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The Body’s Joints and Protection From Rheumatoid Arthritis

The Body’s Joints and Protection From Rheumatoid Arthritis

Rheumatoid arthritis is said to affect around 1.5 million individuals. Recognized as an autoimmune condition that presents with chronic pain in the body’s joints. It commonly affects regularly used joints like the shoulders, hands, and feet. The condition can begin to present in individuals in their 30s. Concerns that come with a rheumatoid arthritis diagnosis are the condition’s effect on the spinal facet joints. These joints are susceptible to attack from a dysfunctional immune system, leaving them prone to weakness, inflammation, and nerve compression. Chiropractors understand the manifestation of rheumatoid arthritis. They can pinpoint at-risk facet joints and provide corrective relief before more dangerous symptoms begin to present.

Facet joint risks

There are two facet joints that connect each vertebra to the one above and below. Their objective is to stabilize the spine, whether in a neutral position or engaged in flexion/extension movement. When targeted by the body’s immune system, the joints begin to weaken. The body attacks the synovial fluid that lubricates the joints. This creates friction that generates inflammation. Over time the joints break down leading to everything from loss of mobility to bone spurs. When left untreated the facet joints begin to deteriorate, causing nerve compression that can lead to permanent nerve damage. When the joints are not working properly the spine has to work around them.

  • Subluxations
  • Disc herniation
  • Ruptured discs
  • Sciatica all are possible with facet joint dysfunction.

Treatment

Currently, rheumatoid arthritis cannot be cured but symptoms can go into remission when treatment begins early. Chiropractic is an effective treatment at disrupting the symptoms of joint deterioration that stops the progression.

  • It has the ability to increase and maintain an individual’s range of motion, from a condition that causes loss of mobility.
  • It helps to bring rapid pain relief and helps with postural improvements.
  • It maintains positive spinal health and homeostasis.
  • Prevents problems with compression and subluxations.
  • Stretching and strengthening exercises are incorporated to preserve an individual’s spinal integrity.
  • Diet and nutrition are also adjusted to mitigate the effects, helping with inflammation prevention.
11860 Vista Del Sol, Ste. 128 The Body's Joints and Protection From Rheumatoid Arthritis

The spinal focus

As rheumatoid arthritis affects the body’s joints, it is vital to protect the facet joints. These joints can experience degenerative damage that can cause long-term problems. Injury Medical Chiropractic and Functional Medicine Clinic provide individuals with the tools necessary to combat rheumatoid arthritis that medications by themselves might not be able to.

Body Composition

Muscle Mass Fitness for Long-Term Health

Muscle building is not just for bodybuilders and athletes. Everyone benefits from building muscle for long-term health. Monitoring the changes in Lean Body Mass can be accomplished by having body composition measured. Body composition analysis can divide an individual’s weight into various components. These include:

  • Fat Mass
  • Lean Body Mass
  • Basal Metabolic Rate will give a clearer picture of overall fitness and health.

Building Lean Body Mass is an investment for maintaining health long-term. The more Lean Body Mass that is built the more is in storage/reserve when the body really needs it. Before adding protein shakes and resistance workouts to the daily regimen, a plan needs to be developed. The first step to building a healthy level of lean body mass is to measure how much there is with a body composition analysis.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP, CIFM, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Pope JE, Cheng J. Facet (Zygapophyseal) Intraarticular Joint Injections: Cervical, Lumbar, and Thoracic. Injections for Back Pain. 129-135. ClinicalKey.com. Accessed July 16, 2019.

Brummett CM, Cohen SP. Pathogenesis, Diagnosis, and Treatment of Zygapophyseal (Facet) Joint Pain. 816-844. ClinicalKey.com. Accessed July 16, 2019.

Janus Kinase Inhibitors For Ankylosing Spondylitis Treatment

Janus Kinase Inhibitors For Ankylosing Spondylitis Treatment

Individuals with ankylosing spondylitis have a new treatment option that was previously used for rheumatoid arthritis. It is a medication that belongs to a class known as JAK inhibitors. Ankylosing spondylitis combines joint pain with reduced mobility. Ankylosing spondylitis is different because in severe cases, the bones in the spine can fuse together, literally reducing mobility.  
11860 Vista Del Sol, Ste. 128 Janus Kinase Inhibitors For Ankylosing Spondylitis Treatment
 
The disease typically begins with pain and stiffness in the back. This is usually after some time of inactivity. Symptoms start before the age of 45 and develop gradually. There is no cure for ankylosing spondylitis but there are treatments that can improve symptoms and put the condition into remission. Ankylosing spondylitis treatment is the most successful when addressed early before irreversible damage to the joints begins.  

Janus Kinase Inhibitors

Janus kinase inhibitors have traditionally been used to treat:
  • Rheumatoid arthritis
  • Psoriatic arthritis
  • Ulcerative colitis
The medication works by decreasing the immune system�s activity. Janus kinase inhibitor drugs affect several cellular compounds that are important in the development and progression of ankylosing spondylitis. Currently, there are only three Janus kinase inhibitor medications available in the United States and FDA-approved to treat rheumatoid arthritis:
  • Xeljanz
  • Rinvoq
  • Olumiant
  • Each of the approved inhibitors targets specific enzymes
 

Current Ankylosing Spondylitis Treatments

Janus kinase inhibitors are not given to individuals right away. However, it could be an option if first and second-line treatments are not working. Treatments usually consist of:

First-Line Treatments

 

NSAIDs

Nonsteroidal anti-inflammatory medications are the most commonly used to treat ankylosing inflammation, pain, and stiffness.

Chiropractic

Chiropractic physical therapy is a major part of ankylosing spondylitis treatment keeping the spine flexible and as healthy as possible. A chiropractic/physical therapy team design and develop specific exercises to fit individual needs, which include:
  • Stretching and Range-of-motion exercises help maintain flexibility in the joints
  • Sleeping and walking posture adjustment exercises
  • Abdominal and spinal exercises to maintain a healthy posture
  • Strength training
 

Second-Line Therapies

If nonsteroidal anti-inflammatory medications do not relieve symptoms, then biological medications could be prescribed. This class of medications includes:

Tumor Necrosis Factor

Tumor necrosis factor blockers work by targeting cell protein that is part of the immune system, known as tumor necrosis alpha. This protein causes inflammation in the body, and the blockers suppress it.  

Interleukin 17 Inhibitors

Interleukin 17 in the body’s immune system defends against infection. It uses an inflammatory response to fight infections. The IL-17 inhibitors suppress the inflammatory response and help reduce symptoms.  
11860 Vista Del Sol, Ste. 128 Janus Kinase Inhibitors For Ankylosing Spondylitis Treatment
 

Other Treatment Options

 

Lifestyle Adjustments

Following a medical treatment plan is often combined with diet and lifestyle adjustments that are recommended to help with the condition, these include:
  • Being as physically active as possible will help:
  1. Improve/maintain a healthy posture
  2. Maintain flexibility
  3. Ease pain
  • Applying heat and ice will help alleviate:
  1. Pain
  2. Stiffness
  3. Swelling

Surgery

Most individuals with ankylosing spondylitis do not require surgery. However, a doctor could recommend surgery if there is joint damage, the hip-joint needs to be replaced, or if the pain is severe.  

Inhibitor Potential

Studies are ongoing in the treatment of ankylosing spondylitis. The drug is currently in Phase 3 trials for the treatment of adults. The trial results have shown patients with active ankylosing spondylitis showed improvement in:
  • Fatigue
  • Inflammation
  • Back pain
The study enrolled adults with active ankylosing spondylitis who took at least two NSAIDs that were ineffective at treating symptoms. Most of the participants were men, average age of 41, and no prior usage of biologic disease-modifying antirheumatic drugs.

Janus kinase could become a standard treatment

There is still not enough research to make a prediction, but the data is promising. The inhibitors seem to be a safe option when used in a properly screened, well-matched setting that includes regular monitoring. The inhibitors appear to be effective and have the advantages of being taken orally and working fast.

Body Composition


 

Osteoarthritis and weight loss

Being obese has shown to be a high-risk factor for the development of osteoarthritis. This is not only from the effects of extra weight on the body’s joints but also as a result of the inflammatory effects of adipose tissue. The lower back, hips, and knees, bear the majority of the body’s weight. An excess amount of adipose tissue on the body’s midsection and legs has been shown to negatively impact the weight-bearing joints. Promoting Lean Body Mass and encouraging weight loss lowers the risk of osteoarthritis and improves an individual’s quality of life. Exercise is regarded safe for individuals with osteoarthritis and should be incorporated to improve body composition, reduce Body Fat Mass, improve Lean Body Mass and maintain a healthy weight.  

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*  
References
Hammitzsch A, Lorenz G, Moog P. Impact of Janus Kinase Inhibition on the Treatment of Axial Spondyloarthropathies. Frontiers in Immunology 11:2488, Oct 2020; doi 10.3389/fimmu.2020.591176.�https://www.frontiersin.org/article/10.3389/fimmu.2020.591176, accessed Jan 21, 2021. van der Heijde D, Baraliakos X, Gensler LS, et al. Efficacy and safety of filgotinib, a selective Janus kinase 1 inhibitor, in patients with active ankylosing spondylitis (TORTUGA): results from a randomized, placebo-controlled, phase 2 trial.�Lancet.�2018 Dec 1;392(10162):2378-2387. doi: 10.1016/S0140-6736(18)32463-2. Epub 2018 Oct 22. PMID: 30360970.�https://pubmed.ncbi.nlm.nih.gov/30360970/�accessed Jan 19, 2021.
Getting Better Sleep with Inflammatory Spinal Arthritis

Getting Better Sleep with Inflammatory Spinal Arthritis

Inflammatory spinal arthritis can cause significant joint pain and severely damage sleep quality. Any of the following conditions can cause individuals to experience sleep problems:
  • Spondylosis (osteoarthritis)
  • Rheumatoid arthritis
  • Ankylosing spondylosis
  • Juvenile idiopathic arthritis
Dr. Jimenez from Injury Medical Chiropractic and Functional Medicine Clinic gives insight into how inflammatory spinal arthritis can disrupt healthy sleep, along with some tips to help individuals with joint pain restore healthy sleep.  
11860 Vista Del Sol, Ste. 128 Getting Better Sleep with Inflammatory Spinal Arthritis
 

Inflammatory Spinal Arthritis and Sleep

First, it is not just the joint pain of arthritis that is causing sleep problems. Research is discovering that more factors could be at play. A study in the journal SLEEP examined how individuals with chronic pain, including osteoarthritis slept. What was revealed was a strong connection between chronic pain and insomnia. Insomnia can lead to added joint pain because poor sleep can trigger inflammatory pathways that worsen arthritis pain. Plus a poor night of sleep can heighten an individual’s perception of pain the next day. Arthritis pain does not just impact the sleep of adults, but young individuals with juvenile idiopathic arthritis can also struggle with getting healthy sleep. Sleep, pain levels, and mood are strongly related.  
 

Sleep Tips

Achieving quality sleep and a well-rested body can be done. Things to consider to help secure a healthy sleep.  

Medication interference/side effects

Corticosteroids could be part of the sleep problem, as corticosteroid treatment has been linked to insomnia. If struggling to fall asleep, talk with a doctor about altering any prescribed medication regimen before sleep like taking aspirin or a nonsteroidal anti-inflammatory NSAID medication in its place.  

Adjust sleep position to joint pain

If the neck is sore/aching rest the head on a flat pillow so the cervical spine is in a neutral position. For low back joint pain, individuals might find relief by sleeping on their back or side with the knees and hips flexed at a 90-degree angle. For hip joint stiffness, sleeping on the side with a pillow between the legs is recommended.  
 

A firm mattress and support pillow

A firm mattress will support the body and help reduce pain. The right pillow/s are also important for healthy sleep. A lumbar and cervical pillow can help cushion tender areas.  

Readjust chores

Joint pain first thing in the morning needs time to adjust. For morning physical chores try to reschedule for later on in the day or if possible the night before. This could be fixing lunches, picking out clothes, preparing breakfast, or packing the work case, tools, etc. The extra time will reduce morning stress and allow the body to gently adjust.  
11860 Vista Del Sol, Ste. 128 Getting Better Sleep with Inflammatory Spinal Arthritis
 

Wake up and stretch

With joint pain in the morning, some gentle stretching can help. Doing some stretches before even getting out of bed will help minimize pain and allow the body to gradually prepare for movement. Follow the stretch session up with a hot shower to loosen stiff joints.  
 

