MUSCULOSKELETAL IMAGING FOR PHYSICAL THERAPISTS. COMBINED SECTIONS MEETING 2006 San Diego, CA February 1-5, 2006
|
|
- Hannah Carpenter
- 6 years ago
- Views:
Transcription
1 MUSCULOSKELETAL IMAGING FOR PHYSICAL THERAPISTS COMBINED SECTIONS MEETING 2006 San Diego, CA February 1-5, 2006 John Meyer, DPT, OCS University of Southern California Department of Athletic Medicine Los Angeles, California Handout Length 12 Pages 1
2 Musculoskeletal Imaging for Physical Therapists Presentation Objectives: Recognize common views on various imaging studies (X-ray, MRI) Identify relevant anatomy Learn a specific reading process to recognize common pathologies in the spine, shoulder and knee. Discuss how to utilize information from the images to guide clinical decisions Cervical Spine X-Ray Standard Views: A/P Open Mouth A/P Lateral Left A/P Oblique LAO: Left side near the film pt. rotated anterior and you will visualize the open left IVF. The side marker will be placed behind the spine, which tells you it is an anterior film. LPO: Left side near the film pt. rotated posterior and you will visualize the open right IVF. The side marker will be placed in front of the spine, which tells you it is a posterior film. Right A/P Oblique RAO: Right side near the film pt. rotated anterior and you will visualize the open right IVF. The side marker will be placed behind the spine, which tells you it is an anterior film. RPO: Right side near the film pt. rotated posterior and you will visualize the open left IVF. The side marker will be placed in front of the spine, which tells you it is a posterior film. Flexion Extension 2 views or films are required to be a legal document. AP Open Mouth X-ray View Reading Process 1. Dens or Odontoid Process 2. Lateral Mass of Atlas 3. Transverse Process of Atlas 4. Atlantoaxial Joint Space 5. Anterior Arch of Atlas 6. Posterior Arch of Atlas 7. Body of C-2 8. Spinous Process of C-2 2
3 Common Upper Cervical Spine Pathology: Odontoid Fractures: Type I: A stable oblique fracture through the upper part of the odontoid Type II: An unstable transverse fracture through the base of the odontoid Type III: A stable fracture through the base of the odontoid extending into the body of the axis Jefferson Fractures: Result of axial loading on a head through the occiput leading to a burst type fracture of C1 There is disruption of the lateral masses of C1 and the transverse ligament. Diving is the most frequent cause of these fractures other causes include a motor vehicle accident or falls onto the head On the open mouth x-ray you will see overhang on one or both sides of the lateral masses of C1 AP Lower Cervical X-ray Reading Process 1. Identify T1 transverse Process 2. Trace C7 transverse process looking for a cervical rib 3. Check the uncinate processes 4. Block head vertebral body reading process 5. Spinous processes and pedicles 6. Check the discs for height and color 7. Trace the tracheal air space 8. Check the soft tissue IVF: Formed by the following components Roof: Pedicle Floor: Pedicle Anterior wall: Uncinate process Posterior wall: Facet joint Clinically it is helpful to assess the uncinate processes for arthritic changes and use this information to guide manual therapy treatment Lateral Cervical X-ray Reading Process 1. Check the Atlanto-odontiod space 2. Check the height of the dens 3. Trace the dens including the base looking for fracture 4. Check for a posterior ponticle 5. Trace the front of the vertebrae Anterior vertebral line 6. Trace the back of the vertebrae Georges Line 7. Trace the spinolaminar line 8. Trace the spinous processes line 3
4 9. Trace the body of the vertebrae 10. Check the disc spaces 11. Check the pedicles 12. Check the facets 13. Check the spinous process spacing 14. Check the soft tissues 3 spaces are evaluated AOI no >3mm, if greater than 3mm upper cervical instability is present Retropharyngeal space: 7 mm Retrotracheal space: mm These spaces are often enlarged after cervical trauma or MVA 4 main lines are observed 1. Anterior vertebral line 2. Posterior vertebral or Georges line 3. Spinolaminar line 4. Spinous process line The distance between the posterior vertebral body line and the spinolaminar line represents the sagittal dimension of the spinal canal. >15 mm is normal <12 mm is considered stenosis Common Mid-Cervical Pathology: Hangman s Fracture: A fracture of the pedicle of C2 Best seen on a lateral view Burst Fractures: The nucleus pulposus is driven through the fractured end plate into the vertebral body; the body explodes from within and results in a comminuted fracture. A vertical split in the vertebral body on an AP x-ray characterizes it. It is easier to see on a lateral x-ray or CT. Teardrop Fracture: Usually caused by a flexion compression injury Fracture of the posterior elements and posterior displacement of the involved vertebrae Stress is applied to the ALL and causes it to either rupture or avulse from the vertebral body. A triangular or teardrop shaped fragment is displaced anteriorly and inferiorly Best seen on a lateral view, most severe and unstable cervical fracture 4
5 Clay-Shoveler s Fracture: Spinous process fracture of C6, C7, or T1 Result of a hyperflexion injury Degenerative Joint Disease: Non-uniform loss of joint space, osteophytes, subchondral sclerosis, deformity and subluxation are the 5 general radiological features of DJD. Oblique Cervical X-ray Reading Process 1. Vertebral Bodies 2. Transverse Process 3. Intervertebral Foramen C2-C3 is the first IVF you see. C3 nerve root exits here. 4. Facet joints In the cervical spine anterior oblique films view the same side structures, posterior oblique films view the opposite side structures Flexion Extension X-ray Reading Process 1. Look at the 3 lines of alignment 2. Look at the space between spinous processes for irregularities. 3. Check the AOI Canadian Cervical Spine Rules Canadian cervical spine rules (100% sensitivity and 43% specificity for identifying important cervical injuries) (6) Cervical and Lumbar MRI Examination Cervical and Lumbar MRI Signal Contrasts Water is bright on a T2 image Fat is bright on a T1 image Vertebral bodies: The signal intensity of the vertebral body depends on the marrow content of the vertebral body. T1 image, the vertebral body will image bright T2 image, the vertebral body will image low signal intensity After radiation treatment, the bone marrow is replaced with fat and the vertebral bodies are brighter on T1 images Discs: The spinal discs show low signal on T1, high signal on T2 The nucleus is brighter because of greater water content Degenerative disc disease is a progressive decrease in signal intensity. Ligaments: 5
