Radiology Flashcards
what do we do with new fractures?
refer to orthopedist
if in cervical spine, call 911
what makes a compression fracture new?
step defect
trabecular impaction
compare to old films
What will MRI show when looking at a new fracture? CT?
marrow edema
extent of body involvement and possible comminution
what do we do with degenerative arthritides?
we manage it
consider MRI for disc evaluation and CT/MRI for spinal canal stenosis
if it gets worse, consider orthopedic/neurological consult
what do we do with inflammatory/connective tissue arthridities?
co-manage with rheumatologist. lab studies support radiographic diagnoses.
erosions could lead to instabilities
perform cervical flexion, extension views, which may refer to orthopedist
what do we do with metabolic arthridities?
co-manage with rheumatologist
what do we do with benign tumors?
co manage
benign tumors are imaged with MRI to evaluate marrow characteristics and CT to evaluate cortical bone changes. some tumors simply need monitoring for future symptom development (osteochrondroma, hemangioma).
some benign tumors weaken bone and will need to be removed to avoid complications.
refer to orthopedist
what do we do with malignant tumors?
co-manage with oncologist
MRI will evaluate for bone destruction.
CT will define the extent of cortical destruction
radionuclide scintigrophy will reaveal multiple sites of involvement
chest films will evaluate metastatic spread to the lungs
lab studies may confirm bone destruction and most likely pathology
biopsy will reveal the particular pathology
what do we do with tumor like process?
co manage with oncologist and orthopedist, similar to malignant management. paget disease and fibrous dysplasia are benign, but have malignant potential
where does OA typically occur?
disc, posterior facets, extremities
associated conditions of OA
DISH, OPLL, OCI, risks for canal stenosis
who usually gets OA?
40 and older
may be seen in limited number of post-trauma, more likely in regions of anomalous joints (SCFE, DDH, healed AVN)
management for OA
chiro care unless with hypermobility
allopath: pain meds, surgical fusion, joint replacement
does OA cause erosions or lead to fusion?
NO
findings on xray with disc disease
decreased disc height, osteophytes, intercalary ossicles, vaccum phenomenon, posterior translation of vertebra, subchondral sclerosis (eburnation), uncinate hypertrophy (lushka joint hypertrophy)
findings on xray with posterior joint disease
posterior facet hypertrophy/arthrosis, anterior translation of vertebrae (spondylolisthesis), interspinous sclerosis (baastrup’s/kissing spinous process)
types of spondylolisthesis
I: dysplastic, congenital anomalies
II: isthmic, pars interarticularis defect
III: degenerative
IV: traumatic, fracture other than pars (Hangman’s fracture)
V: iatrogenic
bony causes of spinal canal stenosis
osteophytes, paget, hemangioma (when expansile), pedicle hypoplasia, congenital anomalies
soft tissue causes of spinal canal stenosis
disc herniations, OPLL, facet capsule ossification, ligamentum flavum thickening
C2-7 discs go with which nerve roots?
C2 disc- C3 NR C3 disc- C4 NR C4 disc- C5 NR C5 disc- C6 NR C6 disc- C7 NR C7 disc- C8 NR
if there was a PARACENTRAL disc herniation in the lumbars, which nerve roots would be affected?
L1 disc- L2 NR L2 disc- L3 NR L3 disc- L4 NR L4 disc- L5 NR L5 disc- S1 NR
if there was a LATERAL disc herniation in the lumbars, which nerve roots would be affected?
L1 disc- L1 NR L2 disc- L2 NR L3 disc- L3 NR L4 disc- L4 NR L5 disc- L5 NR
people who get DISH
people who get diabetes, middle age-older, overweight, metabolic syndrome, cardiovascular disease
what should you evaluate for for people with DISH? how?
diabetes
blood or urine analysis
Can we adjust a segment with DISH?
no..
osteitis condensans ilii
most commonly seen in postpartum women, but could be seen in men
iliac-based sclerosis, importantly WITHOUT EROSIONS
if there is erosions, DDX of sacroiliitis
