Phase 1

what degenerative joint disease is only found in the cervical spine

uncovertebral joint arthrosis

what are the findings in this image?

uncovertebral joint arthrosis

what do you call the radiographic feature commonly seen in uncovertebral joint arthrosis

pseudofracture

what are the findings in this image?

facet arthrosis

what are the findings in this image?

erosive osteoarthritis

waht are the features denoting erosive osteoarthritis on radiograph?

central erosions creating gull wing sign

EOA likes what joints?

DIP, PIP, 1st CMC

what referral should you make with EOA

rheumatologist

what are the findings in this image?

DISH

what are the 3 diagnostic criteria of DISH?

1. flowing calcification of at least 4 contiguous vertebral bodies

2. relative preservation of disc height

3. abense of facet joint ankylossi and sacroilitis, sclerosis, or intra articular osseous fusion

DISH is the ossification of what ligament

ALL

where is DISH most common?

T7-T11 on right side due to pulsatile descending aorta

what symptoms would you potentially expect with this radiograph?

asymptomatic or stiffness, dysphagia, or joint/tendon pain

what health state has some co-occurence with DISH?

diabetes mellitus

extraspinal DISH might have effects at what sights?

ligamentous and tendionous attachments

is DISH a contraindication to adjusting? if so, what kind?

yes, relative contraindication

what is this radiographic feature associated with?

DISH

what is this radiographic feature associated with?

DISH

cause of neuropathic arthropathy in ankle/feet

diabetes

neuropathic arthropathy aka

charcot’s joint

cause of neuropathic arthropathy in lumbar spine/knee/ankle

syphilis

cause of neuropathic arthropathy in shoulder, elbow or wrist

syringomyelia

what is the finding in this radiograph? AKA?

OPLL/japanese disease

OPLL might present with what kind of issues? what symptoms would this cause?

neurological disturbance causing

heavy feeling legs

inability to walk and brisk pace

deterioration of fine motor skills

intermittent shooting pains into arms and legs

most common site of OPLL

cervical spine

is this a contraindication to adjusting? if so, what kind?

yes, absolute contraindication

what finding is in this image?

syringomyelia

what is this clinical presentation describing?

painless swelling

deformity

weakness

instablity

crepitus

bag of bones

neuropathic arthropathy

what are the 6 Ds of hypertrophic neuropathic arthropathy

disorganization

distension

debris

destruction

dislocation

density increase

what finding is in this image

hypertrophic neuropathic arthropathy

what is the finding in this image? AKA

neuropathic arthropathy AKA charcot’s joint

what finding is in this image

atrophic neuropathic arthropathy

what appearance does atrophic neuropathic arthropathy typically take on ?

licked candy stick

what would this charcot joint be caused by

syphilis

what would this charcot joint be caused by

syringomyelia

what would this charcot joint be caused by

diabetes

what is this finding?

synovial chondromatosis (SCM)

what is this finding?

synovial chondromatosis (SCM)

what is this finding?

synovial chondromatosis (SCM)

what is the most commong site for synovical chrondomatosis

knee

what are the types of synovical chondromatosis

primary (unknown factor)

secondary (sequala due to DJD, neuropathic joint disese, OCD, osteochondral fractures, joint dislocations)

loose bodies from synovial chondromatosis might predispose the patient to?

degenerative osteoarthritis

what do you call this feature? what diagnosis is this part of ?

apple core deformity, synovial chondromatosis

what does it mean to be a seropositive arthropathy

presence of RF or ACPA in serum

what is the seropositive arthropathy

RA

what is the target tissue in RA? what are the areas called that are especially at risk?

synovium

bare areas

RA causes a proliferative response in synovial joints called

pannus

using the diagnostic criteria of RA, what does one need to score to be diagnoses with definite RA

score of 6 or greater

T/F: RF is sensitive and specific to RA

false, neither

T/F: ACPA is senstive to RA, not specific

false, ACPA is specific (almonst never found in people without disease), not sensitive

onset of RA before what age denotes JRA

16

what are these clinical features describing

stiffness in morning lasting as least 1 hour

joint pain, tenderness

bilateral and symmetrical invovlement

fusiform soft tissue swelling

weight loss

fatique

myalgia

RA

What are these called and what is it a common clinical feature of ?

