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Musculoskeletal System
Musculoskeletal System
CHAPTER 6
Skeletal System
and Joints
Retarded
1. Chronic ill health
– Congenital cardiac disorders.
– Chronic renal failure.
– Inflammatory bowel disease.
– Malnutrition including rickets.
– Maternal deprivation.
2. Chromosomal disorders
– Down’s syndrome.
– Turner’s syndrome.
– Trisomy 18, etc.
– Noonan syndrome.
– Prader-Willi syndrome.
3. Endocrinal disorders
– Hypothyroidism.
– Hypogonadism.
– Hypopituitarism.
– Cushing’s disease and steroid therapy.
4. Congenital syndromes
– Bone dysplasias.
– Malformation syndromes.
5. Miscellaneous
– Extreme emotional deprivation.
Skeletal System and Joints 385
Accelerated
a. Localized
1. Local hyperemia secondary to inflammation/infection.
2. Trauma.
3. Vascular malformations (hemangioma/AVM)
4. Klippel-Trenaunay-Weber syndrome.
5. Maffucci syndrome.
6. Neurofibromatosis.
7. Macrodystrophia lipomatosa (Fig. 6.1)
b. Generalized
i. Endocrinal
– Idiopathic sexual precocity
– Hypothalamic masses
– Adrenal and gonadal tumors
– Hyperthyroidism
Asymmetric
a. Localized Gigantism
Causes similar to localized accelerated maturation.
b. Localized Atrophy
1. Paralysis.
2. Radiation treatment in childhood.
Rhizomelic
(Proximal Limb Shortening)
1. Achondroplasia
– Large skull with small base and sella and a small foramen
magnum.
Skeletal System and Joints 387
– Short ribs with deep concavities to anterior ends.
– Decreased interpedicular distance caudally in lumbar
spine.
– Short pedicles with narrow lumbar canal.
– Posterior scalloping with anterior vertebral body beaking.
– Square iliac wings with champagne glass pelvic cavity.
– Rhizomelic micromelic with bowing of long bones (Fig. 6.2).
– Trident hands.
2. Hypochondroplasia
– Similar to achondroplasia except skull never affected.
– Height normal or mildly reduced.
3. Pseudochondroplasia
– Similar to achondroplasia.
– Except that skull is normal.
– No changes seen in first year of life.
4. Chondrodysplasia punctata
– Stippling in long bone epiphysis, spine or larynx.
Mesomelic
(Middle Segment Shortening)
1. Dyschondrosteosis
– Also known as Léri-Weill’s disease.
– Usually affects females.
– Madelung’s deformity.
– Medial aspect of proximal/distal tibia defective with or
without hypoplastic fibula.
2. Mesomelic dysplasia
– Type Langer.
– Type Reinhardt-Pfeiffer.
Acromesomelic
(Middle and Distal Segment Shortening)
1. Chondroectodermal dysplasia
– Also known as Ellis-van Creveld syndrome.
– Paired long bones are short with dome-shaped meta-
physes.
– Abnormal medial tibial plateau with defective epiphyses
laterally.
– Postaxial polysyndactyly.
– Carpal fusions seen esp. capitate and hamate with delayed
development of carpal bones.
– Partial/total absence of teeth.
– Abnormal hair and nails.
– Rib cage similar to asphyxiating thoracic dystrophy.
2. Acromesomelic dysplasia
3. Mesomelic dysplasia
– Type Nievergelt.
– Type Robinow.
– Type Werner.
Skeletal System and Joints 389
Acromelic
(Distal Segment Shortening)
1. Asphyxiating Thoracic Dystrophy
– Also known as Jeune’s disease.
– Thorax is stenotic.
– Ribs are short and horizontal and clavicles are highly placed.
– Polydactyly (Fig. 6.3).
2. Peripheral Dysostoses
6.7 MUCOLIPIDOSES
1. Type I (Neuraminidase deficiency)
2. Type II (I-cell disease)
3. Type III (Pseudopolydystrophy of Maroteaux)
Children
i. Dysplasias
– Osteopetrosis.
– Pyknodysostosis.
– Craniotubular dysplasia.
