SLIDES - Logan Class of December 2011



SLIDES

DISCOGENIC SPONDYLOSIS

*marked decrease in joint space

*subchondral sclerosing

*blunt uncinate processes as opposed to sharp with defined peak

*UVA = uncovertebral arthrosis

*disc space symmetrically involved

Intruding on disc space in lateral view

Decrease joint space, subchnodral sclerosis and osteophytes

Pedical position is towards edge of body (want it in anterior 1/3)

*patient is not rotated well (too A-P)

*can’t believe the amount of IVF encroachment

Increased white in mid body @ inferior margin in Lateral view

Could be a marginal osteophyte

Making too be a deal of Osteophytes

*Pt asks “Can you help me?”

*Answering Yes is reasonable

*However, taking a follow up film, the osteophytes will still be there!!

T-Bone accident, football players hit on the side = asymmetric pattern of cervical joints

(PICTURE)

CENTRAL CANAL STENOSIS

1. Treatment choices

a. Posterior arch surgery - not as good as thought (laminectomy)

b. Fixation surgeries / discectomy

2. Lack of predictable signs

a. Not segmental

b. Bizarre

3. What do we do as chiropractors?

a. Treat them!

b. May not be complete but will be improved

ATLANTODENTAL JOINT AND DJD

*decrease minimum value suggest DJD in ADI

*how do we increase wear and tear here?

*still need study over symptoms

OSTEOPHYTES INTO IVF

*don’t be afraid to adjust

*bone not on nerve, often soft tissue is the issue

*symptoms will improve

*hard neurologic signs (ataxia, atrophy of mm) point to surgery

*Steve Pomeranz, M.D. = conservative care for 18 months before surgery considered

*American Chriopractic Network are negating what we do!!!

Wear and tear is not the only thing that promotes and caused progression of DJD.

*Couch potato study = lazy people more prone to get DJD

*Rat Study

~injected good young joints w/ old DJD hip synovial fluid

~end of 2 wks had decrease joint space

~subchondral sclerosis, and osteophytes!!

~osteogenic factors?

A motor unit’s reference vertebra will be the one on the bottom.

*Describe the top vertebra’s position in alignment to bottom

*Gonstead is opposite

TRACTION OSTEOPHYTE – outer annular fibers

TREFOIL APPEARANCE – shape of central canal as facet hypertrophy develops

Rastral-Caudal migration = Facet imbrication

*good example of facet DJD

*seen on lumbar oblique (Hadley’s S-curve)

*Scotty dog ear rolling forward

GAS IN DISC?

*Vacuum Phenomenon –

~thorough dehydration of nucleus pulposis followed by dessication

~potential space – extension decreases pressure in space

~gas out of solution occupying central canal area of disc space

*Vacuum Cleft

~defect of outer annular fibers – sharpey fibers connecting them has let go

~smaller

~close to margin of joint

~see anterior in extension and posterior in flexion

~same process to create post traumatic or part or degenerative process

SPONDYLOLISTHESES – 5 CATEGORIES

Dysplastic - spondylolistheses w/ a congenital abnormality affecting upper sacrum or neural arch of L5

Isthmic – involve direct alteration to pars interarticularis

Lytic or Stress (fatigue) of pars

Elongated but intact pars

Acute fracture of the pars (rare)

Degenerative (pseudo-spondylolisthesis) – secondary to long-standing DJD of lubar zygapophyseal joint and discovertebral articulations, w/o pars separation

Traumatic – secondary to a fracture of part of the neural arch other than pars

Pathologic – occurs in conjuction w/ generalized or localized bone disease

HAHN’S FISSURE – normal communication b/t artery supply and vein drainage = normal!

MRI image w/ darker signal intensity of disc = dehydration

DJD does not occur as ankylosis! It would be due to inflammatory arthritis or post infections in joints

CT Myelogram showing neuritis (based on synovitis)

*increase use of this tool especially w/ patient suspected of disc herniation

*exceeds both tests individually as far as accuracy is concerned

*”Tie-Breaker” due to highest sensitivity

*most expensive – good w/ occasional study where conflict exsists

*2 study test

*contrast into thecal sac

*NERVE ROOTS ON THIS STUDY

~blurry one has neuritis

~edema of root sleeve

~symptoms in nerve root distribution

~joint responds to treatment quicker than nerve

HEMI-SPHERICAL SPONDYLOSCLEROSIS

*seen in discogenic spondylosis

*DJD product when paired across from disc to one another

*no disc space

OVERHANG – loss of motion. Sloppy joint

DEGENERATIVE ANTEROLISTHESIS

*anterior gravity line

*George’s line = offset of 4 on 5

*facet degeneration leads to the diagnosis

*can slow down by chiro tx and keep @ current health of facet care

~weight control ~exercise

~core strength ~not surgery

*can only go forward 25%

*plain film oblique can differentiate spondylolisis and DJD anterolisthesis

*compression/distraction radiographs if not getting better

~over 3mm translation = serious talk

Boney hypertrophy of anterior tubercle – superior and inferior pole

DJD of scarococcygeal joint

GLENOHUMERAL JOINT

*acromio-humeral space decreased –

~rotator cuff (supraspinatus) issues

~deltoid pulls it up

*humerus exists in healthy tug of war

~rotator pulling down

~deltoid pulling up

*increase space may be due to opposite, but mostly due to ….

~1st = disclocation

~2nd = nerve injury

OSTEOPHYTE ON CLAVICLE @ AC JOINT

*AC joint commonly because of trauma

*increase motion, increase wear and tear

*joint is gapping

*baby arm view would show decrease joint space

STERNOCLAVICULAR DJD

*finding on AP lower cervical

*palpable bump that is not painful

*bondy hypertrophy

WALDENSTROM’S SIGN FOR THE HIP

*weight of pelvis onto femur most expected form of DJD

*transmit down medial cortex of femoral shaft

*frog leg shows osteophyte at margin (head/neck junction)

*more often seen in hip than acetabular DJD, but does happen

KNEE

*bone projection off of superior pole of patella (patella/femoral DJD)

*ossified joint mouse b/t plateau and joint capsule

*soft tissue calcification = calcific bursitis

*no tibial eminence = remodeling

*decrease joint space on both sides

D.I.S.H – DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS

*can find original outline of vertebra

*thick anterior border of bodies

~Anterior longitudinal ligament

~50% will also have posterior longitudinal ligament involvement

*limited, but still have relativiely good ROM

*flowing exuberant ossification

*10% of patients have trouble swallowing b/c pushes on pharynx and esophagus

*definition

~generalized spinal and extraspinal articular disorder that is characterized

by ligamentous calcification and ossification

~distinct entity = does not represent ankylosing spondylitis or DJD

~broad spectrum of presentations; may be assymptomatic

~AKA’s; Forestier’s disease

Spondylosis hyperostotica

Spondylitis ossificans ligamentosa

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