Dr. Alex Jimenez, El Paso's Chiropractor
I hope you have enjoyed our blog posts on various health, nutritional and injury related topics. Please don't hesitate in calling us or myself if you have questions when the need to seek care arises. Call the office or myself. Office 915-850-0900 - Cell 915-540-8444 Great Regards. Dr. J

Knee Arthritis: Diagnostic Imaging Approaches I | El Paso, TX.

Degenerative Knee Arthritis

  • Knee Arthritis
  • Knee OA (arthrosis) is the m/c symptomatic OA with 240 cases per 100,000, 12.5% of people >45 y.o.
  • Modifiable risk factors: trauma, obesity, lack of fitness, muscle weakness
  • Non-modifiable: women>men, aging, genetics, race/ethnicity
  • Pathology: disease of the articular cartilage. Continuing mechanical stimulation follows by initial increase in water and cartilage thickness. Gradual loss of proteoglycans and ground substance. Fissuring/splitting. Chondrocytes are damaged and release enzymes into the joint. Cystic progression and further cartilage loss. Subchondral bone is denuded and exposed to mechanical stresses. It becomes hypervascular forming osteophytes. Subchondral cysts and bone thickening/sclerosis develop.
  • Imaging plays a crucial role in Dx/grading and management
  • Clinically: pain loigoarthritis. DDx: morning pain/stiffness is >30-min DDx from inflammatory arthritis
  • Treatment: in mild to moderate cases-conservative care. Severe OA-total knee arthroplasy

OA: L.O.S.S. Radiologic Presentation

knee arthritis chiropractic care el paso tx.
  • Typical radiologic-pathologic presentation of  OA: L.O.S.S.
  • Loss of joint space (non-uniform/asymmetrical)
  • Osteophytes
  • Subchondral sclerosis
  • Subchondral cysts
  • Bone deformity: Genu Varum- is the m/c deformity d/t medial knee compartment affected more severely
  • In addition: weakening of periarticular soft tissues, instability and other changes

Imaging

knee arthritis chiropractic care el paso tx.
  • Radiography is the modality of choice
  • Views should include b/l weight bearing
  • Evaluation of joint space is crucial. Normal joint space -3-mm
  • Grading is based on the degree of joint space narrowing (JSN), osteophytes, bone deformation, etc.
  • Grade 1: minimal JSN, suspicious osteophytes
  • Grade 2: appreciable osteophytes and JSN on AP weight-bearing view
  • Grade 3: multiple osteophytes, definite JSN, subchondral sclerosis
  • Grade 4: severe JSN, large osteophytes, marked subchondral sclerosis and definite bony deformity
  • Typical report language will state:
  • Minor, mild, moderate or severe aka advanced arthrosis

Technique

knee arthritis chiropractic care el paso tx.
  • Radiography: AP weight-bearing knees: note severe JSN of the medial compartment more severely with lateral knee compartment. Osteophytes and marked genu varum deformity and bone deformation
  • Typically medial femoro-tibial compartment is affected early and more severely
  • Patellofemoral compartment is also affected and best visualized on the lateral and Sunrise views
  • Impressions: severe tri-compartmental knee arthrosis
  • Recommendations: referral to the orthopedic surgeon

Moderate JSN

knee arthritis chiropractic care el paso tx.
  • B/L AP weight bearing view (above top image): Moderate JSN primarily of the medial femorotibial compartment. Osteophytosis, subchondral sclerosis and mild bone deformation (genu varum)
  • Additional features: PF OA, intra-articular osteophytes, secondary osteo-cartilagenous loose bodies and subchondral cysts (above arrows)

Secondary Osteochondromatosis

knee arthritis chiropractic care el paso tx.
  • Intra-articular osteo-cartilagenous loose bodies known as secondary osteochondromatosis
  • Typical in DJD especially of the large joints
  • It may accelerate further cartilage destruction and progression of OA
  • May worsen signs of synovitis
  • Intra-articular locking, catching etc.

Management of Severe Knee OA

knee arthritis chiropractic care el paso tx.

