Joints – general

image of Joints – general
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Each joint of the appendicular skeleton is structurally different. Accordingly, while two orthogonal views are considered a radiographic necessity, the special views required for a full examination of each joint will vary depending on the joint being examined. Oblique views should be routinely included in evaluation of the more complex joints such as the carpus or tarsus. Radiography of the opposite limb can be extremely helpful as a normal comparison and also to detect cases of bilateral disease where lameness appears unilateral. This chapter explores indications; radiography; normal anatomy and physiology; alternative imaging techniques; and abnormal image findings.

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Image of 11.1
11.1 Examples of stresses that can be applied to a joint during radiography. (1) Traction. (2) Shearing. (3) Wedge. (4) Rotation. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 11.3
11.3 MRI of a normal canine stifle in a sagittal plane at the level of the cranial cruciate ligament. (a) Proton density sequence. (b) T2-weighted fat-suppressed sequence. Note how hyperintensity from the infrapatellar fat pad seen in (a) has been suppressed, leaving only the hyperintense intra-articular fluid to be seen in (b).
Image of 11.4
11.4 Ultrasonography of normal canine biceps tendon. (a) Sagittal plane showing biceps tendon (arrowed) as a linear stippled structure that provides greatest echogenicity when the fibres are under tension and perpendicular to the incident sound waves. Note the hyperechoic margins of the supraglenoid tuberosity (S) and humerus (H), beyond which no useful image is produced owing to acoustic shadowing. (b) Transverse plane. In cross-section the biceps tendon is an ovoid structure (arrowed). The tendon fibres appear as stippled echoic foci.
Image of 11.5
11.5 Bone-phase scintigraphy was used to localize lameness in a 16-month-old Boxer with chronic left thoracic limb lameness. The aetiology of the lameness could not be identified on physical or radiological examination of the elbows. Scintigraphy demonstrated a greater uptake of radiopharmaceutical in the left than in the right elbow; this asymmetry of uptake localized the lameness to the left elbow. The head was shielded and therefore is not visible. (Courtesy of RM Zuber)
Image of 11.6
11.6 The radiological signs of joint disease. The left side is normal and the right side illustrates the pathology. 1 = uneven subchondral bone surface; 2 = periarticular new bone formation; 3 = articular soft tissue swelling; 4 = intra-articular calcified material; 5 = osteophyte; 6 = increase in subchondral bone opacity; 7 = cyst-like changes within subchondral bone.
Image of 11.7
11.7 Mediolateral (ML) views of the left and right stifles of a 2-year-old spayed female Labrador Retriever. (a) Normal right stifle. (b) Abnormal left stifle with marked soft tissue swelling. Increased soft tissue/fluid opacity in the joint is outlined cranially by the broken line. The arrow in (a) identifies the infrapatellar fat pad, which is of lower opacity than the soft tissue/fluid opacity of the confluence of joint capsule and effusion. The arrowhead points to the cranial surface of the patellar ligament, which is more opaque than adipose tissue. The (*) is placed in the region of the meniscus and other normal soft tissue opacity structures in the joint. (c–d) Mid-sagittal reformatted CT images in a bone window of the right and left stifles in the same patient: (c) the black arrow points to a thin linear focus of soft tissue opacity extending from the meniscal region proximally into the infrapatellar fat pad, representing slight fluid in the joint. The white arrow identifies the infrapatellar fat pad; (d) abnormal stifle with marked intracapsular soft tissue swelling (outlined by the broken line).
Image of 11.8
11.8 Ventrodorsal (VD) views of extended right hip joint. (a) The normal coxofemoral joint space can be seen between the two arrows, which define the radiolucent articular joint space between the femoral head and the cranial acetabular margin. These two joint spaces lie parallel to one another between the cranial effective acetabular edge and the fovea capitis that represents the insertion of the round ligament. (b) Reduced coxofemoral joint space. The arrows point to the absence of a radiolucent space between the femoral head and the adjacent acetabular margin. (c) The coxofemoral joint space is increased. The arrows define the enlarged, lucent V-shaped coxofemoral joint space. The femoral head is no longer congruent with the acetabulum.
Image of 11.9
11.9 Changes in subchondral bone. (a) Craniocaudal (CrCd) view of the elbow. Arrows point to a defect in subchondral bone surrounded proximally by subchondral sclerosis. This radiolucent change is an example of medial humeral condylar osteochondrosis. (b) ML view of the shoulder. There is flattening and slight irregularity of subchondral bone of the caudal aspect of the humeral head representing an osteochondral lesion. Black arrows outline surrounding sclerosis. A thin layer of mineralized cartilage is present proximal to the subchondral bone margin. A large articular osseous body (‘joint mouse’) is present in the caudal aspect of the joint (white arrow).
