Dr. Welk Diagnostic Imaging 2 Final
Pectus Excavatum
"Funnel Chest" and horizontal ribs that go posteriorly and steep downward slope of ribs anteriorly seen in?
Non-mechanical (pain at rest, constant or progressive S/S)
A patient with non-traumatic lumbar spine pain may have a possible underlying pathology if there is what type of pain?
Fibrodysplasia ossificans progressiva/ Myositis ossificans progressiva
A rare disabling disorder of connective tissue that is usually genetic leading to progressive ossification of skeletal muscle, tendons, ligaments, and fascia., what is it?
Impaired
A red flag indicator for complicated neck pain includes ______________ consciousness.
Congenital block
A rudimentary disc with calcification, posterior element involvement and wasp-waist deformity is present. Dx?
Os Peroneum
A small accessory bone located at the lateral plantar aspect of the cuboid within the substance of the peroneus longus tendon as it arches around the cuboid; dx?
75
A suspected abdominal aortic aneurism ___________% are incidental finding on physical of imaging exam.
to lumbosacral or gluteal region
A thoracic or lumbar osteoporotic fractures may refer where?
C of Thoracic or T/L
Lower limb spasticity is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
B
Motor vehicle accident greater than 60 MPH affecting cervical spine is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
B
Motor vehicle crashes greater than 50 MPH affecting T/L spine is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
B
Motorized recreational vehicle problem affecting cervical spine is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
children but typically fuse in mid-to-late teens, being uncommonly seen in adults.
OS acetabuli are normally seen in?
Healthy peri- and early postmenopausal females (45-65 years)
OST (Osteoporosis Self Assessment Tool) used for what age group to determine if DEXA should be used?
Laryngeal constriction
On the APLC, it is often mistaken for spina bifida occulta or fracture. Follow tracheal borders to differentiate. Dx?
A
Patient unable to sit in waiting room of cervical spine is considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Straight Back Syndrome
Pectus Excavatum is associated with what condition?
Morquios syndrome
Pectus carinatum is associated with what condition?
tarlov's cyst; 5-10% population
Perineural/perineurial, or sacral nerve root cysts AKA... how common?
Repeat Radiography Indicator of Thoracic Spine
Persistence of signs and symptoms or considerable pain is a:
E
Persistent S/S in T/L spine is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
<20 and >50
Red Flag Indicators (Complicated Neck Pain) is common with what age?
>4 weeks
Red Flag Indicators (Complicated Neck Pain) is how long of significant activity restriction?
Bipartite sesamoid
Sum of "fragments" is usually larger than non-bipartite sesamoid; smooth well-corticated border. Dx?
CNS, ligament laxity, arm or leg, myelopathy and radiculopathy, neck pain and/or headache
Red Flag Indicators Continued of Cervical Spine: 1. ________ signs and symptoms 2. High risk ___________________ population (RA), suspected instability 3. _______ or ______ pain with neck movements 4. Suspected cervical ____________ & ___________ 5. Sudden onset of acute unusual ______________ and/or ______________ (VBAI, Dissection, etc)
Neck rigidity
Red flag indicator of complicated neck pain includes ____________ in the absence of trauma.
Non-mechanical
Red flag indicator of complicated neck pain includes what type of pain?
Agenesis
Signs of altered stress: sclerotic pedicles or anterior arch hypertrophy. Dx?
Rachischisis
Spina bifida occulta at C1 AKA what?
spinolaminar line on lateral view
Spina bifida occulta at C1 is likely to be seen with other anomalies. What are you looking for absence of on a film?
omovertebral bone
Sprengel's deformity is associated with _________________ bone.
styloid processes
Stylohyoid ligament calcification is from ________________ to hyoid bone.
Non-traumatic, no neurologic deficits, no indicators of serious underlying pathology
Adult patients with acute uncomplicated LBP of less than 4 weeks duration; what would mean it is "uncomplicated"?
F/I (0.51 - 0.99) > I.D. (0.82) > Malignancy (0.62) > I.S. (.25-.45)
Adults with complicated (red flag indicators) and indicators of contraindications to spinal adjusting of non-traumatic lumbar spine pain. Radiography deals with malignancy detection, infectious discitis, inflammatory spondyloarthropathy, and fracture instability. What has the highest sensitivity?
Malignancy > I.S. = F/I > I.D.
Adults with complicated (red flag indicators) and indicators of contraindications to spinal adjusting of non-traumatic lumbar spine pain. Radiography deals with malignancy detection, infectious discitis, inflammatory spondyloarthropathy, and fracture instability. What has the highest specificity?
Red flag S/S
Adults with complicated (red flag indicators) and indicators of contraindications to spinal adjusting of non-traumatic lumbar spine pain. Radiography is initially indicated with?
Narrow-based lesions
Adults with complicated (red flag indicators) and indicators of contraindications to spinal adjusting of non-traumatic lumbar spine pain have a suspected malignancy. What specficially is MRI/CT useful for?
1. Indicated Red Flags even if radiography is negative 2. Radiographs don't completely exclude condition 3. MRI preferred over CT 4. Suspected malignancy 5. Suspected infection (MRI) 6. Suspected spondyloarthropathy (MRI, not CT)
Adults with complicated (red flag indicators) and indicators of contraindications to spinal adjusting of non-traumatic lumbar spine pain; what 6 times would you want to utilize MRI/CT?
A
Age Greater than 65 years, dangerous mechanism of injury, extremity paresthesias of cervical spine is considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
D
Age greater than 50 years, high impact accidents affecting T/L, insufficient imaging in T/L, and poor quality imaging are considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator T/L
C1 and mid to lower cervical spine posterior arch structures
Agenesis is common where?
A
Altered consciousness at time of injury (head trauma, alcohol, drugs of T/L is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
C of Thoracic or T/L
Altered sensation below the injury is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
12
Atlantoaxial subluxation occurs in _______% of patients with cervical involvement (RA).
B
Axial loading mechanism affecting cervical spine is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Posterior ponticus
Calcification/Ossification of the posterior atlanto-occipital ligament/arcuate ligament forming an arch-like structure superior to the C1 posterior arch. Dx?
Pincer FAI
Cam or pincer type? More common in middle aged females (avg 40 years)
Cam FAI
Cam or pincer type? More common in young males - average 32 years
Tethered Cord
Can be associated with: 1. Intraspinal lipomas 2. Thickened filum terminale Dx?
