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Radiographic Procedures And Pathology. Prep Course 1 > Module 6 Lower Extremity > Flashcards

Module 6 Lower Extremity Flashcards

1
Q

FOOT BONES AND DIVISIONS

A

Foot has 26 bones divided into 3 groups

  • Phalanges- 14
  • Metatarsals - 5
  • Tarsals- 7
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2
Q

TARSAL BONES 7

A
  • Calcaneus
  • Talus
  • Navicular
  • Cuneiforms x 3 - Medial - Intermediate- Lateral
  • Cuboid
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3
Q

FOOT ARTICULATIONS

A
  • Interphalangeal joints
  • Metatrsophalangeal Joints
  • Tarso metatarsal joints
  • Intertarsal joint
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4
Q

ANKLE

A

Often referred to as the mortise joint or ankle mortise.
- Articulates with the talus on three surfaces :

  • Lateral malleolus of the fibular
  • Inferior surface of the distal tibia
  • Medial malleolus of the tibia
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5
Q

TIBIA MEDIAL END ANATOMICAL FEATURES

A
  • Medial condyle
  • Lateral condyle
  • Tibial plateaus
  • Intercondylar eminence
  • Tibial tuberosity
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6
Q

TIBIA DISTAL END ANATOMICAL FEATURES

A
  • Medial malleolus

- Fibular notch

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7
Q

KNEE JOINT

A

Def: Is the articulation between the femoral condyles and the tibial plateaus with soft tissue support namely :

  • Meniscus (( Lateral and medial )
  • Cruciate ligament ( Posterior and anterior )
  • Collateral ligament ( Tibial and fibula)
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8
Q

TIB FIB ARTICULATION

A

Proximal end - Synovial diarthrosis gliding type joint

Distal end- Fibrous syndemosis

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9
Q

KNEE JOINT ARTICULATION

A

Synovial diarthrosis hinge type of joint.

Articulation between the femoral condyles and the tibial plateaus

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10
Q

PATELLOFEMORAL JOINT ARTICULATION

A

Patellar and patellar surface of the anterior distal end of the femur.

  • Synovial diarthrosis, gliding type of a joint
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11
Q

PATELLA

A

The largest and most constant sesamoid bone which develops in the quadriceps femoris tendon between the ages 3-5 years.
It serves as protection for the knee

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12
Q

FEMUR

A

Bone of the thigh region of the lower limb. Regarded as the longest and strongest bone in the human body

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13
Q

FEMUR PROXIMAL ANATOMICAL FEATURES

A
  • Head
  • Neck
  • Greater trochanter
  • Lesser trochanter
  • Body
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14
Q

FEMUR DISTAL ANATOMICAL FEATURES

A
  • Lateral epicondyles
  • Medial epicondyles
  • Inercondylar fossa
  • Adductor tubercle
  • Popliteal surface
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15
Q

AP OR AP AXIAL PROJECTION TOES

A
  • Patient preferably seated on table
  • Flex knee with plantar surface in contact with the IR
  • CR to the 3rd metatarsal phalange all joint
  • CR perpendicular to the IR when joint space is not critical
  • CR 15 deg posteriorly to open up interphalangeal joints
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16
Q

AP OR AP AXIAL PROJECTION TOES STRUCTURES DEMONSTRATED

A

Open interphalangeal and metatarsi phalange all joint spaces

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17
Q

AP OR AP AXIAL PROJECTION TOES 1st to3rd MEDIAL ROT, 4th to 5th LATERAL ROT

A
  • Foot plantar surface on IR with knee flexed
  • Medially rotate the leg making the foot angle of 30-45 deg with IR
  • CR perpendicular to the 3rd metatarsophalangeal joint
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18
Q

AP OR AP AXIAL PROJECTION TOES 1st to3rd MEDIAL ROT, 4th to 5th LATERAL ROT STRUCTURES DEMONSTRATED

A

Oblique phalanges, open joint spaces

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19
Q

LATERAL TOES PROJECTION

A
  • Patient turns on to the unaffected side for the1stand2nd toes,
  • Patient turns on to the affected side for the 3rd to 5 th toes
  • CR perpendicular to the first toe and perpendicular to proximal interphalangeal joint for toes 2-5
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20
Q

