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Lower Extremity Pathology
RADT 1512
Lower Extremities Section III
Tiera Rigby MS, RT(R)(MR)
Additional Slides Provided by Weber
Faculty
Valgus/Varus
Deformities
valgus
deformity
• knock-kneed
appearance
• distal part of the
leg deviated
outward.
varus
deformity
• bow-legged
appearance
• inward
angulation of the
distal segment of a
bone or joint.
Baker’s Cyst
Osgood-Schlatter’s
Disease
• Large powerful quadriceps join with patellar tendons & run through the knee and insert onto the tibial tuberosity.
• When the quadriceps contracts, the patellar tendons pull away from the shin bone.
• Repetitive activity and tight quadriceps cause cartilage swelling, cortical bone fragmentation, patellar tendon thickening, and/or infrapatellar bursitis. Athletes present with pain and swelling at the tibial tubercle.
Osteosarcoma
• Most common primary malignant bone cancer.
• Often occurs in long bones of arms and legs at areas of rapid growth around knees and shoulders of children.
• Very aggressive with risk of spread to the lungs.
Legg-Perthes Disease
Four Stages of LCPD
1. Femoral head becomes dense with
possible fracture of supporting bone.
2. Fragmentation and reabsorption of
bone.
3. Reossification when new bone has
regrown.
4. Healing, when new bone reshapes. Initial Phase
Reabsorption Phase Reossification Phase / Healed
Form of osteonecrosis of the hip found only in children
Gouty Arthritis
• 50-70 % cases
– gout appears suddenly with
injury in the metatarsal-
phalangeal joint of the
great toe .
• Diagnosis
– made when monosodium
urate crystals are found in
white cells of the synovial
fluid.
– Gout results from crystals
and uric acid depositing in
tissues of the body.
Rheumatoid Arthritis
• Chronic Systemic Disease of unknown origin. – Inflamed peripheral joint.
– Polymorphonulear leukocytes are attracted to the joint space causing destruction of the joint structures.
Juvenile Rheumatoid
Arthritis
JRA is divided into three groups:
1. Systemic onset- anemia, leuocytosis, negative
rheumatoid factors and antinuclear antibodies
(ANA).
2. Polyarticular –ANA in 25% of cases,
rheumatoid factors negative by standard
method, but positive with special techniques.
3. Pauciarticular-ANA in 50% of cases, and
rheumatoid factors are absent
Pyogenic Arthritis
“Septic Arthritis”
• Joint Inflammation due to
Bacterial Infections.
Septic Arthritis
(Medical Emergency)
• Invasion of joint space by infectious agent
resulting in arthritis.
• Often caused by bacterial invasion, but
viral, mycobacterial, and fungal etiology
may occur. (i.e. Staph, Strep, Influenze,
Tuberculin)
• X-rays show joint effusion, soft tissue swelling,
periarticular osteoporosis, loss of joint space, and
marginal and central erosions.
Systemic Lupus
Erythematosus (SLE)
• Unknown origin
– associated with immunologic
mechanism of tissue injury
– most common in women of
child bearing years.
• Symptoms include: fatigue,
fever, muscle pain, facial
rash, arthritis, loss of
appetite and ulcers, unusual
sensitivity to sunlight and
inflammation of the lining
surrounding the heart and
lungs.
Rheumatic Fever
• Inflammatory disease related to previous infection with a group A hemolytic streptococci – Involves heart, joints,
central nervous system, skin and subcutaneous tissues.
• Lab Values – do not indicate
rheumatic fever, but may show continued inflammation.
Progressive systemic sclerosis-Diffuse
“Scleroderma”
• Multi-system disorder – Alterations in connective
tissue leading to fibrosis of the skin and internal organs.
*Scleroderma is a chronic, degenerative disorder accompanied by widespread vascular deterioration and tissue loss. It can be disfiguring, debilitating, and deadly. Scleroderma can cause damage and complications for the body’s digestive, respiratory, and circulatory systems.
Mixed Connective Tissue
Disease
• Clinically overlapping features of
– Scleroderma
– SLE (lupus)
– polyarthritis.
Symptoms:
The symptoms don’t occur all at once, instead come on over a
period of several years. Some of the first signs involve the hands
and fingers swell. Later symptoms include the disease affecting
the heart, lungs and kidneys.
Spondyloarthropathies
• Any joint disease of the
vertebral column.
• Inflammation affects the spine,
and lumbosacral joints
(ankylosing spondylitis), the
urethra (Reiter’s Syndrome),
and the skin (psoriatic arthritis).
• Diseases are linked by their
association with the HLA-B27
gene and by the presence of
enthesitis as the basic
pathologic lesion.
White arrow: early erosion @
achilles tendon insertion
Black arrow: periosteal reaction
@ plantar fascia insertion
Pt with Reiter’s
Syndrome
Osteitis of anterior vertebral margins:
“Shining Corners”
Degenerative Arthritis or
Osteoarthritis
• 85% of persons over 70 yrs of age
• “wear and tear” condition
• pain and low-grade inflammation results from the breakdown and eventual loss of cartilage.
Sjogren’s Syndrome
Primary Sjogren’s
Syndrome:
Destruction of salivary glands,
lacrimal glands, and labial
glands.
Secondary Sjogren’s
Syndrome:
Co-exists with another disease
such as rheumatoid arthritis,
and lupus.
Stress Fracture
Because of repeated
micro-trauma, the bone
fails to absorb shock
and becomes
weakened and
fractures. This is an
overuse injury.
Greenstick Fracture
Transverse Fracture
Oblique Fracture
Spiral Fracture
Comminuted Fracture
Impacted Fracture
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