1. uncomplicated/non-specific 2. neuro deficits 3. underlying pathology
Classifications of non-traumatic lumbar pain include what 3 thing?
major abnormalities occur
Cleido- (clavicle) and cranial (head) tell us where what?
*Osteoporosis with bone fragility *Blue sclera *Dentinogenesis imperfecta *Otosclerosis with hearing loss
Clinical - tarda forms (four major criteria) of osteogenesis imperfecta? 2 are needed for diagnosis.
Osteoporotic Compression Fracture
Comparison with previous radiographs may be needed to distinguish new compression from remote compression. What condition?
Tarsal coalition
Complete or partial union between 2 or more bones of the hindfoot or midfoot, dx?
cord degneration/contusion
Compressive Myelopathy (Cervical Central Canal Stenosis); what would you do MRI to rule out?
C of Lumbar Spine
Decreased DTR is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
C of Lumbar Spine
Decreased motor strength is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
C of Lumbar Spine
Decreased sensation is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Cleidocranial Dysplasia
Dental dysplasia, hypoplasia or aplasia of the clavicles, a narrow pelvis, and several varieties of spinal abnormalities; dx?
Repeat Radiography Indicator of Thoracic Spine
Deteriorating neurologic status is a:
lung masses
First costal cartilage calcifications can mimic what?
DEXA
Gold standard for BMD evaluation for diagnosis of osteoporosis
fracture, epidural venous plexus
Hahn's Venous Clefts should not be confused with ____________. And communicate posteriorly with ___________________.
E
High energy trauma of cervical spine is considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
D
High impact accidents affecting T/L spine is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Hahn's Venous Clefts
Horizontal fissures that extend through the vertebral body; they represent perforations for vertebral veins. Dx?
Plain film
How is diagnosis of Scheuermann's Disease made?
< than 4 weeks
How long is acute pain considered in non-traumatic lumbar spine pain?
>12 weeks duration
How long is persistent/chronic pain considered in non-traumatic lumbar spine pain?
4-12 weeks
How long is subacute pain considered in non-traumatic lumbar spine pain?
You could do CT or MRI.
If you suspected an occult fracture involving cervical spine trauma, what would you order?
MRI
If you suspected ligamentous instability or neural injury of cervical spine would you order CT or MRI?
lumbar spine
Imaging guidelines and "red flag" signs and symptoms of thoracic spine are similar to:
A
Immediate pain onset of cervical spine is considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
MRI
In suspected osteoporotic compression fracture, can CT or MRI differentiate between acute vs. chronic with bone scan?
minimal or occult fractures, epidural hematoma, assessment of retropulsion
In suspected osteoporotic compression fracture, what can MRI detect?
small fractures, retropulsed fragments
In suspected osteoporotic compression fracture, what may go undetected in CT, what goes detected?
if initial radiographs are positive or equivocal
In suspected osteoporotic compression fracture, when would you consider MRI?
Melorheostosis
In what condition is dense bone deposited along cortex of normal bone?
age and corticosteroid use in postmenopausal females
Incidence of asymptomatic compression fractures increases with what? (Osteoporotic compression)
E
Initial radiographs are difficult to interpret; high energy trauma; neurologic signs; and fractures/dislocations on radiography of the cervical spine are considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Os Peroneum
It is very common, seen in up to 26% of feet. Dx?
Acetabular angle
It should be approximately 30 degrees at birth and progressively reduce with maturation of the joint.
normal
Life expectancy of cleidocranial dysplasia:
stenosis
Limbus bone posteriorly can result in ___________ even though anterior is more common.
7.9⁰, 3.5⁰
Long term follow of adolescent idiopathic scoliosis after 20 years revealed ______ progression after bracing and _____ after surgical intervention.
C of Thoracic or T/L
Loss of bowel/bladder control is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
C of Thoracic or T/L
Loss of proprioception is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
large, dural diverticulum
Tarlov's cysts can become _____________ and are found in ________________________.
Marfan's
Thumb sign, shown in this photo can indicate what disease?
>40 degrees (25-40 normal) >30 degrees (0 normal) 3 adjacent vertebrae with schmorl's nodes and wedging >5 degrees
To have Scheuermann's Disease the thoracic spine kyphosis must measure what? OR thoracolumbar spine kyphosis must measure what? AND at least _____ adjacent vertebrae with _____________ and wedging of ________ degrees.
Cam type joint deformity (FAI)
Typically becomes symptomatic in physically active young males, and refers to a bony protrusion, mostly located at the anterosuperior aspect of the femoral head-neck junction just lateral to the physeal scar. Dx?
A
Unable to ACTIVELY turn head 45 degrees in both directions of cervical spine is considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
non-trauma, no neurologic, no "red flags"
Uncomplicated non-traumatic cervical spine pain causes (3):
Limbus bone
Ununited portion of the ring apophysis more common *anteriorly* that can be confused with a fracture. Dx?
Schmorl's Nodes
What are extremely common found in around 75% of autopsies, at all ages, more frequently in males (asymptomatic usually)?
1. Malignancy 2. Infectious discitis 3. Inflammatory spondyloarthropathies 4. Fractures 5. Instability
What are the 5 "Red Flag" S/S of non-traumatic lumbar spine pain?
Cervical rib
What arises from remnant costal processes that usually form part of the cervical transverse processes?
Carpal coalition
What asymptomatic condition may also be acquired from infection or inflammatory arthritis?
Occipitalization
What can be an isolated anomaly or associated with several dysplastic condition that may result in basilar impression?
Multipartite Patella
What can be bipartite, tripartite, and multipartite?
25%, abdominal aortic aneurysm
What condition can mimic suspected musculoskeletal low back pain, what percent of time?
Melorheostosis
What condition has a wavy, elongated, irregular, "candle wax dripping" appearance?
Osteoporotic Compression Fracture
What condition is a radiograph the absence of true "gold standard" for indications for radiography?
osteoporotic compression fracture & painful/progressive scoliosis
What conditions specific to non-traumatic thoracic spine pain?
Osteopathia Striata
What disease is benign where dense, linear striations are found in metaphyses of long bones?
Neurofibromatosis
What disorder usually inherited autosomal dominant would you see cafe au lait spots and numerous subcutaneous masses?
Calcification (most common sign)
What do you see on x-ray of AAA 50% of the time?
constant/nonspecific pain
What has poorer prognosis in painful/progressive scoliosis (adults)?
Dysostosis
What indicates an abnormality in the development of bone?
