A 1983 CMCC graduate, Dr. Marshall deltoff completed his radiology residency at Los Angeles College of Chiro- practic. he is a past radiology department chairman and resi- dency co-ordinator at CMCC, and he initiated the radiology curriculum at UQTr. dr. deltoff has lectured throughout North America, and is co-author, along with dr. Peter Kogon, dACBr, of the radiology text “The Portable Skeletal X-ray Library” published by Mosby- Yearbook of St. Louis. dr. Deltoff can be reached at: images radiology Consultants, 16 York Mills Road, Toronto, Ont. M2P 2E5 Tel: (416) 512-2225 Fax: (416) 512-2226 e-mail: [email protected] Figure 1 T his 43-year-old construction worker presented with a painful, swollen, reddened foot and decreased ROM, a few days after stepping on a nail at a worksite. Here are a few points to remember about septic arthritis: • also known as pyogenic or infectious arthritis • most (90 per cent) are due to Staphylococcus aureus • in long bones, the organism lodges in the metaphysic, due to its high vascularity • organism spreads hematogenously to the vasculature of the synovial membrane • capsular distention ensues as a result of purulent exudate; the exudate interferes with cartilage nutrition, resulting in death of chondrocytes and causing a release of proteolytic enzymes; therefore, you get progressive destruction of cartilage and bone oN X-ray: • early on – soft tissue swelling, joint capsule distention, obliteration of any juxta-articular fat planes • abscess formation, as a result of pus accumulation, produces increased juxta-artic- ular soft tissue density • local periarticular osteoporosis (due to regional hyperemia, proteolytic enzyme release and disuse), often in a moth-eaten pattern • destruction of the articular cartilages invariably results in joint space narrowing, followed by a blurring of intra-articular cortical margins (Figure 1) • if the infection subsides early enough, articular surfaces may be remodelled, but there is usually some degree of residual articular deformity • if infection is not halted, articular cartilage is eventually completely destroyed, leading to bony ankylosis. • 38 • CANAdiAN ChirOPrACTOr | JUNE 2009 www.canadianchiropractor.ca Marshall deltoff, dC, dACBr, FCCr(C)
Chiropractic + Naturopathic Doctor June 2009: Page 38
