Chapter 4 and 5 Procedures Clinical Indications

Bone Metastases

refers to the transfer of disease or cancerous lesions from one organ or part that may not be directly connected.

(Most common of malignant bone tumors)

What is bursitis?

Inflammation of the bursae or fluid-filled sacs that enclose the joints.

What is a common consequence of bursitis involving tendons?

The formation of calcification in associated tendons.

What are two symptoms of bursitis?

Pain and limited joint movement.

What is Carpal Tunnel Syndrome?

A common painful disorder of the wrist and hand.

What causes Carpal Tunnel Syndrome?

Compression of the median nerve as it passes through the center of the wrist.

In which demographic is Carpal Tunnel Syndrome most commonly found?

Middle-aged women.

Fracture

A break in the structurex of bone caused by force (Direct or indirect)

Barton Fracture

Fracture and dislocation of the posterior lip of the distal radius involving the wrist joint

Bennet Fracture

Fracture of the base of the first metacarpal bone (thumb), extending into the carpometacarpal joint, complicated by subluxation (partial dislocation) with some posterior displacement.

Boxer Fracture

Transverse fracture that extends through the metacarpal neck; most commonly seen in the fifth metacarpal

Colles Fracture

Transverse fracture of the distalv radius in which the distal fragment is displaced posteriorly ; an associated ulnar styloid fracture is seen in 50%-60% of cases

Smith Fractures

Reverse of Colles Fracture, or transverse fracture of the distal radius with the distal fragment displaced anteriorly

Joint Effusion

Refers to accumulated fluid (synovial or hemorrhagic) in the join cavity. It is a sign of an underlying condition, such as fracture, dislocation, soft tissue damage, or inflammation

What is osteoarthritis?

A degenerative joint disease (DJD) characterized by gradual deterioration of the articular cartilage.

What type of arthritis is the most common?

Osteoarthritis

Is osteoarthritis inflammatory or non-inflammatory?

Non-inflammatory

What is a characteristic feature of osteoarthritis regarding bone formation?

Hypertrophic (enlarged or overgrown) bone formation.

Is osteoarthritis considered a normal part of the aging process?

Yes

Osteopetrosis

A hereditary disease marked by abnormally dense bone

Osteoporosis

Reduction in the quantity of bone or atrophy of skeletal tissue.

Paget Disease

a common chronic skeletal disease; characterized by bone destruction followed by a reparative process of overproduction of dense, yet soft, bones that tend to fracture easily.

Rheumatoid arthritis

A chronic systemic disease with inflammatory changes throughout the connective tissues; the earliest change is soft tissue swelling that is most prevelant around the ulnar styloid of the wrist.

Scapulounate ligament injuries

involve the ligament that connects the scaphoid to the lunate bone.

Skier's Thumb

A sprain or tear of th eulnar collateral ligament of th ethumb near the MCP joint of the hyperextended thumb.

Tumors (neoplasms, bone neoplasia)

Most often benign, but may be malignant.

Malignant Bone tumors

-Multiple Myeloma

-Osteogenic Sarcoma (Osteosarcoma)

-Ewing Sarcoma

-Chondrosarcoma Cartilage

Multiple Myeloma

(Most common primary bone tumor) that affects persons between ages 40 and 70 years. The tumors grow in various parts of the body, arising from bone marrow or marrow plasma cells.

Osteogenic Sarcoma (Osteosarcoma)

The second most common type of primary cancerous bone tumor and generally affects persons aged 10 to 20 years byt can occur in any age.

Ewing Sarcoma

Common primary malignant bone tumor in children and young adults that arises from bone marrow.

Chondrosarcoma

A slow-growing malignant tumor of the cartilage

Benign Bone or Cartilaginous Tumors (Chondromas)

-Enchondroma

-Osteochondroma

Enchondroma

a slow-growing benign cartilaginous tumor most often found in small bones of the hands and feet of adolescents and young adults.

What is the most common type of benign bone tumor?

Osteochondroma (Exostosis)

At what age range do osteochondromas typically occur?

10 to 20 years

Where does an osteochondroma arise from?

The outer cortex of the bone

How does an osteochondroma grow in relation to the bone?

It grows parallel to the bone, pointing away from the adjacent joint.

X-ray involving Bursitis

Most Common Radiographic Examination:

- AP and lateral joint

Possible Radiographic Appearance:

- Fluid-filled joint space with possible calcification

X-ray of Carpel Tunnel Syndrome

Most Common Radiographic Examination:

- PA and lateral wrist; Gaynor-Hart method

- Sonography

Possible Radiographic Appearance:

- Possible calcification in carpal sulcus

- Enlargement of wrist ligaments and median nerve compression

X-ray of Fractures

Most Common Radiographic Examination:

- AP and lateral of long bones; AP, lateral, and oblique if joint involved

Possible Radiographic Appearance:

- Disruption in bony cortex with soft tissue swelling

X-ray of Joint Effusion

Most Common Radiographic Examination:

- AP and lateral joint

Possible Radiographic Appearance:

- Fluid-filled joint cavity

X-ray of Osteoarthritis (DJD)

Most Common Radiographic Examination:

- AP and lateral affected area

Possible Radiographic Appearance:

- Narrowing of joint space with periosteal growths on joint margins

X-ray of Osteomyelitis

Most Common Radiographic Examination:

- AP and lateral affected bone; nuclear medicine bone scan

Possible Radiographic Appearance:

- Soft tissue swelling and loss of fat pad detail visibility

X-ray of Scapholunate Ligament Tear

Most Common Radiographic Examination:

