RADD 2711 Lecture 10 Summer 2011

RADD 2711 Lecture 10 Summer 2011 - CONT’D Pannus V...

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Unformatted text preview: - CONT’D Pannus V ascular connective (granulation) tissue Formed within the synovium Formed by proliferating fibroblasts and inflammatory cells Pannus causes erosion of bone and cartilage Produces more enzymes that destroy nearby cartilage, aggravating the area and attracting more inflammatory cells, thereby perpetuating the process Rat-bite erosions HAND: End-stage deformity in the hand – arthritis mutilans Rheumatoid Arthritis - WRIST Frequently 1 st seen in wrist (radiographically) 60% more severe than hand changes 20% cases in wrist show no hand changes Distinctive locations: 1. DISTAL ULNA 2. DISTAL RADIUS 3. CARPUS 1. DISTAL ULNA Soft tissue swelling due to: synovitis within joint or adjacent tendon (extensor carpi ulnaris)- PLUS – Erosion of the ulnar styloid process 1. DISTAL ULNA Distal ulnar erosions – potential locations: 1. Extensor carpi ulnaris attachment site 2. Prestyloid recess 3. Radioulnar articulation 2. DISTAL RADIUS Marginal erosions at the radial styloid and adjacent scaphoid Synovial thickening on MRI 3. CARPUS A) “Spotty carpal sign” – multiple marginal erosions throughout carpus (also seen in gout, tuberculous arthritis and Sudeck’s atrophy) Spotty Carpal Sign 3. CARPUS B) Midcarpal joint fusion (spares radiocarpal joint) 3. CARPUS C) Zigzag deformity D) Terry Thomas sign Separation of the scaphoid and lunate 3. CARPUS E) Caput ulnae syndrome Diastasis at the radioulnar joint Ulna moves dorsally May have extensor tendon rupture In 15% of patients, the foot is the initial site of involvement MC- IP joint of great toe- MTP joints – 5 th to 1 st in decreasing order of frequency Radiographic changes: soft tissue swelling marginal erosions juxta-articular osteoporosis uniform loss of joint space deformities Radiographic changes: MARGINAL EROSIONS: On the medial surface of each metatarsal head EXCEPT – fifth metatarsal head – erosion on lateral margin...
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RADD 2711 Lecture 10 Summer 2011 - CONT’D Pannus V...

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