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Degenerative Flashcards

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1
Q

What are osteophytes?

A

Bony outgrowths in the locality of capsular insertion. Bony excrescences with internal trabeculation and cortex, with a cartilage cap pathologically from cartilage mate plasma and ligamentous traction.

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2
Q

What are some Differential diagnoses for erosive osteoarthritis?

A

Psoriatic arthritis

RA

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3
Q

What is degenerative joint disease?

A 
No uniform loss of joint space
Osteopaths
Subchondral sclerosis
Cysts
Asymmetric
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5
Q

Clinical features of OA?

A

Stiffness with rest
Normal blood work
Spinal stenosis
Vertebra basilar ischemia

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6
Q

What are the 2 types of osteoarthritis?

A

Primary and secondary

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7
Q

What is a characteristic clinical feature of OA?

A

Osteopaths have distinct cortex and internal structure continuous with the parent bone and capped with cartilage

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8
Q

Signs of degenerative joint disease?

A

Insidious onset
Intermittent exacerbation a
Aching, pain, stiffness, environmental
Changes in cold and low barometric pressure may aggravate symptoms

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9
Q

When will you see degeneration in the HANDS

A

middle age postmenopausal females

Enlarged soft tissue nodes of DIPS (HEBERDEN’s NODES)

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10
Q

What are subchondral cysts?

A

Seen in any joint disease
Focal regions of bone loss within subchondral bone.
Ovoid, round

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11
Q

Where does degenerative most likely to occur?

A 
Weight bearing articulation of spine
Hips and knees
AC joint
1st MTP, 1st MC-trapezium
DIPS
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11
Q

What is primary OA?

A

No evidence of underlying etiology

It just happened

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12
Q

What causes subchondral sclerosis?

A

Increased mechanical stress

Causing thickened existing trabeculation and formation of new ones

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13
Q

What is osteoarthritis?

A

Deterioration of articular cartilage with articular surface and marginal bone formation

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15
Q

What are intraarticular loose bodies?

A

From cartilage degradation, flaking, and fragmentation

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16
Q

What is the most common joint disorder that is also considered DJD?

A

Osteoarthritis

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17
Q

What are signs of degeneration of the feet?

A

1st MTP joint
When present with symptoms of pain and stiffness(HALLUX RIGIDUS)
Metatarsal virus, HALLUX vagus joint misalignment is common (bunion)

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18
Q

Radiology features of DJD?

A 
Asymmetric distribution
Asymmetric loss of joint space
Osteophytes
Subchondral sclerosis, and cysts
Intraarticular loose bodies
Enthesopathy
Ankylosis (RARE)
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19
Q

What are risk factors of DJD?

A 
Increases with age
Females with hands and knees
Obesity with knees and hips
Trauma is most common local factor
High impact activity
Inactivity
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20
Q

What are the target locations of DJD in the hands?

A

DIPS
PIPS
1st MC carpal joints (thumb and trapezium)

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21
Q

What is secondary OA?

A

Abnormal forces like obesity, trauma, joint deformities
Pre-existing cartilage pathology like RA, fractures, or meniscus damage
Collapse of subchondral bone
A vascular necrosis

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22
Q

What is erosive DJD?

A

Variant of the normal pattern
Presents as bilateral DJD with central joint erosions
Forms a “gull wing sign”
DJD SHOULDN”T BE EROSIVE

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23
Q

What does LOSS stand for?

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

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23
Q

Although uncommon in DJD, what is associated often with erosive osteoarthritis?

A

Gull wing sign

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24
Q

How does a bunion form?