6 The spinal ligaments demonstrate a low signal intensity on T1 and T2 because of there high collagen content except for the ligamentum flavum. Spinal Cord and CSF: T1 image the cord has an intermediate signal T2 image the cord has a low signal CSF low signal on T1 (lower than the spinal cord) CSF high signal on T2 Cervical and Lumbar Spine MRI Common Views T1-weighted sagittal T2-weighted sagittal T1-weighted axial T2-weighted axial Cervical Sagittal View MRI Evaluation 1. Cranio-vertebral junction 2. Atlanto-axial articulation 3. Spinal cord 4. Bone Marrow 5. Disc: Hydrated, Desiccated or Displaced 6. Endplates 7. Alignment Cervical Axial View MRI Evaluation 1. Foramina 2. Disc 3. Spinal Cord Lumbar Sagittal MRI Evaluation 1. Conus 2. Bone marrow Normal bone marrow signal is higher than muscle or disc on T1 Marrow proliferation disorders Multiple myeloma Leukemia Abnormal findings include a signal in the bone that is equal or lower than muscle on T1 3. Endplates 4. Disc: Hydrated, Desiccated or Displaced 5. Foramen Lumbar Axial MRI Evaluation Number the axial pedicles, the pedicles are the key to the spine and knowing where you are L5 has angled pedicles, L4 pedicles are vertical 6
7 You can only see from the bottom of L3 to the top of S1on the axial images so you have to look at L1 L2 L3 on the sagittal 1. Facets 2. Foramen 3. Pedicle 4. Disc 5. Spinal cord 6. Paraspinals and psoas Look for atrophy, fat or abscesses Common Cervical and Lumbar Spine Pathology: Disc Disease Herniation: A term originally meaning a focal protrusion, the meaning of which has become blurred, and which now seems to include bulge, protrusion, extrusion and osteophyte formation Bulge: Broad based disc displacement Usually degenerative No evidence that this occurs acutely Protrusion: Focal disc displacement Connection to native disc of similar dimension May or may not be acute Extrusion: Focal disc displacement Connection to native disc attenuated or absent Sequestered or floating disc Spinal Stenosis Narrowing of the central spinal canal, neural foramen, lateral recess or any combination of these anatomic regions, by soft tissue or osseous structures that impinge on neural elements Standard classification for stenosis is based on cause Congenital: (e.g., short pedicles) Acquired: degenerative Causes of Spinal Stenosis Congenital Osteophytes Alignment abnormalities Ligament or facet hypertrophy Disc abnormalities 7
8 Levels of Stenosis Central Lateral recess Foraminal Diagnosis Depends on size of canal Measurements are not always taken. The diagnosis is made via the shape of the canal and thecal sac. Normally round or oval on axial images Quantify as mild, moderate or severe Must correlate imaging studies with clinical examination May produce myelopathy or radiculopathy Knee MRI Common Views and Signal Contrasts MRI of the knee is the most frequently requested MR joint study in musculoskeletal radiology. It has proven to be very accurate, with sensitivity/specificity in the 90%to 95% range for the meniscus and close to 100% for the cruciate ligaments. (2) Common Views Sagittal Axial Coronal Signal Contrasts Reminder Fat, bright on T1 Water, bright on T2 Appearance of Articular Cartilage Bright on Fat Suppressed Sequences Low to intermediate signal on T1 and T2 MR Signal of Joint Fluid or Marrow Edema Low on T1 High on T2 High on most fat suppressed sequences MR Appearance of Ligaments and Tendons Low on T1 Low on T2 Low on Suppressed sequences 8
9 Knee MRI Reading Process 1. Bone marrow. 2. Synovium. 3. Articular cartilage. 4. Collaterals. 5. Cruciates. 6. Extensor mechanism. 7. Meniscus. Common Knee Pathology: Bone Marrow Infarcts, Edema and Joint Fluid Bone marrow edema is often the result of trauma and there is a strong likely hood of fracture Bone marrow infarcts can be found in individuals who use steroids or work in high pressure environments (divers) Soft Tissue Masses Popliteal or Baker s cysts High signal on T2 Low signal on T1 Commonly associated with meniscal tears and degenerative joint disease Articular Cartilage Articular cartilage appears intermediate in signal intensity on T1/T2-weighted or proton density images with fat saturation It is distinguishable from the dark signal of the adjacent osseous cortex and the bright signal of joint fluid Cartilage defects of the tibia or femur are best seen on the sagittal and coronal images, whereas patellar abnormalities are best demonstrated on the axial images These defects are seen as surface irregularities filled with joint fluid MCL and LCL Injury The MCL (medial collateral ligament) is typically divided into layers The first layer is the superficial fibers The second layer is bursa and fat The third layer is the deep fibers, it is attached to the capsule and the mid portion of the medial meniscus The LCL (lateral collateral ligament) is a capsular thickening but is separated from. the capsule. This well defined cord extends from the lateral condyle to the fibular head. When this ligament is torn, it is not uncommon to see an ACL or PCL tear ACL and PCL Injury The cruciates are best evaluated on a T2 image The ACL has multiple fibers that will show up as linear areas of low signal intensity 9