Fibrodysplasia ossificans progressiva/ Myositis ossificans progressiva They resolve, soft tissue begin to ossify, severely limiting mobility
What initially presents as torticollis with warm and painful masses in SCM but masses spread to rest of neck and upper extremity? What happens to masses?
Costal cartilage calcification
What is a common finding where males tend to have it peripherally and females tend to have it centrally?
Trident hands
What is a description where the hands are short with stubby fingers, with a separation between the middle and ring fingers?
NF1
What is a multisystem neurocutaneous disorder and the most common phakomatosis?
NF2
What is a rare autosomal dominant neurocutaneous disorder (phakomatosis) manifesting as development of multiple CNS tumors?
Tarlov's cyst (perineural/ sacral nerve root cyst)
What is a typically asymptomatic, incidental finding; if symptoms are present they have mass effect and mimic impingement from disc herniation?
NF1
What is also one of the most common inherited CNS disorders, autosomal dominant disorders and inherited tumor syndromes?
Os odontoideum
What is associated with significant upper cervical *instability* in the absence of clinical signs and symptoms?
Butterfly vertebrae
What is associated with K-F, diastomatomyelia, and hemivertebra?
Negative ulnar variance
What is associated with lunate osteonecrosis (Keinbock's Disease)?
Positive ulnar variance
What is associated with ulnar impaction syndrome and TFCC Injury?
Scheuermann's Disease
What is common condition which results in kyphosis of the thoracic or thoracolumbar spine?
Shenton line
What is drawn along the inferior border of the superior pubic ramus and should continue laterally along the inferomedial aspect of the proximal femur as a smooth line?
Perkin line
What is drawn perpendicular to Hilgenreiner line, intersecting the lateral most aspect of the acetabular roof?
Acetabular angle
What is formed by the intersection between a line drawn tangential to the acetabular roof and Hilgenreiner line, forming an acute angle?
1. neck webbing 2. low hairline 3. limited neck mvmt
What is in the classic triad of klippel-feil syndrome in 50% of patients?
Polydactyly
What is increased number of fingers or toes that can occur as an isolated finding or as part of skeletal dysplasia syndromes?
40%, 22%
What is lifetime risk of clinically evident osteoporotic fractures in females? Males?
Pectus Excavatum
What is most common deformity of the chest wall causing anterior concavity of sternum?
Thyroid cartilage
What is physiological and occurs in almost everyone?
Schmorl's Nodes (IVD herniation)
What is protrusions of the cartilage of the intervertebral disc through the vertebral body endplate and into the adjacent vertebra?
DEXA
What is recommended in the presence of osteoporotic fractures or with positive clinical assessments?
Knife-clasp deformity
What is spina bifida occulta of S1 with an elongated spinous process of L5?
30% (poor)
What is success of surgical removal of tarlov's cyst?
Congenital Hip Dysplasia / DDH
What is suspected in the early neonatal period due to the widespread adoption of clinical examination (including Ortolani test, Barlow maneuvers, Galeazzi sign)?
Pectus carinatum
What is the anterior *bowing* of sternum AKA "Pigeon chest"?
Butterfly vertebra
What is the asymptomatic congenital body cleft usually found incidentally?
Spina bifida occulta
What is the failure of lamina to fuse most commonly seen at S1?
Marfans Syndrome
What is the familial disorder of connective tissue, primarily involving the eye, skeleton, and cardiovascular system?
CT
What is the first imaging modality you'd use if you suspected dissection/rupture in AAA?
back pain
What is the most common clinical problem of painful/progressive scoliosis (adults)?
Syndactyly/Synostosis
What is the most common developmental anomaly of the hand that can also be seen in the foot?
Achondroplasia
What is the most common form of dwarfism that disturbs in growth and maturity of cartilage based bone?
Bifid ribs
What is the most common rib anomaly found in anterior aspect of upper ribs?
Achondroplasia
What is the most common skeletal dysplasia?
Pedicle agenesis
What is the stress hypertrophy of pedicle that can only be diagnosed by bone scan or MRI?
no associated with neurofibromas
What makes NF2 different than NF1?
osteoporotic compression fractures of T spine
What may be related to minimal trauma (cough/sneeze, minor falls)?
CT with AAA
What may be used with ultrasound imaging for monitoring enlargement?
• Cobb Angle (up to 5⁰ measurement error) • Nash-Moe method (pedicle rotation)
What measurement methods are used for p/p scoliosis in radiography?
Abdominal aortic aneurysm (AAA)
What mimicking LBP condition is often incidental finding in radiograph, CT and MRI?
Scheuermann's Disease
What occurs in ~5% (range 0.4-8%) of the general population. Slight male predominance?
14%
What percent of osteoporotic compression fractures are related to severe trauma?
3%
What percent of osteoporotic compression fractures are related to specific pathology (pathologic collapse)?
Os odontoideum
What represents an old ununited dens fracture; unstable?
Congenital block
What results from failure of segmentation and may affect the body, arch or both?
Oblique
What specific radiographs will provide useful information for NON-TRAUMATIC CERVICAL SPINE PAIN?
Type 3
What type of acromion variance is associated with shoulder impingement?
AP side bending
What views may determine functional movement of p/p scoliosis?
*1. Bone within bone* *2. Sandwich vertebrae* 3. Sclerotic skull base 4. Although bones appear strong, they are weak
What will you find radiographically with recessive osteopetrosis?
diffuse osteosclerosis
What will you see on radiograph with osteopetrosis?
K-F and sprengel's
When can you see undescended scapula, what 2 conditions?
achondroplasia
When do tubular bones appear widened, but are not in a radiograph?
achondroplasia
When do you see trident hands in a radiograph?
When radiographs or CT do not explain patient's symptoms
When is MRI needed?
ulna more proximal
When is ulnar variance negative?
both the ulnar and radial articular surfaces at the same level
When is ulnar variance neutral?
ulna more distal
When is ulnar variance positive?
Osteopoikilosis
When multiple bone islands are juxta-articular in location, what would you diagnose?
Sprengel's Deformity
When the scapula fails to descend and may present as an isolated anomaly.... what is it?
Os Tibiale Externum
When this condition gets large, it can protrude medially and cause friction against footwear. Dx?
Secondary degenerative disease leading to painful/progressive sclerosis
When will you see: • Congenital spinal anomalies, leg length discrepancy, etc • Deformity secondary to metabolic bone disease (osteoporosis)
1. Not expected treatment response or worsening after 4 weeks 2. Worsening neurologic symptoms 3. Suspected pathology is seen on radiography 4. Specific "red flag" S/S are present
When would you do radiography or advanced imaging with thoracic spine???