Increase Sleep Quality

Sleep problems can affect anyone even those that don’t have inflammatory spinal arthritis/joint pain. There could be other issues causing sleep problems unrelated to joint pain. If still not getting quality sleep, talk to a rheumatologist about available options.

Body Composition

 

Osteoarthritis and Exercise

Obesity is a significant risk factor in the development of osteoarthritis. This is not only from the effects of extra weight on the body’s joints but also as a result of the pro-inflammatory effects of adipose tissue. The hips and knees are the weight-bearing joints. Excessive adipose tissue on the midsection and legs have been shown to negatively impact these weight-bearing joints. Promoting Lean Body Mass and encouraging weight loss can potentially lower the risk of osteoarthritis and improve the quality of life. Gentle exercise is regarded as safe for individuals with osteoarthritis and is a key component to improve body composition, reduce body fat mass, improve lean body mass and maintain a healthy weight. Improving body composition and utilizing exercise in weight management can have a direct and positive effect on joint health.  

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*  
References
Myers W. 9 Ways to Rise and Shine With Osteoarthritis. Everyday Health.�http://www.everydayhealth.com/osteoarthritis/ways-to-rise-and-shine-with-osteoarthritis.aspx. Last updated September 25, 2014. Accessed April 18, 2017. Watson S. Why Osteoarthritis Could Disrupt Your Sleep�and Your Partner�s. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/comorbidities/sleep-insomnia/osteoarthritis-and-sleep.php. Accessed April 18, 2017.
Reduce Stress and Rheumatoid Arthritis Symptoms

Reduce Stress and Rheumatoid Arthritis Symptoms

Reducing stress is important for emotional well being and physical health. Rheumatoid arthritis is a complex condition with no cure and can cause intense chronic pain. Stress only exacerbates the symptoms, affects pain perception, and weakens the body. Stress management is highly important for reducing pain. In a weakened state, an individual is more vulnerable to arthritis symptoms, like flare-ups, weakness, and fatigue.�Chiropractic can help.

There are non-surgical treatments for arthritis, like medications, physical, and massage therapy that address the physical nature of the condition. By eliminating stressful triggers and making healthy behavioral/lifestyle changes a better sense of well being can be achieved.

 

11860 Vista Del Sol, Ste. 128 Reduce Stress and Rheumatoid Arthritis Symptoms El Paso, Texas

 

Different emotions can run rampant:

  • Confusion
  • Frustration
  • Anger
  • Sadness
  • Helplessness

And all of these feelings can generate intense stress on an individual. Chiropractic excels in wellness and is becoming more common for individuals to visit chiropractic clinics for treating a variety of different kinds of pain symptoms and conditions. Chiropractic adjustments provide countless benefits to those with arthritis. We�ll explore how chiropractic can help those with arthritis and give additional information along with suggestions on how to alleviate the pain.

 

What Chiropractic Does

A doctor of chiropractic is a health professional that focuses on wellness and optimal health instead of ailment/sickness symptoms. Their specialty aims at adjusting the spine to correct misalignments that could be pressing down on nerves and causing major disruption in the body. Regular chiropractic not only restores health throughout the body but helps alleviate back pain and any other symptoms associated with an out of alignment spine.

They also work in setting up exercise programs specific to the condition being treated along with the proper diet to utilize in assisting with the management of inflammation and pain.

 

 

Arthritis

Arthritis is inflammation in the body’s joints which results in pain, stiffness and limited range of movement. There are over 200 different varieties of arthritis. Generally associated with age, it can affect young people. It can strike pretty much any area of the body. Arthritis can cause damage to soft tissues and muscles.

Osteoarthritis also known as degenerative joint disease, is the most common type. It comes from repeated trauma to the joints and occurs more often in the elderly.

Other forms include:

  • Rheumatoid arthritis is the second common type in which the body�s immune system attacks the joint/s.
  • Psoriatic arthritis, an autoimmune form of arthritis.
  • Ankylosing spondylitis is a type of arthritis where the body attacks itself.
  • Septic arthritis is caused by a viral or bacterial infection of the joint/s.

Diagnosis

Diagnosing arthritis involves a thorough physical examination. Rheumatologists often need help with these cases, and so a medical work-up can be done and a chiropractor could be recommended. This includes X-rays or MRIs, urine, blood analysis, and physical examinations. Having the condition properly diagnosed will help to more effectively treat the symptoms.

 

11860 Vista Del Sol, Ste. 128 Reduce Stress and Rheumatoid Arthritis Symptoms El Paso, Texas

Chiropractic

The most common treatment is medication, which takes down the inflammation, the swelling and reduces pain. Chiropractors can be of great help in managing arthritis. Medications work but as we’ve seen they can have long-term health risks like impaired healing, damage to the stomach lining and internal bleeding.

A chiropractor can reduce stress, and reliance on medications, all the while managing the pain and symptoms in a natural way. Chiropractic can:

  • Improve range of motion
  • Keeps the spine properly aligned
  • Improve endurance
  • Improve flexibility
  • Increase strength
  • Increase muscle tone
  • Develop a dietary and nutritional plan to reduce inflammation
  • Recommend an exercise regimen conducive to arthritis symptoms

According to the American Chiropractic Association, this is vital in managing arthritis symptoms.

Treatment

Understand that chiropractic cannot cure arthritis. They can help alleviate symptoms, slow the progression and help to reduce stress levels. They will use adjustments in combination with other treatments. This can include:

  • Hot and cold treatments
  • Ultrasound treatments
  • Massage
  • Electronic muscle stimulation
  • Physical rehabilitation
  • Magnet therapy

 

Reduce Stress

Exercise

Water aerobics or make walking around the park/neighborhood part of a daily routine, as it promotes a healthy mind by reducing stress and anxiety. Gentle exercises like aerobic exercise are perfect because it improves mobility and helps shed a few pounds taking pressure off the joints. Exercise creates endorphins, which reduces pain and uplifts the mood.

Support groups

With any type of painful condition, it’s easy to feel alone. Joining a support group can connect you with people who understand what’s going on and the emotions you’re experiencing. The community helps diminish the sense of isolation.

Relaxation therapy

This focuses on calming the body and mind by making a conscious effort to relax. Even for only a few moments, you might find this technique effective at controlling the stress response. Begin by focusing on one part of the body like the hands, feet, etc.

Concentrate until the area you’re focusing on is completely free of stress or tension. Then imagine weightlessness flow through the body. Close your eyes, lie down, turn off the lights, and think of something soothing. There are no strict guidelines for relaxation. Whatever puts you in a relaxed frame of mind is the way to do it.

Warm bath

Warm moist heat from a shower, bath, or steam room can decrease the secretion of stress hormones and raise levels of endorphins, as aforementioned the body’s natural pain killers.

Take time for yourself

When it comes to reducing stress, balance is key. Staying active, and regular rest/sleep is vital to successful treatment. A balance needs to be in everything you do. Therefore, make time for the things you want to do.

 

Results

Inflammatory diseases like arthritis have shown the best results are achieved from combating it from all angles. Working with a chiropractor and rheumatologist to combine treatments can make all the difference. A healthy diet and active exercise program will get you in the right direction toward a healthy active lifestyle. If you or a loved one are suffering from arthritis, don�t hesitate to call. We�re here to help in any way possible!


 

Depression and Chronic Pain

 


 

 

NCBI Resources

 

Juvenile Idiopathic Arthritis Spinal Inflammation El Paso, TX.

Juvenile Idiopathic Arthritis Spinal Inflammation El Paso, TX.

The mostcommon type of arthritis in children and adolescents is Juvenile idiopathic arthritis aka (JIA) a type of inflammatory arthritis that affects kids 16 years and younger. It is a rare condition, that affects around 1 in every 1,000 children. It can cause�jointpain and stiffness throughout the body, especially the facet joints/spinal joints.

 

11860 Vista Del Sol, Ste. 128 Juvenile Idiopathic Arthritis Spinal Inflammation El Paso, TX.

 

Types of Arthritis that Fall Under JIA

Juvenile Idiopathic arthritis was known as juvenile rheumatoid arthritis, but it is not a child/teenage version of adult rheumatoid arthritis. Juvenile Idiopathic arthritis falls into a group of several types of arthritis. When a doctor diagnoses JIA, they will determine the type.

Different types include:

  • Systemic
  • Oligoarticular
  • Polyarticular
  • Undifferentiated
  • Psoriatic
  • Enthesitis-related JIA that affects the spine is enthesitis-related.

 

 

facet arthropathy diagram | El Paso, TX Chiropractor

How It Affects the Spine

To better understand how this arthritis affects the spine, it helps to know some of the terminology.

  • Enthesitis: Inflammation of the entheses is the area where tendons and ligaments connect to bone/s.
  • Spondyloarthritis: Arthritis that attacks the entheses of the spine. Ankylosing spondylitis is an example of spondyloarthritis.

The neck joints are the most common to be attacked by JIA. Whereas, spondyloarthritis causes pain and stiffness in the low back.

 

Typical Symptoms

Juvenile idiopathic arthritis happens in children aged 16 years and younger. Symptoms include:

  • Joint pain
  • Swelling
  • Stiffness
  • Tenderness
  • Mild heat or a warmness that has been present for at least 6 weeks.

Other symptoms can include muscles and soft tissues becoming tight, erosion of the bone,�joint misalignment, and abnormal growth patterns.

 

Diagnosis Can Be A Challenge

Diagnosis is not always straightforward, and there are criteria for diagnosing juvenile idiopathic arthritis. The doctor will perform a physical exam and order tests. They will monitor the child�s symptoms for at least 6 weeks initially, and then for 6 months after the onset of the disease. During this time, figuring the number of joints involved helps determine the diagnosis. As joint involvement can vary by the type of arthritis, and symptoms can and do change regularly.

This arthritis attacks the joints of the spine, specifically in the neck. However, with certain types of spondyloarthropathy, the lower back can become the target.

Diagnosing arthritis involves a complete and thorough examination. If a chiropractor has been brought in to help with the case, a medical work-up by a rheumatologist could be recommended. This includes radiology/X-rays or an MRI, urine, blood analysis and physical examinations.

 

Treatment

A doctor may recommend a multi-disciplinary approach to treat JIA. They may prescribe various types of therapies/treatments focused on stopping the disease’s progression. The treatment plan will include teaching healthy habits to prevent future back pain.

 

Medication/s

Treatment usually starts with nonsteroidal anti-inflammatory’s. A doctor can also prescribe a corticosteroid to control the inflammation. Most respond well to anti-inflammatory medication, however, these medicines do not treat the underlying disease or the root cause.

Inflammatory arthritis and its progression can be controlled with certain medications. There are disease-modifying antirheumatic medications that can slow the disease�s progression. There are also TNF-blocking medications that can help block a specific protein known as tumor necrosis factor that causes inflammation. Etanercept known on the market as Enbrel and adalimumab aka Humira are examples of TNF-blockers that can prevent the disease from progressing.

Chiropractic

Understand that chiropractic medicine cannot cure arthritis, but it can help alleviate the symptoms and slow the progression. They will use spinal adjustments in conjunction with other treatments. These can include:

  • Hot and cold treatments
  • Ultrasound
  • Massage
  • Electronic muscle stimulation
  • Magnet therapy
  • Physical rehabilitation

 

11860 Vista Del Sol, Ste. 128 Juvenile Idiopathic Arthritis Spinal Inflammation El Paso, TX.

Physical Therapy Exercise

Focuses on:

  • Proper posture
  • Joint mobility
  • Deep breathing
  • Exercises
  • Healthy lifestyle education

Patients can develop a forward posture that can lead to a hunched back and neck pain. Postural training and back extension exercises are helpful. Stretching and range of motion exercises keep the facet and rib joints functioning and mobile. Deep breathing expands the chest which expands the rib joints and aids lung function. Depending on the type and severity, a doctor might try other approaches like spine surgery.

 

Optimal Results

If you or someone has been diagnosed with juvenile idiopathic arthritis in the spine,�learn as much as possible about the disease and the ways to combat it. Being informed about this or any disease encourages empowerment and engagement throughout the treatment process.

The best results are achieved by attacking it from all angles. Working with a chiropractor and rheumatologist in combination. A chiropractor will train the individual on how to maintain a healthy diet and maintain an active exercise program to help with movement. This is geared toward a healthy outcome.


 

Low Back & Neck Pain Chiropractic Care


 

NCBI Resources

 

Can Chiropractic Treatment Be Used For Pets? El Paso, TX.

Can Chiropractic Treatment Be Used For Pets? El Paso, TX.

