What is the term used to describe softening of bone?
Osteomalacia , "adult rickets."A lack of Ca++ deposited into the osteoid matrix.
True or false; osteomalacia is characterized by decreased quantity of bone.True False
False: Osteomalacia is characterized by a decrease in QUALITY of bone.
Name the 5 radiographic findings associated with Osteomalacia .
1. Decreased bone density : low bone mineral content.2. Mottled trabecular pattern : disorganized, holes.3. Loss of cortical definition : thinner.4. Pseudo fractures : insufficiency fractures.5. Deformities .
What are 3 a/k/a's for Pseudo Fractures associated with Osteomalacia?
1. Looser lines . 2. Milkman's Syndrome . 3. Umbau Zones .
Where is the most common site for "Looser Lines" in regards to Osteomalacia?
At the femoral necks .Bilateral & symmetrical. Chronic. Other locations: Pubic & ischial rami. Ribs. Axillary border of scapula.
Name 4 deformities associated with Osteomalacia :
1. Weight-bearing bon es. 2. Protusio-acetabuli : femoral necks burst through acetabulum... uni or bilateral, also common with RA 3. Bowing of femur, tibia . 4. Kyphoscoliosis : abnormal curvature of the spine in both a coronal and sagittal plane.
What is the childhood equivalent of osteomalacia?
Rickets 6-12 months old. Rare in first world countries.
Soft tissue swellings around growth plates are associated with which pathology?
Rickets .Secondary to hypertrophied cartilage.
Which pathology is associated with a "Rachitic Rosary Sign?"
Rickets .Rachitis Rosary
How can you tell radiographically if a patient has healed from Rickets?
An opaque metaphyseal line is visualized.
True or false; in regards to growth plate changes associated with Rickets , bone cells grow to rapidly and are unable to calcify.True False
False: cartilage cells grow normally, but fail to calcify .
Name 3 radiographic findings associated with Rickets.
1. Widened growth plate of long bones. 2. Paintbrush metaphysis : irregular, frayed, & cupped metaphyseal margin. 3. Lack of zone of provisional calcification (until healing). Bowing deformities. Fractures. Decreased bone length. Scoliosis. Pseudo- fractures. Rachitic Rosary.
Rachitic bone = increased lucency/osteopenia.
Name 2 a/k/a's for Scurvy.
1. Barlow's Disease : Infentile scurvy. 2. Hypovitaminosis C .
What are the 3 main functions of Vitamin C (ascorbic acid)?
1. Forms collagen . 2. Forms osteoid matrix . 3. Forms endothelial linings .
Which age group is most commonly associated with Scurvy?
Babies, 8-14 months due to improper milk feedings.
Which pathology is associated with spontaneous hemorrhages?
Scurvy , due to capillary fragility.
Cutaneous petechiae, bleeding gums, melena, joint swelling, irritability, pain, & frog leg position are associated with which pathology?
Scurvy .
What are the
5 main radiographic findings associated with
Scurvy ?
1. White Line of Frankel : dense zone of provisional cancification resulting from a delayed conversion to bone.2. Wimberger's Sign : ring epiphysis.3. Corner Sign : Suggestive of subphyseal infarctions.4. Pelken's Spurs : at the edges of the metaphsis, marginal spur formations. 5. Trummerfeld Zones : scorbutic zone... a transverse band of radiolucency beneath the dense zone of provisional calcificationOsteopenia. Subperiosteal hemorrhage. Scorbutic rosary.
Which hormone is associated with acromegaly ?
Growth hormone due to an anterior pituitary adenoma.Results in the activation of bone growth & irregular thickening of the cortex.
What are the 4 clinical findings associated with Acromegaly ?
1. Thick heel pad . 2. Skull & facial changes. 3. Large hands & tufts . 4. Increased ADI space. Patients are predisposed to degenerative changes.
Hyperparathyroidism is associated with over releasing of PTH. What kind of hormone is PTH?
Osteoclastic : removes bone tissue.
What are the 3 type of HPT?
1. Primary HPT : due to hypercalcemia or pituitary adenoma .2. Secondary HPT : complication of renal disease .3. Tertiary HPT : dialysis patients .
