Musculoskeletal Imaging

Question 1

how to decide on appropriate imaging modality?

Answer 1

DDx, body part of interest, age, pt history, COST, RADIATION DOSE, availability

Question 2

guidelines for choosing a modality

Answer 2

1. clinical question?
2. what test most likely to answer this question?
3. if more than one, a) safety and b) cost

Question 3

search pattern for imaging?

Answer 3

hardware; joints; bones; soft tissues: look for fractures, hardware failures, calcifications, tumors, degenerative arthritis. WHAT COULD KILL THEM?

Question 4

tenet of radiology?

Answer 4

one view is no view!

Question 5

types of projections

Answer 5

AP, lateral

Question 6

pitfalls of radiology

Answer 6

inappropriate study/projection, poor quality, satisfaction of search, timing of exam, lack of correlation btwn imaging findings and clinical findings

Question 7

sesamoid bones

Answer 7

bone embedded within a tendon where tendon passes over joint. eg patella.

Question 8

limbus vertebral body

Answer 8

look like fragments, but normal variation

Question 9

ddx mnemonic

Answer 9

VINDICATE

Question 10

benign v. malignant on xray

Answer 10

benign: well circumscribed.
malignant: periosteal rxn, outside of bone. codman’s triangle.

Question 11

calcifications

Answer 11

calcific tendonitis (aunt minnie, in shoulder)

Question 12

abnormal calcifications

Answer 12

crest syndrome; soft tissue hemangiomas

Question 13

effusions

Answer 13

fluid around joint. easiest to see in knee. also in elbow, ankle, wrist, fingers.

Question 14

fat floating on blood?

Answer 14

lipohemarthrosis, special effusion. indicates fracture b/c fat is from medullary canal

Question 15

fracture descriptive terms

Answer 15

location, orientation, displacement, apposition, angulation, intraarticular involvement, comminution, open v closed, associated injuries

Question 16

jones fracture

Answer 16

transverse fracture in 5th metatarsal. outside joint. high likelihood of not healing

Question 17

rolando fracture

Answer 17

at base of thumb. displaced intraarticular fracture

Question 18

intratrochanteric fracture

Answer 18

repairs can be different for the two trochanters at the hip

Question 19

avulsion fracture

Answer 19

pulls bone off

Question 20

joint disloctaion

Answer 20

can be severe (twist + break), hip popping out

Question 21

segond fracture

Answer 21

Avulsion of lateral tibial tubercle from patellar tendon. often with ACL tear, PCL tear, patellar tendon fracture

Question 22

types of arthritis

Answer 22

OA (common): osteophytes, asymmetric joint loss, predictable pattern. Inflammatory: RA, seronegative syndromes like ankylosing spondylitis, deposition diseases like gout and pseudogout

Question 23

age vs appearance on x-ray

Answer 23

consider alt diagnosis when age doesn’t match the image: 26 yo w knee pain and loss of cartilage = JIA