More and more people are going to the chiropractor to relieve their pain and other conditions. But did you know that your pet can get those benefits as well? Chiropractic care for pets has been gaining in popularity, and even some pet insurance policies cover it.

In the same ways that it helps human patients, it also helps animals. It offers a less invasive, medication-free way to manage pain and correct many health issues, including arthritis and joint injuries. A number of pet owners claim chiropractic is not only great for their pets but that their pets are excited to go to appointments and see their chiropractors.

Which animals benefit from veterinary chiropractic care?

Any species of animal can benefit from chiropractic. The most common animals to receive this specialized type of care are dogs, cats, and horses. However, any vertebrate species, including birds, can reap the benefits.

Chiropractic for animals has long been a standard form of treatment with many show horses, race horses, and barrel racers. It is considered a viable, beneficial treatment to help the animals combat the stress their bodies are put under due to their jobs. It is also very good for injuries, speeding healing while managing pain.

It is often used on dogs and cats to help with injuries, arthritis, and aging. Sometimes an animal can hurt but they are unable to communicate that to their owners. If you notice behavioral changes or grumpiness, you may want to check your pet out. He or she may be hurt and can�t tell you � and chiropractic could be the answer.

Most often treated conditions

chiropractic care for pets el paso tx.

Veterinary chiropractic helps pets with many conditions that are biomechanical or neurological in origin � much like it helps humans. Some of these conditions include spondylosis, hip dysplasia, and other types of degenerative joint diseases, intervertebral disk disease, neck pain, back pain, and cervical instability. It can also address problems of the autonomic nervous system like musculoskeletal weakness, fecal and urinary incontinence, chronic neck and back pain, and other pain that don�t respond to conventional treatments.

Serious injuries like ligament tears or fractures may require surgical intervention, but chiropractic can help post-surgery. It can help relieve the pain as well as correct secondary problems that could occur due to the animal overcompensating in response to the injury. In performance animals, regular chiropractic care can help prevent injury by maintaining flexibility and a good range of motion.

How does it work?

Chiropractic is designed to help keep the joints and spine in their natural, healthy alignment. The nerves that surround the joints and run along the spine communicate with the central nervous system. This connects to all of the organs in the body, including the brain.

When the spine is out of alignment, even just a little, it can cause disruptions in how the messages are relayed through the central nervous system and to the organs and brain. A misaligned spine can affect the entire body, causing pain in muscles and joints, affecting organ function, and impact the animal�s overall health and wellbeing. When the spine is not aligned, the body will not function as it should.

Give the best possible chiropractic experience.

When you meet with the veterinary chiropractor, make sure that you have all of your pet�s information available, including vaccinations, health care history, any conditions they have, their diet (including supplements), medications they are taking, and their daily activities. If the doctor is treating an injury, explain how the injury occurred if you know.

When the adjustment is over, make sure that you understand any therapy or exercises to do at home, post adjustment. If there is something you don�t understand, ask. The doctor may also provide recommendations regarding lifestyle changes including saddle fit, collar fit, exercise, conditioning, or shoeing. Make sure you follow these as well. Your pet can�t make those decisions for his or her own health, that is up to you. Don�t let them down.

Sciatic Nerve Treatment El Paso, TX Chiropractor

Wrist/Hand Arthritis And Trauma: Diagnostic Imaging | El Paso, TX.

Wrist/Hand Arthritis And Trauma: Diagnostic Imaging | El Paso, TX.

Wrist & Hand Trauma

  • Distal Radius & Ulnar Fractures (Colles, Smith’s, Barton’s, Chauffeur’s, DiePunch)- complicated by 50% ulnar styloid Fx, TFC path, DRUJ dislocation, scapholunate lig dissociation, lunate/perilunate dislocation )
  • Carpal bones Fracture & dislocations (scaphoid, triquetrum, hamate Fx &Lunate/perilunate dislocation)
  • Ligaments dissociation (Scapholunate dissociation, Lunotriquetral instability)
  • Metacarpal & Phalangeal fractures (Bennett, Rolando, Game keeperFx/Stener lesion, Boxer Fx)
  • Pediatric wrist injury (green-stick Fx, Torus Fx, Bowing/plastic deformity, Salter-Harris injuries)
  • In all cases, Orthopedic hand surgical referral is required
wrist hand diagnostic imaging el paso tx.
  • Colles fx: m/c d/t FOOSH+pronation. m/c inOSP/elder women. Rare in men and if occurs need DEXA to avoid hip Fx etc. Young pts: high-energy trauma. Typically extra-articular.50%-cases show Ulna styloid (US) Fx.
  • Complications: dinner fork deform, CRPS, DJD, nerve entrapment.
  • Imaging: x-rad is sufficient, CT in complex Fx, MRI helps with ligament tears and TFC.
  • Rx: if extra-articular and <5-mm distal radius shortening and <5-degree dorsal angulation closed reduction+casting is sufficient. ORIF in complex cases.
  • �Image Dx: distal rad impaction/shortening,dorsal angulation of distal fragment, carefully examine if intra-articular extension, 50% US Fx
wrist hand diagnostic imaging el paso tx.
  • Smith Fx: Goyrand in French literature. Considered as reversed Colles, otherwise almost identical, I.e., 85% extra-articular, 50%US Fx, OSP/elderly women, young pts-high-energy trauma. Differences: mechanismFOOSHwith flexed wrist thus m. Less frequent.
  • Imaging steps: (see Colles Fx) C
  • Complications: similar to Colles Fx
  • Rad Dx: 85% extra-articular with volar(anterior) angulation of the distal fragment,radial shortening. Carefully examine cortical breach suspecting intra-articular extension that can be named as Smith type 2 or Reversed Barton Fx (next)
  • Rx: similar approach as in Colles.
wrist hand diagnostic imaging el paso tx.
  • Barton fx: FOOSH, impaction of distal radius similar to Colles but the Fx line extends from the dorsal radial aspect into radiocarpal joint resulting with dorsal slip/dislocation of the carpus.
  • Imaging: 1st sept x-radiography often with CTto examine intra-articular Fx extension and operative planning
  • Rad Dx: distal radius Fx extending from dorsal into the radiocarpal joint with a variable degree of displacement, the proximal slip of the carpus
  • If Fx line extends from the volar aspect into the wrist joint named Reversed Barton aka Smith type 2 (above bottom image)
  • Complications: similar to all distal radius Fx
  • Rx: operative with ORIF
wrist hand diagnostic imaging el paso tx.
  • Chauffeur’s/backfire Fx aka Hutchinson Fx: intra-articular Fx of Radial styloid. The name derives from the time when the car had to be started with a hand crank that could backfire inducing wrist dorsiflexion and radial deviation.
  • Imaging: x-radiography is sufficient. CT may be helpful if Fx not readily shown by x-rays.
  • Complications: non-union, malunion, DJD,scapholunate dissociation,lunate/perilunate dislocation
  • Rx: operative with percutaneous lagscrewin all cases d/t intra-articularnature
wrist hand diagnostic imaging el paso tx.
  • Die-Punch Fx: impaction Fx by the Lunate bone into distal articularLunate fossa of the Radius. IntraarticularFx. Derives its name from a technique to shape (impress) a hole in industrial machining “die-punch.”FOOSH injury.
  • Imaging: 1st step x-rays, may be equivocal d/t subtle depression of the Lunate fossa then CT scanning is most informative.
  • Rad Dx: impacted lunate fossa region with intra-articular Fx extension. This can present as a comminuted Fxarticular Fx of the Distal Radius.
  • Rx: operative d/t intra-articular Fx
wrist hand diagnostic imaging el paso tx.

Construct arcs of Gilula when evaluating carpal injuries. An Important step required to avoid missing subtle changes in carpal alignment and cortical continuity

wrist hand diagnostic imaging el paso tx.
  • Scaphoid bone Fx: m/c Fx carpal bone. D/tFOOSH wrist extended radially deviated. Location of Fx is most important to prognosis: Waist-m/c location (70%). May have 70-100%chance of AVN. Proximal pole Fx: 20-30% with a high risk of non-union. Distal pole-10%shows better prognosis. Distal pole Fx is m/c in children. Key clinical sign; pain in the snuffbox.
  • Imaging: 1st step-x-radiography but 15-20%missed d/t occult Fx. Special views required. Thus MRI is the most sensitive and specific for early occult Fx. Bone scintigraphy has98/100% specificity & sensitivity esp. 2-3 days after the onset. Key rad. Dx: Fx line if evident, displacement and obscuration of scaphoid(navicular) fat pad, examine for scapholunate dissociation. If proximal bone appears sclerotic-AVN occurred. MRI: low on T1 & high on T2/STIR/FSPD d/t bone edema, a�low signalFx line can be noted.
  • Rx: Spica cast should be applied if clinically suspected even w/o x-ray findings. For waistFx-cast for 3-mo for prox pole 5-mo immobilization. ORIF or percutaneous pinning with a Herbert screw.

Scapholunate Ligaments Dissociation

wrist hand diagnostic imaging el paso tx.
  • SNAC wrist: scaphoid non-union advanced collapse. Often d/t non-union and dissociation of scapholunate ligaments (SLL)with progressive radiocarpal and intercarpalDJD. The Proximal scaphoid fragment is attached to Lunate with distal dissociating and rotating�signet ring� sign on x-rays.
  • SNAC wrist may often result in DISI
  • Rx: progressive DJD may lead to four-corner arthrodesis
wrist hand diagnostic imaging el paso tx.
  • Scapholunate advanced collapse (SLAC wrist): SLLdissociation with progressive intercarpal and radiocarpal DJD and volar or dorsal carpal displacement (DISI & VISI). Causes: trauma, CPPD, DJD, Kienboch disease (AVN of Lunate), Preiserdisease (AVN of Scaphoid).
  • SLL dissociation will lead to Dorsal or VolarIntercarlate aka Intercarpal Segmental Instability (DISIor VISI).
  • Rad Dx: Dx underlying cause. X-rays demonstrate dorsal or volar angulation of the Lunate with increased or decreased scapholunate angle on the lateral view. On frontal view: Terry Thomas sign or widening of scapholunate distance 3-4-mm as the upper limit of normal.
  • �MRI may help with ligament evaluation and pre-surgical planning
  • Rx: often operative with late DJD. Four-corner arthrodesis
wrist hand diagnostic imaging el paso tx.
  • Triquetrum Fx: 2nd m/c carpal bone Fx. M/C dorsal aspect is avulsed by the�tough Dorsal radiocarpal ligament. Cause: FOOSH.
  • Imaging: x-radiography wrist series is sufficient. Best revealed on the lateral view as an avulsed bone fragment adjacent to the dorsum of the Triquetrum. CT may help if radiographically equivocal.
  • Rx: conservative care
  • Complications: rare, may persist as pain on the dorsum of the wrist
wrist hand diagnostic imaging el paso tx.
  • Hook of the Hamate Fx: m/c occurs in batting sports (cricket, baseball, hockey, impact by a golf club, etc.) 2% of carpusFx.
  • Imaging: x-radiography may fail to detect an Fx unless “carpal tunnel view” is used. CT may help if x-rays unrewarding.
  • Clinically: pain, positive pull test, weak, painful grip. Deep ulnar n. Branch may be affected within the�Guyon canal.
  • Rx: usually non-operative, but chronic non-union may require excision.
  • DDx: bipartite hamate
wrist hand diagnostic imaging el paso tx.
  • �Lunate vs. Perilunate dislocation: Lunate is m/c dislocated carpal bone. Overall infrequent carpal injury. However, often missed!
  • Occurs with FOOSH and wrist extended and ulnar deviated. Imaging: 1st step x-rays. Ifunrewarding or require more complex injury evaluation CT scanning.
  • Key Rad DDx: DDx Lunate from perilunate dislocation. Lunate dislocation: lunate lost its contact with distal radius �spilled teacup� on the lateral. Perilunate dislocation: Lunate maintains its contact with distal radius despite the Capitatedorsally dislocated. Lunate dislocation is additionally helped to identify a �pie sign� d/t Lunate overlapping the Capitate
  • Rx: emergency reduction and operative repair of torn ligaments

