISM
2. GOUT
3. HEMOCHROMATOSIS
***(Mnemonic: CPPD P-G-H)
- these are diseases that tend to occur at the same time that CPPD occurs.
- if the patient has one of these three disorders; he or she
is more likely to have CPPD than is a nonaffected person
- there is probably no good reason to work-up every
patient with chondrocalcinosis for one of the three
associated diseases because they are so uncommon
and CPPD is extremely common.
52
Scleroderma; SLE; Dermatomyositis and mixed connective tissue disease are all grouped together as ______. (p.1054)
COLLAGEN VASCULAR DISEASES
53
The striking abnormality in the hands of patients with
| collagen vascular diseases is ____ and ____. (p.1054)
1. OSTEOPOROSIS
2. SOFT TISSUE WASTING
- erosions are generally not a feature of these disorders
54
TRUE OR FALSE?
SYSTEMIC LUPUS ERYTHEMATOSUS characteristically has
severe ulnar deviation of the phalanges. (p.1054)
TRUE
55
TRUE OR FALSE?
| Soft tissue calcifications are typically present in __ and ____. (p.1054)
SCLERODERMA and DERMATOMYOSITIS
56
Identify the soft tissue calcification location for the following:
(p. 1054)
a. Scleroderma
b. Dermatomyositis
A. SCLERODERMA - SUBCUTANEOUS
| B. DERMATOMYOSITIS - INTRAMUSCULAR
57
______ disease is an overlap of scleroderma; SLE; polymyositis and rheumatoid arthritis. (p.1054)
MIXED CONNECTIVE TISSUE DISEASE
- it has myriad of radiographic findings
58
______ is a disease that causes depostion of granulomatous
tissue in the body; primarily in the lungs; but also in the
bones. (p.1054-1056)
SARCOIDOSIS
59
In the skeletal system (SAROCOIDOSIS); it has predilection
for the _____; where it causes lytic destructive lesions
in the cortex. (p.1056)
HANDS
- these often have a so-called lace-like appearance;
which is characteristic.
- it can have associated skin nodules in the hands
60
___ is disease of excess iron depostion in tissues
throughout the body leading to fibrosis and eventual
organ failure. (p.1056)
HEMOCHROMATOSIS
- 20 to 50% of patients with hemochromatosis have a
characteristic arthropathy in the hands that should suggest
the diagnosis.
61
The classic radiographic changes in HEMOCHROMATOSIS;
| are essentially DJD; which involves the______ MCP joints. (p.1056)
SECOND THROUGH THE 4th MCP JOINTS
- up to 50% of patients with hemochromatosis also have CPPD
- a search should be made for chondrocalcinosis
- another finding that is often seen in hemochromatosis
is called SQUARING OF THE METACARPAL HEADS.
- they appear enlarged and block-like as a result of the large osteophytes commonly seen in this disorder
62
The osteophytes in HEMOCHROMATOSIS are often said to
be _____ because of the unusual way they hang off the
joint margin. (p.1056)
"DROOPING"
63
A classic triad has been described (in NEUROPATHIC OR
| CHARCOT JOINT) that consists of _____. (p.1056)
1. JOINT DESTRUCTION
2. DISLOCATION
3. HETEROTOPIC NEW BONE
- the radiographic findings for a CHARCOT JOINT are characteristic and almost pathognomonic
64
TRUE OR FALSE?
Progressive joint destruction occurs in a neuropathic joint
because the joint is rendered unstable by inaccurate
muscle action and is unprotected by intact nerve reflexes.
(p.1056)
TRUE
65
Heterotopic new bone has also been termed ______
and consists of soft tissue calcification or clumps of
ossification adjacent to the joint.(p.1057)
DEBRIS or DETRITUS
- it too can be present in varying amounts
66
The most commmonly seen Charcot joint today is in ___.
| p.1057
FOOT OF A DIABETIC
67
Charcot joint typically affects the _____ tarsometatarsal
| joints in a fashion similar to a Lisfranc fracture. (p.1057)
FIRST and SECOND TARSOMETATARSAL joints
68
TRUE OR FALSE?
| Tabes Dorsalis from syphilis is rarely seen today. (p.1057)
TRUE
- more commonly seen is a Charcot Joint in a patient with paralysis who continues to use the affected limb for support
- a Charcot joint that is also seen on occasiion is the so-called PSEUDO-CHARCOT JOINT IN CPPD.
