What is some general information about degenerative joint disease?
- Progressive, non-inflammatory
- changes in cartilage and joints components
- small joints of hand, larger weight-bearing joints
- spine, hips, knees, AC, 1st CMC/MTP, D I P's
What are the clinical features of degenerative joint disease?
– M >F up to 45 years then reverse – most common type of joint disease – clinical findings disproportionate to observed x-ray findings – any joint can develop DJD – insidious onset of symptoms – aching, swelling, stiffness, goes away with activity – Environment: temp, humidity may aggravate – primary (idiopathic-no factor to set it off) – secondary (known factor or event)
What is the pathophysiology of degenerative joint disease?
- Forces cause loss of ground substance
- cartilage degrades (loss joint space)
- synovium thickens
- osteophyte formation
- subchondral thickening (sclerosis)
- synovial fluid enters subchondral bone (cysts)
What are the Radiographic signs in the extremities of the DJD?
- Not all roentgen signs in every case
- unilateral or asymmetric distribution
What are the radiographic signs of the DJD in the hip?
- Non-uniform loss of joint space
- Subchondral cysts
- subchondral sclerosis
- joint deformity
What are the radiographic signs of the DJD in the Knee?
- Spiking of tibial eminences
- loose bodies
- chondrochalsinosis in menisci
- Medial tibiofemoral Joint
- Lateral Tibiofemoral Joint
- Patellofemoral Joint
criteria for diagnosis
definition: A syndrome of pain and crepitus from the patellofemoral joint.
clinical features: Adolescence, young adults, Obese females, large Q angle (>20°), Trauma, dislocation, malalignment syndromes, occupational
criteria for diagnosis: Anteriomedial pain with crepitus, buckling, locking, stiffness, swelling, Aggravated by walking up stairs, Patellar compression painful
- radiographic features:Plain films are normal, CT air arthrography can detect loss of cartilage, MRI most sensitive to focal loss of cartilage
What are the radiographic signs of the DJD in the Ankle/Tarsals?
- uncommon site unless post-trauma
- First tarsometatarsal joint may show signs in mid/hind foot - rule out coalition of tarsals
What are the radiographic signs of the DJD in the Foot?
- First MTP most common site
- Osteophytes seen on dorsal, medial and lateral surfaces of joint
- Bunion deformity seen as valgus lateral displacement of phalanx
What are the radiographic signs of the DJD in the shoulder (AC and GH)?
- DJD more common in A-C than G-H
- Loss joint space, sclerosis, osteophytes, small cysts
- Complication: impingement syndrome, rotator cuff tear
DJD signs can = previous/occupational trauma
Osteophytes inferior humeral head
Cysts at rotator insertion
Rotator disruption seen as sup. migration of humeral head
What are the radiographic signs of the DJD in the elbow?
- Very rare and secondary to trauma, occupation
- Loose bodies and osteophytes, olecranon spur at triceps insertion
What clinical features present with Erosive osteoarthritis?