True or false: HPT results in the formation of kidney stones.
True .
Females 30-50 yo. Weakness, lethargy, polydipsia, polyuria. Calculus formation in kidneys.
HPT results in hyper-excretion of which two substances?
1. Calcium . 2. Phosphorus .
What is considered to be the Hallmark sign of HPT?
Subperiosteal bone resorption of the outer cortex, @ ligament & tendon insertion points.
=Brown tumors osteoclastic giant cells. lytic.
Where is subperiosteal resorption associated with HPT visible radiographically?
Radial margins of the middle & proximal phalanges "Shame shame!" Medial metaphysis of the humerus & tibia. Undersurface of the distal clavicle. Trochanters. Tuberosities.
Which pathology is associated with a lace-like appearance of external bone surfaces?
HPT .Lace-like appearance
Subarticular bone resorption associated with HPT is most commonly found where?
AC-joint .Symphysis pubis. SI-joints. Widens joint space. Osteolysis.
Salt & Pepper skull , Brown tumors , chondrocalcinosis , subperiosteal resportion , Rugger Jersey Spine , & osteolysis are common radiographic findings associated with which pathology?
HPT .
HYPOparathyroidism results from accidental removal of the parathyroid glands during thyroid surgery. What are the 4 radiographic findings?
1. Osteosclereosis . 2. Calvarial thickening. 3. Hypoplastic dentition. 4. Basal ganglia calcification . *Hypocalcemia. *Hyperphosphatemia.
What are the 3 differential diagnosises for Osteosclerosis?
1. Osteoblastic metastatic disease. 2. Paget's Disease. 3. Sickle cell anemia.
Is pseuohypoparathyroidism similar to hypoparathyroidism?
Yes, similar symptoms, but additionally includes: characteristic dwarfism, obesity, round face, bradydactyly, abnormal teeth, mental retardation, impaired taste & smell.
Which pathology is associated with a
positive metacarpal sign ?
Pseudo-pseudo-hypo-parathyroidism .Sibbling has PHP (pseudo-hypo-parathyroidism).
Anatomy of joints:
1. Fibrous joints : sutures, tib/fib, radius/ulna.2. Cartilage joints : IVD, symphysis pubis.3. Synovial joints : SI-joint, digits, knees.
Is the joint capsule visualized radiographically with synovial joints?
No.
What are 4 signs of inflammatory radiographic findings?
1. Soft tissue swelling. 2. Uniform loss of joint space. 3. Bone erosions. 4. Juxta-articular osteoporosis.
RA, Psoriasis, Ankylosing Spondylitis, & Reiter's Syndrome are associated with which type of arthritic disorders?
Inflammatory .
P A R R
What are the 4 characteristics for degenerative arthritic disorders ?
1. Non-uniform loss of joint space. 2. Osteophytes. 3. Subchondral sclerosis. 4. Subchondral cysts (geodes).
*asymmetrical*
Name 3 characteristics for metabolic arthritic disorders , such as Gout.
1. Periarticular soft tissue masses. 2. Well-marginated bone lesions. 3. Preservation of joint space .
*degenerative & inflammatory may overlap.*
What is an a/k/a for DJD ?
Osteoarthritis (OA) Progressive. Non-inflammatory. Small joints of hands. Larger weight-bearing joints.
Which form of DJD (OA) is idiopathic ?
Primary DJD : 5th-6th decade, weight bearing joints.Secondary DJD: known factor or event is cause... 2nd-6th decade.
Subchondral cyst formation:
Weakness of joint cartilage & cortical microfractures + Synovial fluid enters subchondral bone (subarticular) = Subchondral cysts (a/k/a : Geodes).
8 radiographic findings of DJD :
1. Asymmetrical distribution. 2. Non-uniform loss of joint space. 3. Osteophytes . 4. Subchondral sclerosis : increased bone formation around joint space. 5. Subchondral cysts. 6. Intra-articular loose bodies. 7. Articular deformities. 8. Joint subluxation.
What is an a/k/a for subchondral sclerosis ?
Eburnation : seen where greatest cartilage is lost.
Subchondral cysts are __ - __ mm in diameter.