- Bilateral PA stress projection (PA clenched)

Possible Radiographic Appearance:

- Abnormal space between the lunate and scaphoid (>3 mm)

X-ray of "Skier's Thumb" (ulnar collateral ligament injury)

Most Common Radiographic Examination:

- PA bilateral stress projection thumbs (FOLIO method)

Possible Radiographic Appearance:

- Widening of inner MCP joint space of thumb and increase in degrees of angle of MCP line

X-ray of Tumors (neoplasms)--malignant and benign

Most Common Radiographic Examination:

- AP and lateral affected area

Possible Radiographic Appearance:

-Appearance dependent on type and stage of tumor

X-ray of Osteopetrosis (marble bone)

Most Common Radiographic Examination:

- AP and lateral long bone

Possible Radiographic Appearance:

- Chalky white or opaque appearance with lack of distinction between the bony cortex and trabeculae

X-ray of Paget Disease

Most Common Radiographic Examination:

- AP and lateral affected area

Possible Radiographic Appearance:

- Mixed areas of sclerotic and cortical thickening along eith radiolucent lesions; "cotton wool" appearance

X-ray of Osteoporosis

Most Common Radiographic Examination:

- AP and lateral affected area

Possible Radiographic Appearance:

- Best visibility in distal extremeties and joints as decrease in bone image receptor exposure; long bones demonstrating thin cortex

X-ray of Rheumatoid Arthritis (RA)

Most Common Radiographic Examination:

- AP and lateral hand/wrist. Brewerton method can detect early signs of RA in hands

Possible Radiographic Appearance:

- Closed joint spaces with sublucation of MCP joints

AC Joint Seperation

Refers to trauma to the upper shoulder region resulting in a partial or complete rear of the AC or coracoclavicular (CC) ligament or both ligaments.

Acromioclavicular dislocation

Injury in which the distal clavicle is usually displaced superiorly.

(Most commonly caused by a fall and is more common in children)

Bankart lesion

Injury of the anteroinferior aspect of the glenoid labrum. This injury is typically caused by anterior dislocation of the proximal humerus.

Hill-Sachs defect

A compression fracture of the articular surface of the posterolateral aspect of the humeral head that is often associated with an anterior dislocation of the humeral head.

Idiopathic chronic adhesive capsulitis (frozen shoulder)

a disability of the shoulder joint that is caused chronic inflammation in and around the joint. Characterized by pain limitation of motion

Impingement Syndrome

is impingement of the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch, generally during abduction of the arm.

Rotator Cuff Pathology

An acute or a chronic traumatic injury to one or more of the rotator cuff muscles: teres minor, supraspinatus, infraspinatus, and subscapularis.

Shoulder dislocation

A traumatic removal of the humeral head from the glenoid cavity.

(95% of these are anterior dislocation)

Tendonitis

AN inflammatory condition of the tendon that usually results from a strain

X-ray of AC Dislocation

Most Common Radiograph Examination:

- Unilateral or bilateral, erect AC joints

Possible Radiographic Appearance:

- Widening of AC joint space

X-ray of AC Joint Seperation

Most Common Radiograph Examination:

- Unilateral or bilateral, erect AC joints (with and without weights) or Zanca method

Possible Radiographic Appearance:

- Asymmetric widening of AC joint compared with contralateral (opposite) side

X-ray of Bankart Lesion

Most Common Radiograph Examination:

- AP internal roatation, PA oblique (Scapular Y), and AP oblique (Grashey)

Possible Radiographic Appearance:

- Possible small avulsion fracture of anteroinfeior aspect of glenoid rim

X-ray of Bursitis

Most Common Radiograph Examination:

- AP and lateral shoulder

Possible Radiographic Appearance:

- Fluid-filled joint space with possible calcification

X-ray of Hill-Sachs defect

Most Common Radiograph Examination:

- AP and internal rotation and transaxillary with exaggerated external rotation

Possible Radiographic Appearance:

- Compression fracture and possible anterior dislocation of humeral head

X-ray of Idopathic chronic adhesive capsulitis (frozen shoulder)

Most Common Radiograph Examination:

- AP rotation shoulder and PA oblique (Scapular Y-Neer method) projection shoulder

Possible Radiographic Appearance:

- Possible calcification or other joint space abnormalities

X-ray of Impingement Syndrome

Most Common Radiograph Examination:

- Apical AP axial shoulder

- PA oblique (Scapular Y), Neer method

Possible Radiographic Appearance:

- Possible bone spurs near acromiohumeral space

X-ray of Osteoarthritis

Most Common Radiograph Examination:

- AP and lateral shoulder

Possible Radiographic Appearance:

- Narrowing of joint space

X-ray of Steoporosis (resultant fractures)

Most Common Radiograph Examination:

- AP and lateral shoulder

Possible Radiographic Appearance:

- Thin bony cortex

X-ray of Rheumatoid Arthritis (RA)

Most Common Radiograph Examination:

- AP and lateral shoulder

Possible Radiographic Appearance:

- Loss of joint space, bony erosion, bony deformity

X-ray of Rotator Cuff Injury

Most Common Radiograph Examination:

- MRI or Sonography

Possible Radiographic Appearance:

- Partial or complete tear in musculature

X-ray of shoulder dislocation

Most Common Radiograph Examination:

- PA oblique (Scapular Y), transthoracic lateral, or Garth method

Possible Radiographic Appearance:

- Seperation between humeral head and glenoid cavity

X-ray of Tendonitis

Most Common Radiograph Examination:

- Neer method, MRI, or Sonography

Possible Radiographic Appearance:

- Calcified tendons