Studied by 5 peoplewhich view of the thoracic reveals all 12 vertebrae, vertebral end plates, pedicles, intervertebral disk
A/P
which view of the thoracic spine reveals all but upper 2 or 3 vertebrae, vertebral bodies, intervertebral disk space
lateral
which view of the thoracic spine reveals the upper thoracic vertebrae
swimmers shoulder
what are some examples of thoracic spine traumatic injuries
anterior compression fx, vertebral fx-dislocatiions, rib fracture
what are some examples of thoracic spine pathologies
Osteoporosis
scoliosis
scheuermann’s disease
spinal tuberculosis (Pott’s disease)
what kind of SCI is detected on radiographs
anterior vertebral body compression fx
what is the MOI for anterior vertebral body fx
flexion
what is common for compression fx to look like
Cod fish
what is used to view bone detail
bone window
what is the gold standard test for osteoporosis
dexa scan
what are some tx for osteoporosis
reduce compression
what can be used to measure the degree of scoliosis
Cobb angle
what is Scheuermann’s disease
unknown etiology
common in adolescent boys and girls
sx of backache and thoracic kyphosis from osteochondrosis
schmorl nodes are consistent findings
what is the diagnostic criteria for Scheuermann’s disease
at least 3 continuous vertebrae to be involved
at least 5 degrees of anterior wedging of each affected vertebra
thoracic kyphosis greater than 40 degrees
what are some PT interventions for Scheuermann’s disease?
lay supine
prayer stretch
supine snow angel with hook lying
mini pelvic tilts
work up to light foam rolling
t/f: Scheuermann’s disease affects the pectoralis major
false
if a patient has Scheuermann’s disease, what muscle would be tight in the low back
erector spinae
what is always secondary to a tuberculosis lesion elsewhere in the body
Tuberculous osteomyelitis (Pott’s disease)
what is the clinical presentation of Tuberculous osteomyelitis (Pott’s disease)
back pain is earliest and most common sx
pain usually localized, most common in thoracic spine
systemic s/s such as weight loss, fever, and fatigue usually present
lower thoracic vertebra are usually sites, followed by upper lumbar
what is a radiologic assessment of Tuberculous osteomyelitis (Pott’s disease)
progressive destruction leads to collapse of anterior vertebral bodies and an associated increase in kyphosis
often more than 1 vertebra involved
osteolysis
which if the preferred view of the chest
P/A
chest x-rays can look at
pneumonia
lobar collapse
pleural effusion
pneumothorax
cardiomegaly
For acute LBP clinical findings, what would lead to leading to get radiograph
cluster of red flags
no response to 3 weeks of PT intervention; 2-3 visits even
what are the recommended screening for lumbar spine imaging
A/P and lateral radiographs
erythrocyte sedimentation rate (ESR) → occult neoplasms of spine
what view of a radiograph of the lumbar spine shows all 5 vertebral bodies
A/P
what view of a radiograph of the lumbar spine shows alignment of lumbar vertebrae and intervertebral disk spaces
lateral
what view of a radiograph of the lumbar spine shows facet articulations, pedicles, pars, scotty dog
A/P and P/A oblique
what is the downside of the A/P and P/A oblique
high levels of gonadal radiation
what is the owl sign
deals with the condition of the pedicle- should be able to see the eyes and beak. can see pedicle erosion, compression fx, and fx dislocation
what are different degenerative conditions
DDD
DJD
spondylosis
spondylolysis
spondylolisthesis
spinal stenosis
what condition has breakdown of discs
DDD
what condition has facet breakdown
DJD
what condition has formation of osteophytes in response to DDD- the umbrella term
spondylosis
what condition has a defect in pars interarticularis (scotty dog)
spondylolysis
what condition has forward displacement of vertebrae can result from degenerative changes and or fx
spondylolisthsis
what condition develops in the central canal, intervertebral foramen, or lateral or sub articular recesses
spinal stenosis
what are the segments of the scotty dog fracture/spondylolysis
transverse process- nose
pedicle- eye
pars interarticular - neck
superior articular facet- ear
inferior articular facet- front leg
what indicates if there is a scotty dog fracture
if the dog has a collar on the parts interarticularis
what are spondylolthesis grades determined by
percentage of motion
what is a protrusion of disk material through annulus
intervertebral disk herniation
t/f: conventional radiographs are poor at showing disk material but will show chronic changes to bone
true
what imaging are good at showing morphological and physiochemical changes in disk
CT myelography & MRI
the vacuum phenomena involving the intervertebral discs are a result of what
