c-spine and TMJ imaging

Question 1

What is the primary objective of imaging in musculoskeletal regions?

Answer 1

Identify landmarks on CT/MRI for MSK regions

This includes understanding anatomy and pathology through imaging.

Question 2

What should be considered if imaging won’t change the referral decision?

Answer 2

Consider direct consult with specialist

Question 3

What are the routine imaging considerations in MSK cases?

Answer 3

• Persistent symptoms
• Suspected structural pathology
• Surgical planning

Question 4

What are the indications for CT of the cervical spine?

Answer 4

• Acute trauma
• Post-op assessment
• When MRI not possible
• Infections, tumors, congenital abnormalities
• Suspected disc herniations/spinal cord compression (w/ contrast if needed)

Question 5

What does the ABCDS interpretation for CT cervical spine include?

Answer 5

• A – Alignment/Anatomy (fx, dislocation)
• B – Bone density (cortical > cancellous)
• C – Canal space (encroachment, fragments)
• D – Disc integrity
• S – Soft tissue (edema)

Question 6

What are the indications for MRI of the cervical spine?

Answer 6

• Neuro deficits (e.g., radiculopathy, myelopathy)
• Persistent neck/shoulder/UE pain >4 weeks
• Trauma (major/minor + neuro findings)
• Suspected infection, cancer, or unexplained pain

Question 7

What views are shown in MRI of the cervical spine?

Answer 7

• Axial View: IV Discs, Nerve roots, IVF, Spinal canal, thecal sac, Facets, ligamentum flavum
• Sagittal View: Vertebral bodies/endplates, disc height/signal, Spinal canal, cord, nerve roots, Ligaments: ALL, PLL, interspinous/supraspinous

Question 8

What does the ABCDS interpretation for MRI cervical spine include?

Answer 8

• A – Alignment
• B – Bone signal
• C – Canal space/CNS
• D – Disc (bulge = diffuse; herniation = focal)
• S – Soft tissue

Question 9

What are the high-risk criteria according to the Canadian C-Spine Rule?

Answer 9

• Age ≥65
• Dangerous mechanism (e.g., fall >1m, axial load, MVA >65mph, bike/motor vehicle collision)
• Paresthesias in extremities

Question 10

What are the low-risk criteria in the Canadian C-Spine Rule that allow safe ROM?

Answer 10

• Simple rear-end MVA
• Sitting in waiting room, ambulatory
• Delayed pain onset, no midline tenderness
• Able to actively rotate ≥45° L/R?

Question 11

What is the sensitivity and specificity of the Canadian C-Spine Rule?

Answer 11

Sensitivity: 0.90–1.00; Specificity: 0.01–0.77

Question 12

Define cervical myelopathy.

Answer 12

Spinal cord compression from cervical spinal canal narrowing

Question 13

What symptoms are associated with cervical myelopathy?

Answer 13

• Paresthesia
• UE weakness
• Ataxia
• (+) Babinski, Clonus, Hoffman, Romberg
• Hyperreflexia

Question 14

What is a clinical insight from the case examples regarding imaging?

Answer 14

CT & MRI needed for post-head trauma with central PAs + bilateral hand/foot numbness

Question 15

What factors contribute to TMJ dysfunction?

Answer 15

• Internal derangements
• Muscle tenderness
• Postural dysfunction
• Cervical spine ROM restrictions

Question 16

What is the limitation of conventional radiographs for TMJ imaging?

Answer 16

Limited due to joint complexity

Question 17

What are the uses of transcranial views in TMJ imaging?

Answer 17

• Evaluate articular eminence
• Condyle shape/position
• Joint height changes (disk displacement suspicion)

Question 18

What are the visible landmarks in TMJ imaging?

Answer 18

• Articular eminence
• Mandibular fossa
• Condylar neck and poles
• Petrous ridge
• External auditory meatus

Question 19

What are the high-yield pearls regarding imaging modalities?

Answer 19

• MRI = best for soft tissue, nerve, spinal cord
• CT = best for bone and trauma
• Canadian C-spine rule helps reduce unnecessary imaging
• C-spine and TMJ are interlinked; treating one may benefit the other
• C-spine imaging can reveal incidental findings; clinical correlation is key