Diagnostic Imaging

• Multiple Myeloma
• Metastisis- Lytic and Blastic
• Hodgkins
• Pagets
• Osteo Sarcoma
• Chondrosarcoma and Fibrosarcoma
• Ewings Sarcoma
• Chordoma

Plasma Cell Sarcoma

• Primary Malignance of Bone
• proliferation od plasma cells infiltrating bone marrow
• can cause pathological collapse (vertebral Plana)
• Associated with "rain drop skull"
• will spare pedicle

• Labs: M spike on the immunuElectroPhoresis
• Reversal of Albumin/ Globulin Ratio (Screen Test)
• Bense Jones Proteinuria, Elevated ESR
• Special Test: Bone Scan - COLD

• Lytic and Blastic
• Most common malignant tumor of bone
• * Multiple Myeloma is the MC primary malignancy*

• > 40 yo
• recent unexplained weight loss
• skeletal pain worse at night
• Moth eaten or permeative pattern
• "EATS" pedicle
• has swiss cheese appearance in skull

• LABS Increased Alk Phos
• Speacial Test: Bone Scan- HOT

• MC ages 20-40 - seen even more in <30 yo males (CAUCASION)
• Ivory White Vertabrae with Anterior Scalloping
• Biopsy is needed - Reed Sternberg cell
• Does not cause bone enlargement

• >40 yo
• ivory white vertabrae (OJO: does not have anterior scalloping like in Hodgkins)
• MC cause from prostatic carcinoma
• may cause pathological collapse
• Metastisizes to lumbars
• Does not cause bione enlargement

• LABS: Increased Alk Phos
• Special Test: Bone scan- HOT

Osteitis Deformans

• > 50 yo Males
• Cortical Thickening
• Bone expansion
• picture frame vertrbrae (1st stage)
• bowing deformities

• Increased Alk Phose
• Increased Urinary Hydroxyproline

Speacial Test: Bone Scan- HOT

• MC BONE Malignancy in CHILDREN
• 10-30yo
• Spiculated/ radiating/ sunburst - radiates at 90 degrees

• Labes: Increased Alkaline Phos
• Special Test: Bone scan- HOT

• >40yo
• creates spiculated/ radiating/sunburst periosteal reaction of bone

• 10-25+/- yo
• MC in Diaphysis of long bones
• multiparalleled onion skin (laminated) - Periosteal reaction
• bone expansion
• Codmans Triangle

an Infection

• >40 yo
• Aberrant notochord cell tumor.
• MC in Sacrum
• 2nd MC location- Skull

females 13-19

by major convexity

spinous deviate the concavity

spinoues deviate to the convexity

• 1. Cobs and Rissers Ferggusons
• 2. Cobs is the best

females - Right thoracic convexity

adjust and monitor

send to orthepist for bracing - Milwaukee

surgical consult

cardiopulmonary compromise

• 1. Lytic or Destructive
• 2. Combined
• 3. Sclerotic
• 4. Malignant (Osteosarcoma)

Basilar Impression

• for Basilar Invagination
• McGregor's Line - Best line
• Chamberlain's Line

• 1. Riessors Sign - look at secondary growth centers at the iliac crest (lateral to medial)
• 2. Wrist Films - Best way
• 3. tanner Stages (pubertal devolpment; looks at external changes; early puberty leads to increased liklihood of curve progression

evaluate and adjust

radiographing the Left Wrist.

1.Risser's sign 2. Wrist films 3. Tanner Stages (pubertal dev't; looks at external changes; early puberty leads to increased liklihood of curve progression)

Inflammatory and Degenerative

• Rheumatoid Arthritis
• Ankylosing Spondylitis
• Enterpathic Arthropathy
• Enteropathic Arthropathy
• Psoriatic Arthritis
• Reiters
• Systemic Lupus Erythematosus
• Scleroderma
• Osteitis Condensans Ilia

• Degenerative Joint Disease
• Diffuse Idiopathic Hyperostosis
• Neurogenic Arthropathy
• Synoviochondrometaplasia

Still's Disease

• Bilateral uniform loss of joint space
• rat bite erosions
• symetrical
• atlanto axial instability
• Bouchards (PIP)
• Haygarth (MCP)
• DIPs are spared
• Swan nech and boutiniere deformity
• ulnar deviation
• Bakers cyst

• Bilateral Protrusio Acetabuli,
• swann neck boutinniere deformaty

• Hyperextension with DIP
• Hyperflexion with PIP

• DIP Hyperflexion
• PIP Hyperextension

benign swelling of the semimembranous bursa

+RA latex, +FANA, +ESR, +CRP and normocytic normochromic anemia

• Dry mouth and eyes
• seen in RA

MarieStrumpell Disease

• Also considered Autoimmune condition
• males 15-35yo
• starts in the SI joints
• lbp
• AM stiffness