accumulation of gas within the crevices of the intervertebral dicks or adjacent vertebrae
what should be looking for with S1
triangle shape
what is the common direction for a primary disc budge
posterior/lateral
why is it common for a disc bulge to be P/L
because the posterior longitudinal ligament is not the entire width of the vertebral body and there is a space
t/f: are fat infiltrated in the lumbar multifidus muscles strongly associated with LBP in adults
true (81% of adult sample)
if an image has the terms melted candle stick on it, what is that indicative of
AS
what view of a radiograph shows entire pevlis, sacrum, coccyx, and lumbrosacral articulation and B hip joint
A/P view of pelvis
what view of a radiograph of the pelvis shows acetabulum, femoral head, neck, and proximal 3rd of shaft, GT, and angle of inclination of femoral neck
A/P view of hip
what view shows femoral head, neck, and proximal 3rd of femoral shaft and greater and lesser trochanter from medial aspect
lateral frog leg of hip
what position is the lateral frog leg of hip image taken in
FABER
what are the 6 important lines of the pelvis
radiographic teardrop
iliopublic
ilioischial
anterior acetabular rim
posteriior acetabular riim
acetabular roof
what does a disruption of the lines of the pelvis indicate
fracture, dislocation or pathology in the hip/pelvis
what are some sex differences on pelvic radiographs
infrapubic angle is greater than 90 degrees in female
pelvic inlet shape
male: heart shaped
female: round or oval
wider greater sciatic notch in females
acetabulum faces more anteriorly in females
sacrum more triangular and shorter in females
oval obturator foramen in females
t/f: CT is not the first line imaging evaluating the pelvic viscera except in the setting of trauma
true
what are common pelvic and hip fx
pelvic ring f
ischiopubic ramus fx
acetabular fx
what constitutes a pelvic ring fx
1 or more fx to the bones that make up the ring (2 inanimate and sacrum)
what is the most common MOI for a pelvic ring fx
MVA
what kind of proximal femoral fx is complicated by vascular disruption, may lead to avascular necrosis
intracapsular fx
what kind of proximal femoral fx is vascular complication is rare
extracapsular fx
t/f: upper fx to proximal femoral head are better than lower fx
false (vise versa)
what kind of femoral neck stress fracture is the best to have
compression
what kind of femoral neck stress fracture is the worst to have
tension
what are some signs of OA
joint space narrowing
sclerotic subchondral bone
osteophyte formation at joint margins
cyst or pseudocyst formation
migration of femoral head
what are the types of migration of the femoral head
superolateral
non-migratory
medial-axial
what are some s/sx of RA
osteoporosis of periarticular area
symmetrical and concentric joint space narrowing B
articular erosions
synovial cysts located within nearby bone
periarticular swelling and joint effusions
axial migration of femoral head
acetabular protrusion
minimal evidence of bone trying to repair itself → lack of sclerotic bone or osteophytes
what is the simple complex of RA
synovial fluid turning into battery acid
what is a SCFE
weakening of epiphyseal plate that leads to slipping and displacement of femoral head
patterns of pain in hip and knee area, limited hip ROM, antalgic gait, and limb shortening
2x more prevalent in boys than girls
onset usually around growth spurts at puberty
what is legg-calve perthes disease
epiphyseal ischemic necrosis of femoral head
associated with subtle trauma, synovitis, infection, or metabolic bone disease
can be unilateral or B
Predominately in boys, avg 6y.o
Findings
non-specific dull pain in joint, thigh or leg
limited hip ROM, progressive limp
what does the femoral head look like on legg-calve-perthes
shrunken walnut
what type of femoral acetabular impingement is the femoral head-neck junction is offset and femoral head doesnt fully clear the acetabular rim
Cam
what type of femoral acetabular impingement has over coverage of femoral head caused by acetabulum, caused by deep socket or other malformations
pincer
what test can test for femoral acetabular impingement
straight flexion
what are common findings for femoral acetabular impingement
snapping
clicking
limited hip ROM
hip flexion contractures
painful provocation tests
true hip locking is associated with what conditioin
labral tears
t/f: many unsymtomatic people have FAI and labral tears
true
t/f:labral tears of the hip can happen anywhere
true
what is the common MOI for a hip labral tear
forced FADIR- pressure on with twisting
looking for labral tears of the hip is similar to the shoulder and we should be looking for what
black triangles
Note
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