Haygarth’s nodes

RA

what syndrome has a common co-existence with RA? what are the symptoms

sjogren’s syndrome

xerostomia (dry mouth)

xeropthalmia (dry eyes)

xeroderma (dry skin)

what are these called?

rheumatoid nodules

T/F: RA typically presents with sclerosis and osteophytosis on radiographs

false

what are hallmark radiographic signs of RA

bilateral symmetic involvment

periarticular soft tissue swelling

marginal erosions

uniform loss of joint space

juxta articular osteoporosis

ADI instability

what is the diagnosis

RA

what is the diagnosis and major finding?

periarticular swelling

RA

what is the diagnosis

RA

what do they call this feature?

part of what diagnosis>?

rat bite erosion

RA

diagnosis?

RA

red arrows are pointing to what feature?

part of what diagnosis?

pseudocysts

RA

what is the number 1 presentation called?

part of what diagnosis?

mallet finger (flexion of DIP)

RA

what is the number 2 presentation called?

part of what diagnosis?

boutinniere deformity (flexion of PIP)

RA

what is the number 3 presentation called?

part of what diagnosis?

swan neck deformity (flexion of DIP with extension of PIP)

what are the target sites of RA

MCP and PIP

ulnar styloid

mid carpals

radiocarpal

2-3 metacarpal heads

marginal erosion due to RA are often located on what side of metacarpals

radial side

what diagnosis is this distribution describing

RA

what’s happening in this image?

may be part of what arthritic diagnosis?

ADI instability (increase in distance)

RA

what is a normal ADI distance?

1-3 mm in adults

1-5 in children

chamberlain’s line measures from ____ to ____

what landmark should not go above it?

ospithion to hard palate

odontoid

what is this appearance called?

often associated with what diagnosis?

stepladder appearance (subaxial subluxation)

RA

RA impact on cervical arthrosis has what characteristics?

loss of disc height

endplate erosions (esp in posterior 2/3)

multisegmental involvement

absence of osteophytes and sclerosis

RA impact on hip can cause what

protrusio acetabuli

what is found in the posterior medial knee in knee arthritis due to RA?

baker’s cyst

baker’s cyst is found between what two muscles?

semimembranosus

medial head of gastrocnemius

RA + pneumoconiosis =

caplan’s syndrome

RA + leukopenia + splenomegaly =

Felty’s syndrome

is RA a contraindication to adjusting? if so, what kind?

yes, absolute at involved joints

what are these clinical features part of

age 2-16

fever

rash

lymphadenopathy

iridocyclitis

receded, hypoplastic mandible causing bird like face

juvenile idiopathic arthritis (JRA)

what is the diagnosis?

JRA

what is the diagnosis?

JRA

what are the common radiographic features of Juvenile idiopathic/rheumatoid arthritis?

soft tissue swelling

osteoporosis

transverse growth arrest lines

periostitis

ballooned epiphyses

what are the most common seronegative arthropathies?

psoriatic arthritis

enteropathic

ankylosing spondylitis

reactive

what lab tests might be positive in ankylosing spondylitis

HLA B27

elevated ESR and CRP

what are the targer sites of AS

bone-ligament junctions

fibrous joints (SI)

synovial joint (spine and root joints)

fibrocartilaginous joints (IVD, symphysis pubis, sternomanubrial)

what is an extraskeletal feature of AS

iritis

what is the diagnosis?

AS

sacroilitis

what are the signs seen in this image? what diagnosis would you make

rosary bead appearance (wavy appearance in SI joint area)

star sign (at superior angle of SI joint)

AS

what are the signs seen in this image? what diagnosis would you make?

ghost joint (line in SI joint area but no space)

star sign (at superior angle of SI joint)

AS

what causes erosion at anterior corner of vertebral bodies in AS?

osteitis

what are the signs seen in this image? what diagnosis would you make?

romanus lesion (erosion at corner of vertebral body )

shiny corner sign (sclerosis at angles of vertebral body romanus lesion)

AS

what are the signs seen in this image? what diagnosis would you make?

barrel shaped vertebra

AS

what type of seronegative arthritis is marked by marginal syndesmophytes?

AS

what is the difference between AS and DISH ossification between vertebra

facet joints are ankylosed in AS

appearance of spine in AS AKA

bamboo spine

what do you call this sign? what diangosis is this apart of?

trolley track sign

AS

what do you call this sign? what diangosis is this apart of?

dagger sign

AS

what do you call this sign? what diangosis is this apart of?

andersson lesion

AS