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Advanced diagnostics > Week 7 > Flashcards

Week 7 Flashcards

1
Q

What are the typical radiograph views of the elbow?

A
  • AP view

* Lateral view

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2
Q

What is the elbow extension test used for?

A

It is a sensitive test that helps determine when radiographs are not needed in a person with an elbow trauma

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3
Q

When should a pt who do not undergo radiography return if symptoms have not resolved?

A

Within 7-10 days.

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4
Q

___ is always the 1st test for elbow pain, acute or chronic

A

Radiographs is always the 1st test for elbow pain, acute or chronic

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5
Q

What is a nightstick fx?

A

A fx of the mid portion of the ulna

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6
Q

What is a monteggia fx?

A

A fx of the proximal ulna and a radial head dislocation, commonly caused by a FOOSH

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7
Q

What is a galeazzi fx?

A

A distal head fx, with an ulnar head dislocation

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8
Q

What is a greensitck fx?

A

An incomplete fracture due to flexibility of young bones, and is common in the forearm

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9
Q

What is a torus (Buckle) fracture?

A

A distal radius irregularity, due to a FOOSH

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10
Q

When is an elbow CT indicated?

A 
• Severe trauma
• Fracture assessment
• Loose bodies
• When MRI contraindicated/unavailable
(MR and MRA)
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11
Q

When is an elbow ultrasound indicated?

A
  • Biceps tendon tears
  • Bursitis
  • Epicondylalgia
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12
Q

When is an elbow MRI indicated?

A

• Ligament sprains, partial or complete tears
• Flexor/extensor, bicep, tricep tendons.
• Muscle/myotendinous injuries
• Occult fractures
• Osteochondral lesions: fractures and osteochondritis dessicans
• Cartilage lesions: chondromalacia, degeneration
• Joint effusion, inflammation
• Intra-articular bodies: bony, chondral, osteochondral
• Plica, synovial folds, menisci
• Bursitis
• Peripheral nerve entrapment,
compression, cubital tunnel, muscle denervation
• Congenital/developmental
abnormalities
• Neoplasm
• Infection – bone, joint, soft tissue
• Forearm interosseous membrane and neuromuscular structures

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13
Q

In what planes is a MRI and CT scan of the elbow done?

A
  • Axial
  • Sagittal
  • Coronal
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14
Q

What is the pt positioning during a MRI or a CT, and why?

A

Preferred position is prone or supine with arm(s) overhead
• Minimizes thoracic radiation for CT
• Puts elbow near center of magnet for MR
• Be aware if your patient has shoulder limitations that prevent positioning

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15
Q

According to the ACR guidelines, what are the suspected pathologies if initial radiographs are negative in a pt with chronic elbow pain?

A
  • Intra-articular osteocartilagenous body – MR w/o (9), MRA (9), CT or CTA (8)
  • Occult injury (i.e. osteochondral) – MRI w/o (9)
  • Unstable osteochondral injury – MRI w/o, MRA (9); CTA (8)
  • Chronic epicondylitis – MRI w/o (8), US** (8)
  • Collateral ligament tear* – MRA or MR (9); US (6)
  • Biceps tendon tear – MRI w/o (9); US** (8)
  • Nerve abnormality – MRI w/o (9); US** (8). US ideal for ulnar n. dislocation
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16
Q

What are the structures best seen in an axial MRI view of the elbow?

A
  • Annular ligament
  • Bicep and Tricep tendons
  • Brachial artery
  • Radial nerve
  • Ulnar tunnel
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17
Q

What are the structures best seen in a sagittal MRI view of the elbow?

A
  • Biceps and Triceps tendons
  • Anterior/Posterior muscle groups
  • Radial Head
  • H-R, H-U joints
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18
Q

What are the structures best seen in a sagittal MRI view of the elbow?

A
  • Med, Lat collateral ligaments
  • Med, Lat muscle groups
  • Common flexor, extensor tendons
  • Med, Lat epicondyles
  • Prox R-U joint
  • Bicipitaoradial bursa
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19
Q

What are the benefits of an ultrasound of the elbow?

A
  • Cost effective
  • Great to visualize soft tissue
  • Allows patient participation
  • Continuous feedback
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20
Q

What are the challenges of an ultrasound of the elbow?

A
  • Experienced operator
  • Good knowledge of anatomy
  • Continuous feedback
21
Q

What is an ultrasound of the elbow useful for?

A
  • Joint effusion
  • Medial/lateral elbow pain
  • Distal bicep/tricep tears
  • RCL/UCL exam
  • Ulnar nerve entrapment
  • Cubital/olecranon bursitis
  • Intra-articular loose bodies
22
Q

What are the potential differential diagnosis for lateral elbow pain?

A
  • Lateral epicondylalgia
  • Nerve entrapments (PIN, RTS, Lateral antebrachial cutaneous n)
  • PLRI
  • Panner’s Disease
  • Osteochondritis dessicans of capitellum
  • Radiocapitellar overload
  • Occult fractures/impaction
  • Arthritis
23
Q

What are the considerations of epicondyalgia as it relates to imaging?

