Fundamentals of Musculoskeletal Imaging

by McKinnis, Lynn N.

• ISBN13: 9780803611887
• ISBN10: 0803611889
• Edition: 2nd
• Format: Hardcover
• Copyright: 2005-06-16
• Publisher: F a Davis Co

Summary

A volume in the Contemporary Perspectives In Rehabilitation Series, edited by Steven L. Wolf, PhD, PT, FAPTA.Written specifically for the rehabilitation specialist, this clinically oriented text introduces the basic principles of imaging and the radiographic evaluation of normal and pathologic bone, and fractures. A systems approach organizes chapters by major anatomical region to provide reference points when viewing patient films. IMPORTANT: The answers to the Self-Test Questions in chapters 4 and 6 were inadvertently omitted from the text. To download them, please click the "Online Resources at DavisPlus" link in the "Explore this Product" section at the upper right of this page.

Table of Contents

General Principles of Musculoskeletal Imaging	1	(38)
Why Study Imaging?	1	(1)
What Is Radiology?	2	(1)
What Is Musculoskeletal Imaging?	2	(1)
Historical Perspective	2	(2)
Turn-of-the-Century Sensationalism	3	(1)
1900 to 1930	3	(1)
The 1930s	3	(1)
The 1940s	3	(1)
The 1950s and 1960s	4	(1)
The 1970s and 1980s	4	(1)
From the 1990s to a New Century	4	(1)
Essential Science	4	(4)
What Is a Radiograph?	4	(1)
What Is Radiation?	5	(2)
What Are X-rays?	7	(1)
Image Receptors: Different Ways to Capture the X-rays	8	(2)
The Gold Standard: Film/Screen Radiography	8	(1)
Fluoroscopy	9	(1)
Computed Radiography	10	(1)
Digital Radiography	10	(1)
Understanding the Image	10	(6)
What Is Radiodensity?	10	(1)
Radiodensity as a Function of Composition: Anatomy in Four Shades of Gray	11	(1)
Radiodensity as a Function of Thickness	12	(1)
How Many Dimensions Can You See?	12	(2)
Radiodensity in a Rose	14	(2)
More to the Radiograph	16	(10)
Radiographic Terminology	16	(1)
Anteroposterior, Lateral, and Oblique Projections	17	(3)
Viewing Radiographs	20	(1)
Identification Markers	20	(1)
Image Quality Factors	21	(5)
The Routine Radiographic Examination	26	(1)
The Radiologist as the Imaging Specialist	26	(2)
Other Common Studies in Musculoskeletal Imaging	28	(7)
Contrast-Enhanced Radiographs	28	(1)
Conventional Tomography	28	(3)
Computed Tomography	31	(1)
Nuclear Imaging	31	(2)
Magnetic Resonance Imaging	33	(1)
Ultrasonography	33	(2)
Interventional Techniques	35	(1)
Epidural Steroid Injections	35	(1)
Spinal Nerve Blocks	35	(1)
Radiofrequency Ablation	35	(1)
Discography	35	(1)
Percutaneous Needle Biopsy of the Spine	36	(1)
Percutaneous Vertebroplasty	36	(1)
Automated Percutaneous Lumbar Diskectomy	36	(1)
Intradiscal Electrothermal Therapy	36	(1)
The Imaging Chain	36	(1)
Summary of Key Points	37	(1)
Self-Test	38	(1)
Radiologic Evaluation, Search Patterns, and Diagnosis	39	(42)
Where Does Radiologic Image Interpretation Begin?	39	(1)
What Are The Pitfalls of Image Interpretation?	39	(1)
What Can the Nonradiologist Offer to Image Interpretation?	39	(1)
Search Pattern: The ABCs of Radiologic Analysis	40	(11)
Alignment	40	(3)
Bone Density	43	(4)
Cartilage Space	47	(2)
Soft Tissues	49	(2)
Radiologic Diagnosis of Skeletal Pathology	51	(6)
Categories of Skeletal Pathology	52	(1)
Distribution of the Lesion	52	(1)
Predictor Variables	52	(5)
Radiologic Characteristics of Common Pathologies	57	(16)
Adult Rheumatoid Arthritis	57	(4)
Osteoarthritis (Degenerative Joint Disease)	61	(3)
Osteoporosis	64	(4)
Musculoskeletal Infections	68	(3)
Bone Tumors	71	(2)
The Radiological Report	73	(5)
Heading	74	(1)
