Spondylolysis

Spondylolysis SPONDYLOLYSIS = Defect in pars interarticularis portion of lamina. Etiology: Repeated Microtrauma Heredity component (hypoplastic pars) Clinical: May be asymptomatic May present with low back pain 3-7% of general population (all ages) Athletes -Increased to 23-62% Males 2-4 more than Females 95% at L5 level Bilateral pars defects can lead to spondylolisthesis XRAY Most sensitive projection- lateral views Most specific projection- oblique views (Scottie dog collar) May not be seen if plane of defect lies near sagittal plane CT Incomplete vertebral ring Linear lucency…

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Cervical Rib

Cervical Rib 3 Different Cases of Cervical Ribs AKA- Supernumerary Rib or Accessory Rib Arises from the seventh cervical vertebre Rate – 0.5% of the population More common in females. Usually asymptomatic It is the most important anatomic rib variant clinically because they can result in thoracic outlet syndrome (compression of brachial plexis or subclavian vessel) Always Remember to Mention the presence of Cervical Ribs if present on cervical spine x-rays and if visualized on chest x-rays   Remember- “The Eyes Will Not See What…

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Madelung Deformity Of Wrist Xray

Madelung Deformity Of Wrist Xray Madelung deformity Premature closure or defective development of the ulnar third of the distal epiphysis of the radius Bilateral in 50-66% of patients. Often rare congenital deformity manifesting 10-14 years  (autosomal dominant- variable penetrance) Can be acquired consequence of trauma to the growth plate More common in females. Can be Associated with: Leri-Weill syndrome Turner syndrome gonadal dysgenesis nail-patella syndrome Hereditary multiple exostoses Hurler mucopolysaccharidosis Achondroplasia Ollier disease Madelung deformity was first described in 1878 by the German surgeon Otto…

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Stress Fracture Xrays

Stress Fracture Xrays 2 Types: Stress Fracture Insufficiency Fracture = Normal Stress on Abnormal Bone Fatigue Fracture = Abnormal Stress on Normal Bone Stress fractures are microscopic fractures which typically do not cause macroscopic interruption of the bone. Therefore no lucent fracture line is visible on x-ray Follow up X-rays as demonstrated above will show bony productive change MRI is the Study of Choice to Diagnose Stress Fracture Untreated stress fractures will go on to be overt fractures Risk factors: Repetitive overuse (more common in Lower…

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Supracondylar Process

  Supracondylar Process AKA supracondylar spur, supratrochlear spur, or avian spur Located along the distal anteromedial humeral cortex ~5 cm proximal to and pointing towards the medial epicondyle of the humerus (as opposed to an osteochondroma which points away from the joint) It is an anatomical varient present in ~1% of the population. Supracondylar Process is considered a vestigial structure as the supracondylar canal (foramen) can be found as a normal structure in many more primitive mammals Ligament of Struthers This may be present and…

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AC Joint Separation

                        Acromioclavicular Joint Separation Occurs in 10% of all shoulder injury; 12% of shoulder dislocations involve AC joint Mechanism –Direct fall on shoulder in adducted position with downward force on acromion- often in football, hockey, rugby players –FOOSH- force directed up to humerus and acromion process, superior displacement and stretching of AC ligament Rockwood Classification Type I- sprained but intact Type II- AC disruption, intact CC Type III- complete disruption AC and CC Type…

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Elbow Effusion and Radial Head Fracture X-ray

  Uplifting of the Anterior Fat Pad (Spinnaker Sail Sign) = Fracture Positive Posterior Fat Pad Sign = Fracture Positive Fat Pad Sign in Adult = Radial Head and/or Neck Fracture Positive Fat Pad Sign in Child = Supracondylar Fracture ALWAYS LOOK FOR THE FAT PAD SIGNS Anterior Fat Pad sign = Uplifting of the fat pad from the anterior inferior humerus Posterior Fat Pad Sign = Visualization of the posterior fat pad FAT PAD SIGNS IN THE ELBOW ARE ALWAYS ABNORMAL  

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5th MT Dislocation Xray

The most obvious finding is that the bases of the metacarpals do not line up. The Base of the 5 MC is proximal to the base of the 4 MC. This should be the first clue. The second clue is the marked soft tissue swelling of the hand on the lateral xray. Plus the lateral xray demonstrates the 5MC to be palmar to the other metacarpals which is a more subtle finding. This is an unusual type of dislocation but if you remember to look…

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Avoid the Easy Button

Is This a NORMAL Xray of the Hand? No? I Agree. But it was read as normal when a Radiologist “Hit the Easy Button” = “Macro Normal Right Hand” This patient complained of hand and wrist pain. The patient’s pain appears to be from their severe midcarpal row arthritis with apparent bone on bone at the capitate-scaphoid articulation. There is also evidence of prominent chondrocalcinosis. Please remember that although there is no fracture evident on the x-ray, it does not mean there is no pathology…

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Kohler’s Disease X-ray

Note the patchy fragmented markedly small and somewhat flat navicular. This reflects avascular necrosis of the Navicular in a skeletally immature patient: Kohler’s disease. This is a self-limiting entity and almost always resolves completely. It is important to alert the referring clinician to this diagnosis as on an x-ray it can be mistaken for an aggressive process. This is not an aggressive process and almost always completely resolves with conservative therapy. Referenced Article  

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