• Chest Expansion
• Foresters Bowstring
• Lewins supine
• Iritis

• Bilateral SI joint fusion
• 2nd mc location T12-L1

• Shiny Corner Sign, Bilateral marginal (syndesmophytes)
• squaring of vertebral bodies
• bamboo spine
• dagger sign
• trolley track sign

+ HLA B27 and +ESR

• Identical to AS with GI dysfunction
• -All signs are the same

• Males 20-50, silver scaly lesions on extensors
• pitted nails
• cocktail sausage fingers
• Increased in joint space
• pencil in cup deformity, mouse ear deformity
• ray sign
• atlantoaxial instability
• non-marginal syndesmophytes

+HLA B27

• Males 20-30+/-
• urethritis
• conjunctivitis
• arthritis
• calcaneal spur
• non marginal syndesmophytes

+HLA B27

• Females, photosensitive, skin rash (malar/butterfly rash)
• alopecia
• Raynoauds Phenomenon
• can cause ulnar deviation of phalanges
• non erosions of joints

• +LE prep
• +FANA
• +RA latex
• +ESR

1. SLE and RA

• 2. In SLE when a patient presents with Ulnar deviation and they place hand on flat surface and if it returns to normal = SLE
• In RA patient this is not true

Progressive Systemic Sclerosis

• females 30-50yo
• CREST Syndrome
• erosions from distal tufts

+FANA, +RA latex (30%)

Osteitis Triangularis

• Multiparous females 20-40yo
• bilateral and symetrical triangular sclerotic areas on the lower half of the ilium.
• JOINT SPACE IS NORMAL

Para glenoid sulci - notches on the inf borders of ilia (bilateral)

Osteoarthritis

• Non-Inflammatory
• MC involves finger and weight bearing joints
• usually stiffens with rest and improves with activity; complication include spinal stenosis and IVF enchroachment
• Asymetrical Distribution, non uniform loss of space

C5/6

• IVD narrowing
• osteophytes
• endplate sclerosis

• Heberden (DIP)
• Bouchards (PIP) nodes

• hard or bony swellings that can develop in the distal interphalangeal joints (DIP)
• Sign of Osteoarthritis

• hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (the middle joints of fingers or toes.)
• Sign of Osteoarthritis

Forestiers Disease

• Males >40yo
• associated with Diabetes Mellitus
• ossification of Posterior Longitudinal Ligament (OPLL)
• flowing hyperostosis, candle wax drippings, 4 contiguous segments

Charcots Joint

• Secondary to impaired sensory function in the joints
• seen with diabetes, tabes dosalis, syphulis and syringomyelina

• seen most commonly in Neurogenic Arthropathy
• Distension,
• Density of Subchondral sclerosis,
• Debris within joint,
• Dislocation, and
• Destruction of bone

• MC joint affected is the knee
• Results in Multiple loose bodies within the joint that are round or ovoid in shape

• males >40yo due to overproduction of uric acid (foods in high purines)
• Recurrent Episodes of a painful, monoarticular, red hot, and swollen joint
• Overhanging margins: Juxta-articulation erosions (above and below joint space)

• MTP of the big toe (Podagra)
• Tophi Crystals maybe seen

• 1. Increased uric acid
• +ESR
• 2. Joint Aspiration

• Acute-Colchinicine
• Chronic Allopurinol

• Thin linear calcification parallel to the articular cortex within the joint space called Chondrocalcinosis when affecting cartilage.
• MC seen in the knee

• MC affects the shoulder joint
• round oval calcificationsnear insertion of bursa or tendon

Pt presents with a fevor, chill, history of trauma/ surgery and a warm tender, swollen joint

WBC

Osteonecrosis/ Osteochondrosis

• All AVN's are self resolving taking 8months-12years
• all major cause is due to trauma

• No labs
• Special tests" Bone scan or MRI

• Preisers
• Scherermanns
• Legg Calves Perthes
• Kohler
• Keinbochs
• Servers
• Blounts
• Freinbergs
• Osteochondritis Dessicans
• Panners

Carpal Scaphoid - 90% thru middle MC fx of carpal

• no longer on AVN list
• Tibial Apophisitis
• Location: Tibial Tuberosity

• kids 8-16 yo
• pin point pain and swelling
• usually sport playing (soccer)\hip felxion and extension
• Cho pat brace
• must stop all sports for 3-5weeks

Vertebral End Plate Epiphysis

femoral Epiphysis

Tarsal Navicular

Carpal Lunate

Calcaneus

Medial Tibial Condyle

Head of 2nd Metatarsal

Articular surface of the medial femoral condyle (mc laterally)

Capitellum