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X-ray diagnosis of osteoarthrosis of the joints of the brushes

 
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Last reviewed: 19.10.2021
 
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Standard radiography of the brushes is carried out in a direct projection. Fingers are located together, the brushes lie exactly on the cassette on one line with the axis passing through the forearms and wrists.

Initial manifestations of osteoarthrosis of the joints of the hands (correspond to stages I-II of Kellgren's arthrosis):

  • small tapering edges or osteophytes with an unsharpened subchondral osteosclerosis,
  • small, subchondral cysts,
  • normal or slightly narrowed x-ray joint arches,
  • the presence of small calcifications in soft tissues in the region of the lateral margins of the articular surfaces of bones.

Expressed changes in osteoarthritis of the joints of the hands (correspond to III-IV stages of arthrosis according to Kellgren):

  • moderately expressed or large osteophytes,
  • deformation of the edges of the articular surfaces of bones,
  • significant narrowing of the x-ray joint gap,
  • osteosclerosis (Geberden's nodules in the distal interphalangeal joints and Bushar's nodules in the proximal ones),
  • cysts with sclerotic rim,
  • marginal defects of articular surfaces (in this case, the bone protrusions on one side can wedge into the other), usually surrounded by an osteosclerosis zone.

Dorsopalmal image of the brush

DA Kallman and co-authors (1989), RD Altman and co-authors (1995) use osteophytes, narrowing of the x-ray joint and periarticular subchondral erosions to assess distal and proximal interphalangeal joints and carpometacarpal joint in their methods of assessing individual radiographic changes in osteoarthritis of the joints of the hands I finger. Additional evaluation data include periarticular subchondral sclerosis and bias in the joint without subluxation.

The four-point scale for assessing the above changes does not contain the entire complex of anatomical changes observed and described by G. Verbruggen, EM Veys (1995). These authors distinguish 5 phases of disease progression. The uncombined joint (N), the stationary phase of osteoarthrosis (S) is based on the presence of RP and / or narrowing of the x-ray joint and / or subchondral sclerosis. Most joints at this stage remain in phase S from 2 to 3 years. Then there is an obliteration of the joint slit (J-phase), which also lasts 2-3 years. This phase precedes or coexists with the appearance of subchondral cysts that disrupt the integrity of the subchondral plate (erosive or E-phase). Erosive episodes subsided spontaneously, followed by restoration of injuries and remodeling (R-phase). This last phase leads to the regeneration of the subchondral plate covered with a cartilaginous tissue, with the formation of large osteophytes giving the affected joints a nodose appearance. G. Verbruggen, EM Veys (1995) believe that the method they proposed provides a quick assessment of the progression of osteoarthritis.

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