LATERAL TOES PROJECTION STRUCTURES DEMONSTRATED

A

Phalanges and interphalangeal joints

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21
Q

AP OR AP AXIAL FOOT PROJECTION

A
  • Patient seated
  • Knee flexed with plantar surface in contact with the IR
  • CR 10 towards the heel or perpendicular to the base of third metatarsal
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22
Q

AP OR AP AXIAL FOOT PROJECTION STRUCTURES DEMONSTRATED

A
  • Tarsals anterior to the talus, metatarsals and phalanges
  • General foot survey
  • Foreign body localisation
  • Fracture localisation
  • Fracture fragments localisation
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23
Q

AP OBLIQUE FOOT PROJECTION MEDIAL ROTATION

A
  • Patient seated with knee flexed with the plantar surface of foot in contact with the IR
  • Rotate leg medially until the foot makes a 30-60 deg angle with the IR
  • CR perpendicular to the base of the third metatarsal
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24
Q

AP OBLIQUE FOOT PROJECTION MEDIAL ROTATION STRUCTURES DEMONSTRATED

A

Open interspaces between:

  • Cuboid and calcaneous
  • Cuboid and fourth and fifth metatarsal
  • Cuboid and the lateral cuneiform
  • Talus and navicular
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25
Q

LATERAL FOOT PROJECTION

A
  • Patient on the affected side
  • Affected foot dorsiflexed
  • Lateral surface of the foot parallel to the plane of the IR
  • CR perpendicular to the base of the third metatarsal
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26
Q

LATERAL FOOT PROJECTION STRUCTURES DEMONSTRATED

A
  • Metatarsals nearly superimposed
  • Fibular overlapping the posterior portion of the tibia
  • Tibiotalar joint and superimposed talar domes
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27
Q

AP AXIAL WEIGHT BEARING PROJECTION

A
  • Patient standing erect with full weight evenly distributed on both feet
  • Feet should be directed ahead parallel to each other
  • CR 10 deg posteriorly to midpoint of feet

-

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28
Q

AP AXIAL WEIGHT BEARING PROJECTION STRUCTURES DEMONSTRATED

A
  • Accurate evaluation and comparison of tarsals and metatarsals
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29
Q

LATERAL WEIGHT BEARING FOOT PROJECTION

A
  • Patient standing on a low bench with IR on the adjacent side or between the feet
  • Weight evenly distributed on both feet
  • CR horizontal to the level of the base of the third metatarsal
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30
Q

LATERAL WEIGHT BEARING FOOT PROJECTION STRUCTURES DEMONSTRATED

A
  • Entire foot should be demonstrated and a minimum of 2,5- 5cm of the distal tibia- fibula.
  • The fibula should be seen superimposed over the posterior half of the tibia
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31
Q

ANKLE AP PROJECTION

A
  • Patient supine of seated
  • Adjust the ankle to make foot be in vertical position
  • No rotation
  • CR perpendicular to the ankle joint
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32
Q

ANKLE AP PROJECTION STRUCTURES DEMONSTRATED

A
  • Tibiotalar joint
  • Medial mortise
  • Lateral and Medial malleoli visualisation
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33
Q

ANKLE AP OBLIQUE PROJECTION : Mortise

A
  • Patient supine or seated
  • Foot partially relaxed medially rotate leg15-20 deg until intermalleolar plane is parallel with IR
  • CR midway between the malleoli
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34
Q

ANKLE AP OBLIQUE PROJECTION : Mortise STRUCTURES DEMONSTRATED

A
  • Entire ankle mortise joint

- Open joint space between the talus and the malleoli

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35
Q

ANKLE AP OBLIQUE PROJECTION : Mortise 45 deg

STRUCTURES DEMONSTRATED

A
  • Distal ends of the tibial and fibula parts of which are often superimposed over the talus
  • Tibiofibular joint
  • Open medial and lateral mortise
  • Medial and lateral malleoli are in profile
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36
Q

ANKLE LATERAL PROJECTION

A
  • Turn Patient on to the affected side until foot and ankle is lateral
  • Straighten the leg
  • Dorsiflex the foot to prevent rotation
  • CR Entering the medial malleolus
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37
Q

ANKLE LATERAL PROJECTION STRUCTURES DEMONSTRATED

A
  • Tibiotalar joint space
  • Fibula over the posterior half of the tibia
  • Supperimposed Talar domes
  • 5th metatarsal to rule out Jones Fracture
38
Q

