LOWER EXTREMITY I.A. Flashcards
LABEL THE IMAGE
- WHAT POSITIONAL ERRORS?
I. Adductor tubercle
J. Lateral condyle
K. Medial condyle
- UNDERROATED & INTERNALLY ROTATED
LABEL IMAGE
- WHAT POSITION ERRORS?
A. Femur
B. Patella
C. Medial condyle
D. Tibia
E. Fibular head
F. Tibiofibular joint
G. Femorotibial join
H. Lateral condyle
- INTERNALLY ROTATED
LABEL IMAGE
- WHAT POSITION ERRORS?
A. Patella
B. Lateral epicondyle
C. Lateral condyle
D. Intercondylar eminence
E. Fibular head
F. Tibia
G. Femorotibial joint
H. Medial epicondyle
I. Femur
- EXTERNALLY / LATERALLY ROTATED AP KNEE
LABEL THE IMAGE
A. Intercondylar fossa
B. Lateral femoral condyle
C. Fibular head
D. Fibula
E. Tibia
F. Intercondylar eminence
G. Medial femoral condyle
LABEL THE IMAGE
A. Fibula
B. Lateral malleolus
C. Lateral mortise
D. Calcaneus
E. Talus
F. Medial mortise
G. Medial malleolus
H. Tibiotalar joint
I. Tibia
LABEL THE IMAGE
A. Fibula
B. Tibiotalar joint
C. Talar domes
D. Calcaneus
E. Talocalcaneal joint
F. Cuboid
G. Fifth metatarsal tuberosity
H. Navicular bone
I. Talus
J. Tibia
LABEL THE IMAGE
A. Phalanges
B. Metatarsals
C. Medial cuneiform
D. Medial-intermediate cuneiform joint
E. Intermediate cuneiform
F. Navicular–cuneiform joint
G. Navicular bone
H. Talus
I. Calcaneus
J. Cuboid
K. Lateral cuneiform
L. Fifth metatarsal tuberosity
M. Fourth tarsometatarsal joint
N. Fifth metatarsal base
REVIEW
NAME TARSAL BONES IN ORDER FROM HEEL TO TOES
CALCANEUS - TALUS - CUBOID - NAVICULAR - 3 CUNEIFORM
C.T.C.N. 3 C
AP FOOT (________)
IMAGE GUIDELINES
DORSOPLANTAR
- EQUAL DISTANCE 2-5TH MTC, overlap OF BASES
- Bases of 1st and 2nd MTs are separated
- Navicular to cuneiform joints open
- INTERTARSAL JOINTS OPEN
-MTP JOINT OPEN
ANALYZE IMAGE
-MEDIAL FOOT ROTATION (EVERSION)
DECREASED SUPERIMPOSITION OF MT BASES
ANALYZE IMAGE
- NO TUBE ANGLE OF 10*
- TMT JOIN SPACES CLOSED
- CR NOT PARALLEL WITH JOINTS
MOST COMMON FOOT FRACTURE:
NAME OF FX:
OPENING IN MIDDLE OF SUBTALAR JOINT IS CALLED:
5TH MT TUBEROSITY = JONES FRACTURE
- SINUS TARSI
AP OBLIQUE FOOT (MEDIAL ROTATION)
IMAGE GUIDELINES
- 30* (2 FINGERS) OBLIQUE
- 3RD-5TH MT FREE SUPERIMPOSITION
- TUBEROSITY OF 5TH MT BASE SEEN IN PROFILE
- SINUS TARSI VISUALIZED
- JOINTS BY CUBOID OPEN
ANALYZE OBLIQUE FOOT IMAGE
EXCESSIVE FOOT OBLIQUITY
ANALYZE OBLIQUE FOOT
- INSUFFICIENT FOOT OBLIQUITY
LATERAL FOOT
IMAGE GUIDELINES
- TIBIOTALAR JOINT OPEN
-Posterior half of distal tibia superimposes the fibula - Tuberosity of the 5th MT seen in profile
- TALAR DOMES ALIGNED (ANTERIOR & POSTERIOR)
IF TOES ARE ELEVATED =
LEG INTERNALLY ROTATED
- TOES UP = FIBULA (LATERAL) MOVES ANTERIOR TO TIBIA (FORWARD)
IF HEEL ELEVATED =
LEG EXTERNALLY ROTATED
- FIBULA TOO POSTERIOR TO MID-TIBIA
ANALYZE LATERAL FOOT
- PROXIMAL LOWER LEG/KNEE ELEVATED
-SUBTALAR & TIBIOTALAR JOINTS CLOSE
IMAGE IS CORRECT OPEN
ANKLE JOINT FORMED BY:
WHERE IS LATERAL MALLEOLUS LOCATED?
