DEGENERATIVE ARTHRITIDES AND ARTHROPATHIES

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DEGENERATIVE ARTHRITIDES AND ARTHROPATHIES

• Michael Whitehead B.S, D.C., DACBR
• Professor
• Chair of Diagnostic Sciences

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DEGENERATIVE DISORDERS

• Osteoarthritis (Degenerative Joint Disease)
• Erosive Osteoarthritis
• Diffuse Idiopathic Skeletal Hyperostosis
• Neurotrophic Arthropathy

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DEGENERATIVE JOINT DISEASE

• General Comments
• Osteoarthritis, osteoarthrosis spondylosis,
  degenerative disc disease
• Most common form of arthritis
• Common cause of disability
• Cartilage destruction and reparative processes
  such as osteophytes and subchondral sclerosis
• Primary and secondary

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DEGENERATIVE JOINT DISEASE

• Etiology and Risk Factors
• Primary Idiopathic and senescent
• Secondary Trauma, osteonecrosis, inflammatory
  arthritis, dysplasias
• Risk Factors Heredity, gender, diet, obesity,
  age, physical activity

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DEGENERATIVE JOINT DISEASE

• Clinical Manifestations
• Primary form usually gt age 50
• Poor correlation between radiographic findings
  and clinical presentation
• Onset insidious, intermittent mild to moderate
  achy pain, stiffness that improves with activity,
  swelling
• Crepitus, palpable excrescences, reduced ROM
• Neural deficits (spine)
• Normal blood studies

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DEGENERATIVE JOINT DISEASE

• Skeletal Distribution
• Hips and Knees
• Spine
• First MTP joint
• AC joint
• 1st metacarpal-trapezium
• DIP of hands
• PIP of hands

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DEGENERATIVE JOINT DISEASE

• Radiographic Manifestations
• Reduced joint space (non-uniform)
• Osteophyte formation
• Subchondral sclerosis
• Subchondral cysts
• Intra-articular fragments (loose bodies)
• Joint deformity
• Joint misalignment
• Asymmetric distribution
• Vacuum phenomena (DDD)

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DEGENERATIVE JOINT DISEASE

• Hip Etiology
• Articular cartilage overload
• Primary idiopathic vs secondary joint disorders
• Old SCFE, DDH, LCP
• Hip Clinical Profile
• Usually gt age 55
• Internal rotation reduced and painful
• Insidious onset of groin and thigh pain, -
  gluteal radiation
• Stiffness, limitations in ability to sit, stand,
  walk
• Pain worse in morning, exacerbated by weight
  bearing

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DEGENERATIVE JOINT DISEASE

• Hip Radiographic Features
• Joint space narrowing, osteophytes, subchondral
  sclerosis, subchondral cysts
• Superior joint space compartment m/c
• Medial and axial compartments may be involved
• Circumferential osteophytes
• Eggers cysts
• Buttressing, deformity
• Advanced changes? coxarthrosis, malum coxae
  senilis

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DEGENERATIVE JOINT DISEASE

• Knee Etiology
• Chronic microtrauma (primary)
• Secondary joint disorders (previous trauma, joint
  instability, AVN
• Knee Clinical Profile
• Pain with utilization of joint
• Variable joint swelling (effusion)
• Catching, locking, grinding in older patient

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DEGENERATIVE JOINT DISEASE

• Knee Radiographic Features
• Narrowing of medial femorotibial joint space m/c
• Small osteophytes
• Mild subchondral sclerosis
• Subchondral cysts lt 10, tibia
• Varus or valgus deformity
• Osteochondral bodies
• Patellar tooth sign
• Isolated patellofemoral joint involvement
  uncommon

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DEGENERATIVE JOINT DISEASE

• KNEE Chondromalacia Patella
• Patellofemoral joint pain and crepitus
  accentuated by knee flexion
• Softening of cartilage and degenerative changes
• May be idiopathic or secondary to patellar trauma
  
• Adolescents and young adults m/c
• Patella alta, increased valgus angle, femoral
  condyle hyperplasia may predispose
• MRI best imaging procedure

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DEGENERATIVE JOINT DISEASE

• Ankle and Tarsal Joints, Foot
• Ankle uncommon site usually 2nd to trauma
• First tarsometatarsal joint suggests
  talocalcaneal bar
• Plantar and posterior aspect of calcaneus
• First metatarsophalangeal joint m/c
• Osteophytes dorsal and medial aspect m/c
• Bunion
• Valgus deformity is common

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DEGENERATIVE JOINT DISEASE

• Hands
• Interphalangeal joints, first carpometacarpal
• Heberdens and Bouchards nodes
• Lateral osteophytes, sclerosis, loss of joint
  space, malalignment

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DEGENERATIVE SPINE DISEASE

• Spine
• M/C locations C5-C7, T6-T12, L4-S1
• Degenerative changes may involve the spine at
  the following sites
• Synovial joints
• Intervertebral disc
• Vertebral bodies and annulus fibrosus
• Fibrous articulations, ligaments, sites of
  ligament attachment
• All four may coexist

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DEGENERATIVE SPINE DISEASE

• Synovial Joints
• Atlantoaxial, apophyseal, costovertebral,
  sacroiliac
• Radiographic features
• Decreased joint space, eburnation, osteophytes
• Atlantoaxial arthrosis not common, can cause
  occipitocervical pain

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DEGENERATIVE SPINE DISEASE

• Synovial Joints Facets and Uncovertebral
• Facet joint involvement m/c mid and lower
  cervical and lower lumbar spine
• AP and oblique views best
• IVF and lateral recess encroachment (degree
  difficult to assess)
• Degenerative spondylolisthesis
• May compromise vertebral art. blood flow
• Synovial Joints Costovertebral
• M/C lower thoracic

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DEGENERATIVE SPINE DISEASE

• Intervertebral Disc
• DDD, spondylosis, intervertebral chondrosis
• Radiographic Findings
• Loss of disc height
• Osteophytes
• Eburnation
• Vacuum phenomenon
• Subluxation

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DEGENERATIVE SPINE DISEASE

• Complications/Associations
• May lead to ant. ankylosis senile kyphosis in
  older patients in thoracic spine
• Canal stenosis (central, lateral recess, IVF)
• Cervical spine m/c C5 and C6, lt 12mm
• Degenerative spondylolisthesis
• Instability
• Baastrups Syndrome

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DEGENERATIVE SPINE DISEASE

• Spondylosis Deformans
• Anterior and lateral osteophytes d/t anterior and
  anterolateral disc herniation
• Initiated by abnormalities of peripheral fibers
  of annulus and vertebral body (Sharpey fibers)
• Disc space relatively spared
• Intervertebral chondrosis/osteochondrosis
• Degeneration of innermost portion of annulus,
  dehydration of nucleus, breakdown of cartilage
  plate