CALCANEUS LATERAL PROJECTION

A
  • Turn patient on to the affected side until leg and foot are lateral
  • straighten the leg
  • CR perpendicular to calcaneus, 2;5cm distal to the medial malleolus
39
Q

CALCANEUS LATERAL PROJECTION STRUCTURES DEMONSTRATED

A

Ankle joint and the calcaneus in lateral profile

40
Q

CALCANEUS AXIAL PROJECTION

A
  • Patient seated with leg fully extended
  • Foot 90 deg to leg
  • Place ankle joint in the centre of IR
  • CR directed 40 deg cephalade at the base of the third metatarsal
41
Q

CALCANEUS AXIAL PROJECTION STRUCTURES DEMONSTRATED

A

Axial projection of the calcaneus from the tuberosity to the sustentaculum tali and trochlear process

42
Q

TIB FIB AP PROJECTION

A
  • Patient in supine or seated position
  • Place leg in AP position with foot inverted slightly without rotation,
  • Long axis of foot in vertical position
  • Include both knee and ankle joints in one image if possible
  • CR perpendicular to the mid shaft of TIB fib
43
Q

TIB FIB AP PROJECTION STRUCTURES DEMONSTRATED

A

Proximal and distal articulations of the tibial fibula moderately

44
Q

TIB FIB LATERAL PROJECTION

A
  • Patient supine and lying on affected side with leg and foot lateral
  • Patella perpendicular to IR
  • Foot dorsiflexed with plantar surface perpendicular to the IR
  • CR perpendicular to mid shaft of TIB/ FIB
45
Q

TIB FIB LATERAL PROJECTION STRUCTURES DEMONSTRATED

A
  • TIB fib and adjacent joints
  • Distal fibula over posterior half of tibia
  • Slight overlap of the tibia on the proximal Fibular head
46
Q

AP KNEE PROJECTION

A
  • Patient in supine position
  • Place leg in true AP position
  • patellar slightly off centred to the medial side
  • CR perpendicular to the knee joint 1,3 cm inferior to the patella apex

Angling - 3-5 deg cauded for thin patients
- 3-5 deg cephalad for large patients

47
Q

AP KNEE PROJECTION STRUCTURES DEMONSTRATED

A
  • Open femora tibial joint space
  • Patella completely superimposed on femur
  • Head of Fibular slightly superimposed by the tibia
48
Q

LATERAL KNEE PROJECTION

A
  • Turn Patient on to affected side until knee is lateral
  • Flex knee 20-30 deg to relax muscles
  • Patella must be perpendicular to the IR
  • CR directed at knee joint 2,5 cm distal to the medial epicondyles at an angle of 5-7 deg cephalad
49
Q

LATERAL KNEE PROJECTION STRUCTURES DEMONSTRATED

A
  • Patella in profile
  • Open femoropatellar space
  • Joint space free of medial femoral epicondyl superimposition
50
Q

AP OBLIQUE EXTERNAL ROTATION PROJECTION KNEE

A
  • Patient supine with leg extended
  • Externally rotate the foot and raise the hip with the extremity forming a 45 deg angle with the IR laterally
  • CR directed 1,3 cm to the patellar apex
51
Q

OBLIQUE PROJECTION KNEE EXTERNAL ROTATION STRUCTURES DEMONSTRATED

A
  • Medial femoral and tibial condyles
  • Tibial plateaus
  • Fibula superimposed over the lateral half of the tibia
52
Q

KNEE AP OBLIQUE INTERNAL ROTATION PROJECTION

A
  • Patient supine with leg extended
  • Invert foot and elevate the hip of the affected side until the extremity is 45deg to the IR
  • CR directed 1,3 cm to the patellar apex
53
Q

KNEE AP OBLIQUE INTERNAL ROTATION PROJECTION STRUCTURES DEMONSTRATED

A
  • Posterior tibia
  • Tibia and fibula separated at their proximal articulation
  • Lateral condyles of the femur and tibia
  • Both tibial plateaus
54
Q

PA KNEE PROJECTION

A
  • Place patient prone on table with toes resting on the table
  • CR 1,3cm below the patellar apex
55
Q

