Skeletal System I Flashcards
If you wanted to evaluate a patient’s joints, hands, or feet–what kind of study would you use?
Plain film but the oblique view
For the skeletal system, which type of plain films are best?
AP and Lateral views
If you wanted to evaluate fine bone structure especially– the skull, spine and pelvis–which study would you use?
CT scan
What would you use if you wanted to evaluate soft tissues – muscles, organs, ligaments, cartilage, and spinal cord?
MRI
What would you use if you wanted to evaluate for bone metastases, osteomyelitis, and occult fractures?
Nuclear medicine-bone scan
What is a fracture which goes at an angle to the axis?
Oblique
What is a fracture of many relatively small fragments?
Comminuted
What is a fracture which runs around the axis of the bone?
Spiral
What is an open fracture?
a fracture which breaks the skin
Why is an open fracture important?
because of the possibility of infection
Greenstick fractures occur in which population primarily?
children because they are flexible
What is a Pathologic fracture ?
a fracture in bone that is abnormal
DUE TO a tumor or metabolic disorder
What are Salter-Harris fractures?
are fractures through a growth plate
Name the 5 C-Spine plain films.
- Lateral view
- AP view
- Odontoid view
- Oblique view
- Swimmers view
Which view gives you a view of C7–T1?
Swimmers view
Which view is done only after fracture or dislocation are ruled out – neural foraminal narrowing and alignment of facet joints?
Oblique view
What is the Odontoid view used for?
a C1-C2 relationship (mouth open)
What is the AP view used for?
alignment & oblique fractures
What is the initial view – used to evaluate alignment, spacing, soft tissues & vertebrae?
Lateral view
What are 5 lines that should be evaluated on the lateral view?
- Anterior soft tissue line
- Anterior spinal (vertebral) line
- Posterior spinal (vertebral) line
- Spinolaminar line
- Spinous process line
At the C-spine line–where should the soft tissue line be?
- At C3 the soft tissue should be between 4 and 5 mm
- May be up to 7 mm on a portable film
- Below C4 the soft tissue ranges from 10 to 20 mm (1 – 2 cm).
When you are looking at the C-spine line for the soft tissue, what is an indication that there might be pathology?
If the soft tissue is wider than the adjacent vertebral body
When you are looking at the C-spine line for the soft tissue, what is an indication that there might be pathology?
If the soft tissue is wider than the adjacent vertebral body
What are the most common sites of spinal fractures?
-C1-C2,
C5-C7 and T9-L2
What do you call a burst fx of C1?
Jefferson’s fracture
What are 5 lines that should be evaluated on the lateral view when evaluating the c-spine?
- Anterior soft tissue line
- Anterior spinal (vertebral) line
- Posterior spinal (vertebral) line
- Spinolaminar line
- Spinous process line
What do you call a Fx of posterior aspects of C2?
Hangman’s fracture
What is a Fx of the spinous process of C6, C7, T1 or T2?
Clay-shoveler’s fracture
What do you call a burst fx of C1?
Jefferson’s fracture
What is a Fx of the spinous process of C6, C7, T1 or T2?
Clay-shoveler’s fracture
What causes a Jefferson’s fracture?
- Due to axial loading of the head being smashed down onto the spine
- Diving in a shallow pool
What do you call a Fx of posterior aspects of C2?
Hangman’s fracture
What is a Fx of the spinous process of C6, C7, T1 or T2?
Clay-shoveler’s fracture
What causes a Jefferson’s fracture?
- Due to axial loading of the head being smashed down onto the spine
- Diving in a shallow pool
Which fx is a hyperextension injury that is often with
spinal cord compromise, with
subluxation of C2 over C3?
Hangman’s fracture
Which Fx is a Hyperflexion injury in the c-spine?
Clay-shoveler’s fracture
Where are common areas in which degenerative changes occur in the c-spine?
C4 – C7
What are signs of c-spine degenerative changes?
Decreased disk space, sclerosis and spurring of the margins of the vertebral bodies
What test is indicated for evaluation of a suspected herniated disk or neurologic deficit in the C-spine?
MRI
What are the two most common reasons for a patient with thoracic spine trauma?
Usually the result of an MVC or osteoporosis
In thoracic spine trauma, what is the AP view used for?
alignment
In thoracic spine trauma, what is the lateral view used for?
subluxation
Osteoporosis causes what type of fractures in the thoracic spine?
