Joint Pathology
Joint Pathology
Joint Pathology
NOTES
JOINT PATHOLOGY
BAKER'S CYST
osms.it/bakers-cyst
CAUSES
PATHOLOGY & CAUSES ▪ Chronic knee joint trauma
▪ Osteoarthritis
▪ Synovial fluid accumulates in popliteal
bursa (between medial head of ▪ Rheumatoid arthritis
gastrocnemius, semimembranosus ▪ Meniscal tears
muscles) → swelling
▪ Adults: popliteal bursa communicates with COMPLICATIONS
synovial sac; underlying knee joint disease ▪ Cyst enlargement
main cause
▫ In popliteal space → obstruction of veins
▫ Knee joint disease → ↑ synovial fluid → lower leg swelling
production → synovial fluid squeezes
▫ Extension to calf → swelling, redness,
through valve-like formation into bursa
bruising, positive Homan’s sign (calf
→ fluid unable to flow backward →
pain during dorsiflexion of the foot) →
bursa enlarges → lump-like structure in
similar to deep-vein blood clot
the popliteal fossa
▪ Rupture
▪ Children: noncommunicating cyst; usually
arises as primary process
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Chapter 114 Joint Pathology
X-ray
▪ Bone, joint pathology associated with cyst
OTHER DIAGNOSTICS
▪ Physical examination
▫ Lump in the back of the knee
TREATMENT
SURGERY
▪ Surgical excision
OTHER INTERVENTIONS
▪ Fluid aspiration, glucocorticoid intra-
Figure 114.1 An MRI scan of the knee joint articular injection → ↓ size and
in the sagittal plane demonstrating a Baker’s inflammation
cyst in the popliteal fossa. ▪ Treat complications
▫ Leg elevation, resting, analgesics
BURSITIS
osms.it/bursitis
CAUSES
PATHOLOGY & CAUSES
▪ Autoimmune disorders
▪ Inflammation of bursa (small sac located ▫ Rheumatoid arthritis, ankylosing
between muscles, tendons, bone spondylitis, scleroderma, systemic lupus
structures) erythematosus → chronic course
▪ Inflammation of bursa → ↑ production ▪ Overuse/trauma, gout, bacterial infections
of synovial fluid → enlargement of (septic bursitis) → acute course
bursa → ↑ friction during movement →
symptomatology
▪ Most commonly affected bursas
▫ Subacromial, olecranon, trochanteric,
prepatellar, infrapatellar
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SIGNS & SYMPTOMS
▪ Joint pain; stiffness of joints; surrounding
skin red
▪ Acute bursitis
▫ Tenderness, pain during activation of
muscles adjacent to inflamed bursa
▪ Chronic bursitis
▫ Swelling with minimal pain
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OSTEOARTHRITIS
osms.it/osteoarthritis
anabolism of cartilage
PATHOLOGY & CAUSES ▪ Obesity
▫ Excessive load, metabolic disorders
▪ Progressive loss of articular cartilage,
affect joints
underlying bone of synovial joints
▪ Genetic disorders
▪ Articular cartilage damage → chondrocytes
replace type II collagen with type I, ↓ ▫ Mutations in cartilage building collagens
proteoglycans → eventual exhaustion, (types II, IX and XI)
apoptosis of chondrocytes → ↓ elasticity, ▪ Biological sex
↑ cartilage breakdown → clefts in articular ▫ Biologically female more prone
surface (fibrillations), “joint mice” in synovial ▪ Previous joint injuries
space with inflammation of synovium → ▪ Infection
bone exposition → rubbing other bone →
▪ Neurologic disorders
eburnation (polished ivory look)
▪ Due to damage/inflammation, new bone
formation on edges of bone with outward COMPLICATIONS
growth → osteophyte (enlargement of the ▪ Cystic degeneration of subchondral bone
joint with a knob-like look) ▪ Surrounding ligaments, neuromuscular
▫ Bouchard nodes: proximal abnormalities
interphalangeal finger joints affected
▫ Heberden nodes: distal interphalangeal
finger joints affected SIGNS & SYMPTOMS
▪ Most commonly affected joints
▫ Lower spine, hip, knee, foot and hand ▪ Sharp pain/burning sensation worsened by
joints prolonged activity
▪ Limited range of motion
▪ Morning stiffness > one hour
CLASSIFICATION
▪ No swelling
▪ Primary
▫ Usually idiopathic
▪ Secondary
▫ Caused by some other condition
(e.g. diabetes, alkaptonuria,
hemochromatosis, chronic joint injury)
RISK FACTORS
▪ Aging
▫ Cartilage thinning with ↓ hydratation
→ protein accumulation, collagen
crosslinking → cartilage is more
breakable; ↑ calcification of meniscus,
cartilage
▪ Inflammation → ↑ proinflammatory Figure 114.4 Heberden’s node on the distal
cytokines interphalangeal joint of the right index finger
▫ IL1, IL6, TNF → ↑catabolism/↓ in an individual with osteoarthritis.