Metacarpal & Phalangeal Injuries

wrist hand diagnostic imaging el paso tx.
  • Bennett Fx: intra-articular but noncomminuted impact-type Fx of the base of 1st MC bone of the thumb. X-radiography is sufficient.
  • Rad Dx: characteristic triangular fragment of bone on the ulnar aspect of the 1st MCbase, often with radial subluxation of the remaining radial aspect of the 1st MC
  • Complications: DJD, non-union, etc.
  • Rx: prone to instability/non-union requiring an operative care
  • Rolando Fx: aka comminuted Bennett with Y or T-configuration. More complex injury. It is unstable requiring operative care
wrist hand diagnostic imaging el paso tx.
  • Gamekeeper thumb: traditionally described as a chronic tear of the�ulnar (medial) collateral ligament at 1stMCP in English Gamekeepers’ who performed neck twisting/killing of small game. An acute injury may also be named as Skier’s thumb. This injury can be ligamentous w/o a fracture and an avulsion injury at the 1st proximal phalanx base.
  • Complication: Stener lesion or displacement of torn ligament over Adductor pollicis muscle that cannot heal w/o surgical repair. MRI Dx is required.
  • Avoid thumb stress views that can induce a Stenerlesion
  • Imaging: x-radiography followed by MRI to Dx Stenerlesion. MSK US can be used if MRI is unavailable.
  • �Stener lesion on MRI & MSUS: ulnar collateral stump is more superficial to Adductor pollicis aponeurosis and appears like a low signal mass-like stump forming so-called “yo-yo on the string sign” reported both on MRI and MSK US.
  • Rx: often operative
wrist hand diagnostic imaging el paso tx.
  • Boxer Fx: m/c MC Fx. An extra-articular usually non-comminuted or minimal comminuted Fx through m/c the 5th and sometimes the 4th MCneck-head junction (occasionally through the shaft) resulting in volar head angulation. Mechanism: direct impact as in clenched fist punching hard surface (e.g., facial bones/wall punching) hence 95% in young males.
  • Imaging: x-radiography hand series is sufficient
  • Rad Dx: Fx line transverse or oblique through MCneck with volar head angulation. Evaluate the degree of displacement, critical to report.
  • Rx: typically non-operative with short �arm gutter splint and digits flexed. (https://www.aafp.org/afp/2009/0101/p16.html)
  • N.B. If the same mechanism fractures the 2ndand 3d MC in the same anatomic area, it may require operative care.
wrist hand diagnostic imaging el paso tx.
  • Phalangeal hand Fx: m/c skeleton Fx (10% of all Fx). Sports and industrial injuries dominate
  • Imaging: x-radiography with hand series or PA/lateral finger views will suffice
  • Rad Dx: if prox phalanx Fx, distal fragment is angled volarly with prox fragment dorsally. Distal phalanx may be angled dorsally. Key observation: nail bed injury, which considered an open Fx with a�risk of infection.
  • Rx: if <10-degree angulation-buddy-taping with motion rehab. CRPP vs. ORIF can be considered in complex cases-Orthopedic hand surgeon referral
  • Complication: loss of motion, necrosis, infection.May result with amputation
  • For additional common injuries: PIP is m/c dislocated joint. Mullet (Baseball) finger, Jersey finger and other injury refer to:
  • https://www.aafp.org/afp/2012/0415/p805.html

 

wrist hand diagnostic imaging el paso tx.

 

  • Felon: septic infection of the fingertip pulp typically with Staph.Aureus. Causes: needle prick(diabetics), paronychia, nail splinters, etc. m/c in index and thumb, presenting with pain, swelling, etc.
  • D/t specific pulp anatomy theinfection>swelling leads to pulp compartment syndrome-pressure and necrosis.
  • Rx: operative with incision distal to DIP, irrigation/debridement

Pediatric Wrist Injury

wrist hand diagnostic imaging el paso tx.
  • Incomplete Fx: Greenstick Fx, Torus (Buckle)Fx, Bowing (Plastic) deformity/Fx. D/t FOSHe.g. fell off the monkey bar. m/c affects <10-years-old.
  • Key Imaging diagnosis: degree of angulation/displacement, epiphyseal growth plate injury (Salter-Harris classification)
  • Rx: usually non-operative (closed reduction and casting)
wrist hand diagnostic imaging el paso tx.
  • Distal Radioulnar Joint (DRUJ) Instability-common injury following trauma as in FOOSHwith wrist hyperextension and rotation and disruption of DRUJ ligaments and TFCcomplex. Avulsion of ulnar styloid with the�dorsal or volar displacement of distal ulnar should be noted.
  • Imaging steps: x-rays initially, MRI may identify ligaments and TFC damage, MSKUScan help with ligaments tearing.
  • Note: isolated DRUJ volar (top image) and dorsal (bottom image) dislocation.

Wrist & Hand Arthritis

wrist hand diagnostic imaging el paso tx.
  • Wrist DJD-typically is secondary to trauma, scapholunate dissociation, SLAC, SNAC wrist, CPPD, Keinboch or Preiser Disease and others.
  • May lead to major functional loss
  • Imaging: typically presents as radiocarpal JSL, subchondral sclerosis,osteophytosis, subcortical cysts, and loose bodies. Typically additional induces intercarpal degeneration and particularly Tri-scaphe joint.
  • MRI may be helpful with early recognition of scapholunate dissociation, Lunate/Navicular AVN.
  • Rx: conservative vs. operative.
wrist hand diagnostic imaging el paso tx.
  • DJD Hand: Extremely common. True primary OA. MCP-never affected w/o DIP & PIP
  • If isolated MCP OA noted considerCPPD & Hemochromatosis (Hook-like osteophytes)
  • Clinically:
  • Mid-age females
  • Typically painless except 1st CMC OA
  • DIPs-Heberden nodes, PIPs-Bouchard nodes
  • Erosive OA (occasionally called�inflammatory OA�)
  • A Spectrum of OA but producing central proximal erosions at DIPs and PIPsresulting with very characteristic �gullwing� appearance. No systemic inflammation (no CRP, RF, Anti-CCP Ab)typically in middle-aged/elderly females, like Hand OA, often seen in families

Rheumatoid Arthritis

wrist hand diagnostic imaging el paso tx.

 

wrist hand diagnostic imaging el paso tx.
  • Rheumatoid Arthritis (RA)-chronic systemic inflammatory disease of unknown etiology, targeting synovial joints, tendons with multiple systemic involvement (lung, CVS, Ocular, Skin, etc.) Pathology: Tcell>Macrophage/APC>mediatedautoimmune process resulting in pannus formation and gradual destruction of ST, cartilage, bone,�and other tissues. 3% FemalesVS.1% Males. Environmental triggers: infection, trauma, smoking,�and others in a genetically susceptible individual. 20-30%may be disabled after 10-years.
  • Dx: clinical, labs, imaging.Symmetrical Polyarthritis esp. in MCP, wrists (2nd & 3RD MCP)
wrist hand diagnostic imaging el paso tx.

 

How Arthritis Can Affect the Knee

How Arthritis Can Affect the Knee

Arthritis is characterized as the inflammation of one or multiple joints. The most common symptoms of arthritis include pain and discomfort, swelling, inflammation, and stiffness, among others. Arthritis may affect�any joint in the human body, however, it commonly develops in the knee. � Knee arthritis can make everyday�physical activities difficult. The most prevalent types of arthritis are osteoarthritis and rheumatoid arthritis, although there are well over 100 distinct forms of arthritis, affecting children and adults alike. While there is no cure for arthritis, many treatment approaches can help treat the symptoms of knee arthritis.

 

Anatomy of the Knee

� The knee is the largest and strongest joint in the human body. It is made up of the lower end of the thigh bone,�or femur, the top end of the shin bone, or tibia, and the kneecap, or patella. The ends of the three bones are covered with articular cartilage, a smooth, slippery structure which protects and cushions the bones when bending and straightening the knee.

� Two wedge-shaped parts of cartilage, known as the meniscus, function as shock absorbers between the bones of the knee to help cushion the joint and provide stability. The knee joint is also surrounded by a thin lining known as the synovial membrane. This membrane releases a fluid which lubricates the cartilage and also helps reduce friction in the knee. The significant kinds of arthritis that affect the knee�include osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

 

Osteoarthritis

� Osteoarthritis is the most common type of arthritis which affects the knee joint. This form of arthritis is a degenerative, wear-and-tear health issue which occurs most commonly in people 50 years of age and older, however, it may also develop in younger people.

� In osteoarthritis, the cartilage in the knee joint gradually wears away. As the cartilage wears away, the distance between the bones decreases. This can result in bone rubbing and it can�create painful bone spurs. Osteoarthritis generally develops slowly but the pain may worsen over time.

 

Rheumatoid Arthritis

� Rheumatoid arthritis is a chronic health issue which affects multiple joints throughout the body, especially the knee joint. RA is also symmetrical, meaning it often affects the same joint on each side of the human body.

� In rheumatoid arthritis, the synovial membrane that covers the knee joint becomes inflamed and swollen, causing knee pain, discomfort, and stiffness. RA is an autoimmune disease, which means that the immune system attacks its own soft tissues. The immune system attacks healthy tissue,�including tendons, ligaments and cartilage, as well as softens the bone.

 

Post-traumatic Arthritis

� Posttraumatic arthritis is a form of arthritis that develops after damage or injury to the knee. By way of instance, the knee joint may be harmed by a broken bone, or fracture, and result in post-traumatic arthritis years after the initial injury. Meniscal tears and ligament injuries can cause additional wear-and-tear on the knee joint, which over time can lead to arthritis and other problems.

 

Symptoms of Knee Arthritis

� The most common symptoms of knee arthritis include pain and discomfort, inflammation, swelling, and stiffness. Although sudden onset is probable, the painful symptoms generally�develop gradually over time. Additional symptoms of knee arthritis can be recognized as follows:

 

  • The joint may become stiff and swollen, making it difficult to bend and straighten the knee.
  • Swelling and inflammation may be worse in the morning, or when sitting or resting.
  • Vigorous activity might cause the pain to flare up.
  • Loose fragments of cartilage and other soft tissue may interfere with the smooth motion of the joints, causing the knee to lock or stick through motion. It could also creak, click, snap or make a grinding sound, known as crepitus.
  • Pain can cause a sense of fatigue or buckling from the knee.
  • Many individuals with arthritis may also describe increased joint pain with rainy weather and climate changes.

 

 

Diagnosis for Knee Arthritis

� During the patient’s appointment for diagnosis of knee arthritis, the healthcare professional will talk about the symptoms and medical history, as well as conduct a physical examination. The doctor may also order imaging diagnostic tests, such as X-rays, MRI or blood tests for further diagnosis. During the physical examination, the doctor will search for:

 

  • Joint inflammation, swelling, warmth, or redness
  • Tenderness around the knee joint
  • Assortment of passive and active movement
  • Instability of the knee joint
  • Crepitus, the grating sensation inside the joint, with motion
  • Pain when weight is placed on the knee
  • Issues with gait, or manner of walking
  • Any signs of damage or injury to the muscles, tendons, and ligaments surrounding the knee joint
  • Involvement of additional joints (an indicator of rheumatoid arthritis)

 

Imaging Diagnostic Tests

 

  • X-rays. These imaging diagnostic tests produce images of compact structures, such as bones. They can help distinguish among various forms of arthritis. X-rays for knee arthritis may demonstrate a portion of the joint distance, changes in the bone as well as the formation of bone spurs, known as osteophytes.
  • Additional tests. Sometimes, magnetic resonance imaging, or MRI, scans, computed tomography, or CT,�scans, or bone scans are required to ascertain the condition of the bone and soft tissues of the knee.

 

Blood Tests

� Your doctor may also recommend blood tests to determine which type of arthritis you have. With some kinds of arthritis, such as rheumatoid arthritis, blood tests can help with the proper identification of the disease.

 

Dr Jimenez White Coat
Although the knee joint is one of the strongest and largest joints in the human body, it is often prone to suffering damage or injury, resulting in a variety of conditions. In addition, however, other health issues, such as arthritis, can affect the knee joint. In network for most insurances of El Paso, TX, chiropractic care can help ease painful symptoms associated with knee arthritis, among other health issues. Dr. Alex Jimenez D.C., C.C.S.T. Insight

Treatment for Knee Arthritis

 

Non-surgical Treatment

� Non-surgical treatment approaches are often recommended before considering surgical treatment for knee arthritis. Healthcare professionals may recommend a variety of treatment options, including chiropractic care, physical therapy, and lifestyle modifications, among others.

Lifestyle modifications. Some lifestyle modifications can help protect the knee joint and impede the progress of arthritis. Minimizing physical activities which aggravate the condition, will put less strain on the knee. Losing weight may also help lessen stress and pressure on the knee joint, resulting in less painful symptoms and increased function.

Chiropractic care and physical therapy.�Chiropractic care utilizes full body chiropractic adjustments to carefully restore any spinal misalignments, or subluxations, which may�be causing symptoms, including arthritis. The doctor may also recommend physical therapy to create an individualized exercise and physical activity program for each patient’s needs.�Specific exercises will help increase range of motion and endurance, as well as help strengthen the muscles in the lower extremities.