Calcium Pyrophosphate Dehydrate Deposition Disease

knee arthritis chiropractic care el paso tx.
  • CPPD arthropathy common in the knee
  • May present as asymptomatic chondrocalcinosis, CPPD arthropathy resembling DJD with predominance of lare subchondral cysts. Often found as isolated PFJ DJD
  • Pseudogout with acute attack of knee pain resembling gouty arthritis
  • Radiography is the 1st step and often reveals the Dx
  • Arthrocenthesis with polarized microscopy may be helpful to DDx between CPPD and Gouty arthritis

Rheumatoid Arthritis

  • RA: autoimmune systemic inflammatory disease that targets soft tissues of joints synovium, tendons/ligaments, bursae and extra-articular sites (e.g. eyes, lungs, cardiovascular system)
  • RA is the m/c inflammatory arthritis, 3% of women and 1% of men. Age: 30-50 F>M 3:1, but may develop at any age. True RA is uncommon in children and should not be confused with Juvenile Idiopathic Arthritis
  • RA most often affects small joints of the hands and feet as symmetrical arthritis (2nd 3rd MCP, 3rd PIPs, wrists & MTPs, sparing DIPs of fingers and toes)
  • Radiographically: RA presents with joint effusion leading to hyperemia and marginal erosions and periarticular osteoporosis. In the knee, lateral compartment is affected more frequently leading to valgus deformity. Uniform aka concentric/symmetrical JSN affects all compartments and remains a key Dx clue
  • Absence of subchondral sclerosis and osteophytes. Popliteal cyst (Baker’s cyst) may represent synovial pannus and inflammatory synovitis extending into popliteal region that may rapture and extend into posterior leg compartment
  • N.B. Following initial RA joint destruction, it is not unusual to note superimposed 2nd OA
  • Radiography is the 1st step but early joint involvement may be undetectable by x-rays and can be helped by US and/or MRI.
  • Lab tests: RF, CRP, anti-cyclic citrullin peptide antibodies (anti-CCP Ab). CBC
  • Final Dx is based on Hx, clinical exam, labs and radiology
  • Clinical pearls: patients with RA may present with a single knee being affected
  • Most patients are likely to have bilateral symmetrical hands/feet RA.
  • Cervical spine, particularly C1-2 is affected in 75-90% of cases throughout the course of the disease
  • N.B. Sudden exacerbation of joint pain in RA should not underestimate septic arthritis because patients with pre-existing RA are at higher risk of infectious arthritis. Joint aspiration may help with Dx.

Radiographic DDx

knee arthritis chiropractic care el paso tx.
  • RA (above left) vs. OA (above right)
  • RA: concentric (uniform) joint space loss, lack of osteophytes and juxta-articular osteopenia.
  • Clinical Pearls: patients with RA may present radiographically with subchondral sclerosis d/t superimposed DJD. The latter feature should not be interpreted as OA but instead considered as secondary OA

AP Knee Radiograph

knee arthritis chiropractic care el paso tx.
  • Note marked uniform JSN, juxta-articular osteopenia and subchondral cystic changes
  • Clinical Pearls: subcortical cysts in RA will characteristically lack of sclerotic rim noted in OA-associated subcortical cysts.

MRI Sensitivity

knee arthritis chiropractic care el paso tx.
  • MRI is very sensitive and may aid during early Dx of RA.
  • T2 fat-sat or STIR and T1 + C gad contrast fat-suppressed sequences may be included
  • MRI Dx of RA: synovial inflammation/effusion, synovial hyperplasia and pannus formation, decreased cartilage thickness, subchondral cysts and bone erosions
  • MRI is very sensitive to reveal juxt-articular bone marrow edema, a precursor to erosions
  • Intra-articular fibrinoid fragments known as “Rice bodies” are characteristic MR sign of RA
  • Note: T2 fat-sat sagittal MRI revealing large inflammatory joint effusion and pannus synovial proliferation (above arrow heads). No evidence of radiographic or MRI bone erosions present. Dx: RA

STIR MR Slices

knee arthritis chiropractic care el paso tx.
  • Note: STIR MR slices in the axial (above bottom image) and coronal planes (above top image) demonstrate extensive synovitis/effusion (above arrowheads) and multiple erosions in the medial and lateral tibial palteau (above arrows)
  • Additionally, scattered patchy areas of bone marrow edema are noted (above asterisks) such marrow edema changes are indicative and predictive of future osseous erosions.
  • Additional features: note thinning and destruction of joint cartilage

