Biophysics Week 2

What are the lumbar plain film standard views (3)

AP

Lateral

Oblique

What view is best for viewing a pars interarticularis fracture

Oblique

Which part of the scottie dog is does the pars interarticularis

neck

Why should you not utilize the oblique lumbar view if unnecessary

excessive radiation

What lumbar level is most pathology located at

L5/S1

What suspected conditions warrant imaging (5)

fracture

infection

cancer

cauda equina

progressive/severe neuro deficits

does severe acute, atraumatic LBP w/o neurological deficit warrant imaging considerations

NO

does chronic LBP before PT warrant imaging considerations

NO

does back pain with leg pain before PT require imaging considerations

NO

does a history of CA and LBP warrant imaging considerations

YES

does long term corticosteroid use and LBP warrant imaging considerations

YES

does a hx of TB and LBP warrant imaging considerations

YES

does a hx of IV drug abuse and LBP warrant imaging considerations

YES

does a hx of recent surgery and LBP warrant imaging considerations

YES

does LBP and suspected infection warrant an MRI

YES

does LBP and suspicion of myelopathy warrant MRI

YES

how long should imaging be avoided for LBP when red flags are not present

6 months

What percent reduction in MRIs was observed when patients utilized DA to PT for their LBP

40%

How many adverse events, disciplinary actions, and litigation cases were observed in military PTs with DA

0

What 4 questions should every PT ask to screen for (spine) CA

1. Age >50 y/o

2. Personal Hx of CA

3. Unexplained weight loss

4. Inadequate relief with rest

What is the most important screening question for determining spine CA

personal hx of CA

How does a personal hx of CA affect the probability of spine CA being present

increase to 9%

Primary cancers most likely to metastasize to bone

Prostate

Thyroid

Breast

Lung

Kidney

What are risk factors for spinal fx (6)

-hx osteoporosis (prior fx)

-corticosteroid use (>5mg over 3mo)

-severe trauma (immediate spinal pain)

-female sex (postmenopausal)

-older age (F>65, M>75)

-prior low impact fx

What diagnostic test could be used specifically to evaluate bone health

DXA

Gold standard for measuring bone mineral density

DXA

-1 DXA T score means

healthy bone

-1 to -2.5 DXA T score means

osteopenia

less than -2.5 DXA T score means

osteoporosis

What kind of disc herniation has improved odds of healing

sequestered

What differences were present when comparing surgical versus PT interventions for lumbar disc herniation

-both get better at the same time

-same outcomes in a year

How do risk factors compound?

Exponentially! The more risk factors combined = significantly more suspicion! (LBP+age+trauma+steroid use)

Conventional cervical radiographs (2)

AP

Lateral

What cervical radiograph view exposes C1/C2 fractures

open mouth

What cervical radiograph view exposes neural foramen

oblique

Conventional thoracic radiographs (2)

AP

Lateral

NEXUS criteria (5)

-no posterior midline cervical spine tenderness

-no evidence of intoxication

-a normal level of alertness

-no focal neurological deficit

-no painful distracting injuries (degloving)

What is the age that makes a pt high risk for Canadian C-spine Rules

65

What are the three high risk factors for Canadian C-spine Rules

age 65+, paresthesia in extremities, dangerous mechanism

what degree does the pt have to be able to rotate their neck actively for Canadian C-spine Rules to avoid imaging

45 degrees L/R

What percent of C spine fxs are C1/C2 complex fx

25%

What are the most frequent C-spine fx and percent occurance

C2, 55% odontoid

How might an odontoid fx present in seniors

neck pain WITHOUT neurological deficits

What conditions (2) may lead to upper cervical instability

downs syndrome, rheumatoid arthritis

what is a spinal cord compression called

myelopathy

what is a bone infection called

osteomyelitis

what condition is caused by a bacterial infection/TB/fungus, is more common in the thoracic/lumbar spine, and is always an emergency

osteomyelitis

what is the progression of thoracic spine pathology

1. osteoporosis

2. Increased kyphosis

3. compression fx (anterior wedge)

