OCI, OP, HOA Flashcards
What is Osteitis Condensans Ilii (OCI)?
Ilium - osteoarthritis of the ilium
Isolated benign SI arthropathy
Hormonal and mechanical in origin
Unusual cause of SI pain
Epidemiology:
- Females > Men (9:1 ratio)
- M/C in women of childbearing age (20 – 40 yoa)
What are the clinical features of Osteitis Condensans Ilii (OCI)?
- No lab findings
- Underlying aetiology unknown BUT may be due to mechanical stress and imbalance across the SI joints causing a chronic stress response
- Self limiting condition- radiographic findings may resolve with time
- Differentiate OCI from other sacroiliitis mimics e.g. sacroiliitis or SIJ OA - no spinal lab findings or ankylosis
What are the signs and symptoms of Osteitis Condensans Ilii (OCI)?
- Usually asymptomatic
- Uncommonly may cause axial Lower back pain & stiffness
- Typically, not centered over SI
- pain may radiate into the groin or down the leg
- may simulate a disc prolapse or mimic Spondyloarthropathy (SpA)
- Lack of or excessive SI motion
What are the radiological features of Osteitis Condensans Ilii (OCI)?
- Bilateral and symmetrical, triangular shaped sclerosis in the lower one-half of the SI joint on iliac side
- “hyperostosis triangularis ilii“
- There is essentially NO change in the joint space (normal space)
- Complete resolution in 3-20 years
What is the treatment for Osteitis Condensans Ilii (OCI)?
- Medical treatment: physical therapy, anti-inflammatory medication
- Manipulation may increase pain initially, but will quickly reduce the symptoms
What is Osteitis Pubis (OP)?
An idiopathic, inflammatory disease of the pubic symphysis and surrounding structures.
Painful condition that consists of resorption and re-ossification of the pubic bones
Epidemiology:
- M/C among athletes (Especially soccer players, runner and rugby players)
- Can occur among non-athletes due to any pelvic stress (e.g., trauma, pelvic surgery, pregnancy)
What are the clinical features of Osteitis Pubis (OP)?
Clinical Features:
- NO LAB Findings
- Possible increase in ESR during acute phase
- Cause may be infectious or a Sudek’s type reaction
- May have venous stasis intraosseous venous engorgement
- MUST differentiate this entity from infection
- infectious agents = Pseudomonas, E. coli
- Post-pregnancy, trauma, unknown
- Seen secondary to pelvic surgery
- Onset of S/S 1-3 months post-op
- prostate (M\C), bladder, cervix
What are the signs and symptoms of Osteitis Pubis (OP)?
- Excruciating pain on palpation, with thigh adduction and trunk flexion
- Audible click may be heard
- Patient will walk with trunk flexed & waddling to decrease stress to pubic region
- localized pain over the pubic symphysis
- Pain may radiate to the groin, medial thigh, or abdomen
- Usually lasts 1-2 years
- may simulate a disc prolapse or mimic Spondyloarthropathy (SpA)
- Lack of or excessive SI motion
What are the radiological features of Osteitis Pubis (OP)?
- Radiographic latent period is about 1-3 weeks
- Will simulate a joint infection
- Bilateral & symmetric involvement of pubic bones & rami
- Irregularity of the joint margins
- Subchondral sclerosis
- Moth eaten osteoporosis
- Widening of the joint space
- The resolution margins will remain irregular & may ankylose
What is Hypertrophic Osteoarthritis (HOA)?
Characterized by abnormal proliferation of the skin and osseous tissues at the distal parts of the extremities
Primary type: result from gene mutation (accumulations of prostaglandin E2)
Secondary type: associated with an intrathoracic or abdominal disease process
M/C underlying condition is Carcinoma (CA) lung - chest evaluation therefore necessary
Vagus nerve reflex abnormal (Note: activation of the vagus nerve normally inhibits inflammation and reduces the pain signal
Epidemiology:
- Men > Women
- 40 – 60 years of age
What the clinical features of Hypertrophic Osteoarthritis (HOA)?
- Triad:
- bulbous deformity of tips of digits (clubbing)
- periostosis of the tubular bones
- synovial effusions - complete triad not always present
- Up to 10% of bronchogenic CAs will produce triad
- Increase in ESR
- The syndrome will resolve with therapy of the underlying cause
What are the signs and symptoms of Hypertrophic Osteoarthritis (HOA)?
- Clubbing: tissue hypertrophy & hyperplasia ST with thickening & increased convex curvature of nail contour (watch-crystal nail)
- seen with intrathoracic, intraabdominal conditions & in heroin addicts
- usually the first manifestation of syndrome
- may be asymptomatic or have burning sensation
Arthritis: usually painful effusions knee, ankles, elbows, wrists, proximal fingers (hand involvement is the most debilitating)
Periostitis: vague, diffuse, deep seated pain along diaphysis of leg & forearm
- more prominent in lower extremities
What are the radiological features of Hypertrophic Osteoarthritis (HOA)?
- Usually symmetric periosteal reaction - Periostitis
- Solid or laminated
- May be thick, linear, dense, layered
- May be fluffy, exuberant - Thickness/extent dependent on disease duration
- Shorter duration of disease → diaphyseal
- Later extends to metaphyses and epiphyses
- most apparent & consistent radiographic sign
- may be separated from the cortex - until late
- lower > upper extremity
- MC in tibia, fibula, radius, ulna, metacarpals, metatarsals, femur, and humerus
- metaphyses and diaphyses
- distal to the elbows and knees
- bilateral/ symmetric
Radiological Features Cont:
- Joint effusion may be seen
- No underlying marrow or soft tissue abnormality
- Clubbing of digits
- Joints
- Soft tissue swelling
- No joint space narrowing
- No erosions or other arthritic changes
- Tuft hypertrophy or acroosteolysis (uncommon)
- Acro-osteolysis - radiographic finding, referring to bone resorption of thedistal phalanges
- Acro-osteolysis - M/C seen in patients with primary HOA , cyanotic heart disease or malignancy
