MSK Xray Flashcards
How do you assess a joint using Xray
2 or more projections
AP and lateral most common
Significant superposition of structures upon one another may require more views e.g. scaphoid (4)
What are the systematic review points or MSK
Bone and joint alligment
Joint spacing
Cortical outline
Medullary texture
Soft tissues
What are you looking for when checking bone and joint alignment
Evidence of subluxation or dislocation
What are you looking for when checking joint spacing
narrowing
- loss of cartilage
Widening
-subluxation or dislocation
What are you looking for when checking cortical outline
trace cortex of each bone to check for a disruption or irregularity
What are you looking for when checking in bone fracture
Bone/part of bone involved
- proximal, middle, distal
- intra-articular
Fracture pattern
- simple or compound
- comminuted
- impacted (fragments overlapping)
Type of fracture
- transverse
- oblique
- spiral
- greenstick (break in one cortex but not the opposite cortex)
- vertical
Displacement
What are you looking for when checking medullary texture
disruption in trabeculations
-e.g. femoral neck fractures
Lucent line - displaced fracture
Sclerotic line - impacted fracture
What are you looking for when checking soft tissues
Swelling
Joint effusion
What are the views for imaging the C spine
Lateral
AP
Open mouth/peg
How do you increase the number of vertebrae visible in lateral view
swimmers view
- one arm raised
- one arm lowered
- Gains view of C7-T1 junction
What do you assess on a lateral view of the C spine
ALIGNMENT
- anterior line
- posterior line
- spinolaminar line
Abnormal alignment due to dislocation or subluxation
NB C-spine also discussed as:
- anterior column - ant long lig
- middle column - post long lig
- posterior column - posterior elements of the vertebra and several associated ligaments
JOINT SPACING
- even?
- cortical outline?
- Prevertebral soft tissues?
Is the prevertebral soft tissue of uniform thickness
No
- No more than 7mm above C5,
- Less than one vertebral body in width below
What might prevertebral swelling indicate
fracture
-may be invisible - CT
What should you assess in peg view
Dens should be equidistant from lateral masses of C1
Dens less dense tha surrounding bone
-fracture in hyperextension or hyperflexion
What holds the dens in place
Transverse ligament of the atlas
-if intact, spinal cord usually unaffected by dens fracture
