Imaging - UQ Flashcards
Canadian Cervical Spine Rules
for alert, stable trauma patienets
need radiography if high risk factors present, can’t rotate neck, or low risk but unsafe ROM
Oblique X-ray
after fx/dislocation, r/o
neural foraminal narrowing, facet jt alignment
Swimmer’s X-ray
C7-T1 if joints can’t be seen in AP/lateral views
Atlantodental Interval
distance between post margin of ant tub and ant surface of dens
> 3.5 mm instability, > 7 transverse lig disrupted
> 9-10 neurologic injury risk
Cause - trauma, Down syndrome, AS, RA, psoriatic arthritis, Reiter syndrome
George Line
lateral view connecting post vertebral bodies (should be smooth)
- flex/ext view useful for appreciate disruption
- antero/retro-lothesis - instability due to fx, dislocation, lig lax, DJD
Center Gravity Line
vert line from apex to dens to C7 body
- gross assessment where gravitational stresses acting on CTJ
Prevertebral Soft Tissue
in front of vert bodies, behind air shadow of pharynx, larynx, trachea
- increases with any soft tissue mass, post trauma hematoma, neoplasm
- C2-C5 < 7 mm in neutral, C5-C7 < 20 normal
Spinal Fx
Jefferson - C1 burst fx (axial loading of head compressed onto spine)
Odontoid - C2
Hangman - C2 post aspects (hyperext, SC compromised, C2 sublux on C3, w/ lysthesis)
Clay-Shovelers - spinous process of C6-T2 (any) (hyperflex)
Stingers/Burners
acute short lived neuropraxic injuries (extremity paresthesia, weakness)
high concurrence with DDD/stenosis
Cervical cord neurapraxia (CCN)
can vary from B sensory deficits to complete quadriplegia (80%) 15 min (74%) to 48 hours pincer mechanism and compression; associated with stenosis
Lateral Elbow view
best; ant fat pad should be adjacent to bone (post = pathology or fx)
CRITOE
capitulum, radial head, int (med) epi, trochlea, olecranon, ext (lat) epi
Elbow Fractures
radial head - most common nightstick - mid ulna fx monteggia - prox ulna, rad head dislocation galeazzi - dist rad fx, uln dislocation greenstick
Nursemaid’s Elbow
significant distraction force cause rad head to slip out of annular ligament
Little League Elbow
medial apophysitis from repetitive throwing; look for lateral compression too
New Orleans Criteria
GCS 15 AND 1 of following
- HA, vomit, > 60 yo, dug/alc
- persistent anterograde amnesia, visible trauma above clavicle, seizure
Canadian CT Head Rule
CGS 13-15 AND 1
- need trauma, no open fx, > 16 yo, not on warfarin (no bleeding disorder)
High risk
- GCS < 15, 2 hours after
- suspected open/depressed skull fx
- signs of basal skull fx, vomit 2+x, > 65 yo
Medium risk
- amenisa 30 min before impact
- dangerous mechanism
- fall > 3 ft or 5 stairs
Shoulder and US
high acc in FT RTC, less Sn in PT
MRA = Sn, > Sp FT and PT
useful for Ca deposit aspiration or bursal injection, eval LH biceps
Shoulder and MRI
high acc FT RTC
= Sn vs MRA (FT), less acc PT; comparable vs US
less Sp vs MRA for RTC tear, less Sn with PT
Shoulder and MRA
most acc RTC
less Sn for bursal PT than articular PT
gold standard labrum
Shoulder and CT
better than X-ray to eval complex fx
Clavicle Fx
A - 80% mid 1/3
B - 15% dist/lat 1/3
C - 5% prox/med
Shoulder Dislocation
95% ant, Y film
Need imaging
> 40 bruising, > 40 and 1st time, < 40 and MOI other than fall/atraumatic injury
Hill-Sachs
defect in post sup HH; indentation from where HH rest on ant rim of glenoid
Bankart
HH hits glenoid = fx of inf edge of glenoid
Hand X-rays
scap - scap fx carpal tunnel - hamate fx PA - uln styloid, uln variance, arches lat - scapholunate angle oblique
Colles Fx
most common, dist rad fx with dorsal angulations and uln sty fx
MOI - FOOSH, break towards thumb
Smith Fx
palmar angulation, wrist flex, break away from thumbg
Scaphoid Fx
can lead to AVN
snuff box, scap tub tenderness, long compression
Peds - rad dev pain, painful wrist AROM, volar scap tender
immob, repeat imaging/exam in 2 weeks
Signet Ring sign
scapholunate lig tear
Keinboch’s diesase
AVN of lunate
1 - mild, intermittent
2 - pain severe/constant, inc density on AP
3 - worst
MC Fx
Boxer - 5th (displacement and angul palmar)
Bennet - 1st (2 piece intraarticular fx dislocation at base
Rolando - 1st (base fx with 3+ fragments)
Gamekeeper
avulsion fx of thumb, UCL rupture of thumb MCP (may have fx vs tear)
Stener’s lesion - reflects out of add apon = never heal again
Ganglion Cyst
dorsum of wrist, check scapholunate jt