Assistive devices. Using assistive devices, such as a cane, shock-absorbing shoes or inserts, or a brace or knee sleeve, can decrease painful symptoms. A brace helps with function and stability, and may be particularly useful if the arthritis is based on one side of the knee. There are two types of braces that are often used for knee arthritis: A “unloader” brace shifts weight from the affected section of the knee, while a “support” brace helps support the entire knee load.

Drugs and/or medications. Several types of medications are useful in treating arthritis of the knee. Since individuals respond differently to medications, your doctor will work closely with you to determine the medications and dosages which are safe and effective for you.

 

Surgical Treatment

� The healthcare professional may recommend surgical treatment if the patient’s knee arthritis causes severe disability and only if the problem isn’t relieved with non-surgical treatment. Like all surgeries, there are a few risks and complications with surgical treatment for knee arthritis. The�doctor will discuss the possible problems with the patient.

Arthroscopy. During arthroscopy, physicians use instruments and small incisions to diagnose and treat knee joint problems. Arthroscopic surgery isn’t frequently used in the treatment of arthritis of the knee. In cases where osteoarthritis is accompanied with a degenerative meniscal tear, arthroscopic surgery may be wise to treat the torn meniscus.

Cartilage grafting. Normal cartilage tissue may be taken from a tissue bank or through a different part of the knee to fill out a hole in the articular cartilage. This process is typically considered only for younger patients.

Synovectomy. The lining damaged by rheumatoid arthritis is eliminated to reduce swelling and pain.

Osteotomy. In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut then reshaped to relieve stress and pressure on the knee joint. Knee�osteotomy is utilized when early-stage osteoarthritis has damaged one facet of the knee joint. By changing the weight distribution, this can relieve and enhance the function of the knee.

Total or partial knee replacement (arthroplasty).�The�doctor will remove the damaged bone and cartilage, then place new plastic or metal surfaces to restore the function of the knee�and its surrounding structures.

� Following any type of surgery for knee�arthritis will involve a period of recovery. Recovery time and rehabilitation will depend on the type of surgery performed. It’s essential to talk with your healthcare professional to determine the best treatment option for your�knee arthritis. The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.

� Curated by Dr. Alex Jimenez �

 

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Additional Topic Discussion: Relieving Knee Pain without Surgery

� Knee pain is a well-known symptom which can occur due to a variety of knee injuries and/or conditions, including�sports injuries. The knee is one of the most complex joints in the human body as it is made-up of the intersection of four bones, four ligaments, various tendons, two menisci, and cartilage. According to the American Academy of Family Physicians, the most common causes of knee pain include patellar subluxation, patellar tendinitis or jumper’s knee, and Osgood-Schlatter disease. Although knee pain is most likely to occur in people over 60 years old, knee pain can also occur in children and adolescents. Knee pain can be treated at home following the RICE methods, however, severe knee injuries may require immediate medical attention, including chiropractic care.

 

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EXTRA EXTRA | IMPORTANT TOPIC: El Paso, TX Chiropractor Recommended

Knee Arthritis: Diagnostic Imaging Approaches II | El Paso, TX.

Knee Arthritis: Diagnostic Imaging Approaches II | El Paso, TX.

Sagittal Fluid Sensitivity

knee arthritis chiropractic care el paso tx.
  • Sagittal Fluid Sensitive MR slice showing large synovial popliteal (Baker’s) cyst (above top image) and sizeable synovial effusion (above bottom image)
  • Note multiple patchy dark signal areas on both images, representing fibrinoid inflammatory deposits aka “rice bodies” a characteristic MRI feature of RA

Management Rheumatological Referral & DRM

Septic Arthritis (SA)

  • Septic arthritis – d/t bacterial or fungal contamination of the joint. SA may cause rapid joint destruction and requires prompt Dx and antibiotic administration
  • Joints affected: large joints with rich blood supply (knee 50%>hips>shoulders).
  • Routs of Infection:
  • 1) Hematogenous is m/c
  • 2) Spread from an adjacent site
  • 3) Direct implantation (e.g., trauma, iatrogenically)
  • Patients at risk: children, diabetics, immunocompromised, pre-existing joint damage/inflammation, e.g., RA, etc.
  • I.V. drug users are particularly at risk and also may contaminate atypical joints “the S joints” SIJ, SCJ, Symphysis pubis, ACJ, etc.

 

  • Clinically: may vary and depends on host immune response and bacterial virulence. May present with rapid onset or exacerbation of pre-existing joint pain, swelling, limitation of ROM. General signs of malaise, fever, fatigue and elevated ESR, CRP, Leucocytosis may be present.
  • N.B. Diabetics and immunocompromised may present with fewer manifestations and lack of fever d/t declining immune response
  • Dx: clinical, radiological and laboratory. Arthrocentesis may be necessary for culture, cell count and purulent synovial examination
  • Management: I.V. antibiotics
  • Imaging Dx: begins with radiography but in the early stage most likely will be unremarkable. MRI can be sensitive and help with early identification of joint effusion, bone edema, etc. US may be helpful in the superficial joints and children. US helps with needle guidance. Bone scintigraphy may be used occaisonally if MRI is contraindicated

Routes of Joint Contamination

knee arthritis chiropractic care el paso tx.

 

  • 1. Hematogenous (M/C)
  • 2. Spread from the adjacent site
  • 3. Direct inoculation
  • M/C organism-Staph aureus
  • N.B Gonococcal infection may be a top differential in some cases
  • IV drug users: Pseudomonas, candida
  • Sickle cell: Salmonella
  • Animal (cats/dogs) bites: Pasteurella
  • Occasionally fungal contamination may occur
knee arthritis chiropractic care el paso tx.

Radiography

knee arthritis chiropractic care el paso tx.

 

  • Initially non-specific ST/joint effusion, obscuration/distortion of fat planes. Because it takes 30% of compact and 50-75% trabecular bone to be destroyed before seen on x-rays, radiography is insensitive to some of the early changes. MR imaging is the preferred modality
  • If MRI is not available or contraindicated. Bone scintigraphy with Tc-99 MDT can help
  • In children, US preferred to avoid ionizing radiation. In children, US can be more sensitive than in adults due to lack of bone maturation

Radiographic Dx

knee arthritis chiropractic care el paso tx.

 

  • Early findings are unrewarding. Early features may include joint widening d/t effusion. Soft tissue swelling and obscuration/displacement of fat planes
  • 1-2 weeks: periarticular and adjacent osseous changes are manifesting as patchy demineralization, moth-eaten, permeating bone destruction, loss, and indistinctness of the epiphyseal “white cortical line” with an increase in soft tissue swelling. MRI may be helpful with early Dx.
  • Late features: complete joint destruction and ankyloses
  • N.B. Septic arthritis may progress rapidly within days and requires early I.V. antibiotic to prevent major joint destruction

T1 & T2 Knee MRI

knee arthritis chiropractic care el paso tx.

 

  • T1 (above left) and T2 fat-sat sagittal knee MRI slices reveal loss of normal marrow signal on T1 and increase on T2 due to septic edema. Bone sequestrum d/t osteomyelitis progressing into septic arthritis is noted. Marked joint effusion with adjacent soft tissue edema is seen. Dx: OSM and septic arthritis
  • Imaging may help the Dx of the septic joint. However, the final Dx is based on Hx, physical examination, blood tests and most importantly synovial aspiration (arthrocentesis)
  • Synovial fluid should be sent for Gram staining, culture, glucose testing, leukocyte count, and differential determination
  • ESR/CRP may be elevated
  • Synovial fluid: WBC can be 50,000-60,000/ul, with 80% neutrophils with depleted glucose levels Gram stain: in 75% gram-positive cocci. Gram staining is less sensitive in gonococcal infection with only 25% of cultures +
  • In 9% of cases, blood cultures are the only source of pathogen identification and should be obtained before antibiotic treatment
  • Articles: https://www.aafp.org/afp/2011/0915/p653.html
  • https://www.aafp.org/afp/2016/1115/p810.html

Crystal-Induced Knee Arthritis

  • Crystalline arthritis: a group of arthropathies resulting from crystal deposition in and around the joint.
  • 2-m/c: Monosodium urate crystals (MSU)� and Calcium Pyrophosphate Dehydrate crystals (CPPD) arthropathy
  • Gout: MSU deposition in and around joints and soft tissues. Elevated levels of serum uric acid (UA) (>7mg/dL) caused by overproduction or under-excretion of uric acid
  • Once UA reached/exceeded 7mg/dL, it will deposit in the peripheral tissues. Primary gout: disturbed metabolism of nucleic acids and purines break down. Secondary gout: increased cell turnover: Psoriasis, leukemia, multiple myeloma, hemolysis, chemotherapy, etc.
  • Gout presents with 5-characteristic stages:
  • 1)asymptomatic hyperuricemia (years/decades)
  • acute attacks of gouty arthritis (waxes and wanes and lasts for several years)
  • Interval phase between attacks
  • Chronic tophaceous gout
  • Gouty nephropathy
knee arthritis chiropractic care el paso tx.

 

Clinical Presentation

  • Depends� on stages
  • Acute attacks: acute joint pain “first and the worst” even painful to light touch
  • DDx: septic joint (both may co-exist) bursitis etc.
  • Gouty arthritis typically presents as monoarthropathy
  • Chronic tophaceous stage: deposits in joints, ear pinna, ocular structures, and other regions. Nephrolithiasis etc. Men>women. Obesity, diet, and age >50-60.
  • Radiography: early attacks are unremarkable and may present as non-specific joint effusion
  • Chronic tophaceous gout radiography: punched out peri-articular, para-articular and intraosseous erosions with overhanging edges. A characteristic rim of sclerosis and internal calcification, soft tissue tophi. Target sites: lower extremity m/c
  • Rx: allopurinol, colchicine (esp. preventing acute episodes and maintenance)

Synovial Aspiration

knee arthritis chiropractic care el paso tx.

 

  • Synovial aspiration with polarized microscopy reveal negatively birefringent needle-shaped MSU crystals with large inflammatory PMN presence. DDx: positively birefringent rhomboid-shaped CPPD crystals (above bottom right) seen in Pseudogout and CPPD
knee arthritis chiropractic care el paso tx.

 

Large S.T.

knee arthritis chiropractic care el paso tx.

 

  • Density and joint effusion punched out osseous erosion with overhanging margins, overall preservation of bone density, internal calcifications Dx: chronic tophaceous gout

MRI Gout Features

knee arthritis chiropractic care el paso tx.

 

  • Erosions with overhanging margins, a low signal on T1 and high on T2 and fat-suppressed images. Peripheral contrast enhancement of tophaceous deposits d/t granulation tissue
  • Dx: final Dx; synovial aspiration and polarized microscopy

Additional Articles

Knee Arthritis

 

Knee Arthritis: Diagnostic Imaging Approaches I | El Paso, TX.

Knee Arthritis: Diagnostic Imaging Approaches I | El Paso, TX.

Degenerative Knee Arthritis

  • Knee Arthritis
  • Knee OA (arthrosis) is the m/c symptomatic OA with 240 cases per 100,000, 12.5% of people >45 y.o.
  • Modifiable risk factors: trauma, obesity, lack of fitness, muscle weakness
  • Non-modifiable: women>men, aging, genetics, race/ethnicity
  • Pathology: da disease of the articular cartilage. Continuing mechanical stimulation follows by an initial increase in water and cartilage thickness. Gradual loss of proteoglycans and ground substance. Fissuring/splitting. Chondrocytes are damaged and release enzymes into the joint. Cystic progression and further cartilage loss. Subchondral bone is denuded and exposed to mechanical stresses. It becomes hypervascular forming osteophytes. Subchondral cysts and bone thickening/sclerosis develop.
  • Imaging plays a crucial role in Dx/grading and management
  • Clinically: pain on walking/rest, crepitus, swelling d/t synovitis, locking/catching d/t osseocartilaginous fragments and gradual functional loss. Knee OA typically presents as mono and oligoarthritis. DDx: morning pain/stiffness is >30-min DDx from inflammatory arthritis
  • Treatment: in mild to moderate cases-conservative care. Severe OA-total knee arthroplasty

OA: L.O.S.S. Radiologic Presentation

knee arthritis chiropractic care el paso tx.

