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Diffuse idiopathic skeletal hyperostosis (DISH)

from Section I - Musculoskeletal radiology

Published online by Cambridge University Press:  22 August 2009

James R. D. Murray ,
Erskine J. Holmes  and
Rakesh R. Misra
James R. D. Murray
Affiliation:
Bath Royal United Hospital
Erskine J. Holmes
Affiliation:
Royal Berkshire Hospital
Rakesh R. Misra
Affiliation:
Buckinghamshire Hospitals NHS Trust
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Summary

Characteristics

  • Bone proliferation at the tendon–bone interfaces (entheses) around peripheral joints and the spine.

  • Occurs relatively commonly in a middle-aged population, sometimes in conjunction with OA.

  • Classically in the over 50s with a male preponderance (3:1).

  • Association with diabetes mellitus.

Clinical features

  • Pain and restricted movement.

  • Isolated DISH is usually asymptomatic, but very often, presents alongside OA.

Radiological features

  • Vertebral column – disc spaces are generally well preserved, no apophyseal ankylosis. Flowing ossification along the anterior/anterolateral aspect of at least four contiguous vertebral bodies.

  • Calcaneal, olecranon and anterior patellar spurs.

  • Broad osteophytes especially on the lateral aspect of the acetabulum, inferior aspect of the sacroiliac joints and superior aspect of symphysis pubis.

  • Ossification of iliolumbar, sacrotuberous and sacroiliac ligaments.

  • Ligamentous ossification – patellar ligament, coracoclavicular ligament and interosseous membranes.

Management

  • Treat the associated osteoarthrosis.

Type
Chapter
Information
A-Z of Musculoskeletal and Trauma Radiology , pp. 53 - 54
Publisher: Cambridge University Press
Print publication year: 2008

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