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7 Imaging > L4 UE > Flashcards

L4 UE Flashcards

1
Q

Y view

A

plain film with the patient rotated to look for suspected shoulder dislocations or fractures of scapula

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2
Q

Axillary view

A

plain film with arm abducted and beam is focused through the axilla with the film cartiridge on the superior aspect of the shoulder

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3
Q

Impingement due to rotator cuff

A

ultrasound is recommended along with plain radiography

MRI is used when ultrasound is not available

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4
Q

CT of shoulder is useful for

A

complex fracture dislocation injuries of the shoulder, as pre-surgical tool

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5
Q

Plain Radiography for shoulder

A
  • initial investigation of choice for all shoulder problems
  • can detect most fractures, dislocations, calcific tendonitis, arthritis, tumor
    *shoulder trauma should hav ≥ 3 views. Usually axillary, scap, y-view, AP
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6
Q

Ultrasoundography for shoulder

A
  • best for full thickness rotator cuff, less sensitive in partial thickness
  • ultrasound is better than MRI, only if the user is experienced. Still only best for full thickness
  • useful for long head of biceps
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7
Q

MRI in shoulder

A
  • highly accurate with full thickness RCT
  • used when further investigation of RCT is needed i.e causes of the impingement
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8
Q

MRI Arthrography

A
  • involves an MRI following injection of contrast agent
  • most accurate for rotator cuff pathology
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9
Q

CT for shoulder

A
  • better for complex fractures and dislocations
  • contrast agent can be used, MRI is now replacing this option
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10
Q

Views for shoulder

A

AP–IR/ER
Scapular Y view (Post)
Axillary
West point
Stryker Notch
Zanca view

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11
Q

Scapular Y View

A

good for scapular fracture and dislocation

shows posterior view

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12
Q

Axillary View

A

best view to determine the direction of dislocation

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13
Q

West Point View

A

shoss anterior inferior glenoid. demonstrates bony bakart lesions and hill sachs lesions

individual is in prone, with shoulder abducted to 90°

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14
Q

Stryker Notch View

A
  • evaluates posterolateral humeral head
  • demonstrates hill-sachs lesions
  • patient is supine, shoulder flexed above head, x-ray goes through armpit
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15
Q

humeral head migration should be less than

A

3 mm

normal is between 7-10 mm

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16
Q

Zanca view

A
  • 10-15° cephalic tilt
  • best to view to evaluate joint displacement and intra-articular fractures of the AC joint and clavicle
  • patient is standing , and x-ray comes in at the chest
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17
Q

Most common shoulder fractures

A

clavicular
humeral
glenoid
scapular

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18
Q

Clavicle Fractures

A
  • most common shoulder fractures
  • harder to heal in adults
  • most occur in the middle 1/3
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19
Q

Scapular Fractures

A
  • most common are body or spine fx, usually results from a severe direct blow
  • other types include acromion, neck, glenoid, coracoid
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20
Q

Acromion fracture

A

results from downward blow to the shoulder. superiorly displaced fractures may occur as result of a superior dislocation of shoulder

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21
Q

Neck fracture

A

direction anterior or posterior blow to shoulder

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22
Q

Glenoid fracture

A

comes from fall onto flexed elbow, direct lateral blow

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23
Q

Coracoid Fracture

A

results from direct blow to superior point of shoulder or humeral head. or results from avulsion fracture

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24
Q

Humerus Fractures

A
  • proximal fractures are common
  • MOI = direct trauma to arm or shoulder or axial load transmitted through the elbow
  • bruising is common, radial nerve can be damaged if the spiral groove is fractured
  • older adults are common because of osteoporosis
  • 4-5% of all fractures
  • RC attachments influence degree of displacement
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25
Q

Anatomical neck

A

residual epiphyseal plate

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26
Q

Surgical Plate

A

bony constriction at proximal end of shaft of humerus

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27
Q

Most fractures through head of humerus are

A

type 1 or type 2 of salter-harris

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28
Q

Shoulder dislocations

A
  • most are anterior from glenoid
    *y-view should humeral head dislocation
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29
Q

Factors with high SNOUT for fracture + dislocation of shoulder

A
  1. 40 yo+ and humeral ecchymosis
  2. 40 yo+ and first episode of dislocation
  3. <40 yo and MOI other than fall or atrauma
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30
Q

Hill-sachs lesions

A
  • defect in posterio superior humeral head
  • chondral or osteochondral
  • indentation from where humeral head was resting on anterior rim of glenoid
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31
Q

MRI with contrast is done in what view?