What is a challenge in diagnosing shoulder conditions that is unlike foot conditions

location of symptoms is harder to pinpoint and may not be helpful, often more than one thing involved too

What are the standard radiography views for the GHJ (2)

AP ER

AP IR

What are the standard radiography views for the scapula (2)

AP
Lateral

What are the standard radiography views for the ACJ (2)

AP w/ weights

AP w/o weights

What is the additional radiography view for the shoulder

Axillary

What does the AP IR GHJ view best show

Lesser tubercle

What does the AP ER GHJ view best show

Greater tubercle

What does the AP scapula view best show

Scapula

What does the AP of the ACJ best show

ACJ space, coracoclavicular space, AC distance comparison

If you wanted near full vision of the scapula, what radiograph view should you order?

AP Scapula

If you wanted to see the greater tubercle, what radiograph view should you order?

AP ER

If you wanted to see the lesser tubercle, what radiograph view should you order?

AP IR

If you wanted to see the relationship between the humeral head and glenoid fossa, what radiograph view should you order?

Axillary

What does the Axillary view best show

relationship between glenoid and humeral head

What does a Hill Sachs Defect indicate

anterior glenohumeral dislocation

What is the term for an impaction of the posterolateral humeral head and anterior glenoid rim

Hill Sachs Defect

What is a fx called when the bone is still connected

non-displaced

What is a fx called when bone has moved

displaced

What is the etiology for a greater tuberosity fx for older adults

fall directly onto point of shoulder

what is the treatment for a non-displaced greater tuberosity fx

sling immobilization 4-6 wks

what is the treatment for a displaced greater tuberosity fx

open reduction with internal fixation

What is the etiology for a greater tuberosity fx for YA/children

avulsion fx from indirect trauma and forceful contraction of rotator cuff muscles or FOOSH

Forceful contraction of what muscle is correlated with lesser tuberosity fx

subscapularis

What type of imaging is best for complex fx

CT

What is the relationship between MRI and US in rotator cuff tears

equally effective- start with US when possible due to ease/cost/radiation

delaying surgery for partial thickness rotator cuff tears for how long resulted in similar outcomes to immediate surgery

6 months

Can PT help full thickness rotator cuff tears

YES (grade B recomendation)

which joint is between the talus and calcaneus

subtalar joint

which joint is between the talus and tibia/fibula

talocrural joint

What are the standard radiograph views of the ankle (3)

AP

AP oblique (mortise)

Lateral

What is the AP ankle radiograph used to visualize

talar dome

When trying to visualize the talar dome, what radiograph view should be used

AP ankle

What is the AP oblique ankle radiograph used to visualize

talocrural joint space (mortise)

When trying to visualize the talocrural joint space, what radiograph view should be used

AP oblique ankle

When trying to visualize the calcaneus, what radiograph view should be used

Lateral ankle

What is the lateral ankle radiograph used to visualize

Calcaneus

What term describes excessive medial/lateral displacement of the talus

talar tilt

During anterior drawer stress at the ankle, how much separation at the talocrural joint is abnormal

<10mm

What are the standard radiograph views of the foot (3)

AP

AP oblique

Lateral

What radiograph view of the foot is best for visualizing the cuboid

AP foot

What is best visualized using an AP radiograph of the foot

Cuboid

When trying to identify pathology related to soft tissue and ligamentous issues, what kind of imaging should be utilized

MRI

What structures are affected in a trimelleolar ankle fx

both malleoli and the posterior tibial rim

What constitutes 85% of all ankle injuries

inversion ankle sprain

Forefoot fx often occur at what location

5th metatarsal

How is the 5th metatarsal usually fx

direct trauma, inversion force

persistent lateral ankle pain after an inversion ankle sprain that is sharp, severe, and debilitating may be indicative of what

cuboid subluxation