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Musculoskeletal Radiography

Musculoskeletal Radiography. Dr. LeeAnn Pack Dipl. ACVR. Osteoarthritis. Occur when supra-physiologic /biomechanical stresses applied. Osteophytes – Intra-capsular periosteal new bone that usually begins at chondrosynovial junction (peri-articular).

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Musculoskeletal Radiography

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  1. Musculoskeletal Radiography Dr. LeeAnn Pack Dipl. ACVR

  2. Osteoarthritis • Occur when supra-physiologic /biomechanical stresses applied. • Osteophytes – Intra-capsular periosteal new bone that usually begins at chondrosynovial junction (peri-articular). • Enthesophytes – Periosteal new bone at origin or insertion of tendon, ligament or muscle. Can also occur at joint capsule attachment.

  3. Degenerative joint disease • 1. Intra-capsular soft tissue swelling • 2. Peri-articular osteophytes • 3. Enthesophytes • 4. Subchondral erosions • 5. Mineralized joint bodies • 6. Subchondral sclerosis • 7. Subchondral “cysts” • 8. Joint space narrowing 8

  4. Degenerative Joint Disease • Intra-capsular swelling • Seen as a result of joint effusion or soft tissue proliferation

  5. DJD - Hips • Peri-articular osteophytes

  6. DJD Stifle • Peri-articular osteophytes

  7. DJD – Radiographic Signs • Subchondral sclerosis results from bone formation and hypertrophy of the trabeculae adjacent to the joint • Also called sclerosis or eburnation • Secondary to increased biomechanical forces • Wolff’s Law – bone remodeling according to the forces acting upon it

  8. DJD • Subchondral sclerosis

  9. Elbow DJD • Note the large osteophyte on the anconeal process – this is often times one of the earliest changes seen with DJD in the elbow

  10. DJD • Subchondral bone cysts are formed by proliferation of the synovium invading subchondral bone • Occurs in severe cases of DJD

  11. DJD – Joint Mice • Joint mice are pieces of articular cartilage that have become detached and are in the joint – they mineralize when they have a blood supply – must R/O avulsion fragment

  12. Enthesopathy Enthesiopathy of origin of coxus articularis m. • Enthesis - site of attachment of muscle, tendon or ligament to bone • Enthesiopathy – proliferation of bone at enthesis due to pulling of attachment • Another form of periosteal reaction Enthesiopathy of insertion of iliopsoas m.

  13. Enthesiopathy • Periosteal response at the site of attachment of soft tissue to bone. • Tendon • Ligament • Muscle • Contrasts with osteophyte – an osseous outgrowth at the peri-articular margin.

  14. DJD • Joint space alteration • Decreased size of joint due to destruction of the articular cartilage • Increased size of join space may be seen in acute injury with severe synovial effusion • Abnormal joint space width is best evaluated with weight bearing views • Stressed views can also be made

  15. DJD • Narrowed joint space • Do not confuse for positioning error

  16. Septic Arthritis • Radiographic signs • Bony lysis is often seen early in the disease process resulting in rough or irregular articular margins • multiple joint surfaces usu involved • The degree of subchondral erosion is much more severe than with just DJD • In chronic cases, periosteal reactions and osteophytes can be seen

  17. Septic Arthritis

  18. Non-erosive Polyarthritis • Causes: • Idiopathic polyarthritis • Systemic lupus erythematosus • Arthritis assocaited with chronic infection • Polyarthritis/polymyositis syndrome • Plasmacytic/lymphocytic synovitis

  19. Non-erosive Polyarthritis • Joints are normal except for effusion • Multiple sites are usually involved • Carpus, tarsus, stifle

  20. Erosive Polyarthritis • Early changes • No radiographic signs are apparent early except for maybe intra-capsular swelling

  21. Erosive Polyarthritis • Late changes • Formation of cystic lesions which progress to irregular erosions of the subchondral bone and marked destruction of the joint surfaces

  22. Erosive Polyarthritis • Further late changes • Joint spaces may narrow due to loss of articular cartilage • Subluxation and luxation of the joints due to the destruction of the ligaments

  23. Synovial Cell Sarcoma • Early in the disease there is intra-capsular and/or peri articular swelling • Swelling then turns to a mass effect • Later there is bone lysis of multiple bones of the joint

  24. Synovial Cell Sarcoma

  25. Synovial Cell Sarcoma

  26. Differentials- Joints • Joint associated neoplasia • Asymmetrical intra-capsular soft tissue swelling (mass) • Multiple bones within joint affected (lysis) • Erosive poly-arthritis & septic arthritis (fungal) • Intra-capsular soft tissue swelling (usually symmetrical) • Typically multiple joints (depends on reason for septic arthritis) • Multiple bones within joint affected (lysis) • Non-erosive poly-arthritis • Typically multiple joints • Intra-capsular soft tissue swelling

  27. Hypertrophic Osteopathy • Palisading periosteal response • Usually solid • Occurs secondary to a mass somewhere • Thoracic • GU tract • Fungal disease • Heartworm disease

  28. HO • Begins on the abaxial digit and progresses proximal and axially

  29. HO

  30. HO • Radiographs of the chest and abdomen should be made • And abdominal US can be preformed if needed

  31. Cruciate Ligament Rupture • Cranial displacement of the infra-patellar fat pad • Caudal displacement of the fascial stripe

  32. Cruciate Ligament Rupture • DJD • Base and apex of the patella • Proximal aspect of the trochlear ridge • Medial and lateral aspects of the distal femur and proximal tibia • fabellae

  33. Cruciate Rupture

  34. Patellar Luxation

  35. Patellar Luxation

  36. Patellar Luxation

  37. Patella Skyline

  38. OCD Shoulder Elbow Stifle tarsus Retained Cartilage Core Fragmented Medial Coronoid Process Ununited Anconeal Process Panosteitis Hypertrophic Osteodystrophy Hip Dysplasia Legg-Calve-Perthes Developmental MS Diseases

  39. Osteochondrosis • Dysfunction of endochondral ossification (bone that forms from cartilage) • Disturbance leads to increased thickness of the cartilage • Cartilage is radiolucent compared to bone therefore, radiographically we see a radiolucent subchondral defect

  40. Osteochondrosis • Subchondral defect – flattening • Surrounding sclerosis as time progresses • Joint mice • Secondary DJD • Locations: shoulder, elbow, stifle, tarsus

  41. Shoulder OCD • Subchondral defect on the caudal aspect of the humeral head • May see a joint mouse • May just be flattened • Secondary DJD • May need arthrogram or explore

  42. Shoulder OCD

  43. Shoulder OCD – note flattening

  44. Shoulder Arthrogram

  45. Elbow OCD • Subchondral defect present on the distal medial aspect of the humerus (humeral condyle) • Surrounding sclerosis

  46. Elbow OCD – CC and Obl

  47. Elbow OCD with FCP

  48. Stifle OCD • Subchondral defect on the distal aspect of the lateral femoral condyle • Mineralized flap rarely seen • Joint effusion common • DJD develops • Do not confuse the extensor fossa for OCD

  49. Tarsus OCD • Rotts! • Medial trochlear ridge of the talus • Often seen small mouse • Joint effusion • DJD • See best on oblique view or flexed lateral

  50. Tarsal OCD MTR

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