L2.6 - Articular Disorders, Crystal Deposition

- Erosion of DIP of right digit 2 starting to wrap around

- Dense soft tissue swelling of right digit 2

- Erosion DIP of left digit 2

- Erosion of left ulnar styloid process

- Periarticular osteopenia

What are the abnormal findings on the hand films?

- Erosion of 1st MTP overhanging

- Dense soft tissue swelling around 1st MTP

- 4th/5th digits eroded

What abnormal findings are present on the foot series?

Gout

Diagnosis?

Uric acid in blood (hyperuricemia)

What lab tests can confirm the diagnosis?

- 3rd digit

- Erosion with overhanging margin

- Dense soft tissue swelling

List findings

Gout

Diagnosis?

Refer to primary

Next step?

- Dense soft tissue swelling

- Erosion of ulnar styloid process

What abnormal findings are consistent in the hand, elbow and knee series?

Gout

Diagnosis?

- Asymptomatic hyperuricemia

- Acute gouty arthritis

- Polyarticular gouty arthritis

- Chronic tophaecous gout

What are the stages of this disease?

- Calcification of cartilage

- Meniscal calcification

- Non-uniform loss of joint space

- Osteophytes

- Subchondral cysts

- Subchondral sclerosis

- Subluxation

What abnormal findings are present?

CPPD

Most likely diagnosis?

- Knee

- Pubic symphysis

- Hand/wrist

- Hip

- Shoulder

- Elbow

- Spine

What are some areas that this disease likes to target?

Refer to rheumatologist

Next step?

- Sclerosis of scaphoradial junction

- Calcification in triangular fibrocartilage complex

- Loss of joint space

- Subchondral cyst

- Capitate moved proximally

- Scapholunate advanced collapse

List findings

CPPD

Diagnosis?

No

Would you adjust this patient?

Refer to orthopedist

Next step?

- Calcification of supraspinatus tendon

- Acromiohumeral interval enlarged

List the abnormal findings

Hydroxyapatite Deposition Disease

Diagnosis?

Supraspinatus

What tendon is involved?

Calcification in lung

Do you see anything else that is abnormal?

- Increased acriohumeral interval

- Glenohumeral subluxation

- Globular calcification in acromiohumeral interval

List the abnormal findings

Hydroxyapatite deposition disease

Diagnosis?

- Continue chiropractic care as long as patient is improving

- If patient not improving, orthopedic referral

Next step?

- Hook-like osteophytes of the metacarpals

Describe the findings on the hand x-rays

Iron

What is deposited in this disease?

- White people

- M=F (M have it at younger age)

Who does this disease affect?

- Skin (very tan)

- Liver (hepatomegaly)

- Cardiovascular (heart failure/arrhythmia)

- Diabetes

What other regions of the body would be affected?

Hemochromatosis

Diagnosis?