part 2 Flashcards
suggested xrays for AC joint
- AP with and without weights
suggested xrays for AC joint
- AP with and without weights
suggested xrays for chest
- PA
- Lateral (full inspiration)
suggested xrays for clavicle
- AP
- Axial (20 deg cephalad)
suggested xrays for humerus
- AP
- Lateral
suggested xrays for ribs
- AP
- obliques (bilat)
- upper rib- inspiration
- lower ribs- expiration
suggested xrays for SC joint
- AP
- obliques (bilat)
suggested xrays for shoulder
- AP
- Grashey
- Y-scapular
why would you order a Y scapular view and axial view of shoulder
- scapular Y tells you if shoulder is dislocated
- axial tells you if dislocation is anterior or posterior
suggested xrays for elbow
- AP
- external oblique
- lateral
suggested xrays for fingers
- AP
- oblique of hand
- lateral of affected finger
suggested xrays for hand
- AP
- Oblique
- Lateral
suggested xrays for thumb
- AP
- Oblique
- Lateral
suggested xrays for wrist
- AP
- oblique
- lateral
nightstick fracture
- defensive wound
- from direct force on forearm
- transverse fx
colles fx
- fx of distal radial metaphysis with dorsal angulation and impaction
- very common
- from FOOSH
- extra-articular
metacarpal fxs
- very common
- 10% of all fx
- 40% of hand fx
- result of direct trauma
- stable fx
suggested xrays for hip
- AP pelvis
- Frog lateral
suggested xrays for ankle
- AP
- mortise
- lateral
suggested xrays for femur
- AP
- lateral
suggested xrays for foot
- AP
- Lateral
- Oblique
suggested xrays for knee over 40 y/0
- bilat PA weight bearing (at 30 degrees flexion)
- bilat tunnel
- bilat sunrise
- lateral of affected knee
suggested xrays for knee over 40 y/0
- bilat PA weight bearing (at 30 degrees flexion)
- bilat tunnel
- bilat sunrise
- lateral of affected knee
T1
- time it takes for tissue to recover to parallel state
- aka recovery
- has short TE and short TR
why would you order a Y scapular view and axial view of shoulder
- scapular Y tells you if shoulder is dislocated
- axial tells you if dislocation is anterior or posterior
suggested xrays for elbow
- AP
- external oblique
- lateral
what typically appears white in T1 weighted images
- fat
- gadolinium
- proteinaceous fluid
- melanin
suggested xrays for hand
- AP
- Oblique
- Lateral
suggested xrays for thumb
- AP
- Oblique
- Lateral
suggested xrays for wrist
- AP
- oblique
- lateral
nightstick fracture
- defensive wound
- from direct force on forearm
- transverse fx
colles fx
- fx of distal radial metaphysis with dorsal angulation and impaction
- very common
- from FOOSH
- extra-articular
metacarpal fxs
- very common
- 10% of all fx
- 40% of hand fx
- result of direct trauma
- stable fx
suggested xrays for hip
- AP pelvis
- Frog lateral
suggested xrays for ankle
- AP
- mortise
- lateral
suggested xrays for femur
- AP
- lateral
suggested xrays for food
- AP
- Lateral
- Oblique
suggested xrays for knee under 40 y/o
- AP
- Lateral
- tunnel
- sunrise
suggested xrays for knee over 40 y/0
- bilat PA weight bearing (at 30 degrees flexion)
- bilat tunnel
- bilat sunrise
- lateral of affected knee
what is considered an adequate film for prostesis
- must see ENTIRE prosthesis to ensure you dont have fx anywhere
maisonneuve fx
- combo of sprial fx in proximal fibula with ankle injury in one or more:
- widening of ankle joint
- deltoid ligament disruption
- fx of medial malleolus
what else should you evaluate if you see calcaneus fx
- spine for compression fx
- mechanism of injury is usualy due to extreme load to axial skeleton
MRI
- uses magnetic field to manipulate electrical activity of H
- releases energy in form of radiofrequency signals
- not ionizing
Hydrogen protons in MRIs
- have positive charge
- also have spin which causes electrical current
- electrical current prodcues magnetic current
- MRI magnet causes protons to align
MRI magnet
- coils cause transmitting RF pulses and also receive signal (echo)
- RF pulse changes orientation of protons
- when pulse turned off protons realign which releases energy
T1
- time it takes for tissue to recover to parallel state
- has short TE and short TR
TE
echo time
TR
repetition time
what typically appears white in T1 weighted images
- fat
- gadolinium
- proteinaceous fluid
- melanin
T2
- time it takes for tissue to return to perpendicular to magnetic field
- short TE and long TR
- water is white*
what typically appears white in T2 weighted images
- water
- fat
- edema
- inflammation
- infection
- cysts
- hemorrhage
gadolinium
- most common IV contrast used in MRI
- shorts T1 relaxation time of H
- enhances tumors and areas of inflammation
imaging planes for MRI
- sagittal
- coronal
- axial
advantages of MRI
- high resolution images in multiple planes
- detailed soft tissue characteristics
- non-invasive
- no known harmful effects
disadvantages of MRI
- expensive
- 30-45 min scan time
- limited by body habitus, pt anxiety, implants, contrast allergies
why order MRI
- soft tissue eval primarily
- dx occult fx
- ligament or articular damage
- modality of choice for disc herniation and internal derangement of joints
ACL tear etiology
- valgus force to lateral knee
- can also be from non-contact jumping, pivoting, deceleration
- women > men
ACL tear clinical presentation
- mild-moderate pain
- large effusion
- instability with side to side movement
- decreased ROM
- protected WB or instability
how to dx ACL tear
- lachman test
- xrays to rule out fx
- MRI
- femoral bone bruise often seen
quad tendon rupture
- often in heavy set males in 40s- 50s
- also seen in young athletes
- cannot perform SLR or extend leg
- almost always surgically repaired
meniscus tear
- medial tear more common than lateral
- often with twisting movements
- can also be rotational or flexed knee movement
- often hears pop
- knee locking
- use macmurray test