WHERE IS MEDIAL MALLEOLUS LOCATED?
WHICH IS MORE POSTERIOR, LATERAL OR MEDIAL MALLEOLUS?
WHICH IS MORE POSTERIOR, TIBIA OR FIBIA?
ANKLE JOINT = TINIA, FINIA & TALUS OF FOOT
- LATERAL MALLEOLUS - DIST. END OF FIBULA (PINKY)
- MEDIAL MALLEOLUS - ELONGATED PROCESS OF TIBIA ( BIG TOE)
- LATERAL MALL. 15-20* MORE POSTERIOR THAN MEDIAL
- FIBIA MORE POSTERIOR THAN TIBIA
AP ANKLE GUIDELINES
- TIBIOTALAR JOINT OPEN
- MEDIAL MORTISE JOINT OPEN AND LATERAL MORTISE CLOSED
- SLIGHT SUPERIMPOSITION OF FIBULA BY TIBIA & TALUS
ANALYZE AP ANKLE
ANKLE IS EXTERNALLY ROTATED
- MEDIAL MORTISE IS OBSCURED, TIBIA SUPERIMPOSES TOO MUCH OF FIBULA
ANALYZE AP ANKLE
- IF LATERAL PORTION OF MORTISE JOINT OPEN, INDICATES RUPTURED LIGAMENT
AP ANKLE MORTISE GUIDELINES
- ALIGN INTERALLEOLAR LINE PARALLEL TO IR, 15-20* INTERNAL ROTATION
- ENTIRE MORTISE JOINT OPEN
- DISTAL FIBULA W/O TALAR SUPERIMPOSITION
- SLIGHT SUPERIMPOSED DISTAL FIBULA & TIBIA
ANALYZE OBLIQUE ANKLE
GOOD IMAGE
- Distal tibiofibular joint is open
- Lateral malleolus and talus joint should show no or slight superimposition but medial
malleolus and talus are partially superimposed
ANALYZE OBLIQUE ANKLE IMAGE
- WHAT IS ARROW POINTING TO
- EXCESSIVE OBLIQUITY
- LATERAL MORTISE CLOSED
- FIBULA SUPERIMPOSED BY TIBIA
- ARROW = SINUS TARSI
ANALYZE IMAGE
FOOT NOT DORSIFLEXED
- LATERAL MORTISE & DISTAL FIBULA SUPERINMPOSED OVER CALCANEUS
LATERAL ANKLE GUIDELINES
- DISTAL FIBULA SUPERIMP. OVER POSTERIOR TIBIA
- TIBIOTALAR JOINT OPEN
- TALAR DOMES ALIGNED
ANALYZE Lateral IMAGE
- LEG EXTERNALLY ROTATED
- FIBULA TOO POSTERIOR TO MID-TIBIA
ANALYZE IMAGE
LEG INTERNALLY ROTATED
- FIBULA ANTERIOR TO MID-TIBIA
REVIEW TIBIA/FIBULA & DISTAL FEMUR ANATOMY
AP TIB-FIB GUIDELINES
- FEMORAL & TIBIAL CONDYLES IN PROFILE
- INTERCONDYLAR EMINENCE CENTERED IN FOSSA
- OVERLAP OF TIB & FIB AT PROXIMAL & DISTAL END
- KNEE & TIBIOTALAR JOINT PARTIALLY CLOSED
- MIDSHAFT TIB FIB SEPERATED
ANALYZE AP TIBFIB
LEG EXTERNALLY ROTATED
- TIB FIB TOO SUPERIMPOSED