A

An increased intermetatarsal angle

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25
What is a heel spur?
An osteophyte growth at the bottom of the heel
26
What joint is often involved in DJD in the shoulder?
The acromioclavicular joint
27
What will you see in DJD of the shoulder?
Decreased joint space of the AC joint Sclerosis of the glenohumeral joint with loss of joint space Osteophytes
28
What are potential problems of degeneration in the shoulders?
AC joint Osteophytes extending inferiorly may impinge on rotator cuff tendons leading to tendon calcification and superior migration of humerus
29
What are potential problems with degeneration of the glenohumeral joint?
Osteophytes and joint misalignment...arouse suspicion of significant previous trauma or perhaps underlying CCPD
30
What is rotator cuff arthropathy?
Superior migration of the humerus do to unopposed deltoid Erosions of the acromian Greater tuberosity enthesopathy
31
What is shoulder impingement syndrome?
Elevation of the numeral head Degenerative enthesopathy can changes of the numeral head Spurring of the acromion process Rotator cuff degeneration (supraspinatus)
32
What is hydroxyapatite deposition disease? | HADD
Deposition of calcium within tendons and bursa
33
Where is HADD commonly seen?
Shoulder, elbow, wrist, hip, knee, ankle, spine MOST COMMON in the supraspinatus tendon Age 40-70
34
What are symptoms of HADD?
Pain, tenderness, swelling, reduced ROM Soft tissue calcification Focus of degeneration follows
35
What is the most accurate way to read DJD in the knee on radiographs?
medial tibiofemoral Lateral tibiofemoral Retropatellar
36
What will you see in DJD of the knee?
Hypertrophic changes of intercondylar spines | Enthesopathy of the anterior non articular surface of the patella
37
What is synovial osteochondrometaplasia?
Multiple intra-articular loose bodies Synovial tissue that produces cartilage masses May ossify and show up on film NOT DJD, but can LEAD TO IT
38
Where is synovial osteochondrometaplasia often seen?
``` Knee Hip Ankle Shoulder Wrist joint mice with joint locking ```
39
What are intraarticular fragments?
Loose bodies, joint mice | Fragments of cartilage, meniscus, or synovial within the joint that often calcify
40
What is pigmented villonodular synovitis? | PVNS
Slow growing benign, and locally invasive tumor | Metaplasia of synovium
41
Where do you commonly see PVNS?
Knee, hip, ankle, elbow | Consider in young patients with unexplained hip pain
42
What are differential diagnoses of PVNS?
RA
43
What is a sign of PVNS?
Apple core deformity (NECK OF THE FEMUR) Intraarticular effusions, lobulalated masses Boney erosions
44
Describe OA of the hip
DJS 80% toward superior compartment Osteophytes Cysts Buttressing*
45
What is buttressing?
Thickened cortex at the medial femoral neck as the result of bio mechanical changes across the joint. Cyst formation likely
46
What is ace tabular protrusion?
Severe medial hip migration Remodeled acetabulum Evaluated with KOHLERS LINE AKA otto's pelvis
47
Acetabulum protrusion DDX's
Arthritides: OA, RA, bone softening, pagets | Normal variant for females
48
Describe Degeneration of the spine?
AKA Degenerative Disc Disease Facet arthrosis C5/6 in cervical L4/5 in lumbar
49
What does DDD look like on film?
``` Decreased disc height Osteophyte formation Endplate sclerosis Vacuum phenomenon Subluxation ```
50
What is spondylitis deformans?
Outer disc | Marked by Osteophytes
51
What is intervertebral chondrosis?
Inner disc | Reduced IVD space
52
What is intervertebral disco degeneration?
Degeneration based on the anatomy of the IVD
53
What are the two types of intervertebral disc degeneration?
Spondylitis deformans And Intervertebral chondrosis
54
What is it called when you have loss of disc height with minimal osteophytes?
Intervertebral disc osteochondrosis
55
What is vacuum (knutson's) phenomena?
Radiolucency collections of nitrogen within annular fissures Multiple levels SURE SIGN OF DDD
56
What is an intercalary ossicle?
Annulus degeneration, appears to be a loose body anterior to disc.
57
What is end plate sclerosis?