10 High signal intensity will be seen in acute lesions. Chronic tears are seen as areas of intermediate signal intensity The PCL is thicker and has a more uniform low signal intensity PCL tears are usually mid substance Extensor Mechanism Injury Patellar tendon tear Jumpers Knee Patellar tendonitis Quadriceps tendon Patellar articular surface The extensor mechanism is easily seen on sagittal images Inflammation may result in thickening with increased signal intensity. Complete tears are high signal intensity with tendon separation. Jumper's knee: Assessment of the quad tendon and patellar tendon can be done on sagittal and axial images Meniscus Injury Criteria For Meniscal Tear 1. Gross morphologic abnormality 2. Intra-meniscal signal reaching an articular surface Type of meniscus tears: 1. Degenerative - a horizontal tear. 2. Linear tear. 3. Bucket handle. 4. Flip. 5. Meniscus cyst. 6. Discoid meniscus Bucket Handle Large fragment in notch Absent body of medial meniscus Double PCL Sign Shoulder MRI Common Views Coronal Oblique Axial Sagittal Oblique Shoulder MRI Normal Anatomy and Signal Contrasts Tendons and ligaments are normally low signal intensity on all pulse sequences The subacromial bursa is outlined by fat and should not be distended with fluid 10
11 Shoulder MRI Coronal Oblique View Reading Process 1. Bone Marrow Hill Sachs Lesion: Impaction fracture posterolateral aspect of the humeral head from anterior shoulder dislocation Best seen on an axial in the first 2 slices through the humeral head or the coronal image Posterior impingement cyst: This condition refers to impingement of the infraspinatus and supraspinatus tendons between the humeral head and the posterior glenoid rim during overhead movements with abduction and ER. Degenerative cysts and possible R/C tears are found on MRI 2. Synovium 3. Infraspinatus 4. Supraspinatus 5. AC Joint 6. Acromion 7. Deltoid 8. Biceps 9. Labrum Superior Inferior Common Shoulder Pathology: R/C Tear MRI sensitivity =97% (7) Biceps Tear MRI sensitivity poor to moderate (5) Superior Labral Tear MRI Arthrogram sensitivity =89% (1) Shoulder MRI Axial View Reading Process 1. Long Head of Biceps 2. Labrum Anterior Posterior 3. GHJ Ligaments Superior Middle Inferior Shoulder MRI Sagittal Oblique View Reading Process Use to confirm your findings from the other views 1. Supraspinatus 2. Infraspinatus 3. Teres Minor 4. Biceps 5. Subscapularis 6. Acromion 11
12 References 1. Bencardino JT, Beltran J, Rosenberg ZS, et al: Superior labrum anteriorposterior lesions: Diagnosis with MR arthrography of the shoulder. Radiology214: , Berquist, TH. MRI of the Musculoskeletal System, 4th edition. Philadelphia: Lippincott Williams & Wilkins, Greenspan, A. Orthopedic Radiology: A Practical Approach, 3rd edition. Philadelphia:Lippincott Williams & Wilkins, Kaplan PA, Helms CA, Dussault R, Anderson MW, Major NM. Musculoskeletal MRI. WB Saunders, Mohtadi NG. Vellet AD. Clark ML. Hollinshead RM. Sasyniuk TM. Fick GH. Burton PJ. A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain. [Journal Article] Journal of Shoulder & Elbow Surgery. 13(3):258-65, Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286: Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K. Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases.j Bone Joint Surg Am. 2004;86-A:
Imaging of Cervical Spine Trauma Tudor H Hughes, M.D.
Imaging of Cervical Spine Trauma Tudor H Hughes, M.D. General Considerations Most spinal fractures are due to a single episode of major trauma. Fatigue fractures of the spine are unusual except in the
More informationOutline. Epidemiology Indications for C-spine imaging Modalities Interpretation Types of fractures
C-Spine Plain Films Outline Epidemiology Indications for C-spine imaging Modalities Interpretation Types of fractures Epidemiology 7000-10000 c-spine injuries treated each year Additional 5000 die at the
More informationMRI SHOULDER WHAT TO SEE
MRI SHOULDER WHAT TO SEE DR SHEKHAR SRIVASTAV Sr. Consultant- Knee & Shoulder Arthroscopy Sant Parmanand Hospital Normal Anatomy Normal Shoulder MRI Coronal Oblique Sagital Oblique Axial Cuts Normal Coronal
More informationMRI of the Shoulder What to look for and how to find it? Dr. Eric Handley Musculoskeletal Radiologist Cherry Creek Imaging
MRI of the Shoulder What to look for and how to find it? Dr. Eric Handley Musculoskeletal Radiologist Cherry Creek Imaging MRI of the Shoulder Benefits of Ultrasound: * Dynamic * Interactive real time
More informationMRI KNEE WHAT TO SEE. Dr. SHEKHAR SRIVASTAV. Sr.Consultant KNEE & SHOULDER ARTHROSCOPY
MRI KNEE WHAT TO SEE Dr. SHEKHAR SRIVASTAV Sr.Consultant KNEE & SHOULDER ARTHROSCOPY MRI KNEE - WHAT TO SEE MRI is the most accurate and frequently used diagnostic tool for evaluation of internal derangement
More informationThis presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.
MRI of the Knee Jennifer Swart, M.D. Musculoskeletal Radiology South Texas Radiology Group Outline Coils, Patient Positioning Acquisition Parameters, Planes and Pulse Sequences Knee Arthrography Normal
More informationThis presentation is the intellectual property of the author. Contact them at for permission to reprint and/or distribute.
MRI of the Knee Jennifer Swart, M.D. Musculoskeletal Radiology South Texas Radiology Group Financial Disclosure Dr. Jennifer Swart has no relevant financial relationships with commercial interests to disclose.
More information8/4/2012. Causes and Cures. Nucleus pulposus. Annulus fibrosis. Vertebral end plate % water. Deforms under pressure
Causes and Cures Intervertebral discs Facet (zygopophyseal) joints Inter body joints Spinal nerve roots Nerve compression Pathological conditions Video Causes of back pain Nucleus pulposus Annulus fibrosis
More information1 Normal Anatomy and Variants
1 Normal Anatomy and Variants 1.1 Normal Anatomy MR Technique. e standard MR protocol for a routine evaluation of the spine always comprises imaging in sagittal and axial planes, while coronal images are
More informationSUBAXIAL CERVICAL SPINE TRAUMA- DIAGNOSIS AND MANAGEMENT
SUBAXIAL CERVICAL SPINE TRAUMA- DIAGNOSIS AND MANAGEMENT 1 Anatomy 3 columns- Anterior, middle and Posterior Anterior- ALL, Anterior 2/3 rd body & disc. Middle- Posterior 1/3 rd of body & disc, PLL Posterior-
More informationHidayatullah Hamidi. MD Consultant Radiologist. Lumbar Spine MR Imaging Interpretation
Hidayatullah Hamidi. MD Consultant Radiologist Lumbar Spine MR Imaging Interpretation 13/12/2018 Presenter Hidayatullah Hamidi Consultant Radiologist, Radiology PGME program director, FMIC, Kabul, Afghanistan
More information2. The vertebral arch is composed of pedicles (projecting from the body) and laminae (uniting arch posteriorly).