 

  • Typical radiologic-pathologic presentation of� OA: L.O.S.S.
  • Loss of joint space (non-uniform/asymmetrical)
  • Osteophytes
  • Subchondral sclerosis
  • Subchondral cysts
  • Bone deformity: Genu Varum- is the m/c deformity d/t medial knee compartment affected more severely
  • In addition: a weakening of periarticular soft tissues, instability and other changes

Imaging

knee arthritis chiropractic care el paso tx.

 

  • Radiography is the modality of choice
  • Views should include b/l weight bearing
  • Evaluation of joint space is crucial. Normal joint space -3-mm
  • Grading is based on the degree of joint space narrowing (JSN), osteophytes, bone deformation, etc.
  • Grade 1: minimal JSN, suspicious osteophytes
  • Grade 2: appreciable osteophytes and JSN on AP weight-bearing view
  • Grade 3: multiple osteophytes, definite JSN, subchondral sclerosis
  • Grade 4: severe JSN, large osteophytes, marked subchondral sclerosis and definite bony deformity
  • Typical report language will state:
  • Minor, mild, moderate or severe aka advanced arthrosis

Technique

knee arthritis chiropractic care el paso tx.

 

  • Radiography: AP weight-bearing knees: note severe JSN of the medial compartment more severely with lateral knee compartment. Osteophytes and marked genu varum deformity and bone deformation
  • Typically medial femorotibial compartment is affected early and more severely
  • The patellofemoral compartment is also affected and best visualized on the lateral and Sunrise views
  • Impressions: severe tri-compartmental knee arthrosis
  • Recommendations: referral to the orthopedic surgeon

Moderate JSN

knee arthritis chiropractic care el paso tx.

 

  • B/L AP weight-bearing view (above top image): Moderate JSN primarily of the medial femorotibial compartment. Osteophytosis, subchondral sclerosis and mild bone deformation (genu varum)
  • Additional features: PF OA, intra-articular osteophytes, secondary osteocartilaginous loose bodies and subchondral cysts (above arrows)

Secondary Osteochondromatosis

knee arthritis chiropractic care el paso tx.

 

  • Intra-articular osteocartilaginous loose bodies known as secondary osteochondromatosis
  • Typical in DJD especially of the large joints
  • It may accelerate further cartilage destruction and progression of OA
  • May worsen signs of synovitis
  • Intra-articular locking, catching etc.

Management of Severe Knee OA

knee arthritis chiropractic care el paso tx.

 

  • Conservative care: NSAID, exercise, weight loss etc.
  • Operative care should be used if conservative care failed or symptoms progress despite conservative efforts in severe OA cases
  • Review article
  • https://www.aafp.org/afp/2018/0415/p523.html

Calcium Pyrophosphate Dehydrate Deposition Disease

knee arthritis chiropractic care el paso tx.

 

  • CPPD arthropathy common in the knee
  • May present as asymptomatic chondrocalcinosis, CPPD arthropathy resembling DJD with pan predominance of large subchondral cysts. Often found as isolated PFJ DJD
  • Pseudogout with an acute attack of knee pain resembling gouty arthritis
  • Radiography is the 1st step and often reveals the Dx
  • Arthrocentesis with polarized microscopy may be helpful to DDx between CPPD and Gouty arthritis

Rheumatoid Arthritis

  • RA: an autoimmune systemic inflammatory disease that targets soft tissues of joints synovium, tendons/ligaments, bursae and extra-articular sites (e.g., eyes, lungs, cardiovascular system)
  • RA is the m/c inflammatory arthritis, 3% of women and 1% of men. Age: 30-50 F>M 3:1, but may develop at any age. True RA is uncommon in children and should not be confused with Juvenile Idiopathic Arthritis
  • RA most often affects small joints of the hands and feet as symmetrical arthritis (2nd 3rd MCP, 3rd PIPs, wrists & MTPs, sparing DIPs of fingers and toes)
  • Radiographically: RA presents with joint effusion leading to hyperemia and marginal erosions and periarticular osteoporosis. In the knee, the lateral compartment is affected more frequently leading to valgus deformity. Uniform aka concentric/symmetrical JSN affects all compartments and remains a key Dx clue
  • An absence of subchondral sclerosis and osteophytes. Popliteal cyst�(Baker’s cyst) may represent synovial pannus and inflammatory synovitis extending into the popliteal region that may rapture and extend into posterior leg compartment
  • N.B. Following initial RA joint destruction, it is not unusual to note superimposed 2nd OA
  • Radiography is the 1st step but early joint involvement may be undetectable by x-rays and can be helped by US and/or MRI.
  • Lab tests: RF, CRP, anti-cyclic citrulline peptide antibodies (anti-CCP Ab). CBC
  • Final Dx is based on Hx, clinical exam, labs, and radiology
  • Clinical pearls: patients with RA may present with a single knee being affected
  • Most patients are likely to have bilateral symmetrical hands/feet RA.
  • Cervical spine, particularly C1-2 is affected in 75-90% of cases throughout the course of the disease
  • N.B. Sudden exacerbation of joint pain in RA should not underestimate septic arthritis because patients with pre-existing RA are at higher risk of infectious arthritis. Joint aspiration may help with Dx.

Radiographic DDx

knee arthritis chiropractic care el paso tx.

 

  • RA (above left) vs. OA (above right)
  • RA: concentric (uniform) joint space loss, lack of osteophytes and juxta-articular osteopenia.
  • Clinical Pearls: patients with RA may present radiographically with subchondral sclerosis d/t superimposed DJD. The latter feature should not be interpreted as OA but instead considered as secondary OA

AP Knee Radiograph

knee arthritis chiropractic care el paso tx.

 

  • Note marked uniform JSN, juxta-articular osteopenia and subchondral cystic changes
  • Clinical Pearls: subcortical cysts in RA will characteristically lack sclerotic rim noted in OA-associated subcortical cysts.

MRI Sensitivity

knee arthritis chiropractic care el paso tx.

 

  • MRI is very sensitive and may aid during early Dx of RA.
  • T2 fat-sat or STIR and T1 + C gad contrast fat-suppressed sequences may be included
  • MRI Dx of RA: synovial inflammation/effusion, synovial hyperplasia, and pannus formation decreased cartilage thickness, subchondral cysts, and bone erosions
  • MRI is very sensitive to reveal juxt-articular bone marrow edema, a precursor to erosions
  • Intra-articular fibrinoid fragments known as “Rice bodies” are characteristic MR sign of RA
  • Note: T2 fat-sat sagittal MRI revealing large inflammatory joint effusion and pannus synovial proliferation (above arrowheads). No evidence of radiographic or MRI bone erosions present. Dx: RA

STIR MR Slices

knee arthritis chiropractic care el paso tx.

 

  • Note: STIR MR slices in the axial (above bottom image) and coronal planes (above top image) demonstrate extensive synovitis/effusion (above arrowheads) and multiple erosions in the medial and lateral tibial plateau (above arrows)
  • Additionally, scattered patchy areas of bone marrow edema are noted (above asterisks) such marrow edema changes are indicative and predictive of future osseous erosions.
  • Additional features: note thinning and destruction of joint cartilage

Knee Arthritis

 

Diagnosis of Hip Complaints: Arthritis & Neoplasms Part II | El Paso, TX.

Diagnosis of Hip Complaints: Arthritis & Neoplasms Part II | El Paso, TX.

Ischemic Osteonecrosis

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Ischemic Osteonecrosis (More accurate term) aka avascular necrosis AVN: this term describes subarticular (subchondral) bone death
  • Intramedullary bone infarct: depicts osteonecrosis within the medullary cavity of the bone (above x-ray image)
  • Causes: m/c: trauma, systemic corticosteroids, diabetes, vasculitis in SLE. The list is long. Other vital causes: Sickle cell disease, Gaucher disease, alcohol, caisson disease, SCFE, LCP, etc.
  • Pathology: ischemia and bone infarct with resultant devitalized center surrounded by ischemia and edema with normal bone on the outer periphery (MRI double line sign)
  • Sub-articular necrotic bone eventually collapses and fragments leading to progressive bone and cartilage destruction and rapidly progressing DJD
  • Early Dx often missed but crucial to prevent severe DJD

M/C Sites

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Hips, shoulders, talus, scaphoid bone. Many peripheral idiopathic AVN sites are known by their eponyms (e.g., Kienbock aka AVN of the lunate bone, Preisier aka scaphoid AVN)
  • Radiography is insensitive to early AVN and may only present as subtle osteopenia
  • Some of the early appreciable rad features are increased patchy bone sclerosis followed by sub-articular bone collapse or “crescent sign” signifying stage-3 on Ficat classification (above)
  • Earliest detection and early intervention can be achieved by MRI (most sensitive modality)
  • If MRI contraindicated or unavailable, 2nd most sensitive modality is radionuclide bone scan (scintigraphy)
  • X-ray and CT scanning are of equal value

Coronal MRI Slice

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Fluid sensitive, sensitive coronal MRI slice revealing bill ischemic osteonecrosis of the femoral head
  • MRI findings: l

Tc99-MMDP Radionuclide Bone

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Bone scan reveals a central area of photopenia (cold spot) d/t necrotic fragment surrounded by increased osteoblastic activity as increased uptake of Tc-99 MDP in the right hip
  • The patient is a 30-year-old female with breast cancer and chemotherapy treatment who suddenly presented with right hip pain

Radiographic Progression of AVN

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Later stages present with articular collapse, subarticular cysts, increased patchy sclerosis and complete flattening of the femoral head with resultant severe DJD. Rx: THA

Management

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Early imaging Dx with MRI or bone scintigraphy is essential
  • Referral to the Orthopedic surgeon
  • Core decompression (above) can be used to revascularize the affected bone during earlier stages but produces mixed results
  • Delayed changes of AVN: THA as IN severe DJD cases

B/L THA

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • B/L THA in the patient with ischemic osteonecrosis of the right and later left hip
  • When B/L hip AVN is present, typically consider systemic causes (corticosteroids, diabetes)

Inflammatory Arthritis Affecting the Hip

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Consider common systemic inflammatory condition such as RA and AS/EnA
  • Hip RA may develop in 30% of patients with RA
  • Key features to DDx inflammatory arthritis vs. DJD is symmetrical/uniform aka concentric joint loss often leading to axial migration and Protrusion Acetabule in advanced cases
  • Key element between RA vs. AS: the presence of RA bone erosion w/o productive bone changes or enthesitis in AS d/t inflammatory subperiosteal bone proliferation, whiskering/fluffy periostitis (collar-type enthesitis circumferentially affecting head-neck junction)
  • Dx: Hx, PE, labs: CRP, RH, anti-CCP Ab (RA)
  • CRP, HLA-B27, RF- (AS)

Septic Arthritis

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Gonococcal infections, iatrogenic causes, I.V. drug use, and some others
  • Routes:�hematogenous, adjacent spread, direct inoculation (e.g., iatrogenic)
  • Clinically: pain and reduced ROM presented as monoarthritis, generalized signs/symptoms. CBC, ESR, CRP changes. ARthrocentesis and culture are crucial
  • M/C pathogen Staph. Aureus & Neisseria Gonorrhea
  • 1st step: radiography, often unrewarding in the early stage. Later (4-10 days) indistinctness of the white cortical line at the femoral articular epiphysis, loss of joint space, effusion as a widening of the medial joint area (Waldenstrom sign)
  • MRI – best at early DX: T1, T2, STIR, T1+C may help with early. Early I.V. antibiotics crucial to prevent rapid joint destruction

Slipped Capital Femoral Epiphysis (SCFE)

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Important to diagnose but easily missed potentially leading to Ischemic Osteonecrosis of the femoral head aka AVN
  • Presents typically in overweight children (more often boys), age over eight years. Greater incidence in African-American boys
  • 1st step: radiography, especially look for a widened physeal growth plate (so-called pre-slip). Later, slip and disturbed Klein’s line (above image). MRI – best modality for early Dx and early intervention
  • The frog lateral view often demonstrates the medial slip better than the AP view

Clinically Limping Child or Adolescent

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • M>F (10-18 years). African-Americans are at greater risk. 20% of cases of SCFE are B/L. Complications: AVN >>DJD
  • Radiography:�AP pelvis, spot, and frog leg may reveal slippage as Klein line failed to cross through the lateral aspect of the femoral head
  • Additional features: physis may appear widened
  • MRI w/o gad, is required for the earliest Dx and prevention of complications (AVN)

Normal and Abnormal Klein Line

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Consistent with SCFE. The physis is also widened. Dx: SCFE
  • Urgent referral to the Pediatric Orthopedic surgeon

Subtle Changes in Left Hip

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Note suspected subtle changes in the left hip that may require MR examination to confirm the Dx
  • Delay in care may result in major complications

