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<v ->Thank you very much.

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And again it's a privilege to be back

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for a second day

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and continue our discussion on synovial joints,

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looking at disorders and derangements of those joints.

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And once again, part of the thrill of my being involved

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in this particular course is my ability to work

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with scholars who came to us at UCSD from Brazil.

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And today it's a particular privilege to introduce

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Carlos Longo to you.

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I know many of the Brazilians

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and others listening know about him.

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But as I look back on his career,

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he was in San Diego in the 1990s.

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That was pretty early on for us

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when we were involved in MR

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and beginning our involvement in teleradiology.

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And he arrived with us and immediately

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we were very impressed with not only his knowledge,

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but with his personality.

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And I have to tell you the people listening in Brazil

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who came later as visiting scholars

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it's because we thought so much of Carlos Longo

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we decided to enhance our connection

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with Brazil and invite more and more

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of the Brazilian radiologist to visit us.

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So you owe a lot to Carlos.

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I thank Carlos for being willing to be with us today

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and to discuss his cases.

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To give you an idea of what we're gonna cover

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in this particular segment.

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Again, four sessions as you've already heard

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and you can see the topics listed there,

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mainly bursitis, tenosynovitis,

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adhesive capsulitis, intra-articular bodies

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and their differential diagnosis.

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And then we'll begin our discussion of specific disorders

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that involve synovial line joints

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by talking about rheumatoid arthritis

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and the spondyloarthropathies.

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So let's begin by looking at the bursa

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and when they become inflamed,

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let's discuss the topic of bursitis.

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A general classification bursa is presented

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on this particular slide.

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And you can see there are two categories.

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The first are those bursae that are primary.

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And by that it means that they are present at birth

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and they are also, as you will see classified

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according to their particular location

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and their relationship to other structures.

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And I'll get into more detail about that in a few minutes.

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The adventitious bursa are acquired.

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They're often resulting from stress, repetitive stress

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or friction placed on certain areas

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that leads to changes in the connective tissue

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and eventually to the development of the bursa.

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I show you in this particular slide

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one of the best known primary bursa,

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this is a subcutaneous bursa, the prepatellar bursa

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You're gonna learn more about it later on.

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Now, bursa do become abnormal.

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And the causes of abnormalities within these bursa

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is extremely variable.

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A single episode of trauma, repetitive stress,

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a variety of tumors and tumor like processes,

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infection, non-infectious inflammation.

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The list goes on and on.

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Bursitis is rather common and very characteristic

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at certain sites in the human body,

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such that various names have been applied to bursitis

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at these sites.

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On the right side of the slide

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I indicate some of the names.

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Some of them a little bit unusual

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that indicate sites of bursitis in various locations.

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Let's look very briefly at this one.

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This is ischiogluteal bursitis.

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It's also known as weaver's bottom,

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tailer's bottom or a lighterman's bottom.

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And it's a bursitis that involves an adventitious bursa

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that is located deep to the gluteus maximus muscle

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and superficial to the ischial tuberosity.

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And when you think about what happens

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in the sitting position, the gluteus maximus muscle

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contracts and slides upward,

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and therefore that ischial tuberosity

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becomes rather superficial in location.

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So you can imagine that certain occupations

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that require prolonged sitting,

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particularly if they're associated with vibrations

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and I've listed a couple of such occupations here,

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that a bursitis might develop in this particular area.

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Sports related bursitis can also affect this bursa

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as can some systemic disease.

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I show you nicely here an example of fluid within the bursa

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and in the bottom image

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you can see the enhancement of the rim of the bursa

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following intravenous gadolinium.