Extremity Osteoarthrosis

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Extremity Osteoarthrosis

• Presented by M.A. Kaeser, DC
• Radiology Resident
• Spring 2009

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Definition of OA

• Arthritis characterized by erosion of articular
  cartilage, either primary or secondary to trauma
  or other conditions, which becomes soft, frayed,
  and thinned with sclerosis of subchondral bone
  and outgrowths of marginal osteophytes pain and
  loss of function result mainly affects
  weight-bearing joints, is more common in older
  persons

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Hip OA

• Non-uniform loss in joint space
• Superior, medial (inferior) and axial (central)
• Superior M/C medial joint space is widened
  (Waldenstrom sign)
• Axial L/C
• Osteophytes supra-acetabular margin and lateral
  and inferomedial surfaces of the femoral head
• Prominent subchondral bone cysts adjacent to
  reduced joint space
• Sclerosis M/C in acetabular margin of the ilium
• Cortical buttressing thickening of the cortex
  (medial side of femoral neck)
• Joint deformity flattening of the femoral head
  and acetabular roof

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Waldenstrom sign
http//www.learningradiology.com/images/boneimages
1/Hip-DJD.jpg
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http//www.smrfoamroller.com/blog/wp-content/uploa
ds/2009/01/djdhip1.jpg
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Knee OA

• Common site of OA due to weight bearing function
  and susceptibility to injury
• Non-uniform loss of joint space
• Sclerosis
• Small osteophytes
• Loose bodies
• Deformity

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Non-uniform joint space loss
Patellofemoral
http//www.glucosamine-arthritis.org/graphics1/DJD
Knee12.jpg
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Lateral femorotibial
Medial Femorotibial
http//www.wheelessonline.com/image3/i1/knoa1.jpg
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Knee compartments

• Medial Femorotibial M/C
• Lateral Femorotibial
• Patellofemoral

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Femorotibial Joint

• Decreased medial joint space
• Weight bearing AP films are essential
• Sclerosis and osteophytes are usually not
  prominent
• Sharpening of the tibial eminences is a feature
• Loose bodies may be singular but are often
  multiple
• Subchondral cysts, if apparent are inferior to
  the tibial plateau, especially near the tibial
  eminences
• Varus deformity late manifestation

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Patellofemoral Joint

• Found in combination with femorotibial OA
• If isolated, consider CPPD or significant
  previous trauma
• Signs of patellofemoral OA
• Loss of joint space more pronounced in lateral
  initially
• Osteophytes inferior, superior, medial and
  lateral poles
• Sclerosis
• Anterior femoral erosion bony excresences
  (tooth sign)

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http//www.drarnosmit.com/Portals/0/KneeTreatmentO
ptions/smdscn0422.jpg
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Ankle and Tarsal Joint OA

• Ankle uncommon site unless significant previous
  trauma
• Example tibiofibular diastasis that results in
  chronic instability
• Tarsal infrequently involved
• If involved, usually the first tarsometatarsal
  joint

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http//www.londonfootsurgery.com/images/ankle_arth
ritis_fibula.jpg
http//www.hnwanjia.com.cn/wp-content/uploads/2009
/05/ankle_osteoarthritis_diagnosis01.jpg
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Foot OA

• First metatarsophalangeal joint M/C
• Osteophytes
• Dorsal and medial surfaces of the first
  metatarsal head
• May arise from the hallux sesamoids
• May simulate gout
• Deformity
• Loss of joint space
• Sclerosis
• Small subchondral cysts

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http//www.myfootshop.com/images/medical/x-rays/OA
_1st_mpj_mod.jpg
http//content.revolutionhealth.com/contentimages/
nr55552008.jpg
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Shoulder OA

• Most common in AC joint
• OA in glenohumeral joint should arouse suspicion
  of previous significant trauma or an underlying
  cartilage disease (CPPD, ochronosis, acromegaly)

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AC Joint OA

• Loss of joint space
• Sclerosis
• Osteophyte formation
• Small subchondral cysts in distal clavicle

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http//www.clinexprheumatol.org/photo/29.jpg
http//www.cheltenhamshoulderclinic.co.uk/images/d
egenerative-ac-joint.jpg
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Glenohumeral Joint OA

• Non uniform loss of joint space
• Sclerosis
• Osteophyte formation
• Particularly at the inferior humeral head

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http//img.medscape.com/fullsize/migrated/ editori
al/clinupdates/2000/244/smm.v05.fig06a.jpg
http//www.aafp.org/afp/20080901/afp20080901p605-f
1.gif
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Rotator cuff degeneration

• Small cyst formation in the tuberosities
• Superior migration of the humerus in relation to
  the glenoid cavity owing to the unopposed action
  of the deltoid muscle
• Erosion with sclerosis of the inferior surface of
  the acromion usually accompanies superior humeral
  displacement

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http//img.medscape.com/pi/emed/ckb/radiology/3361
39-401595-4612.jpg
http//www.scielo.br/img/fbpe/aob/v10n4/14326f6.jp
g
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Calcific Tendinitis and Bursitis

• In symptomatic and asymptomatic shoulders
• A sequelae of degenerative tendinitis at the bony
  attachments of the tendon usually B/L
• M/C location is supraspinatus tendon insertion at
  the greater tuberosity (seen on external
  rotation)
• Next most common site is the subacromial bursa
• Other tendons which may calcify
• Infraspinatus, teres minor and subscapularis

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http//www.thewholechild.us/integrative_/calcific_
tendonitis.jpg
http//www.shoulderdoc.co.uk/images/uploaded/sdoc_
calcific_tendonitis_xr.jpg
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Elbow OA

• Secondary to previous trauma, occupation or other
  abnormality
• Loose body formation
• Osteophytes
• Olecranon spur at the triceps tendon insertion

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http//www.eorthopod.com/images /ContentImages/elb
ow/elbow_oa/ elbow_oa_cause01.jpg
http//orthoinfo.aaos.org/figures /A00421F01.jpg
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Wrist OA

• Usually limited to the first metacarpal-trapezium
  joint
• Radial subluxation of the first metacarpal base
• Sclerosis
• Osteophytes
• Loose bodies
• Radiocarpal joint OA secondary to trauma
• Radial and scaphoid fractures, carpal ischemic
  necrosis and CPPD
• Diminution of radiocarpal joint space, sclerosis
  and osteophytes, subchondral cysts in carpal bones

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http//orthoinfo.aaos.org/figures/ A00019F03.jpg
http//www.davidlnelson.md/images /Wrist_DJD_sever
e.jpg
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Hand OA

• Heberdens nodes DIP joints
• Bouchards nodes PIP joints
• Lateral osteophytes
• Sclerosis
• Loss of joint space
• Malalignment especially in the DIPS

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References

• Yokum TR, Rowe LJ. Essentials of Skeletal
  Radiology. Baltimore Williams
• Wilkins, 1996 373545.