A

• MRI useful to assess tendon damage in 4-10% of cases
resistant to conservative care
• Tendon degeneration: increased tendon thickness on T1, no increase intensity on T2
• Complete tears: fluid-filled gap separating tendon-bony
attachment
• MRI useful for ID partial and complete tears unlikely to
improve w/ rest, injections….
• If not improved w/ traditional conservative care, consider
differentials, such as radial nerve entrapment, etc.

24
Q

What happens in a bankart lesion?

A

• Labral detachment
(fibrous)
• Fracture of glenoid (bony)

**more common in anterior dislocations

25
Q

What is a Hill-Sachs fx?

A

The deformity of humeral head, which is more common in a posterior dislocation

26
Q

What are the radiographic signs of impingement in the shoulder?

A
  • Calcium deposits will appear as a radioopaque bubble

* Acromion will have a hooked appearance

27
Q

What are the radiographic signs of rotator cuff tear?

A

Superior migration of the humeral head, relative to the glenoid

28
Q

What are the standard radiographic views of the shoulder?

A
  • AP in ER
  • AP in IR
  • AP of AC joint
  • AP of Scapula
  • Lateral of Scapula
29
Q

What are the additional/trauma radiographic views of the shoulder?

A
  • Axillary

* Scapula Y

30
Q

What part of the humerus can be seen in the AP view of the shoulder in ER?

A
  • Greater Tuberosity ++
  • Lesser Tuberosity
  • Anatomic neck
  • Surgical neck
31
Q

What part of the scapula can be seen in the AP view of the shoulder in ER?

A
  • Lat,med,sup borders
  • Superior angle
  • Crest of spine
  • Coracoid process
  • Glenoid
  • Acromion
32
Q

What part of the clavicle can be seen in the AP view of the shoulder in ER?

A

AC Joint

33
Q

What part of the humerus can be seen in the AP view of the shoulder in IR?

A
  • Greater Tuberosity
  • Lesser Tuberosity++
  • Anatomic neck
  • Surgical neck
34
Q

What part of the scapula can be seen in the AP view of the shoulder in IR?

A
  • Lat,med,sup borders
  • Superior angle
  • Crest of spine
  • Coracoid process
  • Glenoid
  • Acromion
35
Q

What part of the clavicle can be seen in the AP view of the shoulder in IR?

A

AC Joint

36
Q

When taking a radiograph of the AC joint, the AP view can be done in both WB and NWB. What are the structures that can be seen in these views?

A
  • Sternum
  • Clavicles
  • Acromion process
  • Coracoid proceses
  • AC gap
  • Coracoclavic gap
37
Q

In the AP view of the scapula, what are the structures that can be seen?

A
  • Med,lat,sup borders
  • Superior & inferior (usually) angles
  • Coracoid process
  • Acromion process
  • Spine of scapula
  • Glenoid
38
Q

In the lateral view of the scapula, what are the structures that can be seen?

A
  • Humeral head
  • Body of scapula
  • Acromion process
  • Coracoid process
  • Glenoid
39
Q

What part of the scapula can be seen in the axillary view of the shoulder?

A
  • Acromion process
  • Coracoid process ++
  • Glenoid ++
40
Q

What are the structures that can be seen in the axillary view of the shoulder?

A
  • Clavicle
  • Humeral Head ++
  • Surgical neck
41
Q

The axillary view of the should is good for visualizing what?

A
  • Coracoid
  • Rim of glenoid
  • Humeral head shape
  • Subluxation/dislocation
42
Q

What part of the scapula can be seen in the scapular Y lateral view of the shoulder?

A
  • Body
  • Acromion process
  • Coracoid process
43
Q

What part of the humerus can be seen in the scapular Y lateral view of the shoulder?

A
  • Humeral head

* Humeral shaft

44
Q

What are the structures that can be seen in the scapular Y lateral view of the shoulder?

A
  • Clavicle

* Ribs

45
Q

The scapular Y lateral view of the should is good for visualizing what?

A

GH dislocations subacromial space

46
Q

What is the presentation of the a SLAP lesion on a MRI?

A 
Tear of the Superior Labrum
with the tear running Anterior to Posterior
• Coronal T2 spin echo with fat
suppression
• Contrast leaking between
glenoid and labrum demonstrates the tear
• Surgical treatment depends on the degree of compromise of the attachment of the biceps
long head
47
Q

True or False

Ultrasound images can be used to visualize calcium deposits

A

True, Ultrasound images can be used to visualize calcium deposits

48
Q

What are the criterias that one must be present when attempting to detect a pelvic fx, in order to go get a xray?

A
  • Age> 3
  • No impairments of consciousness
  • No other major distracting injuries
  • No complaint of pelvic pain
  • No signs of fx on inspection
  • Painless compression of iliac or pubic symphysis
  • Pain free hip rotation and flexion

Advanced diagnostics (8 decks)

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