spine and upper extremity imaging Flashcards
What are the indications of MSK plain films?
-first line for evaluating bony anatomy
-pain
-following injury/trauma
-suspect fracture
-suspect foreign body
-surgical planning
-post-surgical changes
-post-fracture healing
-osteomyelitis
What are the indications of CT scans?
-assess intra-articular fractures
-bony reconstitution
-surgical planning
-presence of metallic implants
What are the indications of MRI imaging?
-soft tissue
-tumors
-surgical planning
-osteomyelitis
What is the systematic approach to interpretation of MSK plain films?
-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
What is the term for a partial dislocation?
subluxation
What is the narrowing of joint space?
subchondral sclerosis
If pathology or abnormal findings are identified, what should you do?
don’t stop with your interpretation, you might miss something else
What should your approach to looking at images of the spine be?
-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)
What are the common views of the cervical spine?
-AP (alignment)
-lateral (count vertebral bodies)
-oblique (neural foramina -narrowing/impingement)
-odontoid (AP with mouth open)
What are some other views of the cervical spine?
-flexion/extension (vertebral body instability)
-swimmer’s view (if cant evaluate C7-T1)
What are some indications of thoracic spine imaging?
-fall from height
-MVA
-neuro deficits
-postop imaging
-assess for metastases
-curvature (scoliosis)
What are the views used for thoracic imaging?
-AP
-lateral
What can AP view of the thoracic spine assess?
-curvature
-fractures/dislocations
-number of vertebrae
-alignment/deformity
What can lateral view of the thoracic spine assess?
-curvature
-fractures/deformities
-tumors
What are the standard views used for lumbar spine imaging?
-AP/lateral
-standing
-supine (trauma)
What are other views used for lumbar spine imaging?
-oblique
-flexion/extension
What does the AP view of the lumbar spine assess?
-alignment
-number of vertebrae
-transverse processes
-pedicles
-sacrum and SI joint
-T11/T12 to sacrum
-deformities (scoliosis)
-other abnormalities (tumors, congenital, normal variants)
What does the lateral view of the lumbar spine assess?
-alignment (subluxation)
-number of vertebrae
-height of vertebrae
-curvature (lordosis)
-other abnormalities (tumors)
What does the oblique view of the lumbar spine assess?
-facet joints
-pars defect or fracture
What does the flexion/extension view of the lumbar spine assess?
-suspect instability
-spondylolisthesis (anterior vertebral displacement)
What are the common variants in the lumbar spine?
-spina bifida occulta
-sacralization
What does the CT scan of the lumbar spine usually assess?
-s/p trauma
-fractures
-seat belt injury
-used when MRI is contraindicated
-spondylolisthesis/spondylosis
-procedural (spinal injections)
What are the indications of a lumbar spine MRI?
-low back pain
-DDD/DJD
-herniated disc
-spinal stenosis
-tumors
-mets
What are the indications of shoulder imaging?
-pain
-trauma
-post-op
-assess fracture healing
What are the standard views of shoulder imaging?
-AP
-scap Y
-axillary
What is os acromiale?
unfused secondary ossification center
What are the typical views of humerus imaging?
AP and lateral
What are the indications to humerus imaging?
-pain
-trauma
-assess fracture healing
-post-op
What are the indications of elbow imaging?
-pain
-trauma
-post op
-assess fracture healing
What are the standard views of elbow imaging?
- AP (elbow in extension)
-lateral (flexed at 90*)
-oblique (elbow in extension)
What are the typical views of the forearm for imaging?
-ap and lateral
-sometimes oblique
What are the indications of forearm imaging?
-pain
-trauma (deformity)
-postop
-fracture healing
What are the typical views for wrist imaging?
-ap, lateral, oblique
-scaphoid view (presence of anatomical snuff box pain)
What are the indications for wrist imaging?
-trauma
-pain
-post-op
-assess fracture healing
What is the approach to wrist imaging?
-distal radius
-distal ulna
-assess the carpal bones (bony changes, widening)
-alignment (dislocations)
What are the typical views for hand and finger imaging?
ap, lateral and oblique
What are the indications for hand and fingers imaging?
-trauma
-suspect foreign bodies
-pain
-deformity
-post op
-assess fracture healing