Failed 4-6 week trial of care Progressive neurologic deficits
When would you want to order an MRI/CT with adult patient with uncomplicated LBP, but suspected spondylolisthesis/lateral stenosis?
1. Major neuro deficits at initial onset or disabling cervical pain 2. no response to treatment at 4 weeks / worsening symptoms 3. preoperative planning
When would you want to take an MRI/CT for non-traumatic cervical spine pain?
Cervical spine
Where are congenital blocks often found?
Anterosuperior margin. Rounded in shape with a concave lateral border and convex medial border.
Where are os acetabuli located? How are they shaped?
75% T spine, then thoracolumbar spine combined, then lumbar, then rarely cervical
Where does Scheuermann's Disease occur?
• Lateral vertebral listhesis • L3 and L4 endplate obliquity angles • Increased lumbar lordosis and thoracolumbar kyphosis • Sagittal deflection greater than 4 cm and lateral listhesis may cause radicular pain
With painful/progressive scoliosis, what 4 radiographic findings are significantly correlated with pain?
Single flexion image
With suspected atlantoaxial instability, what image will show instability?
wasp-waist deformity
anterior concavity at the mid-point of block due to failure of formation of rim apophyses; what is this?
Type 3B
transverse process fuses with sacrum and there is enlarged transverse process with complete fusion B/L
Type 3A
transverse process fuses with sacrum and there is enlarged transverse process with complete fusion U/L
Type 4
type IIa on one side and type III on contralateral side.
Os acetabuli
unfused secondary ossification centers of the acetabulum, dx?
Marfan's syndrome
#1 Cystic medial necrosis of aorta or pulmonary arteries (leading to dissection/rupture) & #2 aortic and mitral insufficiency. Seen with what?
calcification
*Nuchal bone*is __________________ of the nuchal ligament.
Scheuermann's Disease
1. Aseptic necrosis of the ring vertebral apophyses. 2. Excess axial spine load due to heavy weight lifting Could be cause of what?
Madelung's deformity
1. Short, bowed radius 2. Palmar (volar) and ulnar tilt of the distal radial articual 3. Dorsal dislocation of the distal ulna at the radioulnar joint 4. Relative elongation of the ulna
NF2
1. intracranial schwannoma(s): mostly vestibular schwannoma(s) 2. intracranial and spinal meningioma(s) 3. intraspinal-intramedullary ependymoma(s) seen with?
15.5% vertebral fracture 17.5% hip 16% wrist
3 locations osteoporotic compression fractures can occur with percentages in women:
1. primary degenerative 2. progressive idiopathic adolescent 3. secondary degenerative scoliosis
3 spinal deformity that will cause p/p scoliosis in adult:
Madelung's Deformity
4 Etiologies: 1. Trauma 2. Genetic 3. Dysplasia 4. Idiopathic What disease?
• Degenerative disease • Central disc protrusion • Trauma (Fracture/Hematoma) • Tumor • Infection DICTT
5 causes of Compressive Myelopathy (Cervical Central Canal Stenosis)?
Compressive Myelopathy (Cervical Central Canal Stenosis)
A 30 year old male has 6 weeks of left arm paresthesia; dx?
highly sensitive, fracture detection/exclusion
A CT is ________________ sensitive and specific for ______________________.
fracture detection than oblique, pillar or F/E views
A CT of cervical spine is more sensitive for _________________ than _________________________.
1. soft tissue pathology 2. spinal cord injury 3. multilevel fracture
A MRI is the best evaluation of what 3 things?
osteopenia
A T-Score on a DEXA of -1 to -2.5 indicates?
osteoporosis
A T-score of > -2.5 on a DEXA indicates?
B
A fall greater than 3 foot or 5 stairs affecting cervical spine; axial loading mechanism affecting cervical spine; motor vehicle accident greater than 60 MPH affecting cervical spine; and a motorized recreational vehicle problem affecting cervical spine are considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
dynamic cord compression
A flexion/extension MRI may demonstrate ___________________________ in Compressive Myelopathy (Cervical Central Canal Stenosis).
Cleidocranial Dysplasia
A large head with delayed suture closure, Wormian bones, hypertelorism, a small face; dx?
Marfans Syndrome
A patient comes in that is tall and thin; the limbs are disproportionally long with respect to the trunk especially in the hands and feet giving "arachnodactyly" appearance. Dx?
Tethered cord
A patient comes in with back pain, problems with gait and cauda equina syndrome symptoms; dx?
Neurofibromatoses
A patient develops kyphoscoliosis with ribs that have a "twisted ribbon" appearance. Scoliosis may progress rapidly, and lead to paraplegia. What did they initially have?
Not necessary; only oblique view with neurological deficit; F/E Views with susupected instability
A patient presents with adult patient with uncomplicated subacute neck pain (4-12 weeks duration) with or without arm pain, no neurologic deficits; x-ray done? if so, what views?
Absent treatment response of worsening condition
A patient with non-traumatic lumbar spine pain may have a possible underlying pathology if there is ___________________ after 4-6 weeks.
> 4 weeks
A patient with non-traumatic lumbar spine pain may have a possible underlying pathology if there is significant activity restriction of what time?
progressive or painful structural
A patient with non-traumatic lumbar spine pain may have a possible underlying pathology if there is what type of deformity?
Abnormal lab exam with positive S/S
A patient with non-traumatic lumbar spine pain may have a possible underlying pathology if there is what type of examination?
Femoral Neck Herniation Pit
AKA: Synovial herniation pit, Pitt's Pit, Fibrocystic Conversion Defect
Repeat Radiography Indicator of Thoracic Spine
Absence of clinical improvement after 4-6 weeks is a:
E
Absence of clinical improvement after 4-6 weeks of treatment is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator T/L
Rhizomelic dwarfism
Achondroplasia is a congenital genetic disorder resulting in _____________.
birth, rhizomelic micromelia
Achondroplasia is recognized at ______________ and referred to as ____________________.
1. Obvious psychological distress 2. Severe pain beyond what is expected (amplification) 3. Hx of prior significant pain recurrences 4. Higher than expected functional impairment 5. Unexplained widespread pain 6. Pain and limitation not consistent with objective findings
Adult patient with absence of expected treatment response of worsening symptoms at 4 weeks • Yellow Flag conditions complicating treatment response (Psychological risk factors) include what?
