1. Lecture no 4
Prepared by Dr.Salah Mohammad Fatih
MBChB,DMRD,FIBMS(radiology)

13. OA RA
•Joint space narrowed max. at •Joint space narrowing uniform.
wt bearing site
•Erosion do no occur. •Erosion is characteristic feature.
•Subchondral sclerosis may •Subchondral sclerosis is not a
be seen. feature.
•Sclerosis is a prominent •Sclerosis not a feature unless
feature. there is secondary OA.
•No osteoporosis. •Osteoporosis often present
•No peri articular soft tissue •Peri articular soft tissue swelling
swelling

26.  Most often due to pyogenic bacterial infection
or TB.
 Usually only one joint affected.
 Synovial biopsy or exam. of the joint fluid is
necessary for identification of infecting
organism

27.  Usually due to staph. Aureus.
 Rapid destruction of the articular cartilage
followed by destruction of the subchondral
bone & cause peri articual soft tissue
swelling.
 Earliest radiological finding is joint effusion,
do US, you can do US guided aspiration of the
joint fluid.
 If Dx is still in doubt , then MRI advisable

29. There is decrease in cartilage width in the
left hip, and cortical indistinctness in the
left acetabulum with subarticular cyst
formation.

30.  Hip& knee are the most commonly affected
peripheral joints.
 Spine involved in 50% of cases.

31.  Localized osteoporosis.
 Cartilage erosion usually occur late for that
resion , at 1st joint space is preserved.
 Margional errosion.
 At late stage there may be gross
disorganization of the joint with calcified
debris near the joint.

33. Neuropathic joint (Charcot joint)

34. • Common causes;
• DM
• Spinal cord injury
• Myelomeningocele/ syringomyelia.
• Alcohol abuse.

35. Radiological features
• classic picture of a Charcot joint. It
demonstrates the five Ds:
• increased or normal density,
• joint distension (effusion),
• bony debris.
• joint disorganization
• joint disassociation.

36. •lateral translation of the tibia relative to
the femur;
• a destructive arthropathy with loss of
cartilage width and fragmentation,
especially of the medial tibial plateau;
•large effusion containing bony debris.

37. • Changes seen in the feet in the pt with diabetic
neuropathy.
• Prominent feature is Resorption of the bone
ends & calcification of the arteries in the feet
often present

38. complete obliteration of the
cartilage width and
destruction with very
abundant fragmentation at
this joint.

39. Avascular(aseptic) necrosis

40. • Also known as osteonecrosis, is where there is death
of bone due to interruption of the blood supply.
• It occur most commonly in the intra-articular
portions of bones & is associated with numerous
underlying condition including.
• Steroid therapy.
• Collagen vascular diseases.
• Radiation therapy.
• Sickle cell disease.
• Exposure to the high pressure environment e.g.
deep- see divers

41. X-ray finding
• Increased density of the subchondral bone with
irregularity of the articular contour or even
fragmentation
• A charactristic lucent line may be seen just
beneath the articular cortex.
• The cartilage space may be preserved until
secondary OA changes occur.

42. left hip joint;
increased
density
centrally and
flattening of
the femoral
head in the
weight-
bearing
region, as
well as the
crescent sign
or
subchondral
fracture.

43. MRI
• Is imaging modality of choice.
• It can show abnormality when the X-ray is
normal & signal pattern allow specific Dx to be
made.

45. osteochondritis

46. • Is a group of condition in which no associated
cause for avascular necrosis can be found.
• Osteochondritis now regarded as being due to
impaired blood supply associated with repeated
trauma.

47. Perthe’s disease
• Is avascular necrosis of the femoral head in
children.
• seen generally between ages 4 and 8, when the
vascular supply to the femoral head is most at
risk.
• Males are affected more than females.
• Bilateral in 10 percent of patients.

48. X-ray finding
• The first radiographic sign may be effusion.
• Later, increased density, fragmentation and
flattening of the ossification center & lucent
areas within it
•
• Metaphyseal irregularity & short wide femoral
neck.

49. The left femoral
capital epiphysis is
dense, has lucent areas
within it, and is
flattened. This left hip
is laterally subluxated,

50. Other forms of osteochondritis

51. • Kienbock’s disease = avascular necrosis of lunate
bone.
• Freiberg’s disease = avascular necrosis of
metatarsal head.
• Kohler’s disease = avascular necrosis of
navicular bone of the foot.

52. There is
increased
density and
collapse of
the lunate
Kienbock's disease

53. Freiberg’s disease

54. Osgood-schlatter’s disease = avascular necrosis of tibial tuberosity .
Fragmentation of
tibial tuberosity

55. Kohler’s disease = avascular necrosis of navicular bone of the foot.
Increased
density with
irregularity in
the out line

56. Slipped femoral epiphysis

57. .
• age range (10 to 16 years of age)
• Males are more commonly affected than females.
• bilateral 20 percent of the time, but rarely symmetric.
• Slipped epiphyses almost always are directed posteromedially.

58. Radiological finding
• The epiphysis itself appears shorter due to the posterior slippage.
• The epiphyseal plate itself appears wider, with less distinct margins
• The epiphysis is also slightly more medially placed, it can be
demonstrated by drawing a line along the lateral femoral neck. This
line should intersect a portion of the femoral head in the normal
individual. In a slipped epiphysis, the line will either not intersect
the femoral head, or will intersect a smaller portion of it.
• The slip is best appreciated in lateral film of the hip

60. The left femoral capital epiphysis appears slightly shorter than does the right,
with an apparent widening of the epiphyseal plate

63. Developmental dysplasia of the hips (DDH
or CDH)

64. developmental dysplasia of the hips (CDH or DDH)
• female: male = 6:1
• 70% occur on the left side, Bilateral involvement
occur in 5%

65. Radiographic finding

69. Thank you