X-rays of joints: indications, preparation, results
X-ray research method was initially used for research of the musculoskeletal system. It provides data about the structure and functioning of bones and joints in a person’s life. X-rays of the joints and bones is the main way to study them in norm and at a pathology. It allows, for example, to detect early changes in zamechatelnyh plates of the epiphysis, or in the subchondral layer of bones, which is important in the study of degenerative changes in the joints, which are fairly common.
Features radiographic anatomy of the skeleton
X-ray picture of the skeleton is not the same. It is dynamic, and depends on the sex and age of man, his anatomical features and state of health. Thus, in newborns, bones do not have ossification nuclei at its ends, and the articular surfaces consist of cartilage which is not visible on x-rays. Because of this, it seems that their articular gap is very wide.
Radiation study of the bones and joints must be prescribed by a doctor. Testimony to it are almost all damage to the musculoskeletal system. Also radiography should be performed in cases of suspected systemic disease, particularly autoimmune component.
The basis of the diagnostic search is the radiography of bones and joints, performed in two, perpendicular to each other, projections. The right needs to display the entire bone and adjacent joints, or the joint and the adjacent departments of the two dice, if the purpose of the shooting was the diagnosis of articular pathology.
Features of the use of radiographs in the diagnosis of diseases of the joints
If these images cannot clearly identify pathological changes or damage, produce more images in the oblique projections, sighting shots. It is possible to use additional diagnostic methods – linear tomography, computed tomography, magnetic resonance imaging.
In the case of injury to x-ray examination at the radiology Department is required for all patients who do not have life-threatening injuries and are conscious. Otherwise, the system uses a mobile x-ray apparatus.
The main symptoms of articular pathology
The main symptom of joint damage on radiographs is considered to be a narrowing of the joint space. If it is uniform, it is likely a degenerative condition of the cartilage of the joint. Irregular narrowing of joint cracks is a symptom of various arthritis, and occurs due to the destruction of parts of the subchondral bone and end plates of the epiphyses.
When fibrous ankylosis, on the contrary, closing of records disappear altogether, and in the form of bone ankylosis renders the transition of the bone beams from one epiphysis to the other. In the case of injury often occur dislocation of joints. Their radiological picture is quite recognizable – in the images is determined by the displacement of the head of one of the bones, which is absent in the articular cavity. This condition is called complete inconsistency of the articular ends of the bones. It is important to follow, not complicated if the dislocation separation of bone fragments from the articular ends.
These fragments can interfere with normal reposition the bones back. In addition, there is a likelihood of subluxation. He is diagnosed with partial mismatch of the articular surfaces between them. An additional symptom is considered the joint space wedge-shaped.
Bone changes occurring with pathology of the joints
In the case of destructive joint disease on x-ray images are detected foci of destruction of the bone and periarticular tissues. They look like small Uzury in the attachment of the joint capsule and ligaments to bone surfaces of the epiphyses. Articular contours in this case, become uneven, in some places thinning, and sometimes sklerosiruta, forming a characteristic «speckled» picture.
Focal destruction of articular tissues causes a disturbance of blood supply and nutrition of the epiphyseal sections of bones that die, forming macrosty. Their separation leads to the formation of sequesters. Of the attenuation processes active arthritis the substitution of the small destructive foci in the bone, their seal sclerotic limit of large lesions. This is especially the pattern for tuberculous arthritis.
The main diseases diagnosed with the help of radiation research
Radiography plays an important role for the diagnosis of osteoarticular panaritium. They look like a typical pyogenic arthritis present with a rapidly progressive and uneven narrowing of the joint space, multiple foci of destruction in the articular surfaces, regional osteoporosis, increased joint. When you hold a bone scan showed increase in concentration of the radiopharmaceutical in the juxta-articular parts of the bones. When using sonography to celebrate the destruction of articular cartilage, which is confirmed by computed tomography.
Significantly spread in recent years has received rheumatoid arthritis. It is a systemic autoimmune disease with a chronic relapsing course which affects mainly the joints. It has a progressive course, and accompanied by disturbances in immune response. In the initial stages of the disease violations are found on a microscopic level, and x-rays are indistinguishable from the norm. In such cases, to evaluate the lesion using osteoscintigraphy showing the increased accumulation of the radiopharmaceutical in the affected joints.
However, with the progression of the disease radiographic method is more informative, and the data beam diagnostics are used to stage the classification of arthritis.
In the images detected by the seal of the periarticular tissue, mild reduction of the gap width of the joint and early onset of osteoporosis in the bones. Further to these manifestations join erosive lesions, which represent the regional defects of small size, situated in the articular ends of the bones. Together with the violation of the integrity of the locking plate, these defects are the main signs of rheumatoid arthritis on radiographs. In the future, the joint space continues to narrow, resulting in loss of hand function. Increases the severity of osteoporosis, develop dislocations of the joints.
Systemic disease affecting joints
There are also a number of diseases that the syndrome of seronegative arthritis:
- Systemic lupus erythematosus.
- The nodular periarteritis.
- Sclerosis of different Genesis.
- Reiter’s syndrome.
- Arthritis in psoriasis.
- Spondylitis ankylosing.
They are difficult to recognize and differentially diagnose each other, if to use only one approach to the study of the patient. Therefore, to establish a correct diagnosis requires a comprehensive study and use as x-ray data and physical examination, laboratory tests and a careful study of the anamnesis of disease.
Evaluation of juxta-articular apparatus
The accession of inflammatory changes in ligaments and tendons – fibroscopy, tendinosis, fibrosity. If they have changed the accumulation of the radiopharmaceutical in the tendon, ossification of the attachment of the ligaments to the bones, bony projections (osteophytes).
Additional methods of research
If necessary, can be used in sonography. You can see the thickened joint capsule, the presence of free fluid in the joint cavity, changes in the density of the articular cartilage, periarticular swelling, and the presence of synovial cysts. Also used MRI and computer tomography. These methods allow to assess the condition of the tissues which surround the joint, and to judge the prevalence of disease, its risk and speed of progression.