Diseases of Joints and Soft Tissue Infections

Cure Arthritis Naturally

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The joints are the sites of a great variety of diseases of known and unknown etiology (Table 8.1). The joint diseases of 99mTc-MDP bone scintigraphic interest, pinhole scintigraphy in particular, include synovitis, infective arthritis, degenerative arthritis, rheumatoid arthritis, seronegative spondyloarthropathies, and metabolic articular disorders. Based on the histo-logical characteristics, joints are divided into the fibrous, cartilaginous, and synovial types (Williams and Warwick 1989). In the respective joints, apposed bone surfaces are fastened by the connective and cartilaginous tissue and separated by the synovial lining and cavity. Table 8.2 shows typical joints that belong to each of these categories.

In general the pathological, radiographic, and scintigraphic manifestations of articular diseases may differ according to the histological characteristics of the joint involved in a given disease and among various diseases. Radiogra-phically, articular diseases can be diagnosed by the analysis and summation of four basic features: (1) changes in the joint space, (2) periarticular bone abnormalities, (3) malalignment or deformity of the joint, and (4) periarticular soft-tissue alterations. This is a classic analysis-based, inductive, interpretational system, long developed and traditionally adopted in radiological diagnosis. Unfortunately, the system is not readily applicable to ordinary bone scanning simply because of relatively low resolution. Pinhole scintigraphy and nuclear angiogra-phy, however, can provide useful and often unique diagnostic information on both the morphology and the vascular and metabolic profiles in articular and periarticular pathologies (Fig. 8.1).

It is clear that the level of resolution of scin-tigraphy even after pinhole magnification is

Blood Pooling Ankle

Fig. 8.1A-C Value of nuclear angiography in arthritis. inflammation (arrow). B Blood-pool scan reveals mild

A Blood-flow phase scan of the right foot in a 57-year-old stain (arrow). C Static bone scan shows intense focal bone male with infective arthritis of the second tarsometatarsal uptake due to an infection (arrow) joint shows focally increased vascularity denoting active

Fig. 8.1A-C Value of nuclear angiography in arthritis. inflammation (arrow). B Blood-pool scan reveals mild

A Blood-flow phase scan of the right foot in a 57-year-old stain (arrow). C Static bone scan shows intense focal bone male with infective arthritis of the second tarsometatarsal uptake due to an infection (arrow) joint shows focally increased vascularity denoting active

Acute infective arthritides

Transient synovitis

Sympathetic or sterile synovitis

Infective and related arthritides

Pyogenic arthritis (pyarthrosis)

Tuberculous arthritis

Chronic infective

Chronic pyogenic arthritis

arthritides

Mycotic arthritis

Others

Primary osteoarthritis

Degenerative joint diseases

(osteoarthritis)

Secondary osteoarthritides

Posttraumatic osteoarthritis

Postinfective osteoarthritis

Diffuse idiopathic skeletal hyperostosis

Seronegative spondyloarthropathies

Rheumatoid arthritis

Ankylosing spondylitis

Reiter's syndrome

Arthritis of collagen diseases

Psoriatic arthritis

Enteropathic arthritis

Systemic lupus erythematosus

Connective tissue

Dermatomyositis

diseases

Scleroderma

Mixed connective tissue disease

Gout

Metabolic joint diseases

Pseudogout (calcium pyrophosphate disease)

Hyperparathyroidism

Ochronosis

Others

Neuropathic joint

Primary neurological joint disease (Charcot's joints)

diseases (neuroar-thropathies)

Diabetes

Miscellaneous

Relapsing polychondritis

Hypertrophic pulmonary osteoarthropathy

Table 8.1 A scintigraphic classification of arthritides

Fibrous joints

Sutures

Cranial sutures (coronal, sagittal, occipital, lamb-doidal, squamosal)

Syndesmoses

Radioulnar syndesmosis, tibiofibular synde-smosis, interspinous syndesmosis, supraspinous syndesmosis, intertransverse syndesmosis

Cartilaginous joints

Synchondrosis

Spheno-occipital synchondrosis, ischiopubic synchondrosis, femoral epiphyses

Symphyses

Pubic symphysis, sacral symphyses, manubriosternal joint, intervertebral joints between bodies

Synovial joints

Hinge

Elbow, knee, ankle, interphalangeal joints

Pivot

Proximal radioulnar joint, atlantoaxial joint

Condyloid

Metacarpo[tarso]phalangeal (knuckle) joint

Gliding

Acromioclavicular joint, vertebral apophyseal joints, joints between some carpal and tarsal bones

Ball-and-socket

Shoulder joint, hip joint

Table 8.2 A scintigraphic classification of joints

Table 8.2 A scintigraphic classification of joints not comparable to that of radiography (the limiting spatial resolution of screen/film radiography and pinhole bone scan is 5-10 line-pairs/mm (Huda and Slone 1995) and 1-5 line-pairs/cm, respectively. Nevertheless, the anatomical detail of pinhole scanning is comparable to that of radiography in so far as it is used as qualitative determinant.

Thus, pinhole scintigraphy in articular diseases reveals (a) obliteration, narrowing, or widening of the joint space, (b) increased, unaltered, or decreased tracer uptake in the periarticular bones, (c) alterations in the size, shape, and architecture of the periarticular bones, (d) dislocation or subluxation, and (e) angulation or other deformities. Analysis of the pattern of tracer uptake in terms of homogeneity or inhomogeneity is another important diagnostic feature of pinhole scintigraphy. Joint obliteration is indicated by the presence of increased tracer uptake in the articular space. Clinically, this may indicate either actual closure of the articular space due to cartilaginous destruction with fibrous or bony ankylosis or markedly increased periarticular bone turnover in response to congestion, inflammation, or infection with or without articular narrowing.

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Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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  • arttu
    What is soft tissue narrowing of cartiloginous eac?
    7 months ago

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