Perthes’ Disease

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • aka Legg-Calves-Perthes Disease (LCP)
  • Refers to Osteochondritis of the femoral head with osteonecrosis likely d/t disturbed vascularization of the femoral head
  • Presents typically in children (more often boys) aged under eight years as atraumatic “limping child.” 15% may have B/L Perthe’s
  • Imaging steps: 1st step x-radiography, followed by MRI especially in stage 1 (early) w/o x-ray abnormalities
  • Unspecific signs: joint effusion with Waldenstrome sign+ (>2-mm increase in medial joint space compared to the opposite side). Past approach: Fluoroscopic Arthrography (replaced by MRI)
  • Pathologic-Radiologic Correlation: in well-established cases, the femoral head characteristically becomes sclerotic, flattened and fragmented due to avascular necrosis (AVN). Later on, an occasional Coxa Magna changes may develop (>10% femoral head enlargement)
  • Management: symptoms control, bracing. Boys at younger ate show better prognosis d/t more immaturity and better chances of bone/cartilage repair mechanisms. In advanced cases, operative care: osteotomy, hip arthroplasty in adulthood if advanced DJD develops

Common Neoplasms & Other Conditions Affecting Hip/Pelvis

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • M/C hip & pelvis neoplasms in adults: bone metastasis ( above far left), 2nd m/c Multiple Myeloma (M/C primary bone malignancy in adults). Tips: remember Red Marrow distribution. Less frequent: Chondrosarcoma
  • Paget’s disease of bone (above-bottom left image) is m/c detected in the pelvis and Femurs
  • Children and young adults ‘limping child’ benign neoplasms: Fibrous Dysplasia (above middle image), Solitary Bone Cyst (21%), Osteoid Osteoma, Chondroblastoma. Malignant pediatric neoplasms: m/c Ewing Sarcoma (above middle right and bottom images) vs. Osteosarcoma. >2y.o-consider Neuroblastoma
  • Imaging: 1st step: radiography followed by MRI are most appropriate.
  • If Mets are suspected: Tc99 bone scintigraphy is most sensitive

Multiple Myeloma

diagnosis hip arthritis and neoplasms el paso, tx.

 

  • Multiple Myeloma in a 75-y.o male (AP pelvis view)
  • Chondrosarcoma in a 60-y.o male (axial and coronal reconstructed CT+C slices in the bone window)

 

Hip Pelvis Arthritis & Neoplasms

Diagnosis of Hip Complaints: Arthritis & Neoplasms Part I | El Paso, TX.

Diagnosis of Hip Complaints: Arthritis & Neoplasms Part I | El Paso, TX.

Degenerative Joint Disease (DJD)

diagnosis hip arthritis and neoplasms el paso tx.

Macroscopic & Microscopic Appearance of Normal vs. Damaged Articular Hyaline Cartilage by DJD

diagnosis hip arthritis and neoplasms el paso tx.

Hip Osteoarthritis (OA) aka Osteoarthrosis

diagnosis hip arthritis and neoplasms el paso tx.
  • Symptomatic and potentially disabling DJD
  • Progressive damage and loss of the articular cartilage causing denudation and eburnation of articular bone
  • Cystic changes, osteophytes, and gradual joint destruction
  • Develops d/t repeated joint loading and microtrauma
  • Obesity, metabolic/genetic factors
  • Secondary Causes: trauma, FAI syndrome, osteonecrosis, pyrophosphate crystal deposition, previous inflammatory arthritis, Slipped Capital Femoral Epiphysis, Leg-Calves-Perthes disease in children, etc.
  • Hip OA, 2nd m/c after knee OA. Women>men
  • 88-100 symptomatic cases per 100000

Radiography is the Modality of Choice for the Dx and Grading of DJD

diagnosis hip arthritis and neoplasms el paso tx.
  • Special imaging is not required unless other complicating factors exist
  • The acetabular-femoral joint is divided into superior, axial and medial compartments/spaces
  • Normal joint space at the superior compartment should be 3-4-mm on the AP hip/pelvis view
  • Understanding the pattern of hip joint narrowing/migration helps with the DDx of DJD vs. Inflammatory arthritis
  • In DJD, m/c hip narrowing is superior-lateral (non-uniform) vs. inflammatory axial (uniform)

AP Hip Radiograph Demonstrates DJD

diagnosis hip arthritis and neoplasms el paso tx.
  • With a non-uniform loss of joint space (superior migration), large subcortical cysts and subchondral sclerosis
  • Radiographic features:
  • Like with any DJD changes: radiography will reveal L.O.S.S.
  • L: loss of joint space (non-uniform or asymmetrical)
  • O: osteophytes aka bony proliferation/spurs
  • S: Subchondral sclerosis/thickening
  • S: Subcortical aka subchondral cysts “geodes.”
  • Hip migration is m/c superior resulting in a “tilt deformity.”

Radiographic Presentation of Hip OA May Vary Depending On Severity

diagnosis hip arthritis and neoplasms el paso tx.
  • Mild OA: mild reduction of joint space often w/o marked osteophytes and cystic changes
  • During further changes, collar osteophytes may affect femoral head-neck junction with more significant joint space loss and subchondral bone sclerosis (eburnation)
  • Cyst formation will often occur along the acetabular and femoral head subarticular/subchondral bone “geodes” and usually filled with joint fluid and some intra-articular gas
  • Subchondral cysts may occasionally be very large and DDx from neoplasms or infection or other pathology

Coronal Reconstructed CT Slices in Bone Window

diagnosis hip arthritis and neoplasms el paso tx.
  • Note moderate joint narrowing that appears non-uniform
  • Sub-chondral cysts formation (geodes) are noted along the acetabular and femoral head subchondral bone
  • Other features include collar osteophytes along head-neck junction
  • Dx: DJD of moderate intensity
  • Referral to the Orthopedic surgeon will be helpful for this patient

AP Pelvis (below the first image), AP Hip Spot (below the second image) CT Coronal Slice

diagnosis hip arthritis and neoplasms el paso tx.
  • Note multiple subchondral cysts, severe non-uniform joint narrowing (superior-lateral) and subchondral sclerosis with osteophytes
  • Advanced hip arthrosis

Severe DJD, Left Hip

diagnosis hip arthritis and neoplasms el paso tx.
  • When reading radiological reports pay particular attention to the grading of hip OA
  • Most severe (advanced) OA cases require total hip arthroplasty (THA)
  • Refer your patients to the Orthopedic surgeon for a consultation
  • Most mild cases are a good candidate for conservative care

Hip Arthroplasty aka Hip Replacement

diagnosis hip arthritis and neoplasms el paso tx.
  • Can be total or hemiarthroplasty
  • THA can be metal on metal, metal on polyethylene and ceramic on ceramic
  • A hybrid acetabular component with polyethylene and metal backing is also used (above right image)
  • THA can be cemented (above right image) and non-cemented (above-left image)
  • Non-cemented arthroplasty is used on younger patients utilizing porous metallic parts allowing good fusion and bone ingrowth into the prosthesis

Failed THA May Develop

diagnosis hip arthritis and neoplasms el paso tx.
  • Most develop within the first year and require revision
  • Femoral stem may fracture (above left)
  • Postsurgical infection (above right)
  • Fracture adjacent to the prosthesis (stress riser)
  • Particle disease

Femoroacetabular Impingement Syndrome

diagnosis hip arthritis and neoplasms el paso tx.
  • (FAI): abnormality of normal morphology of the hip leading to eventual� cartilage damage and premature DJD
  • Clinically:hip/groin pain aggravated by sitting (e.g., hip flexed & externally rotated). Activity related pain on axial loading esp. with hip flexion (e.g., walking uphill)
  • Pincer-type�acetabulum: > in middle age women potentially� many causes
  • CAM-type deformity:�> in men in 20-50 m/c 30s
  • Mixed type (pincer-CAM) is most frequent
  • Up until the 90s, FAI was not well-recognized

FAI Syndrome

diagnosis hip arthritis and neoplasms el paso tx.
  • CAM-type FAI syndrome
  • Radiography can be a reliable Dx tool
  • X-radiography findings:�osseous bump on the lateral aspect of femoral head-neck junction. Pistol-grip deformity. Loss of normal head sphericity. Associated features: os acetabule, synovial herniation pit (Pit’s pit). Evidence of DJD in advanced cases
  • MRI and MR arthrography (most accurate Dx of labral tear) can aid the diagnosis of labral tear and other changes of FAI
  • Referral to the Orthopedic surgeon is necessary to prevent DJD progression and repair labral abnormalities. Late Dx may lead to irreversible changes of DJD

AP Pelvis: B/L CAM-type FAI syndrome

diagnosis hip arthritis and neoplasms el paso tx.

Pincer-Type FAI with Acetabula Over-Coverage

diagnosis hip arthritis and neoplasms el paso tx.
  • Key radiographic signs: “Cross-over sign” and abnormal center-edge and Alfa-angle evaluation methods

Dx of FAI

diagnosis hip arthritis and neoplasms el paso tx.
  • Center-edge angle (above the first image) and Alfa-angle (above the second image)
  • B/L CAM-type FAI with os acetabule�(above right image)

MR Arthrography

diagnosis hip arthritis and neoplasms el paso tx.

Hip Pelvis Arthritis & Neoplasms

Ankylosing Spondylitis Sufferers Find Relief With Chiropractic. El Paso, TX.

Ankylosing Spondylitis Sufferers Find Relief With Chiropractic. El Paso, TX.

Ankylosing Spondylitis is a type of arthritis that typically begins during adolescence or in a person�s early twenties and occurs more often in men than in women. However, once experiences onset, they are affected for the rest of their lives. It is estimated that between 0.2% and 0.5% of individuals in the United States suffers from ankylosing spondylitis. �It can cause significant pain, discomfort, and immobility. While there is no cure for the condition, the symptoms can be treated, bringing some degree of comfort and mobility.

What is Ankylosing Spondylitis?

Ankylosing Spondylitis, or AS, is a type of arthritis that causes inflammation in the spine. While the vertebrae are primarily involved, it can also affect other joints as well, including the hips, shoulders, heels, ribs, and the small joints of the feet and hands.

In some cases, the heart, lungs, and even eyes can be involved. If left untreated, the condition can progress, causing chronic pain that can be severe as the spinal inflammation increases. More advanced cases can cause the spine to grow new bone formations so that it is immobile, or fixed, sometimes resulting in kyphosis, which is a bowed or forward-stooped posture.

What Causes Ankylosing Spondylitis?

While genetics is believed to be a key player in the development of Ankylosing Spondylitis, the exact cause has not yet been determined. The majority of people who have AS also carry a specific gene that has been linked to the condition.

This gene produces HLA-B27, a protein or genetic marker, that more than 95% of Caucasians with ankylosing spondylitis have. However, some people don�t have this protein who develop AS and many people do carry this marker yet never develop the condition.

Researchers theorize that there may be other genes that may be involved, as well as environmental factors that trigger the gene activation, such as a bacterial infection, causing people who are susceptible to AS to activate it. Scientists have identified more than 60 genes that are believed to be associated with AS with only about 30% that are linked to HLA-B27 regarding overall risk. Other genes that have been identified as key to AS include IL-23, IL-17, IL-12, and ERAP.

It is also believed that AS can be triggered when the intestinal defenses break down, allowing certain bacteria into the bloodstream. This can, in turn, cause an immune response.

 Ankylosing Spondylitis chiropractic treatment el paso tx.

How is Ankylosing Spondylitis Treated?

AS cannot be cured, but the symptoms can be treated to relieve stiffness and pain as well as delay or prevent spinal deformity and other complications. The damage that it does to the joints is irreversible, so it is best if treatment is started before that occurs. There are several ways that AS is treated:

  • Medication � Nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin (Indocin) and naproxen (Naprosyn) are commonly used to treat the symptoms of AS. They can be useful in relieving pain, inflammation, and stiffness but may cause some side effects, including gastrointestinal bleeding. This makes long-term use impractical and even unsafe. If NSAIDs do not help, other medications may be prescribed, including:
    • Golimumab (Simponi; Simponi Aria)
    • Certolizumab pegol (Cimzia)
    • Adalimumab (Humira)
    • Etanercept (Enbrel)
    • Infliximab (Remicade)
  • Physical therapy – PT is often recommended to help with flexibility, strength, and pain relief. It can help with posture and prevent some of the more debilitating symptoms.
  • Surgery � Most people with AS do not require surgery, but it may be recommended if there is severe joint damage or pain. In some cases, it can cause significant damage to hip joints, and they will need to be replaced.
  • Chiropractic � Many patients with AS have with outstanding results with chiropractic treatment. It is non-invasive and does not have the unpleasant side effects that many medications have.