VERTEBRAL COLUMN 2018zillmusom I. VERTEBRAL COLUMN - functions to support weight of body and protect spinal cord while permitting movements of trunk and providing for muscle attachments. A. Typical vertebra
More informationAnatomy of the Musculoskeletal System
Anatomy of the Musculoskeletal System Kyle E. Rarey, Ph.D. Department of Anatomy & Cell Biology and Otolaryngology University of Florida College of Medicine Outline of Presentation Vertebral Column Upper
More informationLigaments of the vertebral column:
In the last lecture we started talking about the joints in the vertebral column, and we said that there are two types of joints between adjacent vertebrae: 1. Between the bodies of the vertebrae; which
More informationSPINAL MAGNETIC RESONANCE IMAGING INTERPRETATION
CLINICAL VIGNETTE 2017; 3:2 SPINAL MAGNETIC RESONANCE IMAGING INTERPRETATION Editor-in-Chief: Idowu, Olufemi E. Neurological surgery Division, Department of Surgery, LASUCOM/LASUTH, Ikeja, Lagos, Nigeria.
More informationDegenerative Disease of the Spine
Degenerative Disease of the Spine Introduction: I. Anatomy Talk Overview II. Overview of Disease Processes: A. Spondylosis B. Intervertebral Disc Disease III. Diagnosis IV. Therapy Introduction: Myelopathy
More informationCervical Spine Anatomy and Biomechanics. Typical Cervical Vertebra C3 6. Typical Cervical Vertebra Anterior 10/5/2017
Cervical Spine Anatomy and Biomechanics Typical Cervical Vertebra C3 6 Small, relatively broad body Bifid SpinousProcess Long and narrow laminae Spinal Canal: large, triangular; remarkably consistent dimensions
More informationMDCT and MRI evaluation of cervical spine trauma
Insights Imaging (2014) 5:67 75 DOI 10.1007/s13244-013-0304-2 PICTORIAL REVIEW MDCT and MRI evaluation of cervical spine trauma Michael Utz & Shadab Khan & Daniel O Connor & Stephen Meyers Received: 10
More informationVERTEBRAL COLUMN VERTEBRAL COLUMN
VERTEBRAL COLUMN FUNCTIONS: 1) Support weight - transmits weight to pelvis and lower limbs 2) Houses and protects spinal cord - spinal nerves leave cord between vertebrae 3) Permits movements - *clinical
More informationSpine. Neuroradiology. Spine. Spine Pathology. Distribution of fractures. Radiological algorithm. Role of radiology 18/11/2015
Spine Neuroradiology Spine Prof.Dr.Nail Bulakbaşı X Ray: AP/L/Oblique Vertebra & disc spaces CT & CTA Vertebra, discs, vessels MRI & MRA Vertebra, disc, vessels, meninges Spinal cord & nerves Myelography
More informationMusculoskeletal Examination Benchmarks
Musculoskeletal Examination Benchmarks _ The approach to examining the musculoskeletal system is the same no matter what joint or limb is being examined. The affected and contralateral region should both
More informationDr Ajit Singh Moderator Dr P S Chandra Dr Rajender Kumar
BIOMECHANICS OF SPINE Dr Ajit Singh Moderator Dr P S Chandra Dr Rajender Kumar What is biomechanics? Biomechanics is the study of the consequences of application of external force on the spine Primary
More informationImaging the Athlete s Knee. Peter Lowry, MD Musculoskeletal Radiology University of Colorado
Imaging the Athlete s Knee Peter Lowry, MD Musculoskeletal Radiology University of Colorado None Disclosures Knee Imaging: Radiographs Can be performed weight-bearing or non-weight-bearing View options
More informationImaging of Trauma to the Spine. Orthopedic Diplomate Program University of Bridgeport College of Chiropractic
Imaging of Trauma to the Spine Orthopedic Diplomate Program University of Bridgeport College of Chiropractic Jefferson Fracture Yee, LL: The Jefferson Fracture, Radiology Cases in Pediatric Emergency Medicine.
More informationSURGICAL AND APPLIED ANATOMY
Página 1 de 6 Copyright 2001 Lippincott Williams & Wilkins Bucholz, Robert W., Heckman, James D. Rockwood & Green's Fractures in Adults, 5th Edition SURGICAL AND APPLIED ANATOMY Part of "37 - HIP DISLOCATIONS
More informationThe Shoulder. Anatomy and Injuries PSK 4U Unit 3, Day 4
The Shoulder Anatomy and Injuries PSK 4U Unit 3, Day 4 Shoulder Girdle Shoulder Complex is the most mobile joint in the body. Scapula Clavicle Sternum Humerus Rib cage/thorax Shoulder Girdle It also includes
More informationObjectives. The BIG Joint. Case 1. Boney Architecture. Presenter Disclosure Information. Common Knee Problems
3:30 4:15 pm Common Knee Problems SPEAKER Christopher J. Visco, MD Presenter Disclosure Information The following relationships exist related to this presentation: Christopher J. Visco, MD: Speaker s Bureau
More informationORIGINAL ARTICLE. ROLE OF MRI IN EVALUATION OF TRAUMATIC KNEE INJURIES Saurabh Chaudhuri, Priscilla Joshi, Mohit Goel
ROLE OF MRI IN EVALUATION OF TRAUMATIC KNEE INJURIES Saurabh Chaudhuri, Priscilla Joshi, Mohit Goel 1. Associate Professor, Department of Radiodiagnosis & imaging, Bharati Vidyapeeth Medical College and
More informationImaging Modalities: Clinical Reasoning and Key Instructional Elements: Radiography
Imaging Modalities: Clinical Reasoning and Key Instructional Elements: Radiography Michael D. Ross, PT, DHSc, OCS mross@daemen.edu Disclosure No relevant financial relationship exists Objectives Determine
More informationThe examination of the painful knee. Maja K Artandi, MD, FACP Clinical Associate Professor of Medicine Stanford University
The examination of the painful knee Maja K Artandi, MD, FACP Clinical Associate Professor of Medicine Stanford University Objectives of the talk By the end of this talk you will know The important anatomy
More informationRiver North Pain Management Consultants, S.C., Axel Vargas, M.D., Regional Anesthesiology and Interventional Pain Management.