69
The classic findings for Juvenile Rheumatoid Arthritis
| JRA) and Hemophilia are ______. (p.1057
OVERGROWTH OF THE ENDS OF THE BONES (epiphyseal enlargement) associated with GRACILE DIAPHYSES.
- joint destruction might or might not be present
70
A finding that is purported to be classic for JRA and hemophilia is _______. (p.1057)
WIDENING OF THE INTERCONDYLAR NOTCH OF THE KNEE
- this sign can be quite variable and difficult to use
- it is rarely present when the other classic signs are not also present and obvious
71
TRUE OR FALSE?
Another process that can mimic the findings in JRA and hemophilia is a joint that has undergone disuse from paralysis.
(p.1057)
TRUE
72
It has always been said that the reason the epiphyses
are overgrown in JRA and hemophilia is because of the
______. (p.1057)
HYPEREMIA
- however; many other things cause hyperemia without
affecting the size of the epiphyses (such as Rheumatoid
Arthritis and infection)
73
The common denominator shared by JRA; hemophilia and
| paralysis is ____. (p.1057)
DISUSE
- This is most likely what causes the overgrowth of the ends of the bones seen in all three of these disorders
74
______ is a relatively common disorder caused by a
METAPLASIA OF THE SYNOVIUM resulting in deposition
of foci of cartilage in the joint. (p.1057)
SYNOVIAL OSTEOCHONDROMATOSIS
- most of the time; these cartilaginous deposits calcify and are readily seen on a radiograph.
- it is most commonly seen in the knee; hip and elbow.
- up to 30% of the time; the cartilaginous deposits do not calcify
- In these cases; all that is seen on the radiograph is a JOINT EFFUSION; unless erosion or joint destruction occur.
75
_________ is an uncommon; chronic; inflammatory process of the synovium that causes synovial proliferation. (p.1059)
PIGMENTED VILLONODULAR SYNOVITIS (PVNS)
- a swollen joint with lobular masses of the synovium occurs and causes pain and joint destruction
- it rarely; if ever; calcifies.
76
Term given for pigmented villonodular synovitis when it occurs in a tendon sheath; which is not unusual.(p.1059)
GIANT CELL TUMOR OF TENDON SHEATH and
| TENDON SHEATH XANTHOMA
77
TRUE OR FALSE?
Joints with PVNS look radiographically identical to noncalcified synovial osteochondromatosis; yet they are much less commmon.
(p.1059)
TRUE
- therefore; whenever PVNS is a consideration; SYNOVIAL CHONDROMATOSIS should be mentioned.
- PVNS has a characteristic appearance on MR with low-signal hemosiderin seen lining the synovium on both T1WI and T2WI
78
______ aka as SHOULDER-HAND SYNDROME; REFLEX SYMPATHETIC DYSTROPHY, and CHRONIC REGIONAL
PAIN SYNDROME;
- a poorly understood joint affliction that typically occurs after minor trauma to an extremity; resulting in pain; swellling and dysfunction (p.1060)
SUDECK ATROPHY
- Severe; patchy osteoporosis and soft tissue swelling are seen radiographically
- typically affects the distal part of an extremity such as hand or foot; yet; intermediate joints such as the knee and the hip are believed by some to be occasionally involved.
- the pain usually subsides; but the osteoporosis may persist
- the swelling; with time; will subside and the skin may become atrophic
- it is important of the radiologist to recognize the aggressive osteroporosis in this disorder and differentiate it from disuse osteoporosis so that the treating physician can begin aggresive
physical therapy
79
TRUE OR FALSE?
In the setting of trauma to the elbow; an effusion indicates
a fracture. (p.1061)
TRUE
80
The only fat pad around the hip that gets displaced with
an effusion is the ________; and it is uncommonly seen.
(p.1061)
OBTURATOR INTERNUS
81
The radiographic sign for a knee effusion that seems to be
the most reliable is the measurement of the _______.
