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RADIOLOGY - MUSCULOSKELETAL
Terms in this set (60)
What is the purpose of X-RAYS and CT SCANS in musculoskeletal diagnosis?
- X-ray is almost always used for
initial evaluation of all musculoskeletal complaints
- CT scan is used in assessment of
may also be used to assess certain fractures and the spinal column
What characterizes the use of an MRI in musculosketal imaging?
- the bone itself is not adequately visualized, but the
in cancellous bone produces very clear images
- used to investigate
bone tumors, soft tissue masses, and the spinal column
- now used instead of arthrography to evaluate joints, ligaments, and menisci
What is the role of NUCLEAR MEDICINE in musculoskeletal imaging?
- BONE SCAN used to detect areas of
abnormal metabolic activity
- includes infection, inflammation, metastasis, healing, turnover
Define the following terms -
- epiphyses are the
round ends of long bones
- metaphyses are the
flared ends of bone
- diaphyses are the
tubular midportions of a bone shaft
- physes (also called the
growth or epiphyseal plate
) are the cartilaginous growth plates between the epiphysis and metaphysis
How does CORTICAL BONE differ from CANCELLOUS BONE?
- cortical bone is the
dense, compact outer cortex
- cancellous bone is
spongy and porous, associated with the bone marrow
What characterizes a FRACTURE when it is:
- displaced fractures involve displacement of the distal fragment with respect to the proximal part
- angulated fractures involve angulation of the distal fragment to the proximal part (
the fractured fragments are at angles to each other
- impacted fractures involve overlapping of the fracture fragments
What characterizes a COMPOUND FRACTURE?
penetrates through soft tissue and the skin
- high risk of
What characterizes a COMMINUTED FRACTURE?
- the bone
and small fragments shatter into
more than two pieces
- associated with
, such as a car accident
What characterizes an OBLIQUE FRACTURE?
- the bone breaks at an
across the shaft, usually from a sharp angled blow
What characterizes a SPIRAL FRACTURE?
creates an oblique fracture
around and through
What characterizes a TRANSVERSE FRACTURE?
- a break
a bone, usually from a sharp, direct blow
What is usually involved in a STABLE FRACTURE?
- a fracture that is "somewhat stable"
What is usually involved in an UNSTABLE FRACTURE?
What defines a COMPLETE BONE FRACTURE?
- the bone has been
completely fractured through its width
- the opposite of a hairline or incomplete bone fracture
What occurs in a GREENSTICK FRACTURE?
- bone splinters without breaking into two, a sudden force causes the outer side of the bone to break
- usually occurs in
- can also be referred to as a "torus"
What occurs in a HAIRLINE (fissure) FRACTURE?
- incomplete fracture with minimal trauma to bone and tissue, has
no significant bone displacement
- only extends into the
of the bone
- considered a stable fracture
What occurs in a COMPRESSION FRACTURE?
- generally occurs after a
vertebral column is compressed
and breaks under extreme pressure
- may be caused by osteopenia in older patients
What occurs in an AVULSION FRACTURE?
- a small fragment of bone detaches from where it is attached by tendons or ligaments
- usually in the hand, foot, shoulder, pelvis, or knee
What occurs in a PATHOLOGIC FRACTURE?
- the fracture occurs after the bone is
weakened by an underlying disorder
- can include an infection, tumor, or cancer
What occurs in a BUCKLE FRACTURE or GREENSTICK TORUS?
- common in
children from axial loading
- the topmost layer of bone is compressed, causing the other side to bend away from the growth plate
- in a CLASSIC buckle fracture, the cortex buckles
- in an ANGLED buckle fracture, the cortex is
Where do ANGLE BUCKLE FRACTURES most commonly occur in the ELBOW and WRIST?
- occur in the PROXIMAL RADIUS at the elbow
- occur in the DISTAL RADIUS at the wrist
What is a SALTER HARRIS fracture?
- an injury through the PHYSIS (epiphyseal growth plate)
- by definition, will occur in a
patient before the physis closes
What characterizes the 5 types of SALTER HARRIS FRACTURES?
