General

Arthitis Xray

OA

- subchondral sclerosis, cysts, joint space narrowing, osteophytes

 

RA

- generalised osteopaenia

- marginal joint erosions due to synovial proliferation & pannus

- soft tissue swelling

- joint space narrowing

 

Psoriatic arthropathy

- distal arthritis with affected DIPJs

- periarticular erosions

- affects wrists severely

 

Gout

- erosions due to tophi

- punched out erosions, periarticular

- overhanging sclerotic margin

- no osteopaenia c.f. to RA

 

Bone in Bone

Infection

 

Caffey's

 

Diaphyseal dysplasia

 

Pyknodysostosis

 

FHO

 

 

 

Charcot Joints

SAD SLIPS

 

Spina Bifida

 

Alcoholism

 

DM

- most common cause

 

Syphilis

- Tabes dorsalis

 

Leprosy

- most common UL

 

Indifference to pain (congenital)

 

Peripheral nerve lesions

 

Syringomyelia 20-40%

- number 1 cause in upper limb

 

 

Chondrocalcinosis

WHIP A DOG

 

Wilson's

Haemochromatosis

Idiopathic

Pseudogout, pernicious anaemia

 

Amyloid, acromegaly

 

Diabetes

Ochronosis

Gout

 

 

 

Deformity

6 Causes of Joint Deformity

 

Skin contracture - burn

 

Fascial contracture - Dupuytren

 

Muscle contracture - Volkmann's

 

Muscle imbalance - asymmetric paralysis

 

Joint instability - ACL rupture

 

Joint destruction - RA

 

6 Causes of Bone Deformity

 

Congenital disorder - Pseudoarthrosis

 

Soft bone - Rickets, osteomalacia, OI

 

Dysplasia - Hereditary Multiple Exostosis

 

Physeal injury

 

Malunion

 

Paget's

 

 

 

 

Failed Surgery

 

1.  Diagnosis incorrect

- other local (intra-articular eg meniscal tear)

- referred (hip or spinal pathology)

 

2.  Right diagnosis but wrong surgery

- osteotomy for advanced OA

 

3.  Right surgery performed inadequately

- poorly performed -  inadequate fixation for osteotomy

- incomplete - didn't address all pathology /  incomplete correction of deformity

 

4.  Recognized complication of well performed surgery

 

5.  Well performed surgery with inadequate rehabilitation

- patient motivation

- wrong rehab

- right rehab done poorly

 

6.  Progression of pathology or disease process

- progression of OA after osteotomy

 

 

 

 

Gait

STRAWS

 

Short

Trendelenberg

Rigid

Antalgic

Weak

Spastic

 

 

 

 

General Osteopenia

Primary

 

Type 1

- postmenopausal

- high turnover / osteoclast mediated

- F x 6

     

Type 2

- age-related / senile

- low turnover / osteoblast mediated

- F x 2

 

Can have both

 

Secondary / DDD NICE

 

Disuse

- prolonged bed rest

- inactivity

- paralysis

- space travel

 

Diet

- low Ca, vit C

- anorexia nervosa

 

Drugs

- heparin

- methotrexate

- ethanol

- steroids

 

Neoplasms

- metastatic disease

- myeloma

- lymphoma

- leukemia

- mastocytosis

 

Idiopathic

- adolescent (10-18yrs)

- middle-age men

 

Chronic Illness

- RA

- cirrhosis

- sarcoidosis

- renal tubular acidosis

 

Endocrine Abnormalities

- pituitary hypersecretion

- adrenal cortex excess

- ovary- oestrogen deficiency

- testis - testosterone deficiency

- hyperparathyroidism

- hyperthyroidism

- hypophosphatasia

 

 

 

Generalised Sclerosis

VD FROM PA

 

Vitamin D Intoxication

 

Diaphyseal Dysplasia / Englemann's

 

Fluorosis

 

Renal Osteodystrophy

- secondary hyperparathyroidism

- rugger jersey spine

 

Osteopetrosis

Osteopoikilosis (= spotted bones)

 

Myelosclerosis

Metastasis - prostate / breast

Malignancy - Lymphoma

Mastocytosis

Melorheostosis - candle bones

Metaphyseal dysplasia

 

Paget's

Pyknodysostosis

 

AVN / Sickle Cell

 

 

 

 

 

 

Inflammatory Arthritis

RA

 

Sero-ve Spondyloarthropathies

- Rieter's 

- Ankylosing spondylitis

- Psoriatic

- Enteropathic (IBD)

 

Crystal Arthropathies

- Gout

- CPPD

- HADD

 

Ochronosis / Haemachromatosis

 

CT Diseases

- JCA

- SLE

- Sarcoid

- CREST - scleroderma

 

PVNS

 

Haemophilia

 

Septic arthritis

 

Polymyalgia Rheumatica

 

 

 

Local Osteopaenia

TO DROP BART

 

Transient Osteoporosis of Hip

Osteolytic Tumour

Disuse

RA

Osteomyelitis

Paget's

Burns

AVN

RSD

TB

 

 

 

Nonunion

Patient Factors

 

Patient factors

- age

- nutrition / catabolic states

- anaemia

- smoking

- alcohol

- DM

- immunocomprimise

- non compliance       

 

Pharmacological agents

- steroids

- cytotoxics

- ciproflaxacin

- NSAIDS

 

DXRT

 

Injury factors

     

Injury

- open fracture

- significant soft tissue trauma

- soft tissue interposition

- poor vascularity

- infection

- pathological fracture

- malignant tissue

- osteoporosis

 

Fracture pattern

- intact fellow bone

- excessive bone loss

- segmental injury

- comminution

- displacement

- synovial fluid

     

Surgeon factors

 

Distraction of fracture

Inadequate stability with excessive movement

Excessive stability

Extensive approach with vascular compromise

No axial load

 

 

 

 

     

Periosteal Reaction

I BIT NOAH CNS

 

Infection

     

Blood

- Haemophilia

- DVT

 

Inflammatory arthritis

 

Trauma

 

Neoplasia

 

Osteoarthropathy Hypertrophic

 

A Vitaminosis

 

Hypophosphatasia / Hyperthyroidism

 

Caffey's/ Child Abuse

 

NF

 

Scurvy

 

 

 

 

Peripheral Neuropathy

Idiopathic ~ 50%

 

Congenital

 

HMSN

Friedrich's Ataxia

 

Acquired

 

Trauma

 

Infection

- Leprosy

- TB

- Syphilis

 

Tumour

- Malignancy

- Myeloma

- Polycythemia rubra vera

 

Inflammatory

- GBS

- SLE

- RA

- Sarcoid

- PAN

 

Metabolic

- DM

- CRF

- Chronic liver disease

- Amyloid  

- B1 / B6 / B12

- Thiamine

 

Endocrine

- hypothyroid

 

Drugs and Toxins

- Alcohol

- Lead

- Phenytoin

- Metronidazole

- Nitrofurantoin

- Vincristine

 

 

 

 

 

Soft Tissue Calcification

Metastatic

 

Hypercalcaemia

- primary HPTH

- secondary HPTH

- malignancy (production of PTH like proteins)

- Vit D intoxication

- Milk Alkali Syndrome

- Sarcoidosis

     

Dystrophic

 

Myositis ossificans progressive / MO / HO

Haematoma

Trauma

Burns

Tumoral calcinosis - produces large lobulated mass; high recurrence rate

Atherosclerosis, thrombi

Synovial sarcoma / Chondrosarcoma / Haemangioma

Dermatomyositis

Infection (TB, Infected lymph nodes)

Parasites

Fat necrosis

Scleroderma