Imaging exam 3

thoracic, lumbar, pelvis

which view of the thoracic reveals all 12 vertebrae, vertebral end plates, pedicles, intervertebral disk

A/P

which view of the thoracic spine reveals all but upper 2 or 3 vertebrae, vertebral bodies, intervertebral disk space

lateral

which view of the thoracic spine reveals the upper thoracic vertebrae

swimmers shoulder

what are some examples of thoracic spine traumatic injuries

anterior compression fx, vertebral fx-dislocatiions, rib fracture

what are some examples of thoracic spine pathologies

* Osteoporosis
* scoliosis
* scheuermann’s disease
* spinal tuberculosis (Pott’s disease)

what kind of SCI is detected on radiographs

anterior vertebral body compression fx

what is the MOI for anterior vertebral body fx

flexion

what is common for compression fx to look like

Cod fish

what is used to view bone detail

bone window

what is the gold standard test for osteoporosis

dexa scan

what are some tx for osteoporosis

reduce compression

what can be used to measure the degree of scoliosis

Cobb angle

what is Scheuermann’s disease

* unknown etiology
* common in adolescent boys and girls
* sx of backache and thoracic kyphosis from osteochondrosis
* schmorl nodes are consistent findings

what is the diagnostic criteria for Scheuermann’s disease

* at least 3 continuous vertebrae to be involved
* at least 5 degrees of anterior wedging of each affected vertebra
* thoracic kyphosis greater than 40 degrees

what are some PT interventions for Scheuermann’s disease?

* lay supine
* prayer stretch
* supine snow angel with hook lying
* mini pelvic tilts
* work up to light foam rolling

t/f: Scheuermann’s disease affects the pectoralis major

false

if a patient has Scheuermann’s disease, what muscle would be tight in the low back

erector spinae

what is always secondary to a tuberculosis lesion elsewhere in the body

Tuberculous osteomyelitis (Pott’s disease)

what is the clinical presentation of Tuberculous osteomyelitis (Pott’s disease)

* back pain is earliest and most common sx
* pain usually localized, most common in thoracic spine
* systemic s/s such as weight loss, fever, and fatigue usually present
* lower thoracic vertebra are usually sites, followed by upper lumbar

what is a radiologic assessment of Tuberculous osteomyelitis (Pott’s disease)

* progressive destruction leads to collapse of anterior vertebral bodies and an associated increase in kyphosis
* often more than 1 vertebra involved
* osteolysis

which if the preferred view of the chest

P/A

chest x-rays can look at

* pneumonia
* lobar collapse
* pleural effusion
* pneumothorax
* cardiomegaly

For acute LBP clinical findings, what would lead to leading to get radiograph

* cluster of red flags
* no response to 3 weeks of PT intervention; 2-3 visits even

what are the recommended screening for lumbar spine imaging

* A/P and lateral radiographs
* erythrocyte sedimentation rate (ESR) → occult neoplasms of spine

what view of a radiograph of the lumbar spine shows all 5 vertebral bodies

A/P

what view of a radiograph of the lumbar spine shows alignment of lumbar vertebrae and intervertebral disk spaces

lateral

what view of a radiograph of the lumbar spine shows facet articulations, pedicles, pars, scotty dog

A/P and P/A oblique

what is the downside of the A/P and P/A oblique

high levels of gonadal radiation

what is the owl sign

deals with the condition of the pedicle- should be able to see the eyes and beak. can see pedicle erosion, compression fx, and fx dislocation

what are different degenerative conditions

* DDD
* DJD
* spondylosis
* spondylolysis
* spondylolisthesis
* spinal stenosis

what condition has breakdown of discs

DDD

what condition has facet breakdown

DJD

what condition has formation of osteophytes in response to DDD- the umbrella term

spondylosis

what condition has a defect in pars interarticularis (scotty dog)

spondylolysis

what condition has forward displacement of vertebrae can result from degenerative changes and or fx

spondylolisthsis

what condition develops in the central canal, intervertebral foramen, or lateral or sub articular recesses

spinal stenosis

what are the segments of the scotty dog fracture/spondylolysis

* transverse process- nose
* pedicle- eye
* pars interarticular - neck
* superior articular facet- ear
* inferior articular facet- front leg

what indicates if there is a scotty dog fracture

if the dog has a collar on the parts interarticularis

what are spondylolthesis grades determined by

percentage of motion

what is a protrusion of disk material through annulus

intervertebral disk herniation

t/f: conventional radiographs are poor at showing disk material but will show chronic changes to bone

true

what imaging are good at showing morphological and physiochemical changes in disk