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DIAGNOSIS TREATMENT
DIAGNOSTIC IMAGING MEDICATIONS
▪ Pain management
Radiography
▫ Acetaminophen, tramadol, topical and
▪ Loss of joint space
oral non-steroidal anti-inflammatory
▪ Subchondral bone sclerosis drugs (NSAIDs)
MRI ▪ Intra-articular injections
▪ Loss of joint space ▫ Corticosteroids
▪ Subchondral bone sclerosis ▫ Sodium hyaluronate
▪ Osteophytes
▪ Visualisation of articular cartilage, SURGERY
surrounding soft tissues ▪ Osteotomy
▫ Individuals < 60 years with
CT scan
malalignment of hip, knee joint
▪ Displacement of foot, ankle, patellofemoral
▪ Arthroplasty
joint
▪ Stem-cell therapy
Bone scan
▪ Detect abnormalities OTHER INTERVENTIONS
▪ Exercise
LAB RESULTS ▪ Weight loss
▪ Arthrocentesis ▪ Physical therapy
▪ Electromagnetic field stimulation for
individuals with knee osteoarthritis
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DIAGNOSIS TREATMENT
DIAGNOSTIC IMAGING SURGERY
▪ Fixation with a cannulated screw
X-ray
▪ Preventive fixation of the other hip
▪ Anteroposterior X-ray
▫ Children with SCFP before the age of 10
▫ Melting ice cream cone appearance
visible through line of Klein (virtual line ▫ Persons with endocrinopathies
parallel to femoral neck’s upper edge) ▪ Osteotomy
▪ Frog-leg X-ray
▫ Straight line through center of femoral
neck anterior to epiphysis (rather than
central)
MRI, CT scan
▪ Accurate measurements of displacement
degree
TRANSIENT SYNOVITIS
osms.it/transient-synovitis
DIAGNOSTIC IMAGING
PATHOLOGY & CAUSES
Ultrasound
▪ Inflammation of hip joint synovial ▪ Fluids in joint capsule
membrane
▪ Cause relatively unknown, but may be
preceded by upper respiratory tract
LAB RESULTS
infection ▪ Slightly ↑ white blood cell count
▪ Most commonly seen in male children 3–10 ▪ ↑ Erythrocyte sedimentation rate
years ▪ ↑ C-reactive protein
▪ Most commonly limited to one side ▪ Needle aspiration
▫ Differentiation between transient
synovitis and septic arthritis
SIGNS & SYMPTOMS
OTHER DIAGNOSTICS
▪ May be asymptomatic
▪ Limited abduction and internal rotation
▪ Tenderness/pain during passive movement
▪ One-sided pain in the hip, groin, thigh, knee
▪ Antalgic limping TREATMENT
MEDICATIONS
DIAGNOSIS ▪ NSAIDs
▪ Diagnosis of exclusion
OTHER INTERVENTIONS
▪ Massage
▪ Rest
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