A

anterior approach and arm in moderate external rotation

32
Q

MRI with contrast is done to evaluate

A
  • labral tears
  • capsular disruptions
  • articular cartilage defects
  • proximal biceps tears
33
Q

Signs of RCT

A
  • visualization
  • high T2 signal tracking through RC
  • injected contrast in subacromial bursa

Indirect: fluid in subacromial bursa, high riding humeral head

34
Q

Bankart Lesion

A

anterior or anteroinferior labral tear

  • acute or chronic
  • often assoicated with anterior capsular or IGHL disruption
35
Q

Benign Bone Lesions

A
  • small size
  • no periosteal reaction
  • sharp zone of transition between bone and lesion
  • thin, well-defined sclerotic margin
36
Q

Malignant Bone Lesions

A

any lytic lesion without sclerotic margin should be considered malignant

often have sunburst view

37
Q

periosteal reaction

A
  • thickening of the periosteum, appears white on x ray
  • seen with normal healing fracture, osteomyelitis, tumors
  • radiating is worrisome for malignancy
38
Q

Elbow extension test

A

patients unable to fully extend their elbows indicate that they have a bone injury/fracture

39
Q

Elbow plain film views

A
  • AP view
  • Lateral view w/elbow flexed to 90°
40
Q

Lateral view on elbow shows

A

anterior fat pad may be seen and should be adjacent to the bone

posterior fat pad indicated pathology

41
Q

What nerves and arteries could be injured with elbow fracture?

A

Brachial, Radial, Ulnar

42
Q

Elbow Trauma

A

lateral view is best
* displacement of anterior fat pad or presence of posterior fat pad indicates a fracture

43
Q

Elbow ossification sequence

A

CRITOE –> capitulum, radial head, internal/medial epicondyle, trochlea, olecranon, external/lateral epicondyle

ossification usually complete by mid-teens

44
Q

What is the most common fracture of the elbow?

A

radial head

45
Q

FOOSH

A

escessive force in a closed pack position leads to bony failure

46
Q

if FOOSH force is through radius

A

radial head on capitulum, causing radial head fracture

47
Q

If FOOSH force is through the ulna,

A

ulna on humerus, fracture of either coronoid or olecranon

48
Q

radial head fractures

A
  • mechanical considerations –> axial loading, valgus impaction, or combo

may need fixation or it is unreconstructable

49
Q

Proximal Radius Fx

A
  • most common elbow fx in adults
  • difficult to see a non-displaced radial head, may need oblique view
50
Q

Capitellum Fractures

A
  • mechanical forces = longitudinal foces, valgus impaction
  • associated injuries include medial elbow, radial head, distal humerus, wrist
  • three different types
51
Q

Supracondylar Fracture

A
  • 60% of all peds elbow fx
  • 96% extension injuries, including FOOSH hyperextension
  • 10% have a nerve injury (radial >median>ulnar)
52
Q

Subluxation of radial head

A
  • most common traumatic elbow injury in peds population
  • results from pull on extended pronated arm
  • “nursemaid’s elbow)
53
Q

Fractures of the forearm

A

nightstick
monteggia
galeazzi
greenstick

54
Q

Nightstick fx

A

fx of midportion of ulna

55
Q

Monteggia Fx

A

fx of proximal ulna with dislocation of radial head

56
Q

Galeazzi Fracture

A

fx of distal radius with dislocation of ulnar head from the wrist

57
Q

Greenstick fracture

A

incomplete fx due to flexibility of young bones

one side of bone breaks from a distraction force and other side bends but stays intact

58
Q

Wrist and Hand plain film views

A

include AP, lateral, and oblique, scaphoid view

59
Q

Scapholunate Angle

A

dorsal instability >70
Volar instability < 30

60
Q

The scaphoid lunate gap should be less than

A

3 MM

61
Q

Terry Thomas Sign

A

dislocation of scapholunate ligament

62
Q

Colles’ fracture

A
  • most common fx of wrist
  • fx of distal radius with dorsal angulation of distal fragment
  • includes fx of ulnar styloid
  • MOI = FOOSH
  • dinner fork deformity
  • extension fracture of radius
63
Q

Smith Fracture

A
  • reverse of colles’ fracture
  • distal fragment is angulated towards the palmar surface
  • flexion fracture of radius
64
Q

Torus Fracture

A
  • know as buckle fracture
  • compression fracture in children, in radius
65
Q

Scaphoid Fracture

A
  • most common fracture of carpals
  • often difficult to see on initial plain films
  • can lead to avascular necrosis of scaphoid
  • CT scan is best, bone scan is also good
66
Q

Screening for scaphoid fracture

A
  • snuff box tenderness
  • scaphoid tubercle tenderness
  • longitudinal compression

HIGH snout 100%, high spin

67
Q

Common fractures of metacarpals include

A

boxer’s fracture
bennet and rolando’s

68
Q

Boxer’s fracture

A

fx of 5th MC
often with displacement or angulation

69
Q

Bennett fracture

A

fx of the base of the 1st MC, moi is forced abduction

70
Q

Rolando Fracture

A

MC base fracture with 3 fragments, falling with flexed thumb

71
Q

Common finger fractures

A
  • gamekeeper’s fracture
  • volar plate freacture
  • mallet finger deformity
72
Q

Gamekeeper’s fracture

A
  • avulsion fracture of the base 1st phalange
  • MOI is HE of thumb
73
Q

Volar plate fracture

A

avulsion fracture of the base of the palmar surface of a phalange

74
Q

Mallet Finger

A

avulsion fracture at the base of the DIP or tear of the ED at the DIP

75
Q

Signet Ring Sign

A

shoes a subluxed scaphoid

7 Imaging (4 decks)

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