ANALYZE AP TIBFIB
LEG INTERNALLY ROTATED
- DISTAL TIB FIB FREE SUPERIMPOSITION
-LOWER LEG CLIPPED
LATERAL TIBFIB GUIDELINES
- TIBIAL TUBEROSITY IN PROFILE
- PART OF PROXIMAL FIB HEAD SUPERIMP. BY TIB
- DISTAL FIBULA SUPERIMPOSED BY POSTERIOR TIBIA
ANALYZE LATERAL TIBFIB
- LEG INTERNALLY ROTATED
- TOO MUCH SUPERIMP. OF TIBFIB
AP KNEE GUIDELINES
- SYMMETRICAL APPEARANCE OF FEMORAL & TIBIAL CONDYLES
- HALF FIB HEAD SUPERIMPOSED BY TIBIA
- INTERCONDYLAR EMINENCE IN CENTER OF FOSSA
- FEMOROTIBIAL JOINT OPEN
AP KNEE ANGULATION
CR =
ANGLE DEPENDS ON ______________
CR PARALLEL TO TIBIAL PLATEAU
Tube angle depend on tissue thickness
- 5 degree caudal angle: 18cm and below
- 0 degree tube angle: 19-24 cm
- 5 degree cephalic angle for 25 CM+
BIGGER PATIENT = BIGGER ANGLE
EXPLAIN PATHOLOGY
LEFT = KNEE DISLOCATION
RIGHT = KNEE REPLACEMENT
ANALYZE AP KNEE
- LEG INTERNALLY ROTATED
- PATELLA TOO MEDIAL
- LESS FIB HEAD SUPERIMP. BY TIBIA
ANALYZE AP KNEE
- LEG EXTERNALLY ROTATED
- FIBIA TOO SUPERIMP. BY TIBIA
- PATELLA TOO LATERAL
AP OBLIQUE KNEE - INTERNAL
OBLIQUITY =
- PATELLA SUPERIMP. MEDIAL FEMORAL CONDYLE
- HALF PATELLA FREE SUPERIMP. OF FEMUR
- FIB HEAD FREE TIBIAL SUPERIMP.
- LATERAL CONDYLES OF FEMUR & TIBIA IN PROFILE
- 45 *
ANALYZE OBLIQUE KNEE - INTERNAL
- EXCESSIVE INTERNAL / MEDIAL ROTATION
- EXCESSIVE FEMORAL CONDYLES SUPERIMP.
- PATELLA ALMOST IN PROFILE
ANALYZE OBLIQUE KNEE - INTERNAL
- EXTERNAL / LATERAL ROTATION
- PART OF FIB. HEAD SUPERIMP. BY TIBIA
AP OBLIQUE KNEE - EXTERNAL ROTATION
- OBLIQUITY?
- PATELLA SUPERIMP. LATERAL FEMORAL CONDYLE
- HALF PATELLA FREE SUPIMP. BY FEMUR
- MEDUAL CONDYLES OF FEMUR & TIBIA IN PROFILE
LATERAL KNEE GUIDELINES
- POSITIONING & CR
- PATELLOFEMORAL & KNEE JOINT OPEN
- FEMORAL CONDYLES SUPERIMPOSED
- HEAD FIB SLIGHTLY SUPERIMP. BY TIBIA
- PATELLA IN PROFILE
- KNEE FLEX 20-30, CR - 1IN DISTAL TO MEDIAL EPICONDYLE, TUBE ANGLED 5-7 CEPHALIC
WHAT ANGLE ON LATERAL KNEE? WHY?
WHAT IS SEEN ON SLIGHTLY ROTATED LATERAL KNEE?