1 - transverse fracture through the hypertrophic zone of the physis that does
involve bone, growth disturbance is uncommon
the most common
, fracture is through the growth plate and metaphysis, but not the epiphysis, may cause minimal shortening but rarely limits function
3 - fractures through the growth plate AND epiphysis, disrupts growth plate zones, often treated surgically but rarely causes significant deformity
4 - involves all 3 elements of bone - growth plate, epiphysis, and metaphysis, interrupts growth plate, may result in chronic disability and joint deformity
5 - compression or crush of growth plate only, with no epiphyseal or metaphyseal fracturing, diagnosis is difficult and functional prognosis is poor
What is SUBLUXATION?
incomplete or partial dislocation
of a joint, usually by trauma
What is DISLOCATION?
- bone is displaced from its proper position
- joint may be
visibly displaced, discolored, or misshapen, and intensely painful with limited movement
- may cause ligament or nerve damage, but a simple dislocation may be manipulated back into place
- usually caused by sudden impact to the joint
What is the MOST COMMON traumatic injury of the ELBOW in pediatric patients?
- SUBLUXATION of the RADIAL HEAD, or "NURSEMAID'S ELBOW"
- most commonly occurs in patients 2-4 years old with a
pull on the arm
due to weakness of the
What occurs in SPONDYLOSIS or SPINAL OSTEOARTHRITIS?
- degenerative disorder causing
loss of function and normal structure in the cervical, thoracic, or lumbar spine
- caused by aging and wear on body
- symptoms include
pain that can be caused by flexion or hyperextension (thoracic), prolonged sitting, or that occurs in the morning (lumbar)
- can include
bilateral arm weakness (cervical)
What are X-RAY findings consistent with SPONDYLOSIS?
- DECREASED height of DISC SPACES
- OSTEOPHYTES (bone spurs)
- SCLEROSIS of FACET JOINTS
What occurs in BENNET'S FRACTURE?
- an intra-articular fracture of the
base of the first metacarpal (thumb) that extends to the carpometacarpal (CMC) joint
- MUST involve the first carpometacarpal joint
What MUST you know about SCAPHOID (navicular) FRACTURES?
- caused by a
fall on an outstretched hand
ALWAYS ORDER A SPECIALIZED "SCAPHOID/NAVICULAR" VIEW WHEN THIS FRACTURE IS SUSPECTED
- failure to diagnose may lead to
of the bone
- symptoms include
wrist pain and swelling, tenderness below the thumb, and PAIN in the SNUFF BOX
What characterizes the anatomy of the SNUFF BOX?
- the RADIAL DORSAL aspect of the hand at the wrist
- at the level of the carpal bones, with the floor formed by the
scaphoid and trapezium
, and borders formed by the thumb tendons
palpate here on exam for tenderness
What occurs in COLLE'S FRACTURE?
- fracture of the
, possibly also involving the ulnar styloid
- wrist and hand is displaced
dorsally and radially
(remember that this is the "dinner fork" or "bayonet" fracture, curves the wrist like a fork or bayonet attached to a musket)
- usually caused by a fall onto an outstretched hand by an elderly patient
What characterizes fractures and dislocations of the RADIAL HEAD?
- often occurs in conjunction with injury to the distal radius or ulna, and a dislocated radius usually involves injury to the ulna
- the force of a fall onto an outstretched hand will often
force the radial head into the capitellum
- patient will present with pain, swelling, decreased motion, and tenderness
What must be ensured in cases of RADIAL HEAD dislocation or fracture?
- take multiple views during imaging
- the radial head must be
aligned with the capitellum on ALL views
What occurs in a MONTEGGIA'S FRACTURE?
- ULNAR FRACTURE, RADIAL HEAD DISLOCATION
- usually caused by a fall onto an outstretched arm
What kind of X-RAY images should be taken with any FOREARM FRACTURE?
- image BOTH the ELBOW and the WRIST
- should include a good quality AP and LATERAL view
What is frequently the cause of STRESS FRACTURES?
- REPETITIVE STRESS from the FOOT striking a hard surface, causes cumulative trauma to bone
- usually occurs in
weight bearing bones
- calf, ankle, foot
- osteoporosis and decreased bone density are risk factors
- DIAGNOSIS may require
MRI or BONE SCAN
Who is at the HIGHEST RISK for STRESS FRACTURES?
- ATHLETES involved in high-impact sports
- ADOLESCENTS whose bones have not yet fully hardened
- WOMEN with abnormal or absent menstrual cycles
- MILITARY RECRUITS
What are the SIGNS and SYMPTOMS of a STRESS FRACTURE?
- GRADUALLY WORSENING PAIN that increases with weight-bearing activity and diminishes with rest
- SWELLING, TENDERNESS, and BRUISING at the area
What occurs in SHIN SPLINTS?
