2.4.3. Imaging of Upper Extremity

Question 1

Where are we most likely to find a meningioma under imaging?

Answer 1

Thoracic vertebrae

Question 2

What are the four curvatures of the spine?

Answer 2

Cervical lordosis Thoracic Kyphosis Lumar lordosis Sacral Kyphosis

Question 3

An abdominal cross section contains what three cylinders?

Answer 3

The spine, aorta and inferior vena cava

Question 4

What happens to the three cylinders in an abdominal cross section as we move inferiorly?

Answer 4

Cross sections moving inferiorly show the spine getting larger, the aorta getting smaller, and the inferior vena cava getting smaller

Question 5

What are our most superior organs in an abdominal cross section?

Answer 5

liver, spleen, stomach, and transverse colon are most superior.

Question 6

How do the stomach and colon appear in an x-ray?

Answer 6

The stomach and colon have air and should display as a speckled appearance on x-ray. If it is not one of those, the space may be an abcess.

Question 7

What are the most inferior organs in an abdominal cross section?

Answer 7

psoas muscles, ureters, uterus, and bladder are most inferior

Question 8

What structures do we see mid way through the abdominal cavity cross section?

Answer 8

kidneys, ureters, large and small bowel are inferior to that above

Question 9

Besides plain films like x-ray, what other studies can we do and what are they best for?

Answer 9

MRI - Soft tissue and joints CT - Spinal cord and brain Myelography - type of radiographic exam that uses a contrast medium to detect pathology

Question 10

What is echogenicity?

Answer 10

ability of obtaining return signal

Question 13

Label the parts below. Also, what defect do we typically see in the “Scotty Dog”?

Answer 13

A defect (usually a break) in the pars interarticularis (bones joining superior and inferior vertebrae) gives the “scotty dog” a dog collar. It is a typical “broken neck”. This can lead to spondylolisthesis or a sliding of the vertebrae.

Question 14

What do these studies show?

Answer 14

Patient suffered hyperflexion at L1, typically due to car accidents and sudden traumas involving seatbelts. This is known as the Chance fracture, and causes anterior wedging and compression

Question 15

What’s happening here?

Answer 15

herniated disc at L5 caused by nucleus pulposus pushing through annulus fibrosis. This will push on a nerve root causing pain

Question 16

When doing an x-ray of a possible shoulder separation, what is a good way to better show a gap if there is one?

Answer 16

A separation may be hard to identify and you may need to hold a weight during X-ray imaging to better show the gap in separation.

Question 17

Most common type of dislocation of the glenohumeral joint is in what direction? Caused by what?

Answer 17

anterior (most common) dislocation can occur during a fall on an outstretched arm

Question 18

How does a posterior shoulder dislocation occur and what will it look like on a plain film study?

Answer 18

significant trauma has to occur for a posterior dislocation

However, when the X-ray is taken anteriorly, it will have a positive rim sign and the humeral head will look like a light bulb.

Question 19

What do we mean by bony rings and how do they often fracture/dislocate?

Answer 19

Bony rings such as the pelvis, radius and ulna combined, or a vertebral body are either broken in two places or broken in one and dislocated in the other

Question 20

What shuld we be thinking about with snuffbox tenderness?

Answer 20

A dangerous symptom

Can mean the scaphoid is fractured, blood supply is occluded (because the supply runs back on itself - see below) and the bone may die.