- 5-7* CEPHALIC
- MEDIAL FEMORAL CONDYLE IS 5-7* LOWER THAN LATERAL FEMORAL CONDYLE.
- ANGLE SUPERIMPOSES CONDYLES
- ADDUCTOR TUBERCLE
ANALYZE LATERAL KNEE
- NO ANGLE USED
- MEDIAL CONDYLE DISTAL TO LATERAL,
- NARROW & CLOSED JOINT SPACES
PATHOLOGY IN IMAGES
LEFT IMAGE = DISLOCATED KNEE IN CROSSTABLE LATEROMEDIAL PROJECTION
RIGHT IMAGE = OSGOOD SCHLATTERS
WHAT IS OSGOOD-SCHLATTER DISEASE?
WHAT IMAGE IS IT DEMONSTRATED IN?
- Pain & swelling below the knee joint in children.
- Patellar tendon pulls on the tibial tuberosity and detaches part of it from tibia.
-LATERAL KNEE
- Patellar tendon pulls on the tibial tuberosity and detaches part of it from tibia.
ANALYZE LATERAL KNEE
- KNEE INTERNALLY ROTATED (UNDERROTATED)
- PATELLA FAR FROM IR
- ADDUCTOR TUBERCLE
- MEDIAL FEMORAL CONDYLE POSTERIOR TO LATERAL CONDYLE
ANALYZE LATERAL KNEE
- KNEE EXTERNALLY ROTATED (OVERROTATED)
- MEDIAL CONDYLE ANTERIOR TO LATERAL CONDYLE
- PATELLA TOO CLOSE TO IR
- FIBIA MOVES POSTERIORLY
ANALYZE POSITION OF LATERAL KNEE
- HOW CAN ROTATION BE DETERMINED IN LATERAL KNEE?
- OVERROTATION = _______________
UNDERROTATED
- IDENTIFY ADDUCTOR TUBERCLE ON MEDIAL CONDYLE
- OVER = LESS SUPERIMP. OF FIBULAR HEAD
AP FEMUR GUIDELINES
- LESSER TROCHANTER SUPERIMP OR MINIMALLY SEEN
- GREATER TROCHANTER IN PROFILE
- FEMORAL EPICONDYLES IN PROFILE
- 1-2 IN OVERLAP BETWEEN PROXIMAL & DISTAL IMAGE
ANALYZE AP FEMUR
- LEG EXTERNALLY ROTATED
- LESSER TROCHANTER IN PROFILE
- FEMORAL NECK FORESHORTENED
- TIBIA SUPERIMP. MOST FIB HEAD
- FEMORAL EPICONDYLES NOT IN PROFILE
- PATELLA TOO LATERAL
LATERAL FEMUR GUIDELINES
- FEMORAL NECK IN PROFILE & FORESHORTENED, SUPERIMPOSED BY GREATER TROCHANTER
- LESSER TROCHANTER IN PROFILE MEDIALLY
- KNEE JOINT NOT OPENED
- ANTERIOR & POSTERIOR MARGINS OF FEMORAL CONDYLES ALIGNED
-MEDIAL CONDYLE DISTAL TO LATERAL CONDYLE
EXPLAIN LATERAL FEMUR POSITION:
(OBLIQUITY, POSITION NAME, EPICONDYLES)
- WHY ARENT DISTAL MARGINS OF FEMORAL CONDYLES NOT SUPERIMPOSED?
- ABDUCT FEMUR 45* FROM VERTICLE, “FROG LEG”, FEMORAL NECK PARALLEL & EPICONDYLES PERP. TO IR
- DIVERGENCE OF BEAM
ANALYZE LATERAL FEMUR
OVER ROTATED
- MEDIAL CONDYLE ANTERIOR TO LATERAL CONDYLE
- FIBIA MOVES POSTERIOR
ANALYZE LATERAL FEMUR
UNDERROTAED
- MEDIAL CONDYLE POSTERIOR TO LATERAL
- FIBULA MOVES ANTERIOR