Chiropractic Treatment for Ankylosing Spondylitis

Chiropractors strongly recommend chiropractic treatment for the non-acute inflammatory stage of AS. Once the condition has progressed to acute joint disease, there is a very high risk of injury or damage to the connective tissue. Adjustments and exercise are used to relieve symptoms, but some of the traditional spinal manipulation treatments are not performed.

A chiropractor will also make recommendations to the patient regarding lifestyle changes that can help with symptoms, such as stopping smoking. Tobacco use can increase inflammation and damage connective tissue. They may also advise increasing their intake of omega three fatty acids in their diet. Regular chiropractic care can help patients manage symptoms and prevent disease progression, improving their quality of life.

Cerebral Palsy Chiropractic Treatment

Spinal Arthritis Diagnostic Imaging Approach Part II

Spinal Arthritis Diagnostic Imaging Approach Part II

 

spinal arthritis el paso tx.

 

  • Spinal Arthritis
  • Ossification of Posterior Longitudinal Ligament (OPLL). Less frequent than DISH.
  • Greater clinical importance d/t spinal canal stenosis and cervical myelopathy
  • Asian patients are at higher risk
  • Both OPLL & DISH may co-exist and increase the risk of Fx
  • Imaging: x-rad: linear radioopacity consistent with OPLL
  • Imaging modality of choice: CT scanning w/o contrast
  • MRI may help� to evaluate myelopathy
  • Care: surgical with laminoplasty (above right image) that has been pioneered and advanced in the Far East

 

M/C Inflammatory Arthritis In Spine

 

spinal arthritis el paso tx.

 

  • Rheumatoid spondylitis (Rheumatoid arthritis) d/t inflammatory synovial proliferation pannus rich in lymphocytes, macrophages, and plasma cells
  • C/S RA may affect 70-90% of patients
  • Variable severity from mild to destructive disabling arthropathy
  • RA IN C/S m/c affects C1-C2 due to an abundance of rich synovial tissue
  • Typically infrequent in the thoracic/lumbar region
  • Sub-axial C/spine may be affected later due to facets, erosions, ligament laxity and instability showing “Stepladder” appearance
  • Clinically: HA, neck pain, myelopathy, etc. inc. Risk of Fx/subluxation. Any spinal manipulation HVLT ARE STRICTLY CONTRAINDICATED.
  • Rx: DMARD, anti-TNF-alfa, operative for subluxations, etc.

 

Rheumatoid Spondylitis C1-C2. Perform X-radiography initially with flexed-extended views. Note Dens erosion, C1-2 subluxation (2.5 mm) that changes on mobility

 

spinal arthritis el paso tx.

 

spinal arthritis el paso tx.

 

  • RA spondylitis: an erosion of the odontoid with the destruction of C1-C2 ligaments and instability
  • Stepladder aka Step-step sub-axial deformity d/t facets erosions and ligamentous destruction/laxity
  • MRI required to evaluate cord compression/myelopathy

 

spinal arthritis el paso tx.

 

  • Sagittal T2 WI MRI of pt with RA. Rheumatoid pannus formation is present at C1-2 (arrow) causing mild cord compression
  • RA pannus may develop early before frank x-radiography changes noted
  • Clinically: HA, neck pain, tingling in UE, positive Lhermitte phenomenon d/t cervical myelopathy

 

Operative Care of Rheumatoid Spondylitis and Its Complications

 

spinal arthritis el paso tx.

 

Seronegative Spondyloarthropathies

 

  • Ankylosing Spondylitis (AS)
  • Enteropathic Arthritis (EnA) (d/t IBD: Crohn’s & UC) identical to AS on imaging
  • Psoriatic Arthritis (PsA)
  • Reactive Arthritis (ReA)
  • All share the following features: m/c HLA-B27 marker, RF-, Sacroiliitis, Enthesitis, Ocular Involvement (i.e., conjunctivitis, uveitis, episcleritis, etc.)
  • AS & EnA are radiographically virtually indistinguishable, but EnA typically presents with less severe spinal changes than AS
  • Both PsA & ReA present with virtually identical spinal changes, but ReA typically affects the lower extremity compared to PsA affecting hands and feet

 

spinal arthritis el paso tx.

 

spinal arthritis el paso tx.

 

  • AS: likely autoimmune systemic inflammatory disease that targets SIJ, spinal facet joints annuls of the disc, rib joints and all spinal ligaments.
  • Key path feature: enthesitis.
  • Extraspinal features: uveitis, aortitis, pulmonary fibrosis, amyloidosis, cardiovascular disease.
  • M:F 4:1, age: 20-40 m/c. Clinic LBP/stiffness, reduced rib expansion <2 cm is > specific than HLA-B27, progressive kyphosis, risk of Fx’s.
  • Imaging steps: 1st step-x-rays to id. Sacroiliitis/spondylitis.�MRI & CT may help if x-rays are unrewarding.
  • Labs: HLA-B27, CRP/ESR, RF-
  • Dx: clinical+labs+imaging.
  • Rx: NSAID, DMARD, anti-TNF factor therapy
  • Key Imaging Dx: always presents initially as b/l symmetrical sacroiliitis that will progress to complete ankylosis. Spondylitis presents with continuous ascending discovertebral osteitis (i.e., marginal syndesmophytes, Romanus lesion, Anderson lesion), facets and all spinal ligament inflammation and fusion with a late feature of “bamboo spine, trolley track, dagger sign,” all indicating complete spinal ossification/fusion. Increasing risk of Fx’s.

 

spinal arthritis el paso tx.

 

Key Dx of Sacroiliitis

 

  • Blurring, cortical indistinctness/irregularity with adjacent reactive subchondral sclerosis initially identified primarily on the iliac side of� SIJs.
  • Normal SIJ should maintain a well defined white cortical line. Dimension 2-4 mm. May look incongruous d/t 3D anatomy masked by 2D x-rays.

 

spinal arthritis el paso tx.

 

Key Imaging Dx In Spine

 

  • Marginal syndesmophytes and inflammation at the annulus-disc (above arrows) at the earliest dx; by MRI as marrow signal changes on T1 and fluid sensitive imaging (above top images).
  • These represent enthesitis-inflammation that will ossify into bamboo spine.
  • Lig ossification: trolley track/dagger sign

 

spinal arthritis el paso tx.

 

  • AS in extraspinal joints: root joints, hips, and shoulders
  • Symphysis pubis
  • Less frequent in peripheral joints (hands/feet)
  • All seronegatives may present with heel pain d/t enthesitis

 

spinal arthritis el paso tx.

 

  • Complication: Above Carrot-stick/chaulk-stick Fx

 

spinal arthritis el paso tx.

 

  • PsA & ReA (formerly Reiter’s) present with b/l sacroiliitis that virtually identical to AS
  • In the spine PsA & ReA DDx from AS by the formation of non-marginal syndesmophytes aka bulky paravertebral ossifications (indicate vertebral enthesitis)
  • For a clinical discussion of Spondyloarthropathies refer to:
  • https://www.aafp.org/afp/2004/0615/p2853.html

 

Spinal Arthritis

Spinal Arthritis Diagnostic Imaging Approach Part I

Spinal Arthritis Diagnostic Imaging Approach Part I

Degenerative Arthritis

  • Spinal Arthritis:
  • Spondylosis aka Degenerative disease of the spine represents an evolution of changes affecting most mobile spinal segments beginning with:
  • Intervertebral disc (IVD) dehydration (desiccation) and degeneration aka Degenerative Disc Disease (DDD) with an abnormal increase in mechanical stress and degeneration of posterior elements affecting 4-mobile synovial articulations ( true osteoarthritis)
  • 2-Facets in the L/S & 2-Facets & 2-Uncovertebral joints in the C/S
  • Imaging plays a significant role in the diagnosis, grading, and evaluation of neurological complications (e.g., spondylotic myelopathy/radiculopathy)
  • X-radiography with AP, Lateral & Oblique spinal views provides Dx and classification of Spondylosis
  • MR imaging may help to evaluate the degree of neurological changes associated with degenerative spinal canal and neural foraminal stenosis
spinal arthritis el paso tx.
  • Spinal motion segment:
  • 2-adjacent vertebrae
  • IVD (fibrocartilage)
  • 2-facets (synovial)
  • Pathology: loss of disc height increases mechanical stress on mobile elements
  • Ligamentous laxity/local instability
  • Spinal osteophytes aka spondylophytes & bony facet/uncinate proliferation
  • Disc herniation and often disc-osteophyte complex
  • Ligamentum flavum “hypertrophy” or thickening due to buckling
  • Loss of normal lordosis with or w/o reversal or kyphosis
  • Vertebral canal & neural foraminal stenosis

Neutral lateral cervical radiograph: note mild to moderate disc narrowing and spondylophyte formation at C5-6 & C6-C7 (most common levels affected by cervical spondylosis). Straightening or flattening with mild reversal of cervical lordosis. Some mild facet proliferation is noted at the above levels

spinal arthritis el paso tx.
  • On radiographs: evaluate for disc height (mild, moderate or severe) loss
  • End-plate sclerosis & spondylophytes; mild, moderate or severe
  • Facet and uncinate irregularity, hypertrophy/degeneration; mild, moderate or severe
  • Note degenerative instability aka degenerative spondylolisthesis/retrolisthesis
  • Normal or lost lordosis vs. degenerative kyphosis
  • Key Dx: correlate with a clinical presentation: neck/back pain with or w/o neurological disturbance ( myelopathy vs. radiculopathy or both)
spinal arthritis el paso tx.
  • Uncinate processes undergo degeneration/proliferation resulting in uncovertebral arthrosis
  • Early findings present with mild bone proliferation along the cortical margin (white and black arrows) if compared to normal uncinate (orange arrow)
  • Later, more extensive bone proliferation extending into and narrowing vertebral canal and neural osseous foramina (IVF’s) may be noted. The latter may contribute to spinal/IVF stenosis and potential neurological changes
  • Posterior oblique views may help further
spinal arthritis el paso tx.
  • AP lower cervical (a) and posterior oblique (b) views
  • Note mild uncinated process proliferation with neural foraminal narrowing (arrows)
  • Typically if less than a third of IVF becomes narrowed, patients may present w/o significant neurological signs
spinal arthritis el paso tx.
  • Lumbar spondylosis is evaluated with AP and lateral views with additional AP L5-S1 spot view to examine lumbosacral junction
  • Typical features include disc height loss/degeneration
  • Intra-discal gas (vacuum) phenomenon (blue arrow) along with spondylophytes
  • Degenerative spondylolisthesis and/or retrolisthesis (green arrow) may follow disc and facet degeneration and can be graded by the Meyerding classification
  • In most cases, degenerative spondylolisthesis rarely progresses beyond Grade 2
  • Lumbar facet degeneration seen as bone proliferation/sclerosis and IVF narrowing
spinal arthritis el paso tx.
spinal arthritis el paso tx.
  • MR imaging w/o gad C is an effective modality to evaluate clinical signs of spondylosis & associated neurological complications with pre-surgical evaluation
  • Case: 50-y.o Fe with neck pain. Case b-45-y.o.M (top a b images). MRI reveals: loss of disc hydration or desiccation, spondylophytes and disc herniation w/o neurological changes
  • (Bottom images) Left: preoperative and right postoperative MRI slices of the patient presented with clinical signs of cervical spondylotic myelopathy. Note disc herniation, ligam flavum hypertrophy and canal stenosis (left)
spinal arthritis el paso tx.
  • Sagittal MRI slice of lumbar DDD manifested with disc desiccation and posterior herniation effacing thecal sac
  • Correlating sagittal and axial slices will be more informative to evaluate canal stenosis and potential degree of neurological involvement (above-bottom images)
spinal arthritis el paso tx.
spinal arthritis el paso tx.

Diffuse Idiopathic Skeletal Hyperostosis (DISH) aka Forestier disease

  • Flowing degenerative ossification of ALL
  • M/c Thoracic spine. 2nd m/c-cervical spine
  • Dx by imaging only. X-radiography is sufficient
  • CT w/o contrast helps with Dx of Fx
  • Men>women. Pts>60-y.o. Extensive DISH shows 49% association with type 2DM
  • Complications: Chalk (carrot) stick Fx. Unstable 3-column Fx requiring surgical fusion
  • Sagittal reconstructed CT scan slice in bone window
  • Chalk stick Fx at C5-C6 in the patient with DISH and OPLL

Spinal Arthritis