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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
What is a Hill-Sachs fx?
The deformity of humeral head, which is more common in a posterior dislocation
26
What are the radiographic signs of impingement in the shoulder?
* Calcium deposits will appear as a radioopaque bubble | * Acromion will have a hooked appearance
27
What are the radiographic signs of rotator cuff tear?
Superior migration of the humeral head, relative to the glenoid
28
What are the standard radiographic views of the shoulder?
* AP in ER * AP in IR * AP of AC joint * AP of Scapula * Lateral of Scapula
29
What are the additional/trauma radiographic views of the shoulder?
* Axillary | * Scapula Y
30
What part of the humerus can be seen in the AP view of the shoulder in ER?
* Greater Tuberosity ++ * Lesser Tuberosity * Anatomic neck * Surgical neck
31
What part of the scapula can be seen in the AP view of the shoulder in ER?
* Lat,med,sup borders * Superior angle * Crest of spine * Coracoid process * Glenoid * Acromion
32
What part of the clavicle can be seen in the AP view of the shoulder in ER?
AC Joint
33
What part of the humerus can be seen in the AP view of the shoulder in IR?
* Greater Tuberosity * Lesser Tuberosity++ * Anatomic neck * Surgical neck
34
What part of the scapula can be seen in the AP view of the shoulder in IR?
* Lat,med,sup borders * Superior angle * Crest of spine * Coracoid process * Glenoid * Acromion
35
What part of the clavicle can be seen in the AP view of the shoulder in IR?
AC Joint
36
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?
* Sternum * Clavicles * Acromion process * Coracoid proceses * AC gap * Coracoclavic gap
37
In the AP view of the scapula, what are the structures that can be seen?
* Med,lat,sup borders * Superior & inferior (usually) angles * Coracoid process * Acromion process * Spine of scapula * Glenoid
38
In the lateral view of the scapula, what are the structures that can be seen?
* Humeral head * Body of scapula * Acromion process * Coracoid process * Glenoid
39
What part of the scapula can be seen in the axillary view of the shoulder?
* Acromion process * Coracoid process ++ * Glenoid ++
40
What are the structures that can be seen in the axillary view of the shoulder?
* Clavicle * Humeral Head ++ * Surgical neck
41
The axillary view of the should is good for visualizing what?
* Coracoid * Rim of glenoid * Humeral head shape * Subluxation/dislocation
42
What part of the scapula can be seen in the scapular Y lateral view of the shoulder?
* Body * Acromion process * Coracoid process
43
What part of the humerus can be seen in the scapular Y lateral view of the shoulder?
* Humeral head | * Humeral shaft
44
What are the structures that can be seen in the scapular Y lateral view of the shoulder?
* Clavicle | * Ribs
45
The scapular Y lateral view of the should is good for visualizing what?
GH dislocations subacromial space
46
What is the presentation of the a SLAP lesion on a MRI?
``` 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
True or False Ultrasound images can be used to visualize calcium deposits
True, Ultrasound images can be used to visualize calcium deposits
48
What are the criterias that one must be present when attempting to detect a pelvic fx, in order to go get a xray?
- 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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