River North Pain Management Consultants, S.C., Axel Vargas, M.D., Regional Anesthesiology and Interventional Pain Management. Chicago, Illinois, 60611 Phone: (888) 951-6471 Fax: (888) 961-6471 Clinical
More informationKnee: Cruciate Ligaments
72 Knee: Cruciate Ligaments R. Kent Sanders Sagittal oblique 2.5-mm sequences along the plane of the anterior cruciate ligament (ACL) typically yield three to four images of the ACL, with the first medial
More informationMRI of the Knee: Part 2 - menisci. Mark Anderson, M.D. University of Virginia Health System
MRI of the Knee: Part 2 - menisci Mark Anderson, M.D. University of Virginia Health System Learning Objectives At the end of the presentation, each participant should be able to: describe the normal anatomy
More informationOriginal Report. The Reverse Segond Fracture: Association with a Tear of the Posterior Cruciate Ligament and Medial Meniscus
Eva M. Escobedo 1 William J. Mills 2 John. Hunter 1 Received July 10, 2001; accepted after revision October 1, 2001. 1 Department of Radiology, University of Washington Harborview Medical enter, 325 Ninth
More informationArthroscopy / MRI Correlation Conference. Department of Radiology, Section of MSK Imaging Department of Orthopedic Surgery 7/19/16
Arthroscopy / MRI Correlation Conference Department of Radiology, Section of MSK Imaging Department of Orthopedic Surgery 7/19/16 Case 1: 29 YOM with recurrent shoulder dislocations Glenoid Axial T1FS
More informationFUNCTIONAL ANATOMY OF SHOULDER JOINT
FUNCTIONAL ANATOMY OF SHOULDER JOINT ARTICULATION Articulation is between: The rounded head of the Glenoid cavity humerus and The shallow, pear-shaped glenoid cavity of the scapula. 2 The articular surfaces
More informationSubaxial Cervical Spine Trauma. Introduction. Anatomic Considerations 7/23/2018
Subaxial Cervical Spine Trauma Sheyan J. Armaghani, MD Florida Orthopedic Institute Assistant Professor USF Dept of Orthopedics Introduction Trauma to the cervical spine accounts for 5 of all spine injuries
More informationMEDICAL IMAGING OF THE VERTEBRAE
MEDICAL IMAGING OF THE VERTEBRAE Vertebrae are your friends Matthew Harper MS-IV LECTURE OBJECTIVES INTRODUCE THE MOST COMMON MODALITIES OF MEDICAL IMAGING AND BASIC TECHNIQUES FOR READING THESE IMAGES
More informationCommon fracture & dislocation of the cervical spine. Theerachai Apivatthakakul Department of Orthopaedic Chiangmai University
Common fracture & dislocation of the cervical spine Theerachai Apivatthakakul Department of Orthopaedic Chiangmai University Objective Anatomy Mechanism and type of injury PE.and radiographic evaluation
More informationSpinal Cord Injuries: The Basics. Kadre Sneddon POS Rounds October 1, 2003
Spinal Cord Injuries: The Basics Kadre Sneddon POS Rounds October 1, 2003 Anatomy Dorsal columntouch, vibration Corticospinal tract- UMN Anterior horn-lmn Spinothalamic tractpain, temperature (contralateral)
More informationThe Upper Limb II. Anatomy RHS 241 Lecture 11 Dr. Einas Al-Eisa
The Upper Limb II Anatomy RHS 241 Lecture 11 Dr. Einas Al-Eisa Sternoclavicular joint Double joint.? Each side separated by intercalating articular disc Grasp the mid-portion of your clavicle on one side
More informationJoints Dr. Ali Ebneshahidi
Joints Dr. Ali Ebneshahidi Function of Joints 1. Serve as functional junctions between bones. 2. Bind bones, strokes, and other related tissues together. 3. Allow bone growth to occur. 4. Permit certain
More informationAnatomy & Physiology II. Trunk
Anatomy & Physiology II Trunk Bones and Landmarks of the Vertebral column 24 vertebrae Sacrum - consists of 5 vertebrae that fuse into one bone Median sacral crest Sacral hiatus 4 sacral foramina Coccyx
More informationLawrence Gulotta Gillian Lieberman, MD October Gillian Lieberman, MD. Shoulder Imaging. Lawrence V. Gulotta, HMS IV 10/16/02
October 2002 Shoulder Imaging Lawrence V. Gulotta, HMS IV 10/16/02 Goals Review Anatomy of the Shoulder -Dynamic Stabilizers -> Rotator Cuff -Static Stabilizers -> Labrum and Capsule Systematic Approach
More informationKnee: Meniscus Back to Basics
Knee: Meniscus Back to Basics Kyung Jin Suh kyungjin.suh@gmail.com Doctor Radiology, Daegu, KOREA Medial Lateral 7.7 10.2 11.6 9.6 10.6 mm Posterior > Anterior horn 10.6 mm Posterior = Anterior horn Medial
More informationCopyright 2010 Pearson Education, Inc. Copyright 2010 Pearson Education, Inc. Figure Sectioned spinous process. Interspinous.
