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Clin Med II - FINAL > Imaging - Knee and Foot and Ankle > Flashcards

Imaging - Knee and Foot and Ankle Flashcards

1
Q

What are some routine radiograph views of the knee?

A

AP
Lateral
PA Axial “Tunnel” View
Tangential View

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2
Q

What does the knee AP view show?

A

Visualizes distal Femur, proximal Tibia and respective joint, and Fibular head

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3
Q

What are some important observations of the structures in a knee AP view?

A
  • Patella superimposed and not typically visible unless patella baja
  • Well defined joint spaces and equal
  • Alignment of Femur and Tibia
  • Distinct cortical margins and cancellous markings
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4
Q

What does a knee lateral view show?

A

Visualizes profile of PF joint

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5
Q

What are some important observations in a knee lateral view?

A

Important observations- patellar alta/baja positioning

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6
Q

What should we see regarding the length of the patellar tendon and patella?

A

Length of patella and patellar tendon should be similar, within 20% variance

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7
Q

What does the knee PA axial “tunnel” view show?

A

Intercondylar fossa and eminence
Posterior Femur and Tibia
Tibial plateaus

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8
Q

What is the knee PA axial tunnel view used to detect?

A

Used to detect loose bodies, osteochondral defects, or narrowing of Tibiofemoral joint space

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9
Q

Why is the knee PA axial tunnel view often performed?

A

Often performed in standing for Age-related changes

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10
Q

What are some important observations with the knee PA axial tunnel view?

A

Important observations
Tunnel should be open, round and not squared off
Well defined joint spaces and equal

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11
Q

What is the knee tangential view showing?

A

Visualizes PF joint space and surfaces

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12
Q

What should we observe with the knee tangential view?

A

Smooth and distinct joint surfaces
Sulcus angle
congruence angle

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13
Q

What does the sulcus angle tell us?

A

depth of sulcus; if shallow more prone to dislocations

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14
Q

What is the congruence angle?

A
  • Helps to define patellar position within the sulcus
  • If > 16° lateral to the zero line, more prone to dislocations
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15
Q

What are some routine radiographs of the ankle?

A

AP
AP Oblique (mortise)
Lateral

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16
Q

What does the ankle AP view visualize?

A

Visualizes distal Tibia and Fibula and Talar dome

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17
Q

What are some important observations in the ankle AP view?

A
  • Lateral malleolus more distal than medial
  • Visualize upper and medial talus- a medial or lateral shift of Talus is abnormal
  • Distal Tibiofibular joint space- an abnormally wide joint is abnormal
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18
Q

What is an ankle AP oblique mortise view?

A

Visualizes entire ankle mortise with 15-20° of hip IR

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19
Q

What are some important observations in an ankle AP oblique mortise view?

A
  • Entire talocrural joint space
  • Mortise width- typically, 3-4 mm or < ½ a cm all the way around is normal
  • Distal Tibiofibular joint- NO optimal radiographic parameter exists to assess syndesmotic integrity but > 6 mm is utilized
20
Q

What does the ankle lateral view visualize?

A
  • Tibiotalar and subtalar joints
  • Talonavicular and Calcaneocuboid joints
  • Bony members
21
Q

What are ankle stress views?

A

X-ray while performing ligamentous Special Test

22
Q

What is the ankle anterior drawer stress view measuring?

A

Measure from posterior Tibia to posterior Talus

23
Q

What is an normal value for the ankle anterior drawer stress view radiograph? abnormal?

A

Normal = 5 mm or a ½ a cm
Abnormal = > 10 mm or 1 cm
5-10 mm of separation requires comparison between sides

24
Q

What is an ankle EV/IV stress view looking at?

A

Measure angle between bottom of Tibia and Talar dome

25
Q

What are abnormal findings with the ankle EV/IV stress views?

A

Mortise widens
Talar displacement or tilt
* > 15° for IV and > 10° for EV are abnormal
* Also, abnormality exists if > 5° difference between sides of the body

26
Q

What are some routine radiographs of the foot?

A

AP
Lateral
Oblique

27
Q

What does the foot AP visualize?

A

Visualizes the mid- and forefoot

28
Q

What are some important observations with the foot AP view?

A
  • Note individual mid- and forefoot bones along with sesamoid bones
  • 1st intermetatarsal angle= intersection of lines bisecting 1st and 2nd MT shafts (Normal < 5-10°)
29
Q

What is the foot lateral view visualizing?

A

Subtalar, talonavicular, and calcaneocuboid joints and members

30
Q

How is the foot lateral view different from the lateral ankle view?

A

Different from lateral ankle view bc less Tibiofibular imaged

31
Q

What is the foot oblique view?

A

Foot and leg medially rotated

** primarily for forefoot

32
Q

What does the foot oblique view visualize?

A
  • Primarily for forefoot
  • All tarsals except 1st Cuneiform and a portion of the Talus
33
Q

What are some important observations with the foot oblique view?

A
  • MTs image with sharp clearly defined cortical borders
  • Sesamoids
  • 2nd-4th distal phalanges difficult to visualize
  • Note joint spaces of intermetatarsal and midtarsal joints
34
Q

What is the Bernese Foot and Ankle CDR?

A

≥ 91% sensitive and specific
- Ankle radiographs are required with P! from either of the following:
* Compress malleolar fork with palm ~4 inches above fibular tip and avoiding the injured region
* Press thumb pad directly on medial malleolus
- Foot radiographs are required with P! while stabilizing calcaneus and then compressing midfoot into rearfoot

35
Q

What are the Ottawa food and ankle CDR?

A

98% sensitive and 88% specific
Ankle radiographs are required with:
- P! along distal 2.5 inches of posterior border OR tips of fibula OR tibia
- Inability to walk 4 steps immediately OR in ER
Foot radiographs are required with:
- P! at 5th MT base OR Navicular
- Inability to walk 4 steps immediately OR in ER

36
Q

What should be the ankle position with Matle’s test? PF or DF?

A

PF

37
Q

What is an ultrasound?

A

Ultrasound waves are absorbed, reflected, and diffused differently from varying tissues to construct an image

38
Q

What are the advantages of an ultrasound?

A
  • Offers real time information for superficial soft tissue
  • Higher resolution for superficial tendon, ligament, and muscle than MRI
39
Q

What are some major disadvantages of an ultrasound?

A
  • Inability to scan deeper joint structures
  • image quality highly dependent on operator
40
Q

What do higher (brighter) signals come from on US?

A

Higher (brighter) signal from reflection of smoother and denser structures indicate swelling, tendinosis (fibrosis/degeneration), aka hyperechoic appearance

41
Q

What do irregular borders or lack of structure indicate on US?

A

tears

42
Q

What does a wider structure indicate on US?

A

swelling, thickening

43
Q

When should we use a radiograph?

A

initial images

44
Q

When are CT and MRI recommended?

A

complex fractures and osteochondral lension

45
Q

When is a MRI recommended?

A

Stress fx and tendon abnormalities

46
Q

When is a MRI arthrography (with contrast) recommended?

A

for ligamentous and cartilage issues

47
Q

When is US appropriate?

A

For superficial soft tissue abnormalities

Clin Med II - FINAL (5 decks)

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