Compression fractures of the middle and lower thoracic spine
What can hyperflexion injuries lead to in the thoracic spine?
can result in compression burst fractures–with bony fragments projecting into the spinal canal
What are the 2 most common causes of a Compression fracture?
osteoporosis or a fall
What are the three most common degenerative changes in the thoracic spine?
- Spurs (hypertrophic osteophytes)
- Calcification of the anterior spinal ligament
- Calcification of an intervertebral disk
T/F: Spurs (hypertrophic osteophytes) are usually of no clinical significance.
True
T/F: Calcification of the anterior spinal ligament (diffuse idiopathic skeletal hyperostosis – DISH) is a clinical emergency.
False
Where is calcification of an intervertebral disk usually seen?
– usually seen in mid-thoracic region
If there is calcification of ONE single intervertebral disk–what is the most likely cause?
– a single disk is usually the result of trauma
If there is calcification of MULTIPLE intervertebral disks–what is the most likely cause?
-multiple disk involvement may be due to hypercalcemia or other causes
What causes Diffuse idiopathic skeletal hyperostosis (DISH)?
Due to excessive bone formation
calcification of spinal ligaments where they attach to bone
What are the most common fractures of the lumbar spine? (4)
- Wedge compression fractures
- Compression burst fractures with fragments that are retropulsed
- Spondylolysis
- Spondylolisthesis
What occurs in spondylolisthesis?
bilateral fracture of the pars interarticularis which causes subluxation of the vertebral body
Which vertebra is displaced in spondylolisthesis?
anterior displacement of vertebra L5
What is spondylolysis?
Unilateral fracture of the pars interarticularis
What are some common degenerative changes that can be found in the Lumbar spine?
- Loss of disk space
- Hypertrophic spurs (osteophytes)
- Disk calcification
- Herniated or protruding disks
What is the best study for suspected herniated or protruding disks?
MRI
A patient named Jo Gibtry is complaining of lower back pain. She suffered significant trauma when she tripped over stairs. She is happy because she seems to have lost a lot of weight–however–she is not sleeping due to her very painful lower back pain and has complained about “tinkling her pants” more than twice this week. Is she a good candidate for imaging?
YES! This negro has: -Urinary or bowel incontinence -Significant trauma -Pain that wakes them up at night -Unexplained weight loss
Spinal infections occur in which two types of patients?
Usually only occur in diabetic or post-operative patients
Britney Noodle-Hair–a female patient comes into your clinic with localized lower pack pain, elevated ESR, and a fever. You run some lab work and discover she has elevated WBC’s, and + blood culture. What is your BEST choice for a study? And what is you potential diagnosis?
- MRI is PREFFERED over CT
2. Spinal infection
Spinal infection VS. Spinal tumor
Infection: Appears as a destructive process that involves or crosses a disk space
Tumor: does NOT involve the disk space
What is the most common neoplasm in the spine?
is metastatic disease from cancer somewhere else in the body
T/F: Spinal neoplasm lesions may be lytic or sclerotic
True
What are some examples of Lytic lesions?
Lung,
renal, or breast cancer, or multiple myeloma
What are some examples of sclerotic lesions?
Prostate or breast cancer
Since metastases arise in the ________, they occur most frequently in the skull, ribs, spine, pelvis and proximal humerus and femur.
red marrow
Regina Llama-Face, a female patient with a history of breast cancer is complaining to you about bone pain. Her initial visit was a follow up to see how the chemotherapy has been effecting her. The lab work reveals an elevated alkaline phosphatase. Is she a good candidate for a bone scan?
Yes!
Indications for bone scan:
-Initial staging of lung, BREAST or prostate CA
-Bone pain
-Elevated alkaline phosphatase
-To evaluate the response to chemotherapy
T/F: Ankylosing Spondylitis is a form of spondyloarthritis that is considered an acute condition.
False: it is considered a CHRONIC condition
T/F: Ankylosing Spondylitis occurs more commonly in young adult females.
False: occurs in young adult MALES
What other (GI) condition is Ankylosing Spondylitis associated with?
Ulcerative colitis
With a patient suffering from Ankylosing Spondylitis, what is the cause of the Bamboo appearing spine?
caused by calcifications bridging over the disk spaces
What could Ankylosing Spondylitis eventually cause?
fusion of the spine
95% of Ankylosing Spondylitis patients have what type of antigen?