PowerPoint Lecture Slides prepared by Janice Meeking, Mount Royal College C H A P T E R 7 The Skeleton: Part B Vertebral Column Transmits weight of trunk to lower limbs Surrounds and protects spinal cord
More informationImaging the Knee 17/10/2017. Friction syndrome Common in runners or cyclists Fluid between ITB and Lateral femoral condyle
17/10/2017 Imaging the Knee Alicia M. Yochum RN, DC, DACBR, RMSK Iliotibial Band Syndrome Ligamentous Tears (ACL, PCL, MCL, LCL) Meniscal Tears Cartilage Degeneration Quadriceps/Patellar tendinosis Osteochondral
More informationBony framework of the vertebral column Structure of the vertebral column
5.1: Vertebral column & back. Overview. Bones o vertebral column. o typical vertebra. o vertebral canal. o spinal nerves. Joints o Intervertebral disc. o Zygapophyseal (facet) joint. Muscles o 2 compartments:
More informationMastering the Musculoskeletal Exam UCSF Essentials of Women s Health July 7, 2016 Carlin Senter, M.D. Henry Crevensten, M.D.
Mastering the Musculoskeletal Exam UCSF Essentials of Women s Health July 7, 2016 Carlin Senter, M.D. Henry Crevensten, M.D. I have nothing to disclose Outline Knee exam Shoulder exam Knee Anatomy The
More informationMeniscal Tears with Fragments Displaced: What you need to know.
Meniscal Tears with Fragments Displaced: What you need to know. Poster No.: C-1339 Congress: ECR 2015 Type: Authors: Keywords: DOI: Educational Exhibit M. V. Ferrufino, A. Stroe, E. Cordoba, A. Dehesa,
More informationChapter 9 Articulations Articulations joints where two bones interconnect. Two classification methods are used to categorize joints:
Chapter 9 Articulations Articulations joints where two bones interconnect Two classification methods are used to categorize joints: Functional classification Structural classification Functional classification
More informationClarification of Terms
Clarification of Terms The Spine, Spinal Column, and Vertebral Column are synonymous terms referring to the bony components housing the spinal cord Spinal Cord = made of nervous tissue Facet = a small,
More informationClarification of Terms
Clarification of Terms The Spine, Spinal Column, and Vertebral Column are synonymous terms referring to the bony components housing the spinal cord Spinal Cord = made of nervous tissue Facet = a small,
More informationTHE VERTEBRAL COLUMN. Average adult length: In male: about 70 cms. In female: about 65 cms.
THE VERTEBRAL COLUMN Average adult length: In male: about 70 cms. In female: about 65 cms. 1 Vertebral Column (Regions and Curvatures) Curvatures of the vertebral column: A. Primary curvature: C-shaped;
More information4/28/2010. Fractures. Normal Bone and Normal Ossification Bone Terms. Epiphysis Epiphyseal Plate (physis) Metaphysis
Fractures Normal Bone and Normal Ossification Bone Terms Epiphysis Epiphyseal Plate (physis) Metaphysis Diaphysis 1 Fracture Classifications A. Longitudinal B. Transverse C. Oblique D. Spiral E. Incomplete
More informationHuman Anatomy and Physiology - Problem Drill 07: The Skeletal System Axial Skeleton
Human Anatomy and Physiology - Problem Drill 07: The Skeletal System Axial Skeleton Question No. 1 of 10 Which of the following statements about the axial skeleton is correct? Question #01 A. The axial
More informationMRI of LEFT KNEE. There is a fluid collection seen anterior to and inferior to the superiorly displaced patella.
MRI of LEFT KNEE Protocol: Multiplanar MRI of the left knee joint performed in the sagittal, coronal and transverse planes using T1 weighted spin echo, T2 and proton-density weighted fast spin echo, fatsaturated
More informationThe Back. Anatomy RHS 241 Lecture 9 Dr. Einas Al-Eisa
The Back Anatomy RHS 241 Lecture 9 Dr. Einas Al-Eisa The spine has to meet 2 functions Strength Mobility Stability of the vertebral column is provided by: Deep intrinsic muscles of the back Ligaments
More informationChapter 7 Part B The Skeleton
Chapter 7 Part B The Skeleton 7.2 The Vertebral Column General Characteristics Extends from skull to pelvis Also called spine or spinal column Functions to transmit weight of trunk to lower limbs, surround
More informationClarification of Terms
Clarification of Terms The Spine, Spinal Column, and Vertebral Column are synonymous terms referring to the bony components housing the spinal cord Spinal Cord = made of nervous tissue Facet = a small,
More informationGlenohumeral Joint Instability. Static Stabilizers of the GHJ. Static Stabilizers of the GHJ. Static Stabilizers of the GHJ
1 Glenohumeral Joint Instability GHJ Joint Stability: Or Lack Thereof! Christine B. Chung, M.D. Assistant Professor of Radiology Musculoskeletal Division UCSD and VA Healthcare System Static Stabilizers
More informationVertebral Column. Backbone consists of 26 vertebrae. Five vertebral regions. Cervical
Vertebral Column Backbone consists of 26 vertebrae. Five vertebral regions Cervical vertebrae (7) in the neck. Thoracic vertebrae (12) in the thorax. Lumbar vertebrae (5) in the lower back. Sacrum (5,
More information3D imaging reformation was obtained. The 3D color imaging reformation was reviewed in a different high resolution setting.
POST OPERATIVE SPINE WITH CONTRAST CLINICAL INDICATION: Low back pain, Patient is post operative status for L4/5 diskectomy TECHNIQUE: MRI of the lumbosacral spine was performed with multiplanar imaging
More informationMRI evaluation of the shoulder: Beyond rotator cuff
MRI evaluation of the shoulder: Beyond rotator cuff Poster No.: C-2447 Congress: ECR 2015 Type: Educational Exhibit Authors: C. Rumie, A. Vasquez, J. A. Abreu, A. P. Guarnizo, O. Rivero, 1 1 2 3 1 1 1
More informationIt consist of two components: the outer, laminar fibrous container (or annulus), and the inner, semifluid mass (the nucleus pulposus).
