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Reactive Arthritis

Reactive arthritis is a postinfectious seronegative spondyloarthropathy (SNSA) syndrome characterized by a spectrum of specific musculoskeletal and extra-articular manifestations. The syndrome occurs after infection with specific organisms in two major settings: diarrheal illness and urogenital infection. The majority of patients have an underlying predisposing factor, either the presence of the human leukocyte antigen (HLA)-B27 or infection with the human immunodeficiency virus (HIV). Onset of symptoms is…

Psoriatic Arthritis and Psoriatic Spondyloarthropathy

Psoriatic arthritis (synonym: psoriatic osteoarthropathy) is an autoimmune response disorder that belongs to the seronegative spondarthropathies. It is strongly associated with dermatologic psoriasis. Psoriatic spondylarthropathy (synonym: psoriatic spondyloarthritis) refers to the involvement of the axial skeleton in patients who suffer from psoriatic arthritis. A special feature of psoriasis is pustulosis palmoplantaris (PPP) that may be associated with destructive and proliferative changes at the anterior chest wall…

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic and progressive inflammatory systemic disease that primarily affects the synovium and is characterized by destruction of bone and cartilage. The small joints of the hands and feet are typically affected, although the larger joints can also be affected by the disease. Radiographic changes, characterized by joint space narrowing and marginal erosions, typically occur within the first 2 years of the…

Degenerative Disease : Physiology and Advanced Imaging

Degeneration and loss of joint function are common end points for many arthropathies, the most prevalent of which is osteoarthritis (OA). Until the late twentieth century, OA was regarded as a mechanical disease, with damage to the articular surface resulting from the inevitable wear and tear of daily living. More recently, the Osteoarthritis Research Society International has defined OA as a progressive disease of the synovial…

Aging

What is Aging? The processes and inevitability of aging are as certain as death and paying taxes. In the past 5 years, the population of the world has grown by approximately 1.7% per year. On the other hand, the number of elderly people has increased by 2.7% per year. In the developing world, the number of people older than age 65 years will increase by 200%…

Degenerative Disorders of the Spine

Etiology Degeneration of the spine is universal and involves structural changes in the disk, bone, ligaments, and articular cartilage of the facet joints. Despite the high prevalence of degeneration, the underlying etiology is still only partially understood. There is, however, an interrelationship of the different components of the spine in that changes in one component, such as the disk, will have an effect on another, such…

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS), formerly referred to as reflex sympathetic dystrophy (RSD) or causalgia, is a complex clinical entity. Most authors consider it a neuropathic pain disorder with some autonomic features and without a single pathognomonic test or marker. Nevertheless, the definition of neuropathic pain has been questioned lately because there are many mechanisms proposed for this disease, as we explain in this chapter. CRPS…

Muscle Injury and Sequelae

Prevalence, Epidemiology, and Definitions Injury of muscle, whether contusion, laceration, or strain, is one of the most frequently encountered injuries in athletes. Strain injury accounts for 90% of sports injuries of muscle and may result in significant disability. Muscle injuries are not limited to athletes, however, and the interpreting radiologist must be comfortable with recognizing their radiologic presentation. Normal muscle activity relies on innervation and perfusion;…

Complications of Osseous Trauma

There are many complications of skeletal trauma, although in most cases fracture healing is uncomplicated. Complications can result from direct trauma to bone and soft tissue or from the treatment of the fractures. Complications may be systemic or local and involve the bones or the adjacent soft tissues and joints. In this chapter an overview is presented of the various complications in which radiology plays a…

Radiation Effects in the Musculoskeletal System

History and Radiation Sources Since the discovery of X-rays by Wilhelm Conrad Roentgen in 1895 and the discovery of radioactivity by Henri Becquerel in 1896, many medical uses of radiation have been developed, both diagnostic and therapeutic. Patients can be exposed to radiation by external or internal sources. External radiation sources include imaging exams like conventional radiography, computed tomography and fluoroscopy, as well as external radiation…