Yes, repeat at follow up for use in absence of clinical response; 4-6 weeks without sufficient treatment response
Adult patient with absence of expected treatment response of worsening symptoms at 4 weeks; imaging needed? MRI/CT needed?
if trial of care fails or operative referral is considered
Adult patient with acute uncomplicated low back pain of less than 4 weeks duration and you suspected lumbar disc herniation; after 4-6 weeks when would you order MRI/CT?
not initially indicated
Adult patient with acute uncomplicated low back pain of less than 4 weeks duration and you suspected lumbar disc herniation; imaging or no?
progressive neurologic deficits or debilitating pain
Adult patient with acute uncomplicated low back pain of less than 4 weeks duration and you suspected lumbar disc herniation; in the first 4-6 weeks when would you order MRI/CT?
Cervical disc herniation and spondylotic radicular syndrome (lateral canal stenosis)
Adult patient with neck pain and radicular symptoms: "Acute cervicobrachial syndrome" encompasses what two things?
45-54
Adult patient with neck pain and radicular symptoms: Suspected acute spondylotic radicular syndrome/Lateral canal stenosis what age?
Osteopetrosis
An uncommon hereditary disorder that results from defective osteoclasts. Dx?
Occult fractures
An MRI of cervical spine detects what?
F/E or traction/compression. You'd suspect >10 degrees of disc angulation or greater than 4 mm of vertebral translation.
An adult patient with acute uncomplicated LBP comes in; however, instability is suggested. What views would you order and why?
Suspected degenerative: 1. spondylolisthesis/lateral stenosis 2. spinal stenosis
An adult patient with acute uncomplicated LBP comes in; what two specific diagnoses would warrant initial radiography?
1. for monitoring (1 yr - 6 month intervals depending on size) and 2. surgical intervention if greater than 5 cm (16% annual rupture rate > 5 cm)
An ultrasound is used with AAA when?
A
Back Pain (immediate onset after trauma), midline tenderness on palpation, distracting painful injury and other "high risk" mechanism of injury, neurological deficits, and altered consciousness at time of injury in T/L is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
1st MTP joint; fracture
Bipartite Sesamoid is found in the __________. DDX is ___________.
Diastematomyelia
Bone, cartilage, or fibrous band fully or partially divides the central canal and spinal cord in T/L region associated with other spinal anomalies. Dx?
Osteopetrosis
Bones are very dense (ivory /marble) or a "bone within-a- bone" appearance (endobones) may be seen. In the spine there may be "sandwich vertebra". Dx?
Osteopetrosis
Bones become sclerotic and thick, but their abnormal structure results in them being both weak and brittle. Dx?
A
CCSR Criteria (Canadian Cervical Spine Rules for Radiography); age greater than 65 years, dangerous mechanism of injury, extremity paresthesias of cervical spine; not simple rear end collision of cervical spine; Patient unable to sit in waiting room of cervical spine; immediate pain; and midline tenderness upon palpation are considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Pincer type FAI
Center edge angle greater than 39⁰ is considered acetabular overcoverage.
B
Cervical fracture highly increases risk for thoracolumbar injury is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
TOS, T1 point upwards then C7 points downwards (TP)
Cervical rib is associated with _________________. Find what vertebrae first?
accessory articulations
Cervical rib may be small or large enough to form ________________________ with the first ribs.
oligohydramniotic, ultrasound
Congenital Hip Dysplasia is associated with _______________ pregnancy and is confirmed with ________________.
1. wasp waist - "c" for congenital; failure of segmentation 2. remnant disc (atrophic/obliterated/rudimentary/hypoplastic) 3. 50% posterior fusion
Congenital block vertebrae has what 3 qualities?
Tarsal coalition
Congenital failure of separation of bones during embryonic development, and 50% are B/L. Dx?
Klippel-Feil Syndrome
Congenital fusions involving more than one motion segment; dx?
Carpal coalition; lunate and triquetral coalition
Congenital segmentation failure of 2 or more carpal bones; dx? Most common kinds?
Tethered cord
Conus medullaris should terminate above L2 inferior endplate; dx?
E
Conventional radiographs are difficult to interpret is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator T/L
Azygos lobe and fissure
Created by downward invagination of the azygos vein through the apical portion of the right upper lobe. Dx?
X-ray, but MRI needed to assess spinal cord
Diastematomyelia is identified on what imaging?
A
Distracting painful injury and other "high risk" mechanism of injury in T/L is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
MRI/CT
Does MRI/CT or oblique views provide more accurate visualization of IVF narrowing in cervical spine?
"Bayonet" appearance
Dorsal deformity in madelung's is known as the ______________________.
1. Posterior vertebral body scalloping 2. "Bullet nose" vertebra *Achondroplasia*
Dx?
AAA
Dx?
Achondroplasia
Dx?
Acute Thoracic Fracture
Dx?
Arachnodactyly in Marfans
Dx?
Atlantoaxial instability
Dx?
Cervical disc extrusion with cord compression
Dx?
Chronic Thoracic Fracture
Dx?
Cleidocranial dysplasia
Dx?
Cleidocranial dysplasia (aplasia of clavicle)
Dx?
Cleidocranial dysplasia (dental anomalies)
Dx?
Dural Ectasia
Dx?
Insufficiency Thoracic Fracture
Dx?
Interpedunctular distances decreased = spinal stenosis *Achondroplasia*
Dx?
Laryngeal constriction
Dx?
Marfans syndrome
Dx?
Melorheostosis
Dx?
Neurofibromatoses
Dx?
OI
Dx?
Osteopathia Striata
Dx?
Osteopetrosis
Dx?
Osteopoikilosis
Dx?
RA
Dx?
Rhizomelic limb shortening in achondroplasia
Dx?
Short and flat "wine glass" pelvis = achondroplasia
Dx?
Trident hands in achondroplasia
Dx?
osteopetrosis
Dx?
Cervical
Dysphagia is a red flag indicator for what area?
1.5x, 2.3x
Each SD decrease in Lumbar BMD increases fracture risk by _________ and new fracture risk by ___________.
B
Ejection from a motor vehicle affecting T/L spine is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Type 1b
Enlarged and dysplastic transverse (at least 19 mm) B/L
Type 1A
Enlarged and dysplastic transverse (at least 19 mm) U/L
Cam type FAI
Enlarged bump at the femoral head/neck junction.
