Musculoskeletal Radiology, and in particular, Bone Tumors, is considered an important topic for the NEET PG exam. This is because bone tumors are a common cause of musculoskeletal pain and can impact an individual's mobility and quality of life.
The diagnosis and management of bone tumors often involves the integration of radiology with other specialties such as orthopedics, oncology, and pathology. A good understanding of musculoskeletal radiology, including bone tumors, is essential for effective patient care.
Chronic history; Asymmetric (E.g., lateral joint space is more involved)
No morning stiffness
Osteophytes (New bone formed)
Subchondral Sclerosis
Rheumatoid Arthritis
Small joints > Large joints
Young female; Morning stiffness (+)
Symmetrical
Erosions (marginal): Periarticular Osteopenia
Sparing : DIP
Important Information
MC bone affected in Rheumatoid arthritis : MCP joint
Because of constant inflammation synovial proliferation k/a Pannus seen in Rheumatoid arthritis
Important Information
Long standing RA
Deformities like swan neck, boutonniere, Z deformity
Ball Catcher’s view
Done for RA
MCP joint are better visualized in this view
Aka Brewerton’s view
Psoriatic Arthritis
Gross destruction of bone are seen giving
Pencil in cup appearance
Telescoping (+)
Has associated skin, nail changes [silvery scale, oil pitting nail]
Very destruction form of psoriatic arthritis k/a Arthritis Mutilans
Opera glass sign
MC joint affected : DIP
Gouty Arthritis
Older Male
MC joint : 1st MTP
Large erosions k/a “Rat bite erosion”
Overhanging margins: “Martel G sign”
Dual energy CT can identify (Tophi) the presence of uric acid in subcutaneous and in joint space
Important Information
DECT can also tell whether the calculi is Ca2+ / Uric acid
VRT-CT : 3D image showing uric acid crystals in Gouty arthritis using DECT
Neuropathic Joint / Charcot joint
Joint looks very destructed but patient feels no pain
MC seen in DM patients
MC : Foot (mid tarsal joint)
Other causes
Leprosy
Syringomyelia
Any neuropathy
X-ray shows 6Ds
Distention (joint effusion (+))
Density (increased)
Debris
Dislocation
Disorganization
Destruction
One liners
Epiphyseal enlargement seen in
Juvenile idiopathic arthritis
Epiphyseal dysgenesis seen in
Congenital hypothyroidism [Baby will have short stature]
Widened intercondylar notch seen in
Hemophilic arthropathy [has squaring of patella]
Ankylosing Spondylitis
Important Information
Ankylosis : fusion of joints
Young patient (<50 yrs); Pan joint fusion / pan spinal fusion
Inflammatory arthritis affecting spine
Most sensitive investigation / IOC for sacroiliitis: MRI [STIR sequence / fat suppressed sequence]
1st manifestation: Sacroiliitis [where there is inflammation in sacro-iliac joint → Bone marrow edema]
End stage: Ankylosis of sacroiliac joint
1st sign on spine (X ray): Shinny corner sign / Romanus lesion (inflammation at attachment of annulus fibrosus)
EnthesopathyorEnthesitis : At all tendentious, ligament attachment there is inflammation
As inflammation progress vertical syndesmophytes (new bone formation) → fusion of intervertebral disc (fusion of spine) → ligaments calcification → anterior, posterior, facet joints fuse; calcification of supraspinous, interspinous ligaments
Tram Track appearance
Dagger sign (central ossification)
Bamboo spine
Diffuse Idiopathic skeletal hyperostosis (DISH)
Pan-Joint fusion (AS)
Flowing wax ossification of ALL
Old (> 50 yrs)
Intervertebral disc and all other joints : Normal
OPLL
Ossification of PLL (Posterior longitudinal ligament)
Aka Japan’s disease
Fluorosis
Density of Bones increased (sclerosis) + Interosseous ligament calcification (Hallmark of Fluorosis)
Can have associated dental changes
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