NOTES

NOTES
JOINT PATHOLOGY

GENERALLY, WHAT IS IT?

PATHOLOGY & CAUSES DIAGNOSIS
▪ Disorders affecting joints DIAGNOSTIC IMAGING
▪ Most commonly caused by trauma ▪ Radiography
▪ MRI

SIGNS & SYMPTOMS

LAB RESULTS
▪ Asymptomatic or pain during rest/ ▪ Synovial fluid analysis
movement
TREATMENT
▪ Treat symptoms pharmacologically
▪ Surgical procedures

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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SIGNS & SYMPTOMS DIAGNOSIS

▪ May be asymptomatic DIAGNOSTIC IMAGING
▪ Stiffness and pain in the knee → worse
Ultrasound and MRI
with prolonged standing
▪ Fluid-filled cyst; differentiation between
cyst, blood clot

X-ray
▪ Bone, joint pathology associated with cyst

OTHER DIAGNOSTICS
▪ Physical examination
▫ Lump in the back of the knee

TREATMENT
SURGERY
▪ Surgical excision

Figure 114.1 An MRI scan of the knee joint
in the sagittal plane demonstrating a Baker’s
cyst in the popliteal fossa.
OTHER INTERVENTIONS
▪ Fluid aspiration, glucocorticoid intra-
articular injection → ↓ size and
inflammation
▪ 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

Figure 114.3 An MRI scan of the elbow

demonstrating a high signal fluid collection
in the olecranon bursa in an individual with
olecranon bursitis.

Figure 114.2 An individual with olecranon

bursitis. TREATMENT
MEDICATION
DIAGNOSIS ▪ Non-steroidal inflammatory drugs (NSAIDs)
▪ Injection of steroids, local anesthetics
DIAGNOSTIC IMAGING ▪ Septic bursitis
▫ Antibiotics
Ultrasound
▪ Differentiation from Baker’s cyst
SURGERY
▪ Surgical excision
LAB RESULTS ▫ Chronic or recurrent bursitis
▪ Aspiration and analysis of synovial fluid
▫ Infection: ↑ polymorphonuclear
leukocytes, proteins, ↓ glucose
OTHER INTERVENTIONS
▪ Resting, elevation
▫ Gout: ↑ monosodium urate crystals

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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

Figure 114.5 An X-ray image of the pelvis

demonstrating osteoarthritis of the right hip
joint. The femoral head is malformed, there
is marked loss of joint space and there are
numerous subchondral bone cysts.

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SLIPPED CAPITAL FEMORAL

EPIPHYSIS
osms.it/slipped-capital-femoral-epiphysis

PATHOLOGY & CAUSES COMPLICATIONS

▪ Osteoarthritis
▪ Anterior displacement of femoral head ▪ Metaphysis slippage → ↓ blood flow →
metaphysis, with epiphysis remaining in hip avascular necrosis
acetabulum ▪ Secondary SCFP affecting other hip; usually
▪ Caused by growth plate (physis) fracture within a year of first SCFP
▪ Example of type I Salter–Harris fracture ▪ Unstable displacement: ↑ complication rate
usually affecting one hip
▪ Hypertrophy of growth plate → abnormal
endochondral ossification, cartilage
SIGNS & SYMPTOMS
maturation → growth plate weakness →
if too much force generated across growth ▪ Hip, groin, knee pain
plate → slippage ▪ Duck-like gait
▪ Hip in external rotation, flexion
CLASSIFICATION
▪ Based on disease course
▫ Acute: > three weeks
▫ Chronic: < three weeks
▫ Acute on chronic: chronic with acute
exacerbations
▪ Based on lesion stability
▫ Stable: walking possible with/without
crutches
▫ Unstable: walking impossible, even with
crutches
▪ Displacement of the femoral head from
neck; seen on radiography
▫ Type I: slippage < 33%
▫ Type II: 33–50%
▫ Type III: > 50%

RISK FACTORS Figure 114.6 An X-ray image of the pelvis

demonstrating a slipped capital femoral
▪ Obesity
epiphysis on the left side.
▪ ↓ thyroid, growth hormone
▪ Osteodystrophy
▪ Down syndrome
▪ Demographics
▫ Adolescent black males of African
descent most commonly affected

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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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