Represents infraction, compression, necrosis of stressed subchondral bone trabecular
58
What is scheuermann's disease?
Strict criteria requiring presence of abnormalities of at least three continuous vertebrae, each with wedging of 5 degrees or more.
59
What are the abnormalities you should look for in sheuermann's disease?
Disc space narrowing, end plate irregularity
60
What age range will we see scheuermann's disease?
14-17 onset
61
What symptoms are associated with scheuermann's disease?
Pain, cosmetic deformity, premature DDD
62
What is juvenile discogenic disease?
Thoraco-lumbar scheuermann's disease
63
What is Juvenile discogenic disease caused by?
Failure of embryologist vascular channels, centrum defects, notochord clefts to disappear leaving endplate defects.
64
What are the subluxation patterns for DDD and posterior joint arthrosis?
DDD= posterior subluxation | Posterior joint arthrosis= anterior subluxation(spondylolisthesis )
65
What are anterior or posterior subluxations indicative of?
DDD
66
Where is degeneration of the cervical spine most commonly seen?
C5/6
67
What will you see with degeneration of the uncovertebral (luschka joint)?
C3-7 | MOST COMMON middle to lower cervical spine
68
What types of projections will you see with degeneration of the uncovertebral joint?
Frontal- bulbous osteophytes Lateral- pseudofracture May encroach on the IVF
69
Uncovertebral degeneration has this characteristic that is a bit different than an osteophyte.
Uncinate hypertrophy...grows up and out laterally...looks like dog ears on top of the vertebral body from anterior view, and shark fin on posterior body on lateral view.
70
Where will you most commonly find degeneration of the zygapophyseal joints?
Lower lumbar Middle cervical Upper and middle thoracic spine
71
What does degeneration of zygapophyseal joints look like on radiograph?
Looks like a radio dense band extending superiorly and inferiorly compared to the other side hypertrophic Irregularity Osteophytes
72
What does posterior joint arthrosis look like on film?
May see lateral projections further than the rest of the spinal segments.
73
What is the most common cause of sciatica?
Disc herniation
74
What is important information to know for a practitioner treating disc herniations?
They are the 3rd most common malpractice cases against chiropractors coupled with informed consent usually.
75
How to treat degeneration?
``` Chiropractors assist function Pharm- reduce inflammation Joint replacement Lose weight Physiotherapy ```
76
What are the sources of pain for degeneration?
Joint capsule distension and contracture Spasms Periosteal elevation Pressure on subchondral bone
77
What does DISH stand for?
Diffuse idiopathic skeletal hyperostosis
78
What is DISH?
Exuberant hypertrophic changes involving anterior vertebral body margins. PREDOMINATELY INVOLVING THE A.L.L. AKA ankylosis get hyperostosis or forestier's disease
79
Who will you see DISH in?
``` Males over 50 DIABETICS* May be asymptomatic Neck stiffness Dysphasia in 20% Hoarseness ```
80
Describe DISH.
Exuberant proliferation of bone at osseous sites of ligament and tendon attachments. (ENTHESOPATHY) ALL of middle and lower thoracic spine, upper lumbar, lower cervical.
81
What is enthesopathy?
Pathological osseous proliferation at tendon or ligament insertion. May be degenerative or inflammatory (Ex. Heel spur)
82
What does DISH look like on radiograph?
Multiple levels of flowing ossification Disc height is PRESERVED, and minimal evidence of disc disease Absence of sacroilitis
83
Who will you see ossification of the POSTERIOR LONGITUDINAL LIGAMENT?
Japanese | 40-50% of DISH patients
84
What does ossification of the PLL look like on radiograph?
Radiodense strip along posterior margins of vertebral bodies | Loss of spinal canal diameter
85
What will patients with ossification of the PLL experience?
Sensory/motor disturbances of especially the legs Difficulty walking Paresthesias
86
What is treatment for ossification of the PLL?
Laminectomy is a common treatment

Diagnostic img (4 decks)

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