Stress Injury

Prevalence, Epidemiology, and Definitions Stress injuries are a common cause of pain and morbidity and have become commonplace among the members of our increasingly active society. There is some confusion regarding the numerous terms used to describe these injuries, and the clinical diagnosis of stress fractures can be difficult: Symptoms are often vague, and soft tissue injuries may mimic bony abnormalities. Stress injuries represent a wide…

Skeletal Manifestations of Pediatric Nonaccidental Injury

Prevalence, Epidemiology, and Definitions Nonaccidental injury (NAI; child abuse) is a widespread social problem of special concern to pediatricians. It is present worldwide but has different manifestations in differing cultures with increased awareness in Western societies. The presentation varies from neglect, thermal injury, sexual abuse, bruising to physical neurocranial and skeletal injury. The true prevalence is hard to obtain because it frequently occurs behind closed doors,…

Upper Extremity Injuries in Children

Prevalence, Epidemiology, and Definitions Patterns of injury in children are different from those of adults, partly because of the unique structure of the pediatric skeleton. Injuries of the upper extremity account for 65% of all fractures and dislocations in children and often are the result of a fall on an outstretched hand. The distal radius, the supracondylar elbow, and the clavicle are among the most common…

Lower Extremity Injuries in Children

Epidemiology and Background The prevalence of both acute traumatic and chronic overuse injuries of the lower extremity has increased in children for a number of reasons. Children are participating in athletics at earlier ages and a higher rate than in the past. Data from the last decade indicate that 30 million, or half, of all U.S. children engage in an organized sport, with children's sports injuries…

Imaging of the Forefoot

Imaging Techniques Radiographs are an essential tool in the initial assessment of most conditions affecting the foot, whether they are acute or chronic traumatic lesions or infectious, inflam­matory, or neoplastic conditions. Standard views include anteroposterior, lateral, and external oblique projections. Assessment of developmental or acquired osseous malalignment and evaluation of the arch require radiographs taken with the patient bearing weight on the affected extremity. A sesamoid…

Compressive and Entrapment Neuropathies of the Lower Extremity

Lower Extremity Pelvis/Thigh Piriformis Syndrome Compression of the sciatic nerve by the piriformis muscle is noted in the pelvis. The L4, L5, S1, and S2 nerve roots give contributions to the sciatic nerve. As the nerve exits the greater sciatic foramen, it is composed of the tibial and peroneal divisions, enclosed by a common nerve sheath. The sciatic nerve descends anteriorly to the piriformis muscle in…

Soft Tissue Injury to the Ankle: Osteochondral Injuries and Impingement

Most patients who suffer an ankle sprain return to normal sport and daily living activity. However, chronic pain or instability can limit activity and affect up to 20% to 40% of these patients. Ankle impingement syndromes and osteochondral lesions are the leading causes of chronic pain following ankle sprain. Other important causes of painful sprained ankle pain are peroneal tendon injuries (peroneal tendon split syndrome and…

Soft Tissue Injury to the Ankle : Tendon Injuries

Etiology Ankle tendon injuries most commonly occur as a result of chronic microtearing due to overuse from athletic activity and/or primary degeneration. Systemic diseases such as rheumatoid arthritis, seronegative spondyloarthropathies, gout, hyperparathyroidism, and diabetes can also lead to tendon infiltration or degeneration. Discrete tears of the ankle tendons occur as a result of specific biomechanical forces applied to the tendon that are frequently superimposed on a…

Soft Tissue Injury to the Ankle: Ligament Injuries

General Considerations Prevalence and Epidemiology Ankle ligamentous injury or sprain is the most common type of ankle injury and accounts for 14% of visits to an emergency department, 1.6 million physician office visits, and more than 8000 hospitalizations per year in the United States. In the general U.S. population, the incident rate of ankle sprains is 2.15 per 1000 person-years. Fifteen- to 19-year-olds have the highest…

Acute Osseous Injury to the Ankle and Foot

Overview Of all of the major weight-bearing joints in the body, the ankle is the most frequently injured. In athletes, foot and ankle injuries account for up to one fourth of sports-related injuries, with the ankle ranking first as the most common cause of time lost in sports competition. In otherwise healthy patients, ankle injuries may be complicated by chronic joint instability and pain. Female gender,…