Lumbar Spine The lumbar vertebrae are the last five vertebrae of the vertebral column. They are particularly large and heavy when compared with the vertebrae of the cervical or thoracicc spine. Their bodies
More informationHuman Anatomy - Problem Drill 06: The Skeletal System Axial Skeleton & Articualtions
Human Anatomy - Problem Drill 06: The Skeletal System Axial Skeleton & Articualtions Question No. 1 of 10 Instructions: (1) Read the problem and answer choices carefully, (2) Work the problems on paper
More informationPatient ID. Case Conference. Physical Examination. Image examination. Treatment 2011/6/16
Patient ID Case Conference R3 高逢駿 VS 徐郭堯 55 y/o female C.C.: recurrent right shoulder dislocation noted since falling down injury 2 years ago Came to ER because of dislocation for many times due to minor
More informationMusculoskeletal Ultrasound. Technical Guidelines SHOULDER
Musculoskeletal Ultrasound Technical Guidelines SHOULDER 1 Although patient s positioning for shoulder US varies widely across different Countries and Institutions reflecting multifaceted opinions and
More informationAXIAL SKELETON FORM THE VERTICAL AXIS OF THE BODY CONSISTS OF 80 BONES INCLUDES BONES OF HEAD, VERTEBRAL COLUMN, RIBS,STERNUM
AXIAL SKELETON FORM THE VERTICAL AXIS OF THE BODY CONSISTS OF 80 BONES INCLUDES BONES OF HEAD, VERTEBRAL COLUMN, RIBS,STERNUM APPENDICULAR SKELETON BONES OF THE FREE APPENDAGES & THEIR POINTS OF ATTACHMENTS
More informationMUSCLES OF SHOULDER REGION
Dr Jamila EL Medany OBJECTIVES At the end of the lecture, students should: List the name of muscles of the shoulder region. Describe the anatomy of muscles of shoulder region regarding: attachments of
More informationRad Tech 4643 MRI Torso and Extremities
Rad Tech 4643 MRI Torso and Extremities Prostate Cancer Leiomyoma Retroverted Anteverted Ovarian Cyst Gone Wrong Fibroid (Leiomyoma) IUD Ovary Hysterectomy? What are we to see when imaging a female pelvis
More informationDISTINGUISHING BETWEEN ACUTE AND CHRONIC ROTATOR CUFF INJURIES IN WORKERS COMPENSATION PATIENTS
DISTINGUISHING BETWEEN ACUTE AND CHRONIC ROTATOR CUFF INJURIES IN WORKERS COMPENSATION PATIENTS Lyndon B. Gross M.D. Ph.D. The Orthopedic Center of St. Louis SHOULDER PAIN Third most common musculoskeletal
More information목, 어깨통증. 연세의대가정의학교실 이용제 MD, MPH, PhD
목, 어깨통증 연세의대가정의학교실 이용제 MD, MPH, PhD COI (Conflict of Interest) Declaration 본강좌의내용에대해서 본강의의강사는 직접적또는간접적인 어떠한이해관계도없음을밝힙니다. 2015 년대한가정의학회춘계학술대회 Core perspectives of optimal health 1. Subclinical inflammation
More informationSports Medicine: Shoulder Arthrography. Christine B. Chung, M.D. Professor of Radiology Musculoskeletal Division UCSD and VA Healthcare System
Sports Medicine: Shoulder Arthrography Christine B. Chung, M.D. Professor of Radiology Musculoskeletal Division UCSD and VA Healthcare System Disclosure Off-label use for gadolinium Pediatric Sports Injuries
More informationUltrasound of the Knee
Ultrasound of the Knee Jon A. Jacobson, M.D. Professor of Radiology Director, Division of Musculoskeletal Radiology University of Michigan Disclosures: Consultant: Bioclinica Book Royalties: Elsevier Advisory
More informationTake Pride in Performance
2017 Take Pride in Performance Knee: Meniscal Tear FSE PD - Sagittal FSE PD - Coronal FSTIR - Coronal Knee: ACL Tibial Avulsion 3D SHARC ISO - Sagittal FSE PD - Sagittal FSTIR - Coronal Knee: Subchondral
More informationUS finding of the shoulder (with live demonstration) 인제의대상계백병원 안재기
US finding of the shoulder (with live demonstration) 인제의대상계백병원 안재기 Shoulder US Biceps tendon & Rotator Cuff Long Head of Biceps Tendon Subscapularis tendon Supraspinatus tendon Infraspinatus tendon Teres
More informationVERTEBRAL COLUMN ANATOMY IN CNS COURSE
VERTEBRAL COLUMN ANATOMY IN CNS COURSE Vertebral body Sections of the spine Atlas (C1) Axis (C2) What type of joint is formed between atlas and axis? Pivot joint What name is given to a fracture of both
More informationhuman anatomy 2015 lecture four Dr meethak ali ahmed neurosurgeon
The Vertebral Column the vertebral columnis central pillar of the body.it serve to protect the spinal cord and support the weight of the head trunk, which it transmits to the hip bones & the lower limbs.
