Lines of Alignment Flashcards
Cx- AP View
▪ Sidebending (scoliosis) ▪ Rotation pedicular method or SP - + / ++ / +++ / ++++ ▪ Interpedicular distance - C3: 28mm - C4: 29mm - C5: 29mm - C6: 29mm - C7: 28mm
Cx- Lateral View
▪ ALL, PLL, SLL
- Georges Line = PLL
▪ Cervical canal width
- Distance between PLL and SLL is spinal canal space (<12mm stenosis)
▪ Angle of the Cervical Spine
- Midpoints of anterior and posterior tubercles of the atlas and a line through inferior endplate of C7.
- Normal: 35-45 degrees
▪ Ruth Jackson / Physiological Line of Stress
- Posterior aspect of Dens and Posterior Aspect of C7
- Neutral: Should pass through C4/5 IVD
- Flexion: Should Pass through C5/6
- Extension: Should Pass through C4/5 posterior
▪ Vertical line of stress (cervical body gravity Line)
- As with Ruth Jackson, should pass thru C4/C5 IVD
▪ ADI
- Anterior aspect of dens and posterior aspect of anterior tubercle
- 1-3mm adults
- 1-5mm children
▪ Retropharyngeal and retro tracheal spaces
- 7mm @ C2
- 22mm @ C7
Tx- AP View
▪ Sidebending (scoliosis)
- COBB-Lippman
- Risser-Ferguson
▪ Rotation
- pedicular method, or;
- SP
- / ++ / +++ / ++++
▪ Interpedicular distance
▪ Tracheal bifurcation
- Newborn: T3
- Child @ 10yo: T5
- Adult: T6
Tx- Scoliosis
The four basic parameter investigated in scoliosis are:
1) curvature
2) rotation
3) flexibility
4) skeletal maturation
Tx- Lateral View
▪ ALL, PLL, SLL
- Georges Line = PLL
Lx- AP View
▪ Sidebending (scoliosis)
- COBB-Lippman (preferred)
- Risser-Ferguson
▪ Rotation
- pedicular method, or;
- SP
- / ++ / +++ / ++++
▪ Interpeduncular distance
- Should not be below 20mm
Lx- Lateral View
▪ Fergusons Line (Lx gravitational Line)
- Perpendicular line dropped from centre of L3.
- Should strike anterior margin or anterior 1⁄4 of sacral base
▪ Sacro-vertebral and Lumbar Body Angles
- Lines drawn through and parallel to each lumbar bony endplate,
lines being extended posteriorly until they intersect.
- 8-15 deg (incr inferiorly)
▪ Sacral Base angle
- 1: Horizontal line to bottom of film, intersects with;
- 2: Line drawn parallel to sacral base.
- Upright: Avg. 41 deg. 26 - 57
▪ McNab’s Line
- Line drawn through inferior endplate at level to be evaluated. Relationships to superior articular process of vertebrae below is then assessed.
- Line should lie above tip of adjacent sup. Articular facet.
▪ Lumbar Curve Angle
- 1: Horizontal line to superior endplate L1, intersects with;
- 2: Horizontal line to inferior endplate L5.
- Upright: 35 – 45deg
▪ Meyerding (Lx spondylolisthesis)
- To classify a spondylolisthesis. Sacral base is divided into 4 equal parts. The
relative slip of the vertebrae above is classified.
Hip
▪ Hip joint width (Tear drop distance)
- Superior: 3-6 4mm
- Axial: 3-7 4mm
- Medial: 6-11 8mm
▪ Acetabular depth
▪ Symphysis pubis width
- Distance between opposing articular surfaces.
▪ Shenton’s line
- Curvilinear line traced along undersurface of femoral neck and continued across the joint to the inferior margin of the superior pubic ramus..
- Line should be smooth and uninterrupted.
▪ Ilio-femoral line
- Line along lateral margins of the ilium should continue as an unbroken curve along the superior margins of the femoral neck.
- Even appearance bilaterally
▪ Skinners line
- Line drawn through and parallel to axis of femoral shaft.
- Line is constructed tangential to the tip of the greater trochanter.
- Relationships to the fovea is assessed and fovea should lie above or at the level of the level of the trochanteric line.
▪ Femoral angle - Angle formed by the axis of the neck and the long axis of the shaft of femur. - 120-130 degree's ▪ Acetabular angle
▪ Measurement of protrusio acetabuli (Kohlers Line)
- Line tangential to cortical margin of pelvic inlet and outer border of obturator foramen. Relationships to acetabular floor is assessed.
- Acetabular floor should not cross this line -> normally lateral to it.
▪ Slipped epiphysis in children (Klein’s line)
- Line drawn tangential to the superior margins of the femoral neck. Bilateral examinations should be made.
- Failure of the femoral head to cut the line drawn -> SFCE suspected.
Knee
Axial Relationships
- Draw Fem. Condyle and Tib. Plateau lines (paralell)
- Mid axis Tib and Fem. lines
- Fem. Angle: 75-85 deg
- Tib Angle: 85- 100deg
Q Angle
▪ A: Line taking origin from ASIS through patella midpoint.
▪ B: Line through tibial plateau and midpoint of the patella.
- M= 14 deg
- F= 17 deg
Patella Position
▪ AP- note symmetry of articulation
▪ Lateral- Patella length and patella tendon usually equal (20% variance accepted)
Shoulder- AP w/ ER
● GH Joint width
- Superior, middle and inferior aspect of glenoid. Combined and averaged.
- Normal: 4-5mm
● Humeral Axial angle
- Greater tuberosity apex to where medial cortex of diaphysis becomes a thin line.
- Line down the axis of the humerus.
- Normal: 60-62 degrees
● Acromiohumeral Joint Space
- Measured: Inferior aspect acromion and apices of humerus.
- Normal Measurement: 9mm avg.
● Acromioclavicular Joint Space
- Measured: 2 points on lat clavicle and 2 points acromion.
- Normal Measurement: M=3.3mm F=2.9mm
Wrist
1: Line curving along scaphoid, lunate, triquetrum
and pisiform
- Line running along superior articulations of
pisiform, lunate, scaphoid. - Line at inferior articulation of hamate
Capitate.
Ankle
Tibial Shaft Line: drawn through and parallel
to tibial shaft.
Medial Malleolus line: A line drawn tangential; to articular surface of medial; malleolus
Lateral Malleolus line: A line is drawn tangential to the articular surface of the lateral malleolus.
Talus line: A line drawn tangential to the articular surface of the talar dome.
Tibial Angle: Angle is formed medially between medial malleolus and talus line. (52 deg)
Fibular Angle: The angle is formed laterally between the lateral malleolus line and talus line. (53 deg)
Foot
Heel Pad Measurement- Measured: Normal = < 20mm