Osteogenesis imperfecta
Etiology includes abnormal collagen quality and quantity (maturation); dx?
early degenerative diseases
FAI can lead to what?
flexion and internal rotation
FAI exacerbated by:
anterior labral, arthritis
FAI may result in what pathology and early onset of what?
hip pain with limited ROM
FAI most common presenting symptom:
Lateral, then AP to confirm
Fabella is best seen in what projection?
Occipitalization
Failure of segmentation of the occiput and C1, so C1 often assimilated into occiput and isn't visible. Dx?
B
Falls greater than 3 feet, ejection from a motor vehicle, Motor vehicle crashes greater than 50 MPH affecting the T/L spine and cervical fracture are considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Femoral Neck Herniation Pit
Found in up to 5% of the population, asymptomatic and *well-defined round/oval lucency with sclerotic margins* in the anterolateral aspect of the femoral neck. Dx?
E
Fractures/dislocations on radiography of cervical spine is considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Repeat Radiography Indicator of Thoracic Spine
Function does not improve or deteriorates is a:
E
Function does not improve or deteriorates is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator T/L
Syndactyly
Fusion of the skin between the digits; dx?
Degenerated spondylolistheis/lateral stenosis or spinal stenosis
Identify.
Yes
If an adult patient with acute uncomplicated LBP of less than 4 weeks duration, but there is no clinical response after 4-6 weeks of treatment, and or symptoms are worsening. Would radiography be recommended?
Usually not initially
If an adult patient with acute uncomplicated LBP of less than 4 weeks duration, would radiography be needed?
Not initially unless neurologic compromise or suspected systemic disease
If an adult patient with acute uncomplicated LBP of less than 4 weeks duration; would you consider MRI/CT? why?
osteoporotic collapse
If osteoporotic compression fractures isn't from trauma or specific pathology what would you suspect?
Shenton line
If there is superolateral migration of the proximal femur due to DDH then this line will be discontinuous.
suspected myelopathy (Stenosis, tumor, infection, infarction); neoplasm, progressive structural deformity
If you suspect red flag indicator in cervical spine, MRI/CT would be indicated with what condition(s)?
F/E or Oblique
If you suspect red flag indicator in cervical spine, what views would be good to do in radiography?
Cord evaluation through MRI/CT
If you suspect red flag indicator in cervical spine, what would be indicated if radiographs reveal instability?
Yes, even though MRI is more accurate for dx
In Compressive Myelopathy (Cervical Central Canal Stenosis) would you do a radiograph?
Axial sensory/motor dysfunction
In Compressive Myelopathy (Cervical Central Canal Stenosis) you'll get ______________ that doesn't involve head or face.
Gait; broad base, instability, shuffling, rhythm disruption
In Compressive Myelopathy (Cervical Central Canal Stenosis) you'll get ______________________ abnormality; examples?
bowel/bladder
In Compressive Myelopathy (Cervical Central Canal Stenosis) you'll get ______________________ dysfunction.
pathologic
In Compressive Myelopathy (Cervical Central Canal Stenosis) you'll get ______________________ reflexes.
Arm or leg pain
In Compressive Myelopathy (Cervical Central Canal Stenosis) you'll get ______________________ with neck movements (shocking sensation with flexion/extension).
variable neurological deficits
In Compressive Myelopathy (Cervical Central Canal Stenosis) you'll get __________________________ in the upper and lower extremity.
AP central canal diameter <13 mm (normal 17-18 mm C3-7); manual therapy cautioned if <11mm
In Compressive Myelopathy (Cervical Central Canal Stenosis), what is indicative of stenosis?
proximal femur, pelvis superior femoral epiphyses, ossification
In DDH the key to plain film assessment is looking for symmetry and defining the relationship of the _______________ to the developing ____________. The ossification of the _______________ should be symmetric. Delay of _______________ is a sign of DDH.
>70 mm and older patients
In MRI/CT you find manual therapy recommended first if central canal area ____________ and in ______________.
short, bowed palmar (volar) and ulnar tilt Dorsal dislocation Ulna
In Madelung's deformity you see a ______________________ radius. Also, see __________ & __________ of the distal radial articular surface. ____________________ of the distal ulna at radioulnar joint. Relative elongation of the ___________.
cardiac
In Marfans syndrome ____________ abnormalities can lead to shortened life expectancy.
1. femoro-acetabular impingement 2. hip dysplasia 3. osteochondrosis dissecans 4. post-traumatic or degenerative bone fragments
In Os acetabuli, ossicles in acetabular region may also be found in what 4 conditions?
parallel, sunburst pattern
In Osteopathia Striations, striations run ___________ to the long axis of the bones and can present in __________________ in ilium.
degenerative changes
In a follow-up evaluation, _____________ are more common with scoliosis.
Achondroplasia
In a radiograph you find appendicular findings including rhozomelic limb shortening in the humerus; dx?
Insufficiency Thoracic Fracture
In a radiograph you see biconcave vertabra appearance; dx?
Chronic fracture thoracic spine
In a radiograph you see: • Anterior wedge deformity • Adjacent disc degeneration/reactive changes
Acute fracture thoracic spine
In a radiograph you see: • Anterior wedge deformity • "Step defect" • Condensation band Dx?
1. Posterior vertebral body scalloping 2. "Bullet nose" vertebra 3. Interpedicular distances are decreased > causing spinal stenosis 4. Ilia are short & flat "champagne glass" pelvis
In a spinal radiograph of achondroplasia what 4 things could you see?
small; prominent neurological problems and spinal stenosis
In achondroplasia the foramina of the skull base and spine and the spinal canal are often __________, which leads to what?
AAA
In an MRI, what may not be seen due to suppression bands?
acute schmorl nodes
In contrast these are uncommon and are associated with inflammation and symptoms; dx?
10-50%
In moderate-to-high-risk trauma, delays in diagnosis of clinically significant cervical spine injuries range between 5-23% cervical spine trauma with cervical spine radiography. Neurologic deterioration occurred in ____________ of these patients.
5-23%
In moderate-to-high-risk trauma, delays in diagnosis of clinically significant cervical spine injuries range between _____________ with cervical spine radiography.
skeleton
In neurofibromatosis the _____________ is affected in 80 percent of patients.
radicular pain and claudication
In painful/progressive scoliosis (adults), what can occur with weight-bearing?
inferomedial; below Hilgenreiner line, and medial to Perkin line
In perkin line, the upper femoral epiphysis should be seen in what quadrant below/medial what lines?
