Common Primary Complaints Flashcards
When should you order imaging?
- To confirm a suspicion
- Should impact your treatment
- Should include relevant and brief Pt Hx with purpose of evaluation*
Why should you not order imaging?
- Should not be a “fishing expedition”
- Avoid imaging “just in case”
What are common issues within primary care for x-rays?
- Acute foot pain
- Acute ankle pain
- Acute knee pain
- Elbow pain
- Wrist pain
- Shoulder pain
- Low back pain
- Headache
When is an X-ray indicated for acute ankle series?
Ottowa Rules:
- Pain in the malleolar zone
- Bone tenderness at the posterior edge (6cm) at the medial/lateral malleolus
OR
- Inability to bear weight both immediately after injury and four steps in the evaluation room
The Pt can bear weight on their ankle/foot if:
- If Pt can transfer weight twice to each foot
- If Pt can limp
When is an X-ray indicated for acute foot pain?
Ottowa Rules:
- Pain in the “midfoot” region
AND
- Bone tenderness at the base of the 5th metatarsal or navicular
OR
- Inability to bear weight both immediately after injury and four steps in the evaluation room
Considerations for stress fractures in association with acute foot pain?
- X-rays may be normal initially
- Bone scan can show abnormalities before X-ray
- Consider CT or MRI
When is an X-ray indicated for acute knee pain?
Ottowa Rules:
- Age >55
- Isolated tenderness of patella (no other bony tenderness)
- Tenderness at head of fibula
- Inability to flex to 90
- Inability to bear weight both immediately after injury and four steps in the evaluation room
- *Ottowa knee rules are for bony injuries
When should you schedule additional imaging for knee injuries (non-bony)?
- MRI is preferred if ligamentous injury suspected
- Immobilize while awaiting further eval
- If plain radiographs are negative and you still suspect bony fracture, consider CT
When is an X-ray indicated for shoulder pain?
- Traumatic cause
- Presence of pain
- Loss of range of motion
What problems will you be able to identify on shoulder x-rays?
- Fractures
- Dislocations
- Arthritis
- Acromioclavicular (AC) or Sternoclavicular (SC) joint injuries
When is MRI preferred for shoulder pain?
- Labral
- Ligamentous
- Rotator Cuff
When is an X-ray indicated for the hand?
Depends on: - Clinical assessment - Suspected injuries Based on: - Physical exam - MOI
Consultation with Radiologist is often helpful
X-ray views for suspected phalanx (hand)?
- AP
- True Lateral
X-ray views for close to or involving joint (hand)?
- Oblique
X-ray views for inability to delineate because of superimposed digits (i.e. base of proximal phalanx)?
Obtain radiograph of entire hand
All metacarpal fractures require what views?
- AP
- Lateral
- Oblique
X-ray for suspected scaphoid fracture?
Scaphoid series
Hand fracture description to guide radiological exam and management?
Described radiologically by:
- Location
- Geometry
- Whether commutation is present
How to describe fracture location for radiological exams of the hand?
- Name broken bone and finger involved
then further anatomic details of exact location of fracture
Location descriptions for phalanges and metacarpals?
- Head
- Neck
- Shaft
- Base
Location descriptions for scaphoid fracture?
- Tubercle
- Waist
- Proximal pole
- Distal pole
Tuft fractures refer to fractures involving what?
Head of the distal phalanx
Intra-articular fractures refer to what?
Fractures involving the joint