Image of 11.10
11.10 Extended VD view of a coxofemoral joint. Increased subchondral bone opacity is present in the cranial acetabular margin (arrowed).
Image of 11.11
11.11 (a) ML view of shoulder joint. Periosteal new bone proliferation is noted on the medial edge and the caudal margin of the glenoid. The white arrows point to a focal spur of new bone proliferation; these changes represent enthesophytes. The black arrows point to calcified material that was located within the scapulohumeral joint. It was an osteochondral fragment from an OCD lesion located in the glenoid. (b) CrCd view of the elbow. Roughened periosteal new bone formation is present on the medial epicondyle (arrowed). A small lucent cavity is present in the subchondral bony surface of the medial humeral condyle. These changes were caused by humeral OCD and secondary arthrosis of the elbow. (c) Extended VD view of coxofemoral joint. The arrows point to enthesophytes lining the axial surface of the trochanteric fossa. The arrowhead points to enthesophytes on the craniodorsal margin of the acetabulum.
Image of 11.13
11.13 Radiographic and CT images in a bone window of a dog with fragmentation of the medial coronoid process. There is a large osseous body at the medial aspect of the joint adjacent to the medial coronoid process (arrowed). (a) CrCd view of the elbow. Humerus (H), radius ® and ulna (U) are labelled. (b) CT image in a dorsal plane showing the same osseous body as arrowed in (a). (c) Sagittal and (d) transverse CT images, showing osseous fragments adjacent to a blunted, sclerotic medial coronoid process.
Image of 11.14
11.14 (a) ML and (b) CrCd views of the right stifle of a 7-year-old Oriental cat. (a) A large osseous body is present in the cranial aspect of the stifle and a smaller osseous body is present in the caudal aspect of the stifle. In the CrCd view (b) there is a large continuous zone of proliferative new bone and several smaller osseous bodies at the medial aspect of the stifle in the region of the medial collateral ligament and medial joint capsule. Surgical exploration and histopathological diagnosis were consistent with synovial osteochondromatosis. (Courtesy of Eastside Veterinary Emergency and Specialists, Sydney)
Image of 11.15
11.15 Vacuum phenomenon in the coxofemoral joint. (a) VD flexed view of the right hip joint using the Penn-HIP® technique in the distracted position. The arrows point to small gas bubbles within the synovial fluid typical of vacuum phenomenon. (b) Transverse CT image in a bone window through the coxofemoral joint. Gas is present within the joint between the femoral head and acetabulum (black arrows). Compare the appearance of hypoattenuating gas in the rectum (white arrow) with hypoattenuating gas in the coxofemoral joint.
Image of 11.17
11.17 (a) Caudocranial (CdCr) view showing congenital luxation of the shoulder of a dog. The humeral head has luxated proximally and medially. The glenoid has remodelled as a consequence of chronic malarticulation. (b) CrCd view showing congenital luxation of the elbow. The radial head is luxated proximally and laterally with respect to the humeral condyle.
Image of 11.18
11.18 VD views of the right hip joint obtained using the Penn-HIP® technique. (a) The compressed position, demonstrating excellent coxofemoral joint congruity. (b) The distracted position, demonstrating increased joint volume. This indicates excessive joint laxity and poor joint congruity.
Image of 11.19
11.19 ML view of the shoulder and part view of the cervical vertebral column showing signs of hypervitaminosis A in a cat. There is an extensive ankylosing spondylopathy involving the bodies of the cervical vertebrae and signs of arthrosis in the scapulohumeral joint.
Image of 11.20
11.20 VD view of a canine coxofemoral joint with septic osteoarthritis. A positive culture of was obtained from joint tissue. A large zone of lucency (a sign of erosive bone disease) can be seen in subchondral bone of the femoral head (arrowed). The femur is cranially subluxated. The femoral neck has foci of increased and decreased opacity. Osteophytes are also present on periarticular surfaces of the acetabulum and proximal femur. Modelling of acetabular margins indicates chronicity of disease and likely pre-existing osteoarthrosis.
Image of 11.21
11.21 Images of the elbow of a 5-month-old Boxer with incomplete fusion of the left humeral condyle (arrowed). (a) CrCd view. A radiolucent line (arrowed) is present between medial and lateral parts of the humeral condyle. This represents incomplete fusion of the humeral condyle, a condition most commonly reported in spaniels. (b) Transverse CT image in a bone window through both elbows comparing the affected left and normal right elbow. (c) Dorsal plane CT image of the left elbow. (d) A dorsal plane image caudal to (c), with the tip of the anconeal process seen proximal to the fusion defect.
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