CT myelography & MRI

the vacuum phenomena involving the intervertebral discs are a result of what

accumulation of gas within the crevices of the intervertebral dicks or adjacent vertebrae

what should be looking for with S1

triangle shape

what is the common direction for a primary disc budge

posterior/lateral

why is it common for a disc bulge to be P/L

because the posterior longitudinal ligament is not the entire width of the vertebral body and there is a space

t/f: are fat infiltrated in the lumbar multifidus muscles strongly associated with LBP in adults

true (81% of adult sample)

if an image has the terms melted candle stick on it, what is that indicative of

AS

what view of a radiograph shows entire pevlis, sacrum, coccyx, and lumbrosacral articulation and B hip joint

A/P view of pelvis

what view of a radiograph of the pelvis shows acetabulum, femoral head, neck, and proximal 3rd of shaft, GT, and angle of inclination of femoral neck

A/P view of hip

what view shows femoral head, neck, and proximal 3rd of femoral shaft and greater and lesser trochanter from medial aspect

lateral frog leg of hip

what position is the lateral frog leg of hip image taken in

FABER

what are the 6 important lines of the pelvis

1. radiographic teardrop
2. iliopublic
3. ilioischial
4. anterior acetabular rim
5. posteriior acetabular riim
6. acetabular roof

what does a disruption of the lines of the pelvis indicate

fracture, dislocation or pathology in the hip/pelvis

what are some sex differences on pelvic radiographs

* infrapubic angle is greater than 90 degrees in female
* pelvic inlet shape
* male: heart shaped
* female: round or oval
* wider greater sciatic notch in females
* acetabulum faces more anteriorly in females
* sacrum more triangular and shorter in females
* oval obturator foramen in females

t/f: CT is not the first line imaging evaluating the pelvic viscera except in the setting of trauma

true

what are common pelvic and hip fx

* pelvic ring f
* ischiopubic ramus fx
* acetabular fx

what constitutes a pelvic ring fx

1 or more fx to the bones that make up the ring (2 inanimate and sacrum)

what is the most common MOI for a pelvic ring fx

MVA

what kind of proximal femoral fx is complicated by vascular disruption, may lead to avascular necrosis

intracapsular fx

what kind of proximal femoral fx is vascular complication is rare

extracapsular fx

t/f: upper fx to proximal femoral head are better than lower fx

false (vise versa)

what kind of femoral neck stress fracture is the best to have

compression

what kind of femoral neck stress fracture is the worst to have

tension

what are some signs of OA

* joint space narrowing
* sclerotic subchondral bone
* osteophyte formation at joint margins
* cyst or pseudocyst formation
* migration of femoral head

what are the types of migration of the femoral head

* superolateral
* non-migratory
* medial-axial

what are some s/sx of RA

* osteoporosis of periarticular area
* symmetrical and concentric joint space narrowing B
* articular erosions
* synovial cysts located within nearby bone
* periarticular swelling and joint effusions
* axial migration of femoral head
* acetabular protrusion
* minimal evidence of bone trying to repair itself → lack of sclerotic bone or osteophytes

what is the simple complex of RA

synovial fluid turning into battery acid

what is a SCFE

* weakening of epiphyseal plate that leads to slipping and displacement of femoral head
* patterns of pain in hip and knee area, limited hip ROM, antalgic gait, and limb shortening
* 2x more prevalent in boys than girls
* onset usually around growth spurts at puberty

what is legg-calve perthes disease

* epiphyseal ischemic necrosis of femoral head
* associated with subtle trauma, synovitis, infection, or metabolic bone disease
* can be unilateral or B
* Predominately in boys, avg 6y.o
* Findings
* non-specific dull pain in joint, thigh or leg
* limited hip ROM, progressive limp

what does the femoral head look like on legg-calve-perthes

shrunken walnut

what type of femoral acetabular impingement is the femoral head-neck junction is offset and femoral head doesnt fully clear the acetabular rim

Cam

what type of femoral acetabular impingement has over coverage of femoral head caused by acetabulum, caused by deep socket or other malformations

pincer

what test can test for femoral acetabular impingement

straight flexion

what are common findings for femoral acetabular impingement

* snapping
* clicking
* limited hip ROM
* hip flexion contractures
* painful provocation tests

true hip locking is associated with what conditioin

labral tears

t/f: many unsymtomatic people have FAI and labral tears

true

t/f:labral tears of the hip can happen anywhere

true

what is the common MOI for a hip labral tear

forced FADIR- pressure on with twisting

looking for labral tears of the hip is similar to the shoulder and we should be looking for what

black triangles