More informationRole of Magnetic Resonance Imaging in Patients with Knee Trauma
Original Research Article Role of Magnetic Resonance Imaging in Patients with Knee Trauma Bhautik Kapadia 1, Bhumika Suthar 2* 1 Associate Professor, 2 Assistant Professor, Department of Radiodiagnosis,
More informationSkeletal System. Bones & Joints
Skeletal System Bones & Joints Vertebral Column Upper Limb Lower Limb OUTLINE Clinical Related Features Arrangements Features of the Joints Vertebral Column (Overview) Costal Element Regional Features
More informationRETROLISTHESIS. Retrolisthesis. is found mainly in the cervical spine and lumbar region but can also be often seen in the thoracic spine
RETROLISTHESIS A retrolisthesis is a posterior displacement of one vertebral body with respect to adjacent vertebrae Typically a vertebra is to be in retrolisthesis position when it translates backward
More informationESSENTIALS OF PLAIN FILM INTERPRETATION: SPINE DR ASIF SAIFUDDIN
ESSENTIALS OF PLAIN FILM INTERPRETATION: SPINE DR ASIF SAIFUDDIN Consultant Musculoskeletal Radiologist Royal National Orthopaedic Hospital Stanmore,UK. INTRODUCTION 2 INTRODUCTION 3 INTRODUCTION Spinal
More informationCERVICAL SPINE: Radiographs and MRI Cases
www.jprad.com Radiology reports with recommendations & clinical information - $30 per region, x-ray - $50 per MRI - Medpay Monthly Newsletter 700 East Redlands Blvd, Redlands CA 92373 909.353.9348 jpedley299@yahoo.com
More informationKnee Dislocation: Spectrum of Injury, Evolution of Treatment & Modern Outcomes
Knee Dislocation: Spectrum of Injury, Evolution of Treatment & Modern Outcomes William M Weiss, MD MSc FRCSC Orthopedic Surgery & Rehabilitation Sports Medicine, Arthroscopy & Extremity Reconstruction
More informationAnatomy of the Shoulder Girdle. Prof Oluwadiya Kehinde FMCS (Orthop)
Anatomy of the Shoulder Girdle Prof Oluwadiya Kehinde FMCS (Orthop) www.oluwadiya.com Bony Anatomy Shoulder Complex: Sternum(manubrium) Clavicle Scapula Proximal humerus Manubrium Sterni Upper part of
More informationTHE SHOULDER JOINT T H E G L E N O H U M E R A L ( G H ) J O I N T
THE SHOULDER JOINT T H E G L E N O H U M E R A L ( G H ) J O I N T CLARIFICATION OF TERMS Shoulder girdle = scapula and clavicle Shoulder joint (glenohumeral joint) = scapula and humerus Lippert, p115
More informationTHE THORACIC WALL. Boundaries Posteriorly by the thoracic part of the vertebral column. Anteriorly by the sternum and costal cartilages
THE THORACIC WALL Boundaries Posteriorly by the thoracic part of the vertebral column Anteriorly by the sternum and costal cartilages Laterally by the ribs and intercostal spaces Superiorly by the suprapleural
More information102 Results RESULTS. Age Mean=S.D Range 42= years -84 years Number % <30 years years >50 years
102 Results RESULTS A total of 50 cases were studied 39 males and 11females.Their age ranged between 16 years and 84 years (mean 42years). T1 and T2WI were acquired for all cases in sagittal and axial
More informationThe Shoulder. Systematically scanning the shoulder provides extremely useful diagnostic information. The Shoulder
1 ! The most ACCESSIBLE to sonographic exam! The most MOBILE and VULNERABLE extremity AND Systematically scanning the shoulder provides extremely useful diagnostic information! The Goal for this section
More information7/31/2012 THE SHOULDER JOINT CLARIFICATION OF TERMS OSTEOLOGY OF THE GH JOINT(BONES)
THE SHOULDER JOINT T H E G L E N O H U M E R AL ( G H ) J O I N T CLARIFICATION OF TERMS Shoulder girdle = scapula and clavicle Shoulder joint (glenohumerual joint) = scapula and Lippert, p115 OSTEOLOGY
More informationSHOULDER JOINT ANATOMY AND KINESIOLOGY
SHOULDER JOINT ANATOMY AND KINESIOLOGY SHOULDER JOINT ANATOMY AND KINESIOLOGY The shoulder joint, also called the glenohumeral joint, consists of the scapula and humerus. The motions of the shoulder joint
More informationThe suction cup mechanism is enhanced by the slightly negative intra articular pressure within the joint.
SHOULDER INSTABILITY Stability A. The stability of the shoulder is improved by depth of the glenoid. This is determined by: 1. Osseous glenoid, 2. Articular cartilage of the glenoid, which is thicker at
More informationCopyright 2010 Pearson Education, Inc.
E. VERTEBRAL COLUMN 1. The vertebral column extends from the skull to the pelvis and forms the vertical axis of the skeleton. 2. The vertebral column is composed of vertebrae that are separated by intervertebral
More informationAO CLASSIFICATIONS THORACO-LUMBAR SPINAL INJURIES
AO CLASSIFICATIONS THORACO-LUMBAR SPINAL INJURIES T H E A O / A S I F ( A R B E I T S G E M E I N S C H A F T F Ü R O S T E O S Y N T H E S E F R A G E N / A S S O C I A T I O N F O R T H E S T U D Y O
More informationKnee, Ankle, and Foot: Normal and Abnormal Features with MRI and Ultrasound Correlation. Disclosures. Outline. Joint Effusion. Suprapatellar recess
Knee, Ankle, and Foot: Normal and Abnormal Features with MRI and Ultrasound Correlation Jon A. Jacobson, M.D. Professor of Radiology Director, Division of Musculoskeletal Radiology University of Michigan
More informationSpinal canal stenosis Degenerative diseases F 06
What is spinal canal stenosis? The condition known as spinal canal stenosis is a narrowing (stenosis) of the spinal canal that in most cases develops due to the degenerative (wear-induced) deformation
More informationand K n e e J o i n t Is the most complicated joint in the body!!!!
K n e e J o i n t K n e e J o i n t Is the most complicated joint in the body!!!! 1-Consists of two condylar joints between: A-The medial and lateral condyles of the femur and The condyles of the tibia
More informationROTATOR CUFF DISORDERS/IMPINGEMENT
ROTATOR CUFF DISORDERS/IMPINGEMENT Dr.KN Subramanian M.Ch Orth., FRCS (Tr & Orth), CCT Orth(UK) Consultant Orthopaedic Surgeon, Special interest: Orthopaedic Sports Injury, Shoulder and Knee Surgery, SPARSH
More informationSpine Trauma- Part B
Spine Trauma- Part B Cervical Spine Injuries Atlanto- Occipital Dislocation Hyperextension and distraction mechanism Down s syndrome, RA more susceptible Asymmetric lateral masses on odontoid view Widened
More information