Knee Arthritis

Trauma Specialist Testimonies and Case Studies

Why Patients Choose Accidents Specialist to Treat Injuries
By Dr. Alexander Jimenez
1/ 42
  1. 1 Chiropractic Care on Whiplash | El Paso, Tx Chiropractic Care on Whiplash | El Paso, Tx 02:15
  2. 2 Car accident Injury Rehabilitation | El Paso, Tx Car accident Injury Rehabilitation | El Paso, Tx 02:19
  3. 3 *CAR ACCIDENTS* Chiropractor | El Paso, Tx (2019) *CAR ACCIDENTS* Chiropractor | El Paso, Tx (2019) 02:35
  4. 4 Recommended El Paso, TX Chiropractor Recommended El Paso, TX Chiropractor 03:43
  5. 5 Severe Back Pain Chiropractic Treatment El Paso, TX Severe Back Pain Chiropractic Treatment El Paso, TX 04:09
  6. 6 *CHRONIC* Pain Chiropractic Care | El Paso, Tx (2019) *CHRONIC* Pain Chiropractic Care | El Paso, Tx (2019) 02:38
  7. 7 *Car Accident Injury* Chiropractic Solution  |  El Paso, TX (2019) *Car Accident Injury* Chiropractic Solution | El Paso, TX (2019) 02:25
  8. 8 Chronic Pain Chiropractor | El Paso, Tx (2019) Chronic Pain Chiropractor | El Paso, Tx (2019) 02:07
  9. 9 Chiropractic Help on Car Accidents | El Paso, Tx Chiropractic Help on Car Accidents | El Paso, Tx 02:27
  10. 10 *Car Accident Injuries* Treatment  |  El Paso, TX (2019) *Car Accident Injuries* Treatment | El Paso, TX (2019) 02:18
  11. 11 Why Chiropractor for Auto Injuries? | El Paso, Tx Why Chiropractor for Auto Injuries? | El Paso, Tx 02:30
  12. 12 *Neck* Pain Chiropractic Care | El Paso, Tx (2019) *Neck* Pain Chiropractic Care | El Paso, Tx (2019) 02:59
  13. 13 Personal Injury Chiropractic Care | El Paso, Tx (2019) Personal Injury Chiropractic Care | El Paso, Tx (2019) 02:16
  14. 14 Most Effective Chiropractor | El Paso, Tx (2019) Most Effective Chiropractor | El Paso, Tx (2019) 03:16
  15. 15 Personal Injury Lawyers & Chiropractors | El Paso, Tx Personal Injury Lawyers & Chiropractors | El Paso, Tx 02:47
  16. 16 Top Chiropractor Near Me | El Paso, Tx (Best) Top Chiropractor Near Me | El Paso, Tx (Best) 02:29
  17. 17 Chronic Body Pain Recovery | El Paso, Tx Chronic Body Pain Recovery | El Paso, Tx 01:57
  18. 18 Chiropractic Pain Relief | El Paso, Tx Chiropractic Pain Relief | El Paso, Tx 01:56
  19. 19 Quiropractico Recomendado | El Paso, Tx Quiropractico Recomendado | El Paso, Tx 02:11
  20. 20 Most Recommended Chiropractor El Paso, Tx Most Recommended Chiropractor El Paso, Tx 02:04
  21. 21 El Paso, TX Shoulder Pain Chiropractic Treatment El Paso, TX Shoulder Pain Chiropractic Treatment 02:52
  22. 22 El Paso, TX Lower Back Pain Chiropractor Treatment El Paso, TX Lower Back Pain Chiropractor Treatment 05:51
  23. 23 El Paso, TX Chiropractic Treatment for Car Accidents El Paso, TX Chiropractic Treatment for Car Accidents 02:37
  24. 24 El Paso, TX 18 Wheeler Accident Chiropractic Treatment El Paso, TX 18 Wheeler Accident Chiropractic Treatment 02:23
  25. 25 Chiropractic Neck Pain Treatment El Paso, TX Chiropractic Neck Pain Treatment El Paso, TX 02:14
  26. 26 El Paso, TX Chiropractor 79936 El Paso, TX Chiropractor 79936 02:00
  27. 27 Sciatica Pain Treatment in El Paso, TX Chiropractic Care Sciatica Pain Treatment in El Paso, TX Chiropractic Care 01:56
  28. 28 El Paso, TX Chiropractic Care For Auto Accidents El Paso, TX Chiropractic Care For Auto Accidents 03:28
  29. 29 El Paso, TX Chiropractic Care Neck Pain Treatment El Paso, TX Chiropractic Care Neck Pain Treatment 04:47
  30. 30 El Paso, TX Chiropractor Auto Accident Injuries El Paso, TX Chiropractor Auto Accident Injuries 07:00
  31. 31 El Paso, TX Chiropractor New Patient Intake Form El Paso, TX Chiropractor New Patient Intake Form 02:05
  32. 32 Whiplash Chiropractic Massage Therapy El Paso, TX Whiplash Chiropractic Massage Therapy El Paso, TX 01:55
  33. 33 El Paso, TX Cervical Pain Treatment Chiropractic Care El Paso, TX Cervical Pain Treatment Chiropractic Care 05:08
  34. 34 18 Wheeler Accident Pain Treatment Chiropractor El Paso, TX 18 Wheeler Accident Pain Treatment Chiropractor El Paso, TX 02:23
  35. 35 Shoulder Pain Treatment El Paso, TX Chiropractor Shoulder Pain Treatment El Paso, TX Chiropractor 02:49
  36. 36 Back Pain Management El Paso, TX Chiropractor Back Pain Management El Paso, TX Chiropractor 05:51
  37. 37 Car Accident Injury Treatment El Paso, TX Chiropractor Car Accident Injury Treatment El Paso, TX Chiropractor 02:36
  38. 38 Auto Accident Injury Treatment El Paso, TX Auto Accident Injury Treatment El Paso, TX 02:15
  39. 39 Neck Pain Treatment El Paso, TX Chiropractor Neck Pain Treatment El Paso, TX Chiropractor 02:15
  40. 40 Slip And Fall Injury Treatment El Paso, TX Chiropractor Slip And Fall Injury Treatment El Paso, TX Chiropractor 01:55
  41. 41 *CHIROPRACTOR* The Most Recommended | El Paso, Tx (2019) *CHIROPRACTOR* The Most Recommended | El Paso, Tx (2019) 02:19
  42. 42 *CHIROPRACTIC CARE* on Car Accident Injuries | El Paso, Tx (2019) *CHIROPRACTIC CARE* on Car Accident Injuries | El Paso, Tx (2019) 01:54

