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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

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Page 1: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

Lower Extremity Pathology

RADT 1512

Lower Extremities Section III

Tiera Rigby MS, RT(R)(MR)

Additional Slides Provided by Weber

Faculty

Page 2: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

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.

Page 3: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

Baker’s Cyst

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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.

Page 5: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

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.

Page 6: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

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

Page 7: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

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.

Page 8: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

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.

Page 9: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

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

Page 10: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

Pyogenic Arthritis

“Septic Arthritis”

• Joint Inflammation due to

Bacterial Infections.

Page 11: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

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.

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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.

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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.

Page 14: RADT 1512 Lower Extremities Section IIIradpacs.weber.edu/Images/T_Rigby/RADT 1512/PPT 3 LOWER... · 2014-02-02 · RADT 1512 Lower Extremities Section III Tiera Rigby MS, RT(R)(MR)

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.

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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.

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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”

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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.

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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.

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Stress Fracture

Because of repeated

micro-trauma, the bone

fails to absorb shock

and becomes

weakened and

fractures. This is an

overuse injury.

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Transverse Fracture

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Oblique Fracture

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Comminuted Fracture

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Impacted Fracture

www.biotronics research.com