spine and upper extremity imaging

Question 1

What are the indications of MSK plain films?

Answer 1

-first line for evaluating bony anatomy
-pain
-following injury/trauma
-suspect fracture
-suspect foreign body
-surgical planning
-post-surgical changes
-post-fracture healing
-osteomyelitis

Question 2

What are the indications of CT scans?

Answer 2

-assess intra-articular fractures
-bony reconstitution
-surgical planning
-presence of metallic implants

Question 3

What are the indications of MRI imaging?

Answer 3

-soft tissue
-tumors
-surgical planning
-osteomyelitis

Question 4

What is the systematic approach to interpretation of MSK plain films?

Answer 4

-osseous cortex (outline the bone)
-look at joint space
-subluxation/dislocation
-new bone formation
-subchondral cyst formation
-subchondral sclerosis
-soft tissue swelling
-calcification in soft tissue
-foreign bodies

Question 5

What is the term for a partial dislocation?

Answer 5

subluxation

Question 6

What is the narrowing of joint space?

Answer 6

subchondral sclerosis

Question 7

If pathology or abnormal findings are identified, what should you do?

Answer 7

don’t stop with your interpretation, you might miss something else

Question 8

What should your approach to looking at images of the spine be?

Answer 8

-identify bony landmarks
-count the vertebral bodies
-assess vertebral body height
-evaluate the intervertebral spaces
-alignment
**anterior vertebral body margins
**posterior vertebral body margins
**posterior spinal canal
**spinous process
-assess curvature (anterior soft tissue, anterior spinal line, posterior spinal line, spinolaminal line, spinous process line)

Question 9

What are the common views of the cervical spine?

Answer 9

-AP (alignment)
-lateral (count vertebral bodies)
-oblique (neural foramina -narrowing/impingement)
-odontoid (AP with mouth open)

Question 10

What are some other views of the cervical spine?

Answer 10

-flexion/extension (vertebral body instability)
-swimmer’s view (if cant evaluate C7-T1)

Question 11

What are some indications of thoracic spine imaging?

Answer 11

-fall from height
-MVA
-neuro deficits
-postop imaging
-assess for metastases
-curvature (scoliosis)

Question 12

What are the views used for thoracic imaging?

Answer 12

-AP
-lateral

Question 13

What can AP view of the thoracic spine assess?

Answer 13

-curvature
-fractures/dislocations
-number of vertebrae
-alignment/deformity

Question 14

What can lateral view of the thoracic spine assess?

Answer 14

-curvature
-fractures/deformities
-tumors

Question 15

What are the standard views used for lumbar spine imaging?

Answer 15

-AP/lateral
-standing
-supine (trauma)

Question 16

What are other views used for lumbar spine imaging?

Answer 16

-oblique
-flexion/extension

Question 17

What does the AP view of the lumbar spine assess?

Answer 17

-alignment
-number of vertebrae
-transverse processes
-pedicles
-sacrum and SI joint
-T11/T12 to sacrum
-deformities (scoliosis)
-other abnormalities (tumors, congenital, normal variants)

Question 18

What does the lateral view of the lumbar spine assess?

Answer 18

-alignment (subluxation)
-number of vertebrae
-height of vertebrae
-curvature (lordosis)
-other abnormalities (tumors)

Question 19

What does the oblique view of the lumbar spine assess?

Answer 19

-facet joints
-pars defect or fracture

Question 20

What does the flexion/extension view of the lumbar spine assess?

Answer 20

-suspect instability
-spondylolisthesis (anterior vertebral displacement)

Question 21

What are the common variants in the lumbar spine?

Answer 21

-spina bifida occulta
-sacralization

Question 22

What does the CT scan of the lumbar spine usually assess?

Answer 22

-s/p trauma
-fractures
-seat belt injury
-used when MRI is contraindicated
-spondylolisthesis/spondylosis
-procedural (spinal injections)

Question 23

What are the indications of a lumbar spine MRI?

Answer 23

-low back pain
-DDD/DJD
-herniated disc
-spinal stenosis
-tumors
-mets

Question 24

What are the indications of shoulder imaging?

Answer 24

-pain
-trauma
-post-op
-assess fracture healing

Question 25

What are the standard views of shoulder imaging?

Answer 25

-AP
-scap Y
-axillary

Question 26

What is os acromiale?

Answer 26

unfused secondary ossification center

Question 27

What are the typical views of humerus imaging?

Answer 27

AP and lateral

Question 28

What are the indications to humerus imaging?

Answer 28

-pain
-trauma
-assess fracture healing
-post-op

Question 29

What are the indications of elbow imaging?

Answer 29

-pain
-trauma
-post op
-assess fracture healing

Question 30

What are the standard views of elbow imaging?

Answer 30

• AP (elbow in extension)
  -lateral (flexed at 90*)
  -oblique (elbow in extension)

Question 31

What are the typical views of the forearm for imaging?

Answer 31

-ap and lateral
-sometimes oblique

Question 32

What are the indications of forearm imaging?

Answer 32

-pain
-trauma (deformity)
-postop
-fracture healing

Question 33

What are the typical views for wrist imaging?

Answer 33

-ap, lateral, oblique
-scaphoid view (presence of anatomical snuff box pain)

Question 34

What are the indications for wrist imaging?

Answer 34

-trauma
-pain
-post-op
-assess fracture healing

Question 35

What is the approach to wrist imaging?

Answer 35

-distal radius
-distal ulna
-assess the carpal bones (bony changes, widening)
-alignment (dislocations)

Question 36

What are the typical views for hand and finger imaging?

Answer 36

ap, lateral and oblique

Question 37

What are the indications for hand and fingers imaging?

Answer 37

-trauma
-suspect foreign bodies
-pain
-deformity
-post op
-assess fracture healing