Clinical Information	74	(2)
Findings	76	(1)
Conclusions	76	(1)
Recommendations	77	(1)
Signature	77	(1)
Radiologic Report Example
Summary of Key Points	78	(1)
Self-Test	79	(2)
Radiologic Evaluation of Fracture	81	(36)
Trauma, the Most Common Disorder	81	(1)
What Is a Fracture?	82	(1)
Biomechanics of Bone	82	(1)
Definition of Fracture	82	(1)
Trauma Radiology	82	(1)
Elements of Fracture Description	83	(8)
Anatomic Site and Extent of the Fracture	84	(1)
Type of Fracture: Complete or Incomplete	84	(1)
Alignment of Fracture Fragments	84	(2)
Direction of Fracture Lines	86	(2)
Presence of Special Features	88	(1)
Associated Abnormalities	88	(2)
Fractures Due to Abnormal Stresses or Pathologic Processes	90	(1)
Fractures in Children	91	(5)
Location Description	91	(1)
Difficulties in Assessment of Immature Bone	92	(1)
Elements of Fracture Description	92	(3)
Healing Factors	95	(1)
Reduction and Fixation of Fractures	96	(1)
Reduction	96	(1)
Fixation	96	(1)
Fracture Healing	97	(2)
Cortical Bone Healing	97	(1)
Cancellous Bone Healing	98	(1)
Surgically Compressed Bone Healing	98	(1)
Radiologic Evaluation of Healing	98	(1)
Time Frame for Fracture Healing	99	(2)
Factors That Influence Rate of Fracture Healing	99	(2)
Radiologic Examination Intervals During Fracture Healing	101	(1)
Complications in Fracture Healing	101	(5)
Complications at Fracture Site	101	(2)
Late-Effect Complications of Fracture	103	(1)
Associated Complications of Other Tissues	104	(1)
Life-Threatening Complications	105	(1)
Commonly Missed Fractures	106	(3)
Clinical History, Evaluation, and Rule of Treatment	106	(1)
How Often Are Fractures Missed?	107	(2)
Summary of Key Points	109	(1)
Case Study	109	(2)
Self-Test	111	(1)
Appendix: Fracture Eponyms	112	(5)
Advanced Imaging: CT, MRI, and Ultrasound	117	(24)
Hilmir Agustsson
Computed Tomography	117	(5)
History	117	(1)
Principles of CT	118	(1)
Making the CT Image	118	(2)
Viewing CT Images	120	(1)
Clinical Uses of CT	121	(1)
Summary and Future Developments	122	(1)
Magnetic Resonance Imaging	122	(8)
History	122	(1)
Principles of MRI	123	(3)
Making the MR Image	126	(1)
Viewing MR Images	127	(1)
Clinical Uses of MRI	128	(2)
Summary and Future Developments	130	(1)
Diagnostic Ultrasound	130	(2)
History	130	(1)
Principles of Diagnostic Ultrasound	130	(2)
Ultrasound Intensity	132	(4)
Creating the Ultrasound Image	133	(1)
Viewing the Ultrasound Image	133	(2)
Clinical Uses of Ultrasound	135	(1)
Summary and Future Developments	136	(1)
Comparison of Evaluative Properties of CT, MRI, and Ultrasound	136	(2)
Summary of Key Points	138	(1)
Self-Test	138	(3)
Radiologic Evaluation of the Cervical Spine	141	(42)
Anatomy Review	141	(6)
Osseous Anatomy	141	(3)
Ligamentous Anatomy	144	(1)
Joint Mobility	145	(1)
Growth and Development	146	(1)
Postural Development	146	(1)
Routine Radiologic Evaluation	147	(11)
Practice Guidelines for Spine Radiography in Children and Adults	147	(11)
Basic Projections and Radiologic Observations	158
Routine Radiologic Evaluation of the Cervical Spine	148	(8)
Optional Projections for Radiologic Evaluation of the Cervical Spine	156	(2)
Trauma at the Cervical Spine	158	(10)
Radiology for Trauma of the Cervical Spine	158	(1)
Potential Injury to Spinal Cord and Spinal Nerves	158	(3)
Fractures	161	(2)
Dislocations	163	(3)
Cervical Spine Sprains	166	(1)
Intervertebral Disk Herniations	167	(1)
Degenerative Changes in the Cervical Spine	168	(3)
Degenerative Disk Disease	169	(1)
Degenerative Joint disease	169	(1)
Foraminal Encroachment	170	(1)