– Craniotubular hyperostoses.
ii. Metabolic
– Renal osteodystrophy.
iii. Poisoning
– Lead = Dense metaphyseal bands.
– Flask-shaped femora.
– Fluorosis = Thickened cortex with narrow medulla.
– Ossification of tendons, ligaments and interosseous
membranes.
– Hyper- = Dense metaphyseal bands.
vitaminosis D = Widened zone of provisional calcification.
– Soft tissue calcification.
– Hyper- = Subperiosteal new bone
vitaminosis A formation.
– Reduced metaphyseal density.
Skeletal System and Joints 395
iv. Idiopathic
– Caffey’s disease.
– Idiopathic hypercalcemia of infancy.
Adults
i. Myeloproliferative
– Myelosclerosis.
– Marrow cavity narrowed by endosteal reaction.
– Patchy lucencies due to fibrous tissue.
ii. Metabolic
– Renal osteodystrophy.
iii. Poisoning
– Fluorosis.
– Similar as in children.
iv. Neoplastic
– Osteoblastic metastases (Figs 6.5A and B).
A B
Figs 6.5A and B: Anteroposterior and lateral radiographs of LS spine
show osteoblastic metastases
396 Differential Diagnosis in Radiology
Fig. 6.6: Paget’s disease: Early long-bone changes. Lateral view of the
humerus in a middle-aged man shows an “advancing wedge” (“blade of
grass” or “flame shadow”) appearance at the end of the bone, characteris-
tic of early Paget’s disease. Since the disease process generally proceeds
from one articular end of the long bone to the other, all three phases—
early, intermediate and late—may be seen in the same bone
– Lymphoma.
– Mastocytosis.
– Sclerosis of marrow with patchy areas of lucency.
v. Idiopathic
– Paget’s disease (Figs 6.6 to 6.8).
– Coarsened trabeculae.
– Bone expansion.
Developmental
i. Single
a. Fibrous dysplasia.
b. Bone islands (Enostosis)
Skeletal System and Joints 397
Fig. 6.7: Paget’s disease: Late long-bone changes. Lateral view of the
tibia shows anterior bowing secondary to late-phase
Vascular
• Bone infarcts
(Single/Multiple).
• In sickle cell anemia.
– Sclerotic lesions in femoral or humeral head in medullary
bone.
– Sharply-defined or ill-defined diffuse sclerosis.
Traumatic
• Callus (Single/multiple fracture sites)
Infective
• Sclerosing osteomyelitis of Garré.
– Localized gross sclerosis in absence of apparent bone
destruction.
Idiopathic
• Paget’s disease.
(Single/Multiple).
– Coarsened trabeculae, cortical thickening and bone
expansion.
– Encroachment of medullary cavity with epiphyseal
involvement as well.
– “Cotton-Wool spots” in skull.
Skeletal System and Joints 401
Neoplastic
i. Single
a. Metastases.
b. Lymphoma. (De novo or after RT of a lytic lesion)
c. Osteoma.
– Usually skull, PNS and mandible.
d. Ivory or dense type; spongy or trabeculated type.
Broad-based with smooth well-defined margins.
e. Osteoid osteoma (Figs 6.9 and 6.10)
– Round/oval radiolucent lesion with dense surrounding
sclerosis with a central nidus <1 cm.
– Lesion sited in relation to cortical bone with dense
scleroses extending into medullary cavity as well.
f. Osteoblastoma
– Similar to osteoid osteoma but central radiolucency is
larger, approx. 2–10 cm in diameter.
g. Primary bone sarcoma
– Commonest being osteosarcoma.
– Wide zone of transition with periosteal reaction and
soft tissue extension.
– Healed/Healing benign or malignant bone lesions as
lytic areas following RT on CT, bone cyst, fibrous cortical
defect, etc.
A B
Traumatic
• Healing fractures with callus formation.
Neoplastic
• Metastases.
• Lymphoma.
• Osteoid osteoma/osteoblastoma.
• Osteosarcoma.
• Ewing’s sarcoma (Fig. 6.12).
• Chondrosarcoma.
Infective
• Osteomyelitis.
• Syphilis.