+ HLA-B27 antigen
What is Primary osteoporosis?
age related disorder in which the density of bone mass is reduced leading to an increased risk of fractures
What causes Primary osteoporosis?
Caused by aging and estrogen deficiency
What are some causes of Secondary osteoporosis?
- Hyperparathyroidism
- Excess glucocorticoids (steroids)
- Malabsorption
- Multiple myeloma
- Excessive thyroid hormone (synthroid)
T/F: Plain films do not show osteopenia until bone loss is more than 30%
True
What is the preferred method to measure bone density?
DEXA (dual energy x-ray absorptiometry)
Be familiar with some indications for a DEXA scan.
- Osteopenia on plain films
- Nontraumatic vertebral fracture in postmenopausal female
- Suspected osteopenia due to metabolic disorder
- Loss of height
- Chronic disease that increases risk of osteopenia (renal, liver, thyroid replacement, chronic steroid therapy)
- Considering prescribing hormone replacement
What does DEXA measure when measuring????
bone density of the femoral head and lumbar spine
If a patient is complaining of monoarticular joint pain–but you suspect septic arthritis and trauma–what type of monoarticular joint pain is it?
Acute
What would classify monoarticular joint pain as chronic?
usually due to DJD,
aseptic necrosis,
loose body or synovial tumor
If Brittany Noodle-Hair came in with joint pain, what type of test would be indicated?
Plain film/Radiograph
What would make Brittany Noodle-Hair’s joint pain indicative of an MRI?
- if plain films are negative and the presence of
- Decreased motion, joint effusion, or acute muscle spasm
- Aseptic necrosis is suspected
What causes acute polyarticular joint pain?
-usually due to viral infection or acute exacerbation of systemic arthritis
What causes chronic polyarticular joint pain?
-usually due to osteoarthritis or metabolic disorder such as gout, renal disease
What is the most common joint disease?
Osteoarthritis
Regina Llama-Face comes in with mild inflammation in her joints, degeneration of the cartilage, and bone hypertrophy (osteophytes)–what should you suspect?
Osteoarthritis
What type of image of the hands can be used to evaluate arthritic changes?
Plain films
What is Osteoarthritis?
joint space narrowing and osteophytes especially involving the distal interphalangeal joints
What do you diagnose a patient with if they have: joint space narrowing, subchondral cysts, erosions at the lateral edges of the joints, and ulnar deviations at the MCP joints?
Rheumatoid arthritis
What IP joint is jacked up in Swan-neck deformity?
PIP
What IP joint is jacked up in Boutonniere deformity?
DIP
Regina Llama-Face is diagnosed with gout–where should she most likely see tophi?
usually involves the first MTP joint
T/F: Any lytic bone lesion without a sclerotic margin should be considered malignant.
True
If a bone lesion has these characteristics, is it benign or malignant?
- Small size
- No periosteal reaction
- Sharp zone of transition between bone and lesion
- Thin, well-defined sclerotic margin
benign
Where are giant cell bone tumors are usually found?
in the long bones, most often the distal femur,
proximal tibia, and
distal radius
Osteomyelitis is commonly caused by what?
Usually a bacterial infection but may be fungus,
TB, or viruses
How is diagnosis of Osteomyelitis usually made? Why?
- by culture
- Plain films may be negative for up to 2 weeks.
After 2 weeks, what should a plain film of osteomyelitis show?
focal loss of calcium, bone erosion or periosteal reaction
If after 2 weeks, the plain film of osteomyelitis is negative, what is the next step?
MRI
What is Septic arthritis ?
acute bacterial process
During septic arthritis, what is occurring 90% of the time?
90% have only joint involved
*knee
hip
Ankle, shoulder, wrist and elbow
How is Diagnosis made for septic arthritis?
by joint aspiration
If a patient has destruction of a single joint space on both sides of the joint–what test is indicated?
Plain film
What is Periosteal reaction? And how does it appear on x-ray?
-thickening of the periosteum – appears white on x-ray
When will you see a Periosteal reaction?
Seen with normal healing fracture, osteomyelitis, benign and malignant tumors
If you see a A radiating periosteal reaction (sun-burst)–would you worry?
yes–may be malignant