Cervical Spine Spondylosis	170	(1)
Spondylosis Deformans	171	(1)
Diffuse Idiopathic Skeletal Hyperostosis	171	(1)
Clinical Considerations of the Degenerative Spine	171	(1)
Cervical Spine Anomalies	171	(3)
Summary of Key Points	174	(1)
Case Studies	175	(5)
Self-Test	180	(3)
Radiologic Evaluation of the Temporomandibular Joint	183	(26)
Hilmir Agustsson
Historical Perspective	183	(1)
The Causes of TMJ Disorders	183	(1)
Anatomy Review	184	(3)
Osseous Anatomy	184	(1)
Ligamentous Anatomy	184	(1)
Biomechanics of the TMJ	185	(2)
Growth and Development	187	(1)
The Role of Imaging in the Evaluation of the TMJ	187	(9)
Conventional Radiographs	187	(1)
Routine Radiologic Evaluation of the Temporomandibular Joint	188	(6)
Conventional Tomography	194	(1)
Computed Tomography	194	(1)
Magnetic Resonance Imaging	194	(2)
Arthritides at the TMJ	196	(2)
Osteoarthritis	196	(1)
Rheumatoid Arthritis	197	(1)
Disk Displacement	198	(2)
Etiology	198	(1)
Clinical Presentation	198	(1)
Classification	198	(1)
MR Imaging of Disk Displacements	199	(1)
Treatment of Disk Displacement	199	(1)
Other Disorders	200	(1)
TMJ Hypermobility	200	(1)
Fractures	200	(1)
Craniomandibular Anomalies	200	(1)
The TMJ and the Cervical Spine	201	(2)
Positional Faults of the Cervical Spine	202	(1)
Acknowledgment	203	(1)
Summary of Key Points	204	(1)
Case Study	205	(1)
Self-Test	206	(3)
Thoracic Spine, Sternum, and Ribs	209	(40)
Anatomy Review	209	(4)
Osseous Anatomy	209	(2)
Ligamentous Anatomy	211	(1)
Joint Mobility	212	(1)
Growth and Development	212	(1)
Routine Radiologic Evaluation	213	(13)
Practice Guidelines for Spine Radiography in Children and Adults	213	(1)
Basic Projections and Radiologic Observations	213	(1)
Routine Radiologic Evaluation of the Thoracic Spine	214	(4)
Routine Radiologic Evaluation of the Sternum	218	(4)
Routine Radiologic Evaluation of the Ribs	222	(4)
Trauma at the Thoracic Spine	226	(6)
Radiology for Trauma of the Thoracic Spine	226	(1)
The Three-Column Concept of Spinal Stability	227	(1)
One- or Two-Column Injuries	227	(3)
Two- or Three-Column Injuries	230	(2)
Fractures of the Bony Thorax	232	(1)
Abnormal Conditions	232	(8)
Osteoporosis	232	(2)
Scoliosis	234	(4)
Tuberculous Osteomyelitis (Pott's Disease)	238	(1)
Scheuermann's Disease	239	(1)
Thoracic, Rib, and Sternal Anomalies	240	(2)
Summary of Key Points	242	(1)
Case Study	243	(4)
Self-Test	247	(2)
Lumbosacral Spine and Sacroiliac Joints	249	(42)
Anatomy Review	249	(6)
Osseous Anatomy	249	(2)
Ligamentous Anatomy	251	(2)
Joint Mobility	253	(1)
Growth and Development	254	(1)
Routine Radiologic Evaluation	255	(13)
Practice Guideline for Lumbar Spine Radiography in Children and Adults	255	(1)
Basic Projections and Radiologic Observations	255	(1)
Routine Radiologic Evaluation of the Lumbar Spine	256	(8)
Routine Radiologic Evaluation of the Sacroiliac Joint	264	(4)
Trauma at the Lumbar Spine	268	(5)
Radiology for Trauma of the Lumbar Spine	268	(1)
Fractures of the Upper Lumbar Spine	268	(1)
Fractures of the Lower Lumbar Spine	268	(1)
Spondylolysis	268	(2)
Spondylolisthesis	270	(3)
Degenerative Conditions at the Lumbar Spine	273	(6)
Clinical Considerations of the Degenerative Spine	274	(1)
Lumbar Stenosis	274	(2)
Intervertebral Disk Herniations	276	(3)
Sacroiliac Joint Pathology	279	(2)
Ligamentous Injury	279	(1)
Degenerative Joint Disease	280	(1)
Sacroiliitis	280	(1)
Ankylosing Spondylitis	280	(1)
Lumbosacral Anomalies	281	(3)
Facet Tropism	281	(1)
Aberrant Transitional Vertebrae	282	(1)
Spina Bifida	283	(1)
Summary of Key Points	284	(2)