PA KNEE PROJECTION STRUCTURES DEMONSTRATED

A
  • Open femorotibial joint space

- Slight superimposition of the Fibular head with the tibia

56
Q

PA OBLIQUE INTERNAL ROTATION PROJECTION

A
  • Patient is in prone position
  • Internally rotate the affected leg raising the hip resulting in a 45-55 deg angle
  • Flex the knee 5-10 deg
  • CR perpendicular to the IR exiting the palpated patella
57
Q

PA OBLIQUE INTERNAL ROTATION PROJECTION STRUCTURES DEMONSTRATED

A

Medial aspect of the patella free of superimposition of the femur

58
Q

PA OBLIQUE KNEE EXTERNAL ROTATION

A
  • Patient is prone
  • Affected leg extended
  • Rotate the affected leg 45-50 deg externally
  • Flex the knee 5-10 deg
  • CR perpendicular to the IR, exiting the palpated patella
59
Q

PA OBLIQUE KNEE EXTERNAL ROTATION STRUCTURES DEMONSTRATED

A

Lateral aspect of the patella free of superimposition of the femur

60
Q

AP WEIGHT. BEARING KNEES PROJECTION

A
  • Patient standing with knees fully extended against erect Bucky
  • Patient weight equally distributed with both knees in true AP position
  • CR directed horizontally entering at the mid way point 1;3 cm below the patella apices
  • Usually done bilateral
  • CR angle parallel with tibial plateau
61
Q

AP WEIGHT. BEARING KNEES STRUCTURES DEMONSTRATED

A
  • Arthritic knees
  • Narrowing of joint space that appears normal on the non weight bearing study
  • More accurate examination of the degree of lower extremity varus or value deformity

-

62
Q

VARUS DEFORMITY ON WEIGHT BEARING KNEES

A

Demonstrates a narrowed medial knee compartment

63
Q

VALGUS DEFORMITY ON WEIGHT BEARING KNEES

A

Demonstrates a narrowed lateral knee compartment

64
Q

PA PATELLA PROJECTION

A
  • Patient prone with toes resting on the table
  • Affected leg straight in true PA position
  • CR entering the mid popliteal area exiting the patellar
65
Q

PA PATELLA PROJECTION STRUCTURES DEMONSTRATED

A
  • Open femorotibial joint space

- Slight superimposition of the Fibular head with the tibia

66
Q

LATERAL PATELLA PROJECTION

A
  • Turn patient towards affected side until the knee is lateral
  • Flex the knee 5-10 deg to relax muscles NB: Not more than 10
  • Patella perpendicular to the IR
  • CR directed to the knee joint at the midpatellofemoral joint
67
Q

LATERAL PATELLA PROJECTION STRUCTURES DEMONSTRATED

A
  • Patella in profile

- Open femoropatellar space

68
Q

PATELLA TANGENTIAL PROJECTION

A
  • NB= Fragment displacement needs to be ruled out with a lateral projection before a tangential is performed
  • Patient supine
  • Flex knee 40-45deg or until patella is perpendicular to IR
  • No leg rotation
  • Place IR on edge, resting on mid thighs
  • Adjust the leg so that it’s long axis is vertical
  • CR Directed inferosuperior 10-15 deg depending on the fox ion of the leg
69
Q

PATELLA TANGENTIAL PROJECTION STRUCTURES DEMONSTRATED

A
  • Vertical fractures of the bone

- PATELLOFEMORAL articulation

70
Q

INTERCONDYLOID FOSSA PA AXIAL PROJECTION ( Camp- Coventry Method )

A
  • Patient in prone position with femoral portion of the knee on the IR
  • Flex the knee 40 deg
  • Ensure that there is no rotation
  • Tilt tube to be perpendicular with TIB fib +-40 deg
  • CR at the centre of the knee joint
71
Q

INTERCONDYLOID FOSSA PA AXIAL PROJECTION ( Holmblad Method)

A
  • Patient in prone position kneeling on the table ( all fours) leaning forward about 20 deg
  • Ensure patient knee is in true PA position
  • CR perpendicular to the lower leg entering popliteal fossa exiting apex of the patella
72
Q

INTERCONDYLOID FOSSA PA AXIAL PROJECTION

A
  • Open intercondyloid fossa, tibial spines
  • Apex of patella not superimposing the fossa
  • Detection of joint mice ( loose bodies)
73
Q

AP AXIAL INTERCONDYLOID FOSSA PROJECTION ( Beclere Method )