2-20 mm.
What is an a/k/a for intra-articular loose bodies ?
Joint mice MC = knee.
Name 2 a/k/a's for DJD of the hip?
1. Coxarthrosis . 2. Malum coxae senilis . =increased risk of osteoporosis. non-uniform loss of joint space = migration.
3 types of margination:
1. Superior : Waldenstrom Sign ... MC = medial joint space widened. 2. Medial : displacement of femoral head medially = protrusio acetabuli .3. Axial : superomedial displacement.
Where does buttressing take place?
At the hip w/ DJD. Thickening. Medial side. Stress-related. Altered joint mechanics.
Sharpening of the tibial eminences is characteristic for which pathology?
DJD of the knee .
Patellar tooth sign :
advanced patellofemoral degeneration.
Where is the pain with chondromalacia patella?
Aneromedial. Crepitus, buckling, locking, stiffness, swelling. "Movie sign." "Patella alta."
Tarsal beaks & heel spurs are associated with which pathology?
DJD of the ankle & tarsal joints. Uncommon, due to previous trauma.
DJD of the foot is most common at which joint?
1st MC .
What is the most common joint associated with DJD of the shoulder?
AC-Joint .evaluate from inferior borders. GH-joint = previous trauma or cartilagenous disease.
True or false: HADD affects any joint in the body.True False
False: HADD = tendons, bursae, ligaments.
Where is the most common location for HADD/DJD of the shoulder?
Supraspinatus tendon : insertion on greater tuberosity.2nd MC: subacromial bursa.
___ = non-uniform loss of joint space.
DJD = non uniform loss of joint space.
Which disease is characterized as "lumpy bumpy?"
Metabolic deposition disease : gout, hyperlipidemia, etc.
What does HADD stand for?
H ydroxy
A patite
D eposition
D isease: calcifying tendinitis & bursitis.
Monoarticular. MC = shoulder rotator cuff, followed by hip & upper cervical spine. Etiology unkown. Does not attach to cortex.
What does CPPD stand for?
C alcium P yroP hosphate D ihydrate (Deposition Disease). "Pseudo Gout."
Peripheral joints.
Which disease is the exception to the no erotions in RA rule?
Erosive OA.
Gull Wing's Sign is associated with EOA, and affects which joints?
DIP joints .DJD changes with central. bone erosions. Main DDX = RA... but RA rarely involves the DIP joints. or Psoriatic arthritis : marginal erosions.
Rheumatoid Arthritis:
1. Autoimmune . 2. Attacks hands & feet first. 3. Moves proximal to distal . 4. Ulnar/fibular deviation will not correct with pressure . 5. Connective tissue disorder. 6. Etiology unkown. 7. Attacks synovial tissue. 8. Jelling phenomenon : morning joint stiffness. 9. Haygarth's Nodes
Felty's Syndrome:
RA + Leukopenia + Splenomegaly.
Pannus :
rough, grainy tissue that evolves cartilage.
RA findings: (frequently seen in the wrist first ).
1. Bilateral symmetrical. 2. Periarticular soft tissue swelling. 3. Juxt-articular osteoporosis. 4. Uniform loss of joint space. 5. Marginal erosions (rat bites). 6. Deformity. 7. Ankylosis : fusion/metacarpal joints. 8. Boutonniere deformity. 9. Swan neck deformity. 10. Zigzag deformity : digital ulnar deviation + carpal radial deviation. **DIP joints not involved**
Terry Thomas sign involves which 2 carpal bones?
Marginal erosions are medial with digits 1-4, digit 1 = MC.
Fifth metatarsal head = lateral.
Lanois deformity:
fibular.
What is the most common cause for bilateral protrusio acetabuli?
RA.
Which joint has a positive fat pad sign with RA?
The elbow.
What is the most frequent systemic autoimmune inflammatory disease affecting children?
JRA.
JCA = Still's Disease.
Seronegative for RA factor.
Polyarticular disease is the most common form of JRA.
Distal extremities & cervical spine. Simulates rheumatic fever. Bird like appearance. JRA/hand & foot : spares distal joints. Inferior pole of patella is squared.
SLE has _______ deformities.
reversible