1. (special thanks to Dr A Raghavan)
Bones & Joints
Ian Bickle
Radiology for Finals
Nottingham
(special thanks to Dr A Raghavan)

2. Main Themes
Systemic bone diseases
Fractures
The KEY pathologies

3. The Aim of the Film Powers of observation Completeness of Search
Descriptive abilities
ALL FEATURES OF A GOOD JUNIOR DOCTOR

4. Key Points Have a system of approach Stick to it
Don’t forget the soft tissues

5. Viewing Bones Typically 2 views Essential for Fractures (90 degrees)
Compare & Contrast
Check bone outline and density

6. Don’t overcomplicate the
simple

7. Anatomy of the Hand & Wrist
Carpal Bones:
Proximal Row:
Scaphoid (a),
Lunate (l),
Triquetrum (tq),
Pisiform (p)
Distal Row:
Trapezium (t),
Trapezoid (tp),
Capitate (c),
Hamate (h) tp c t h p tq l

8. Anatomy of the Pelvis & Hip
A = sacral ala
B = left sacroiliac joint
C = iliopectineal line
D = ilium
E = ischial spine
F = pubic symphysis
G = inferior pubic ramus
H = obdurator foramen b d e c g h f

9. Anatomy of Knee femur patella Medial condyle fibula
Intercondylar eminence
Tibial tuberosity
tibia

10. Anatomy of lumbar spine
1 = vertebral body
2, 3 = intervertebral disc space
4 = pedicle
5 = lamina
6 = spinous process

11. Anatomy of lumbar spine
1 = vertebral body
2 = intervertebral disc space
3 = lamina
4 = spinous process

12. Normal Anatomy Childhood Adult cortex diaphysis metaphysis
epiphysis
medullary space
physis
physeal scar
Childhood
Adult

13. Systemic Bone Diseases

14. Common Pathologies Osteoarthritis Rheumatoid disease Gout
Psoriatic Arthropathy
Paget’s disease
Osteoporosis
Ankylosing Spondylitis
Multiple myeloma

15. Common Pathologies HPOA Osteomyelitis Hyperparathyrodism Osteosarcoma
Charcot’s joint
Bone Metastases
Sclerotic Eg, Prostate
Lucent (Lytic) eg. Lung
Pathological fracture

16. Osteoarthritis Key Features Loss of joint space Subchondral bone cysts
Subchondral sclerosis
Osteophyte formation
 Difference in hips 

17. OA Features Sub-chondral sclerosis   Reduced joint space
Sub-chondral cyst

18. Rheumatoid Arthritis Erosions  Erosive arthropathy Spares DIP joints
Periarticular osteopenia
Soft tissue swelling
Erosions 

19. Gout Erosions – ‘punched out’ (away from joint) Soft tissue swelling
Gouty tophi
Erosion 
Soft tissue

20. Psoriatic Arthropathy
Erosive arthropathy
DIP typically
Sarcoiliac joints
(may be involved)
Pencil and cup deformity
DIP’s only

21. Paget’s Disease (of bone)
Key Features
Sclerotic Bone
Coarse trabecular pattern
Expanded Bone
Pathological #
 Sclerotic bone
1% osteosarcoma

22. Osteoporosis Key Features Normal biochemical tests Wedge # 
Plain x-ray not sensitive
DEXA scan best test
Sequelae on x-ray – wedge #
Wedge # 

23. Ankylosing Spondylitis
Spine and SI joints
Sacroilitis
Syndesmophye formation
Calcification of anterior longitudinal spinous ligament
Apophyseal joint fusion
 Bamboo Spine

24. multiple lytic bone lesions
Multiple Myeloma
multiple lytic bone lesions

25. Metastases Sclerotic: Lytic: Bowel Bronchus Breast Kidney Prostate
 Lytic Met
 Sclerotic Met

26. HPOA Unusual but important diagnosis Bronchial carcinoma
Suppurative lung disease
Periosteal reaction 

27. Osteomyelitis Key Features: Peri-osteal reaction Osteopenia
Bony destruction
Pathological #
Both sides of the joint

28. Hyperparathyroidism Key Features:
Sub-periosteal bone resorption – typically middle phalanx of hand
Osteopenia
Scalloping 

29. Charcot’s Joint Think Diabetics Disorganized and disrupted joint
Sclerosis
Destruction of joint
Fragmentation
Think Diabetics

30. Osteosarcoma Typically at the knee Frequently young patient
Periosteal reaction
Soft tissue mass
Destructive lesion
 Soft tissue mass
periosteal reaction

31. Codman Triangle periosteal reaction Codman Triangle
advancing tumor margin
destroys periosteal new
bone before it ossifies
tumor

32. Fractures

33. Fractures: Features to Describe
Bone
Place of Bone
Nature of Fracture
Special Features of Fracture
Management Implications

34. Fracture Features Black (lucent) line White if overlapping fragments
Associated soft tissue abnormalities
Displacement & Angulation
Always look for another abnormality
Another #
A dislocation
An underlying cause

35. Fresh & Former
 callus
Fracture 

36. Systemic Disease with Bone/Joint Involvement
Best Exam Cases
Great test of knowledge
Test lateral thinking
BE THE BEST – think for the test

37. Erosive Arthropathy & Pulmonary Fibrosis
Rheumatoid Disease
Erosive Arthropathy & Pulmonary Fibrosis

38. Bronchial CA & HPOA

39. Paget’s Disease  Osteosarcoma