A

For patient who can’t assume the prone position

  • Patient supine
  • Partially flex the knee of interest 60 deg and provide padding support
  • Place IR under neath knee
  • Ensure true AP position; No rotation;
  • CR perpendicular to lower leg (40-45 deg cephalad) directed 1;3 cm to the patella apex

-

74
Q

AP AXIAL INTERCONDYLOID FOSSA PROJECTION ( Beclere Method )STRUCTURES DEMONSTRATED

A
  • INTERCONDYLOID fossa in profile, open with out superimposition by patella apex
  • Tibial spines
  • Tibial plateau and femoral condyles are seen
75
Q

AP FEMUR PROJECTION

A
  • Patient in supine position
  • Femur cantered to the midline of the table/ IR
  • The body in true AP position
  • Internally rotate the affected leg 10-15 to open up the femoral neck
  • Collimate from the top of the ASIS to 5cm below the knee
  • CR mid shaft
76
Q

FFEMUR PROJECTION STRUCTURES DEMONSTRATED

A
  • Femoral neck not foreshortened
  • Greater trochanter
  • Include both joints, included
77
Q

FEMUR LATERAL PROJECTION

A
  • Have patient turn on to affected side
  • Centre affected thigh in the mid line of table
  • Adjust pelvis to open up the hip joint ( proximal femur)
  • Adjust pelvis to true lateral position ( distal femur)
  • CR Mid shaft to include hip ( proximal femur)
  • CR Mid shaft to include knee (Distal femur )
78
Q

FEMUR LATERAL PROJECTION STRUCTURES DEMONSTRATED

A

BOth joints included

79
Q

AP AXIAL FOOT IMAGE ANALYSIS

A
  • Include for toes to proximal calcaneus
  • Ensure No rotation medially or laterally
  • Open joint space between the medial and intermediate cuneiforms
  • Tarsometatarsal joint space open
  • Navicular- cuneiform joint space is open
80
Q

AP OBLIQUE PROJECTION IMAGE ANALYSIS

A
  • 3rd-5th metatarsals are free from superimposition
  • 5th metatarsal tuberosity in profile
  • Sinus tarsi
  • Open cuboid and calcaneous space
  • Open cuboid and fourth and fifth metatarsal space
  • Open cuboid and the lateral cuneiform space
  • Open Talus and navicular space
81
Q

GOUT

A

This is deposition of Uris acid crystals in the joints which is caused by increase of blood level Uric acid.

  • Manifests as painful arthritis primarily in the first metatarsophalangeal joint.
82
Q

OSTEOARTHRITIS

A

Degenerative joint disease which mainly affects weight- bearing joints (hips, knee, ankles and spine

-

83
Q

OSTEOARTHRITIS RADIOGRAPHIC APPEARANCE

A
  • Loss of joint cartilage
  • Joint space narrowing
  • Development of small bony spurs
84
Q

OSTEOGENIC SARCOMA

A

Malignant bone tumour, typically found in end of long bones especially above the knees.

  • Patient May complaining of localised pain and swelling, may also exhibit a fever, weight loss and anemia

RADIOGRAPHIC appearance of sunburst pattern and or mixed destructive and sclerotic lesion

85
Q

EWINGS SARCOMA

A

Malignant tumour often seen in children,

  • Found in bone marrow and soft tissue of long bones ( pelvis and or femur)

Clinical signs- Bone pain and fever

RADIOGRAPHIC appearance- Bone destruction in the medullary canal

86
Q

MULTIPLE MYELOMA

A

Malignant condition which results in bone destruction.

  • Malignant plasma cells rapidly divide and remove normal blood cells

Clinical signs = anemia and fatigue

RADIOGRAPHIC appearance = Multiple lessions throughout the bone
= Commonly found in bones containing red bone marrow ( pelvis, ribs, vertebrae)

87
Q

OSGOOD- SCHLATTER DISEASE

A

Incomplete avulsion of the tibial tuberosity

88
Q

OSTEOID OSTEOMA

A

Benign lession of cortical bone

89
Q

SHOCK ABSORBER WITHIN THE KNEE JOINT

A

MENISCI CARTILAGE

90
Q

TENDON THAT ECASES OR SURROUNDS THE PATELLA

A

Quadriceps Femoris

Radiographic Procedures And Pathology. Prep Course 1 (18 decks)

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