Uncomplicated neck pain < 4 weeks duration
In radiography: • Not routinely indicated on initial exam • Consider radiography after 4 weeks of no or worsening response What condition?
D
Insufficient imaging in T/L is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for missed injuries on radiographs E. Advanced Imaging Indicator
Not until advanced imaging after 4 weeks of no or worsening response
Is MRI/CT required for non-traumatic cervical spine pain?
Hilgenreiner line
Is mainly used as a reference for Perkin line and measurement of the acetabular angle.
Os Supranaviculare
It is also known as talonavicular dorsale or (dorsal) talonavicular ossicle and is present in ~1% of the population.
higher risk & older patients
ORAI, SCORE, and AMMED used for what patients to determine if DEXA should be used?
extreme extension
Knife-clasp deformity may produce symptoms in what position?
• After failed 4 week trial of care • Suspected pathology on radiography • Progressive/disabling neurological deficits • Signs and symptoms of cervical instability (subaxial)
MRI is needed for adult patient with absence of expected treatment response of worsening symptoms at 4 weeks when?
MRI; spinal stenosis
MRI or CT. Dx?
MRI; spondylolisthesis?
MRI or CT. Dx?
MRI; stenosis
MRI or CT. Dx?
rule out cord contusion or compressive myelopathy
MRI/CT could be useful in suspected atlantoaxial instability. Why?
females, 50%
Madelung's Deformity; males or females more common? What percent are bilateral?
single, scleratogenous
Melorheostosis is usually confined to a __________ extremity, in a ______________ distribution.
A
Midline tenderness of cervical spine is considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
A
Midline tenderness on palpation in T/L is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Congenital Hip Dysplasia / DDH
More common in females, and occurs from ligamentous laxity and or abnormal position in utero.
Medial side foot pain aggravated by walking/running/weight-bearing
Most common presenting feature of accessory navicular bone (os tibiale externum)?
Calconeonavicular, talocalcaneal
Most common type of tarsal coalition, second most common?
40%
Most n-t cervical spine pain, _______ have low intensity, low disability pain.
superolateral corner
Multipartite Patella is most common where?
von Recklinghausen disease
NF1 AKA what?
< 2.5 mm shorter
Negative ulnar variance means _____________________ than radius.
E
Neurologic signs involving cervical spine is considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
A
Neurological deficits in T/L considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Supracondylar process
Neurovascular compression of the median nerve and brachial artery may occur, but is usually asymptomatic. Dx?
Repeat Radiography Indicator of Thoracic Spine
New or progressive neurological deficits (claudication, radiculopathy) is a:
66.7%
Non-traumatic cervical spine pain happens to ________________ of adults over their lifetime.
6 month prevalence
Non-traumatic cervical spine pain; 66.7% encounter it; 22% of those people have what?
Fabella
Normal sesamoid bone in the tendon of the lateral head of the gastrocnemius, dx?
A
Not ambulatory since trauma of cervical spine is considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
A
Not simple rear end collision (pushed into oncoming traffic, hit by large vehicle, rollover) of cervical spine is considered a(n): A. Criteria Indicating Need for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
~7% ossicle fuses with the talus
Os Trigonum is estimated to be present in ______ of adults. The __________ usually forms between 7-13 years of age and ______________________ in a majority of patients, otherwise persisting as an os trigonum.
Synostosis
Osseous fusion of adjacent digits; dx?
Voorhoeve's disease
Osteopathia Striata AKA what?
for sclerotic metastases.
Osteopoikilosis disease has a familial tendency and can be mistaken _______________________.
asymptomatic
Osteoporotic compression fractures identified may be __________________.
Marfans Syndrome
Other common skeletal findings include scoliosis, pectus deformities and hypermobile joints in this condition.
Neurofibromatoses
Other skeletal findings include posterior scalloping of vertebral bodies, multiple NOF, pseudoarthrosis of the tibia, hemihypertrophy and enlargement of the spinal neural foramina. Dx?
Pincer type FAI
Overcoverage of the acetabulum can result in labral injury and early onset osteoarthritis.
P/P Scoliosis
PA full spine images reduce breast and thyroid dose. Recommended on follow-up exams. Associated with what condition?
C of Thoracic or T/L
Pathologic reflexes is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
1. Dental anomalies 2. Hearing loss 3. Scoliosis 4. Dislocations of shoulder, radial head, hip
Prominent complications of cleidocranial dysplasia include what?
Melorheostosis
Pain, skin changes, joint contractures, limited mobility are associated findings; may cause early physeal closure. Dx?
Repeat Radiography Indicator of Thoracic Spine
Painful or progressive structural deformity is a:
Osteopetrosis
Pancytopenia is common and few patients survive childhood and the teens, unless they have the milder "tarda" form of the disease. Pathological findings are also common Dx?
Cam type FAI
Pistol grip deformity is AKA for?
D
Poor quality imaging is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator T/L
C of Lumbar Spine
Positive nerve root tension signs, decreased motor strength, decreased sensation, decreased DTR, lower limb spasticity, pathological reflexes, and Altered sensation below the injury are considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
> 2.5 mm longer
Positive ulnar variance means _____________________ than radius.
E
Presence of fracture suggested by history, examination, or radiography in T/L spine; suspected ligamentous instability or neural injury of T/L spine; conventional radiographs are difficult to interpret; absence of clinical improvement after 4-6 weeks of treatment; persistent S/S in T/L spine are considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
asymmetric disc or facet degeneration
Primary degenerative cause of spinal deformity is triggered by?
It continues into adulthood to cause p/p scoliosis
Progressive idiopathic adolescent cause of spinal has what time frame?
1. Enlargement of the IVFs 2. Kyphoscoliosis 3. Twisted ribbon ribs 4. Posterior mediastinal masses with an extrapleural sign
Radiographic findings of neurofibromatosis?
IVF narrowing with radicular symptoms differentiation from uncinate and or facet hypertrophy; can't show disc lesions
Radiographic imaging for adult patient with neck pain and radicular symptoms (non-cervical cervical spine trauma) shows what? Can't show what?
1. History of previous fracture (4x risk in postmenopausal white women) 2. Greater age 3. Lower femoral neck bone density 4. shorter height
Risk Factors for Additional Vertebral Fractures dealing with osteoporotic fractures include what 4 things?
male, smoker, >70, HTN
Risk factors for abdominal aortic aneurysm (4)
Supracondylar process
Rudimentary exostosis (toward elbow) on the anteromedial humerus above the elbow
Juvenile kyphosis or j discogenic disease
Scheuermann's Disease AKA?