Case Studies	286	(4)
Self-Test	290	(1)
Radiologic Evaluation of the Pelvis and Hip	291	(38)
Anatomy Review	291	(3)
Osseous Anatomy	291	(2)
Ligamentous Anatomy	293	(1)
Joint Mobility	293	(1)
Growth and Development	293	(1)
Routine Radiologic Evaluation	294	(8)
Practice Guidelines for Extremity Radiography in Children and Adults	294	(1)
Basic Projections and Radiologic Observations	295	(1)
Routine Radiologic Evaluation of the Pelvis	296	(2)
Routine Radiologic Evaluation of the Hip and Proximal Femur	298	(4)
Trauma at the Pelvis and Hip	302	(9)
Radiology for Trauma of the Pelvis and Hip	302	(1)
Fractures of the Pelvis	303	(3)
Fractures of the Acetabulum	306	(2)
Fractures of the Proximal Femur	308	(2)
Hip Dislocation	310	(1)
Pathological Conditions at the Hip	311	(10)
Degenerative Joint Disease of the Hip	311	(2)
Rheumatoid Arthritis of the Hip	313	(1)
Avascular Necrosis of the Proximal Femur	313	(5)
Slipped Femoral Capital Epiphysis	318	(1)
Developmental Dysplasia of the Hip	318	(3)
Summary of Key Points	321	(2)
Case Studies	323	(4)
Self-Test	327	(2)
Radiologic Evaluation of the Knee	329	(38)
Anatomy Review	329	(4)
Osseous Anatomy	329	(1)
Ligamentous Anatomy	330	(1)
Joint Mobility	331	(1)
Growth and Development	332	(1)
Routine Radiologic Evaluation	333	(9)
Practice Guidelines for Knee Radiography in Children and Adults	333	(1)
Basic Projections and Radiologic Observations	333	(1)
Routine Radiologic Evaluation of the Knee	334	(8)
Additional Views Related to the Knee	342	(1)
Trauma at the Knee	342	(11)
Imaging for Trauma of the Knee	343	(1)
Fractures of the Distal Femur	343	(1)
Fractures of the Proximal Tibia	344	(2)
Fractures of the Patella	346	(1)
Subluxations and Dislocations of the Patella	346	(1)
Fractures and Dislocations of the Proximal Fibula	347	(1)
Fractures of the Articular Cartilage	348	(1)
Soft-Tissue Injuries at the Knee	349	(4)
Degenerative Joint Disease	353	(7)
Radiologic Characteristics	353	(2)
Clinical Considerations	355	(1)
Treatment	355	(1)
Knee Anomalies	355	(1)
Genu Valgum	355	(1)
Genu Varum	356	(1)
Genu Recurvatum	357	(3)
Summary of Key Points	360	(1)
Case Studies	361	(4)
Self-Test	365	(2)
Ankle and Foot	367	(44)
Anatomy Review	367	(21)
Osseous Anatomy	367	(1)
Ligamentous Anatomy	368	(2)
Joint Mobility	370	(1)
Growth and Development	370	(18)
Routine Radiologic Evaluation	388	(1)
Practice Guidelines for Ankle and Foot Radiography in Children and Adults	388	(1)
Basic Projections and Radiologic Observations	388
Routine Radiologic Evaluation of the Ankle	372	(10)
Routine Radiologic Evaluation of the Foot	382	(6)
Trauma at the Ankle and Foot	388	(10)
Radiology for Trauma of the Ankle and Foot	388	(1)
Sprains at the Ankle	388	(2)
Fractures at the Ankle	390	(4)
Fractures of the Foot	394	(4)
Deformities of the Foot	398	(4)
Radiologic Evaluation	398	(1)
Hallux Valgus	398	(1)
Pes Cavus	399	(1)
Pes Planus	400	(1)
Talipes Equinovarus	401	(1)
Foot Anomalies	402	(1)
Accessory Bones	402	(1)
Summary of Key Points	403	(1)
Case Studies	404	(5)
Self-Test	409	(2)
Radiologic Evaluation of the Shoulder	411	(36)
Anatomy Review	411	(2)
Osseous Anatomy	411	(1)
Ligamentous Anatomy	412	(1)
Joint Mobility	413	(1)
Growth and Development	413	(1)
Routine Radiologic Evaluation	413	(13)
Practice Guidelines for Shoulder Radiography in Children and Adults	413	(13)
Basic Projections and Radiologic Observations	426	(12)
Routine Radiologic Evaluation of the Shoulder	416	(4)
Routine Radiologic Evaluation of the Acromioclavicular Joint	420	(2)
Routine Radiologic Evaluation of the Scapula	422	(4)
