Diffuse idiopathic skeletal hyperostosis (DISH) is not really an arthropathy because it spares synovium, articular cartilage, and articular osseous surfaces. It is a fairly common ossification process involving ligamentous and tendinous attachments to bones and occurs in 12% of the elderly (55). It most commonly affects the thoracic spine but also may involve the pelvis, foot, knee, and elbow. It can involve ossification of all the ligaments surrounding the vertebral bodies, particularly the anterior longitudinal ligament. Ossification of the posterior longitudinal ligament (OPLL) can also be seen. This is reported to be more common in orientals and can be responsible for significant spinal canal stenosis. By definition, DISH must involve a flowing ossification of at least four contiguous vertebral bodies (Fig. 6-43A,B). There must be normal disc spaces and facet joints, without joint sclerosis.

FIGURE 6-43. Diffuse idiopathic skeletal hyperostosis. Frontal (A) and lateral (B) radiographs of the lower thoracic spine. There are flowing ossifications (arrowheads) of the paraspinal ligaments bridging more than four segments of the spine. Note relative preservation of the intervertebral disc spaces.

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Source: Physical Medicine and Rehabilitation - Principles and Practice

It is also known as pseudogout and has the classic triad of pain, cartilage calcification, and joint destruction. Chondrocalcinosis at the knee, wrist, or symphysis pubis is virtually diagnostic of calcium pyrophosphate dehydrate deposition disease (CPPD) (Fig. 6-42).

FIGURE 6-42. Chondrocalcinosis. Frontal radiograph of the right knee. Calcifications (arrows) are present within the medial and lateral tibiofemoral joint along the expected location of the meniscus.

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Source: Physical Medicine and Rehabilitation - Principles and Practice

Rheumatoid arthritis is a connective tissue disorder of unknown etiology that can affect any synovial joint in the body. It is a bilaterally symmetric inflammatory degenerative disease that involves the following joints in order of decreasing frequency: :

  • Small joints of the hands and feet, with the exception of the distal interphalangeal joints
  • Knees
  • Hips
  • Cervical spine
  • Shoulders Elbows

The major radiographic findings include the following: :

  • Symmetric periarticular soft-tissue swelling
  • Juxta-articular osteoporosis proceeding to diffuse osteoporosis
  • Erosions of the intracapsular portions of the articulating bones not covered by cartilage, which can proceed to severe subchondral bone erosion
  • Uniform joint space narrowing
  • Synovial cysts (e.g., Baker’s cysts behind the knee)
  • Subluxations (e.g., boutonniere or swan-neck deformities of the fingers, and palmar and ulnar subluxation of the proximal phalanges on the metacarpal heads) (Fig. 6-40A,B) (54)

FIGURE 6-40. Frontal projections of both hands. There is extensive erosive disease within the wrist joints bilaterally, ulnar subluxations to the 2nd, 3rd MCP and to the 4th PIP and radial subluxation to the 5th PIP on the left.

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Source: Physical Medicine and Rehabilitation - Principles and Practice

Gout is a metabolic disorder that most commonly involves the feet, especially the first metatarsophalangeal joint, as well as the ankles, knees, hands, and elbows in asymmetric fashion. It is produced by a deposition of monosodium urate crystals in tissues with a poor blood supply, such as cartilage, tendon sheaths, and bursae. The radiographic features of gout typically do not appear until after 4 to 6 years of episodic arthritis. Radiographic features characteristic of gout include the following:

  • Tophi or periarticular soft-tissue nodules/masses created by the deposition of urate crystals that may contain calcium.
  • Tophi-induced periarticular or intra-articular bone erosion. Prominent cortical edges overhanging the tophi and well-defined bone erosions (with sclerotic margins) (Fig. 6-41) (54).
  • Random distribution, without marked osteoporosis.

FIGURE 6-41. Gout arthritis affecting the 1st MTP joint. There are large periarticular bone erosions with overhanging edges (arrow) and significant soft tissue swelling.

Refferences

Source: Physical Medicine and Rehabilitation - Principles and Practice

Osteoarthritis or degenerative joint disease (DJD) is an asymmetric, usually bilateral mechanical degenerative process that involves joints significantly involved in weight bearing, such as the hip, knee, and spine, and those involved in frequent repetitive mechanical trauma, such as the distal interphalangeal joints of the fingers, trapezium–first metacarpal joint, trapezium- scaphoid joint, and metatarsophalangeal joint of the great toe. It is the most common arthritis, and it is estimated that 80% of the population with more than 50 years will show radiographic evidence of osteoarthritis. The most common radiographic findings include the following:

  • Nonuniform loss of joint space caused by cartilage degeneration in high load areas (e.g., the superior aspect of the hip and medial knee).
  • Sclerosis of the subchondral bone.
  • Osteophyte formation at the margins of the articular surfaces.
  • Cystlike rarefactions in the subchondral bone that may collapse to produce marked joint deformities.
  • Adjacent soft-tissue swelling (e.g., that which occurs with Heberden’s nodes of the distal interphalangeal joints of the fingers) (Fig. 6-39) (53).

FIGURE 6-39. Frontal projection of both hands demonstrates joint space narrowing, marginal osteophytosis, subchondral bone sclerosis involving the distal interphalangeal joints and the triscaphae joints (short arrow ) of the hands and wrist. In this patient, there are erosions on the right second DIP and left third DIP joints (long arrow ) that suggest erosive OA.

Refferences

Source: Physical Medicine and Rehabilitation - Principles and Practice

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