Scheuermann's Disease
Schmorl nodes are associated with the diagnostic criteria of what disease?
inflammation
Schmorl's nodes may contact the marrow of the vertebra, leading to _________________.
28 cm AP and older patients
Sectional radiographs recommended in what patients with p/p scoliosis?
Atlantoaxial subluxation
Severe hand and wrist deviation, RA > 10 year duration, disease onset < 50 years of age, and increased # of previous drug modifications / RA related surgery has strong relationship with what?
anomalous fibros/ligamentous band (Strother's ligament)
Supracondylar process is more likely to have neurovascular compression if ______________ is attached to the spur. What is this called?
1. no disc 2. straight/convex waist 3. no posterior fusion
Surgical block vertebrae means?
Repeat Radiography Indicator of Thoracic Spine
Surgical planning is a:
RA, psoriatic arthritis, Juvenile RA
Suspected atlantoaxial instability has active inflammatory arthritis known; what 3 things?
F/E indicated
Suspected atlantoaxial instability, what radiographs would you do?
E
Suspected ligamentous instability or neural injury of T/L spine is considered a(n): A. High Risk Screening Criteria for Plain Radiography B.High Risk Mechanism of Injury Criteria C. Neurological Deficit D. Highest Risk for Missed injuries on radiographs E. Advanced Imaging Indicator
Repeat Radiography Indicator of Thoracic Spine
Suspected pathological process is a:
Repeat Radiography Indicator of Thoracic Spine
Suspected segmental instability (lateral bending or flex/ext radiographs) is a:
Developmental Dysplasia of Hip - DDH
The aberrant development of the hip joint and results from an abnormal relationship of the femoral head to the acetabulum. Dx?
Cleidocranial dysplasia
The autosomal dominant disorder that the guy of stranger things has is?
"arcuate foramen", houses vertebral artery
The foramen formed in posterior ponticus is usually bilateral and called _________________.
Osteogenesis imperfecta
The most common radiographic finding is of generalized osteopenia. Multiple fractures resulting from insignificant trauma or normal muscle pull are also seen commonly, and may result in considerable deformity. What is it?
Osteopetrosis
The neural foramina may not grow as the patient and their nerves grow, leading to spinal or foraminal stenosis, especially at the skull. Dx?
two normal vertebral bodies, intervening disc
The overall height of the segments is equal to the height of _______________________ and a normal a _____________________ in a congenital block.
Os Tibiale Excavatum AKA Accessory Navicular bone
The tibialis posterior tendon often inserts with a broad attachment into the ossicle. Most cases are asymptomatic but in a small proportion it may cause a painful tendinosis due to traction between the ossicle and the navicular. Such changes are best seen on MRI. Dx?
1. The peripheral form (von Recklinghausen / "elephant man"syndrome -- seen in 90% of patients) 2. Central form (acoustic neurofibromatosis).
There are two distinct forms of neurofibromatosis, what are they?
Os acetabuli
They may be bilateral and partially fused to the acetabulum. Dx?
Stylohyoid ligament calcification
This disease is usually asymptomatic, but can occasionally be painful (Eagle's syndrome); can fracture and form pseudo joints. Dx?
Osteopoikilosis
This disorder is characterized by small round or oval foci of bone sclerosis located in the trabecular bone, particularly in the pelvis, metaphyses and epiphyses of long bones, tarsals, and carpals. Dx?
Os Tibiale Externum
This is present in ~10% (range 4-21%) of the population; B/L prevalence is ~70%. Most of the time it is asymptomatic, and found incidentally on radiographs of the foot. Dx?
Acromial variance type 2 (most common)
Variation in the morphology of the acromion causing curved undersurface parallel to the humeral head.
Acromial variance type 1
Variation in the morphology of the acromion causing flat undersurface.
Acromial variance type 3
Variation in the morphology of the acromion presenting as downward hook of the acromion.
Acromial variance type 4
Variation in the morphology of the acromion with upward slope of acromion.
• Progressive deformity • Non-mechanical pain • Weight-loss
What "red flag signs" of thoracic spine are present that you'd need advance imaging?
3.8 mm AP
What AP dimension is upper limit of normal on lateral projection of AAA in radiograph?
<age 20 or >age 50
What age would be an indicator of possible underlying pathology with non-traumatic lumbar spine pain?
MRI
Would you order CT or MRI with epidural hematoma?
MRI
Would you order CT or MRI with traumatic disc herniation?
CT
Would you order a CT or MRI for fracture detection/exclusion?
45
__________% of 41-45% of patients with LBP initial complaint are acute.
30-50%
____________ bone mineral loss needed before osteopenia is detectable. (osteoporotic compression fracture)
Cervical spine
_______________ involvement in over 50% of patients with RA.
41-44%
_________________ of initial chiropractic visits are related to LBP complaints.
Females over 50
___________________ are 2x more likely to have clinically evident vertebral fractures (osteoporotic compression).
Os Supranaviculare
accessory ossicle located at the proximal dorsal aspect of the navicular bone or talonavicular joint; dx?
Hilgenreiner line
drawn horizontally through the inferior aspect of both triradiate cartilages. It should be horizontal
Pincer type joint deformity (FAI)
essentially an over-coverage of the femoral head by the acetabulum, dx?
Os Tibiale Excavatum
is a large accessory ossicle that can be present adjacent to the medial side of the navicular bone; dx?
Os Trigonum
one of the bony ossicles of the foot and can be mistaken for a fracture; dx?
Femoro-Acetabular Impingement Syndrome
painful, limited hip motion resulting from certain types of underlying morphological abnormalities in the femoral head/neck region and/or surrounding acetabulum is?
Os Trigonum
posterior to the talus on the lateral foot radiograph and represents a failure of fusion of the lateral tubercle; dx?
Type 2b
pseudoarticulation of the transverse process and sacrum with enlargement of the transverse process and pseudoarthrosis B/L
Type 2a
pseudoarticulation of the transverse process and sacrum with enlargement of the transverse process and pseudoarthrosis U/L
35-55
• Adult patient with neck pain and radicular symptoms • Suspected acute cervical disc herniation: what age?
Neck pain
• Headache • Low back pain • Poor physical health • History of whiplash injury • Poorer general or self-rated health • Cigarette smoking Are conditions associated with?