Additional Views	426	(2)
Trauma at the Shoulder	428	(1)
Radiology for Trauma of the Shoulder	428	(1)
Fractures of the Proximal Humerus	428	(2)
Fractures of the Clavicle	430	(3)
Fractures of the Scapula	433	(1)
Dislocations of the Glenohumeral Joint	434	(2)
Acromioclavicular Joint Separation	436	(1)
Rotator Cuff Tears	437	(1)
Abnormal Conditions at the Shoulder	438	(3)
Impingement Syndrome	438	(1)
Adhesive Capsulitis	439	(2)
Summary of Key Points	441	(1)
Case Studies	442	(4)
Self-Test	446	(1)
Radiologic Evaluation of the Elbow	447	(28)
Anatomy Review	447	(2)
Osseous Anatomy	447	(1)
Ligamentous Anatomy	448	(1)
Joint Mobility	448	(1)
Growth and Development	448	(1)
Routine Radiologic Evaluation	449	(13)
Practice Guidelines for Radiography of the Elbow in Children and Adults	449	(1)
Basic Projections and Radiologic Observations	449	(1)
Routine Radiologic Evaluation of the Elbow	450	(8)
Routine Radiologic Evaluation of the Forearm	458	(4)
Trauma at the Elbow	462	(8)
Radiology for Trauma of the Elbow	462	(1)
Fractures of the Distal Humerus	462	(3)
Fractures of the Radial Head	465	(1)
Fractures of the Proximal Ulna	466	(1)
Fractures of the Radial and Ulnar Shafts	467	(2)
Dislocations of the Elbow	469	(1)
Summary of Key Points	470	(1)
Case Studies	470	(4)
Self-Test	474	(1)
Radiologic Evaluation of the Hand and Wrist	475	(56)
Corlia van Rooyen
Anatomy Review	475	(4)
Osseous Anatomy	475	(1)
Joints and Ligaments of the Hand and Wrist	476	(1)
Joint Mobility	477	(1)
Growth and Development	478	(1)
Routine Radiologic Evaluation	479	(19)
Practice Guidelines for Extremity Radiography in Children and Adults	479	(19)
Basic Projections and Radiologic Observations	498
Routine Radiologic Evaluation of the Hand	480	(6)
Routine Radiologic Evaluation of the Wrist	486	(6)
Optional Wrist Views	492	(6)
Trauma at the Hand and Wrist	498	(11)
General Incidence	498	(1)
Radiology for Trauma of the Hand and Wrist	498	(1)
Fractures of the Hand	498	(4)
Fractures of the Wrist	502	(4)
Distal Radius Fractures	506	(3)
Wrist Instability	509	(10)
Imaging Techniques to Diagnose Instabilty	509	(4)
Instability of the Distal Radioulnar Joint	513	(2)
Classification of Carpal Instabilities	515	(4)
Soft-Tissue Disorders	519	(2)
Triangular Fibrocartilage Complex Pathology	519	(1)
Carpal Tunnel Syndrome	520	(1)
Arthritides	521	(2)
Degenerative Joint Disease	521	(1)
Rheumatoid Arthritis	522	(1)
Summary of Key Points	523	(2)
Case Studies	525	(5)
Self-Test	530	(1)
Integration of Imaging into Physical Therapy Practice	531
J. Bradley Barr
Changing Perspectives on Diagnostic Imaging in Physical Therapy Education	531	(3)
The Traditional Model	531	(1)
An Evolving Model	531	(3)
The Physical Therapist as a Primary Care Provider	534	(1)
The Physical Therapist as the Referral Source	534	(1)
The Physical Therapist as an Educated User of Diagnostic Imaging	534	(1)
The United States Military Health System	535	(1)
Other Practice Environments	535	(1)
Access to Imaging and Relationships with Physicians	535	(2)
The Role of Imaging in the Diagnostic Process	537	(1)
When to Recommend Imaging	537	(1)
Value of the Information	537	(1)
Clinical Decision Making and Clinical Decision Rules	538	(3)
The Role of Imaging in Physical Therapy Intervention	541	(1)
What Do Physical Therapists Look For?	541	(1)
Incorporating Imaging into Treatment Planning	541
Imaging Modalities and Physical Therapy Decision Making	541	(1)
What Does the Future Hold?	542	(1)
Summary of Key Points	543	(1)
Case Studies	544	(1)
Self-Test	548