- fracture of the TIBIA caused by REPETITIVE STRAIN
- may have
same symptoms as a stress fracture
- pain increased by activity and decreased by rest, swelling and tenderness of area
True or False: Radiography is highly sensitive for initial testing of stress fractures
- X-Rays may not show initial evidence of fracture, more likely to only retroactively show callus formation
How should BONE TUMORS be imaged?
- PLAIN FILM to assess tumor
- MRI or CT to evaluate
extent of lesion and soft tissue invasion, response to treatment
What is the MOST COMMON form of BENIGN BONE TUMOR? What is the most common MALIGNANT BONE TUMOR?
- METASTATIC BONE DISEASE
What characterizes an OSTEOCHONDROMA?
- most common form of
benign bone tumor
- composed of
cartilage, calcified cartilage, and bone
, found incidentally, usually in the metaphysis
- can appear pedunculated with smooth merging into normal bone cortex
What characterizes an ENDOCHONDROMA?
- a BENIGN bone tumor that
arises from CARTILAGE cells
, may have small calcifications
- most commonly seen in hands and at or near epiphysis
- causes thinning of cortex as it enlarges and
may cause pathological fractures
What characterizes a GIANT CELL BONE TUMOR?
- 15% are malignant
- classified as benign, but locally agressive with metastatic potential
expansile destructive lesion
with sharp borders, without periosteal reaction
- can grow to be larger than an endochrondroma
- usually affects mature skeleton with closed epiphyseal plates, usually adjacent to the knee, with peak incidence in 3rd decade of life
What characterizes an OSTEOID OSTEOMA?
- benign, small,
- usually occurs in bones of the leg, most commonly the proximal femur
- usually occurs in male teenagers
pain that is relieved by NSAIDs and worsened by vasodilators such as alcohol is very characteristic
True or False: Poorly defined margins, disruption of the overlying cortex, and a mottled appearance are all characteristic of malignant bone tumors
What is a CODMAN'S TRIANGLE?
- rapid growth caused by a bone malignancy results in
only the edges of the raised periosteum
What should be considered when a bone lesion is found in a patient
older than 45 years of age?
- METASTATIC BONE DISEASE
- MULTIPLE MYELOMA
What is the typical origin of a BONE TUMOR that is OSTEOLYTIC (radiolucent)?
What is the typical origin of a BONE TUMOR that is OSTEOBLASTIC (radiopaque)?
What occurs in MULTIPLE MYELOMA?
most common primary bone tumor
- malignancy of plasma cells with
replacement of bone marrow and bone destruction
- most common in males older than 60 years
- back pain, fatigue, and anemia are common symptoms
- radiographically presents with
lytic lesions, "punched out" bone, and osteoporosis
in the spine, ribs, pelvis, skull, and proximal humerus and femur
- may cause a "moth-eaten" pattern over time
What occurs in OSTEOSARCOMA?
- a BONE-FORMING cancer
- presents with a "SUNBURST PATTERN"
- bony cortical destruction is ragged, poorly defined, with "codman's triangle" periosteal reaction
- most common in males ages 10 to 25
- 90% located in metaphysis
- may metastasize to the lungs
What occurs in EWING'S TUMOR or SARCOMA?
- peak incidence in males between
, rare after 30
- usually found in metaphyseal region of long bones
MOST COMMON COMPLAINT IS PAIN, that occurs at NIGHT and at REST, that is NOT responsive to ASPIRIN
- X-ray reveals "moth eaten" pattern, large, destructive, poorly defined margins, and an "onion skin" layered periosteal reaction
- poor prognosis, metastasizes to other bones
When should NON-ACCIDENTAL TRAUMA be suspected in a pediatric patient?
- INJURIES INCONSISTENT with HISTORY
- INJURIES INCONSISTENT with DEVELOPMENT
- DELAY in seeking CARE
What FRACTURES are consistent with CHILD ABUSE?
- LONG BONE
- METAPHYSEAL CORNER
RIB - from abusive compression of ribs while holding child
True or False: Bilateral retinal hemorrhages are consistent with shaken baby syndrome
What part of the HUMERUS does the RADIAL HEAD articulate with?
What is a SAIL SIGN?
- elevation of an anterior fat pad creates a sail-shaped silhouette
- due to INTRA-ARTICULAR FRACTURE in the ELBOW
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