Degenerative Joint Disorders

Transcription

1 Imaging Degenerative Joint Disorders Niels Egund, MD Osteoarthrosis Osteoarthritis - OA a. OA is defined as a focal lesion of the articular cartilage, combined with hypertrofic reaction in the subchondral bone and new bone formation at the joint margins b. The overall picture resembles a failure in attempt at repair c. Secondary synovitis Specific joints - OA Hip 5% > 60 years Knee 4% > 60 years Medial/lateral = 10:1 Ankle rare posttraumatic Foot common often asymptomatic Shoulder occurs Elbow occurs Wrist uncommon CMC I common in females 1

2 OA and arthritis Radiographic signs of OA Joint space reduction = localized cartilage defect Eburnation attrition Cyst formation intraosseous ganglion Osteophytes Joint instability Osteonecrosis 2

3 3 måneders problemer med hø hofte Diagnosforslag? Mediale smerter Har denne pt. artrose? Normal anatomy, slope of the medial and lateral tibial condyle 3

4 The normal joint and OA Radiologisk artrose? Normale ledspalter Let medial OA + lateral PF 4

5 ? Kan være normal OBS lateral OA bilat Kan være normal Medial OA Female 37 Y pain lateral left 5

6 Female 37 Y pain lateral left Analysis of radiographs OA and knee examination technique OA and knee examination technique 6

7 Liggende Stående OA and knee examination technique 7

8 Normal anatomy, slope of the medial and lateral tibial condyle Normal anatomy and examinations technique 8

9 Patellofemoral joint examination technique Weigthbearing Differences between Supine Vertical high Orientation of joint surface relative to the femoral condyles Femoro-tibial rotation 70 Year old female Supine Standing 9

10 61 year old female 42 year old female Supine Standing 54 year old female treated with gold for anterior knee pain Supine Standing 10

11 Radiographic grading of the severity of OA of the knee Compartmental assessment from standing examinations Joint space, JSW mm. grade MFT LFT MPF LPF Normal 0 50% narrowing 1 100% narrowing 2 < 5 mm bone attrition 3 X X > 5 mm bone attrition 4 > 10 mm bone attrition 5 Osteophytes 0 3 Subchondral sclerosis 0 1 Sharpening of the tibial spine 0 1 Ahlbäck 1968 and Scott et al Kellgren, Lawrence 1957 Supine Standing Joint instability and OA Joint instability and OA Radin et al. J. Biomech

12 Stressfractur change of osseous elasticity Radin et al. J. Biomech 1973, Brandt, Dieppe, Radin 2008 Medial OA of the knee - etiopathogenesis Bilateral lateral OA pain right or left? Female 54 years 12

13 Synovitis Bone marrow inflammation = pressure OA and enthesopathies (?) The hip joint and OA 70% Synovial osteofyt Apposition 13

14 The hip joint and OA Synoviale osteofytter The hip joint and OA Hip OA and synovitis 14

15 Hip pain clinical examination 3 måneders problemer med hø hofte Diagnoseforslag? 3 måneders problemer med hø hofte 25 årig mand - Diagnoseforslag? 15

16 Differential diagnosis knee pain Male 28 years Your report? 22 years of age 16

17 CAM impingement måske Men artrit sequelae!!!! 17

18 FAI before surgery Supine or standing exam? Take home point!!!! Diagnosen artrose er generelt og principielt forbeholdt patienter over 40 år Hvis ledspaltereduktion ikke er sikkert fokal: overvej altid seronegativ artrit i alle aldre 18

19 The OA confined to females I am not allowed to show images of their mandibular joints 19

20 ?? Klinisk og radiologisk diagnostik Diagnose Alder, køn Anamnese Anatomisk lokalisation Klinisk undersøgelse Konklusion? Henvisning Anamnese Klinisk undersøgelse? What to look for!!!!!!????? 20

21 Metastase og bevaret ledspalte 63-year-old female with pain and signs of reduced sensibility Diagnosis 21

22 Female 43-year-old Gout and diabetic neuroarthropathy Artritis urica 22

23 Gout Fra Resnick Gout 23