(p.1061)
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
- a distance of 5 TO 10 MM is EQUIVOCAL
- it does not make any difference if there is an effusion
in the knee - regardless; the patient gets treated the same
- if it were vital to the patient; one could aspirate the joint
or perform an MR study to find out
- I should point out that an MR should never be performed
just to seen whether there is fluid in the joint
82
TRUE OR FALSE?
Shoulder effusions are very difficult to detect unless they
are massive enough to displace the humeral head inferiorly;
as with a fracture and hemarthrosis. (p.1061)
TRUE
- fortunately; as with most other joints;treatment is not based solely on the presence of absence of an effusion; so it hardly matters.
- the same is true in the ankle; wrist and smaller joints.
83
_______ can occur around almost any joint for a host of
reasons including steroids; trauma; various underlying
disease states; and even idiopathically.
- it is often seen in renal transplant patients (p.1061)
AVASCULAR NECROSIS (AVN) or OSTEONECROSIS
84
The hallmark of AVN is________. (p.1061)
INCREASED BONE DENSITY AT AN OTHERWISE NORMAL JOINT
- increased density at a narrowed joint usually indicates DJD; however; if either osteophytes or joint space narrowing are absent; another disorder should be considered
85
The earliest sign of AVN is a ______. (p.1061)
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.
- the next sign for AVN is a patchy or mottled density
86
In AVN or OSTEONECROSIS:
In the knee; this density increase can occur throughout
an entire _____;
whereas in the hip; it often involves the entire ______.
(p.1062)
entire CONDYLE; entire FEMORAL HEAD
87
The final sign in AVN is ______. (p.1062)
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
88
TRUE OR FALSE?
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. (p.1062)
TRUE
89
In the hip; AVN typically has an area of low signal or
mixed signal on T1WIs; which is located in the _____.
(p.1062)
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
to present otherwise
- posterior femoral head of 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
90
A form of AVN that is smaller and more focal than that
| just described is ______. (p.1062)
OSTEOCHONDRITIS DISSECANS
- it is most likely caused by trauma; however; this is controversial; with one school of thought believing the cause is idiopathic.
- it occurs most often in the KNEE at the MEDIAL EPICONDYLE
- it also is frequently seen in the DOME OF THE TALUS (foot) and occasionally in the CAPITELLUM (elbow)
91
Osteochondritis dissecans frequently leads to a small fragment of bone being sloughed off and becoming a free fragment in the joint; a " _____". (p.1064)
"JOINT MOUSE"
92
TRUE OR FALSE?
| AVN is one of the disorders around joints in which subchondral cyst or geodes can occur. (p.1064)
TRUE
- it is the only one of the 4 disorders (rheumatoid arthritis; DJD; and CPPD being the others) that can have an essentially normal joint and have a geode.
- the other abnormalities will have any or a combination of joint space narrowing; osterophytes; osteoporosis;chondrocalcinosis or other findings
93
____ - a host of names have been ascribed to certain bones
with AVN usually with the eponym being the first person
to describe the disorder. (p.1064)
OSTEOCHONDROSES
- they are believed to be idiopathic for the most part but can also occur secondary to trauma.
94
```
A few of the more common epiphyses involved in
osteochondroses are the following:
(Identify their eponyms):
1. CARPAL LUNATE - _____________
2. TARSAL NAVICULAR - __________
3. METATARSAL HEADS - _________
4. FEMORAL HEAD - _____________
5. RING EPIPHYSES OF THE SPINE: _
6. TIBIAL TUBERCLE: _____________
```
1. CARPAL LUNATE - Kienbock Malacia
2. TARSAL NAVICULAR - Kohler disease
3. METATARSAL HEADS - Freiberg infraction
4. FEMORAL HEAD - Legg-Perthes disease
5. RING EPIPHYSES
OF THE SPINE: - Scheuermann disease
6. TIBIAL TUBERCLE: - Osgood-Schlatter disease
(also called SURFER KNEES)
- MR can be very useful in identifying AVN in these sites
- it shows diffuse low signal on T1WIs; which involves the
entire area of AVN