PUSH-as-Rx ®™ Beyond Rehabilitation For All - No Matter The Age

Again,  We Welcome You 👊🏻.

Our Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive, cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, practical strength training, and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.

We use Specialized Chiropractic Protocols, Wellness Programs, Functional & Integrative Nutrition, Agility & Mobility Fitness Training and Rehabilitation Systems for all ages.

As an extension to effective rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high-performance exercises and advanced agility treatment options. We have teamed up with the cities premier doctors, therapist and trainers to provide high-level competitive athletes the possibilities to push themselves to their highest abilities within our facilities.

We’ve been blessed to use our methods with thousands of El Pasoans over the last three decades allowing us to restore our patients’ health and fitness while implementing researched non-surgical methods and functional wellness programs.

Our programs are natural and use the body’s ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, un-wanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, a positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living.

With a bit of work, we can achieve optimal health together, no matter the age or disability.

Join us in improving your health for you and your family.

It’s all about: LIVING, LOVING & MATTERING! 🍎

Welcome & God Bless

EL PASO LOCATIONS

Central:
6440 Gateway East, Ste B
Phone: 915-850-0900

East Side:
11860 Vista Del Sol, Ste 128
Phone: 915-412-6677

Call (915) 850-0900 Today!

Clinic Location 1

Address: 11860 Vista Del Sol Dr Suite 128
El Paso, TX 79936
Phone
: (915) 412-6677
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Webwww.DrAlexJimenez.com

Clinic Location 2

Address: 6440 Gateway East, Building B
El Paso, TX 79905
Phone: (915) 850-0900
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Clinic Location 3

Address: 1700 N Zaragoza Rd # 117
El Paso, TX 79936
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Address: 6440 Gateway East, Building B
El Paso, TX 79905
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El Paso, TX 79902
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