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Diagnostic Imaging 3

Question	Answer
Glenohumeral joint	4-5mm
Acromiohumeral joint	7-11mm
Acromioclavicular joint	3-4mm
Coraclavicular joint	11-13mm
AP elbow	hand supinated
Medial Oblique Elbow	Hand pronated
Lateral Elbow	Flexed 90 with thumb pointed up.
Jones Projection	Tangential Olecranon
Jones Projection	Joint space between trochlea and olecranon process. Ulnar groove.
Capitellum view	Lateral position. Tube is cephalad 45.
AP elbow	coronoid fossa is superimposed upon the olecranon.
Olecranon foramen or Supratrochlear	Humeral foramen. Allows for more extension.
Radioulnar synostosis	Bone fusion. Bilateral and familial, extending 3-6 cm. Limit or prevent supination and pronation of forearm.
Later projection	Radial tuberosity is present just distal to the radial neck.Pseudocyst
Anterior fat pad	Small triangular radiolucency. Anterior to humerus on lateral view.
Posterior fat pad	adjacent to the posterior aspect of distal humerus. NEVER NORMAL. Seen with displacement of anterior fat pad.
Supinator fat stripe	Lateral elbow view. Parallel to the ventral spect of the proximal third of radius. Lies withing 1cm of ventral margins of the radius. Normal chevron appearance to trabecular pattern in distal humerus.
Supracondylar process	Exostosis of bone(spur) projecting from anteromedial aspect of distal humerus. toward the elbow joint.
Supracondylar process	Struther's Ligament. from the process to the medial epicondyle.
Capitellum	1-8 months
Radial Head	3-6 years
Internal(medial)epicondyle	3-7 years
Trochlea	9-10 yrs
Olecranon	6-10 yrs
External(lateral) epicondyle	9-13 yrs
Critoe	Earlier in girls.
Trochlea is	NEVER seen before the medial epicondyle
Fusing of elbow occurs	14-15yrs. Except for medial epicondyle which closes at 18 -19 years.
Anterior Humeral Line	Drawn tangential to anterior aspect of humerus on lateral view, past the elbow joint.
Anterior Humeral Line	Normal: The line should fall through the middle one third of the capitellum.
Anterior Humeral line	Abnormal: May suggest a supracondylar fracture
Radiocapitellar Line	Lateral projection: This line is drawn down the Center of and parallel to the long axis of the radius extending through joint space.
Radiocapitellar line	should pass center of the capitellum on all standard views. Could be dislocation of the Radial head or fracture of the capitellum.
Standard wrist series	PA wrist, PA Medial Oblique Wrist, Lateral Wrist.
PA medial Oblique wrist	Joint space between trapezium and trapezoid.
Lateral wrist	Determining relationship of the carpal bones with the distal radius following trauma.
Accessory view of wrist	PA Wrist with Ulnar Deviation and Carpal Tunnel view
PA wrist with Ulnar deviation	AKA Ulnar flexion. Helps rule out scaphoid fracture.
Scaphoid fat stripe	Extends from the trapezium to the radial styloid process.
Scaphoid fat stripe	Between radial collarteral ligament and the tendons of the EXTENSOR POLLICIS BREVIS and ABDUCTOR POLLICIS LONGUS.
90% of fractures of the radial compartment	the fat stripe is displaced lateral or obliterated.
The radius articulates with the head of the ulna at the	ulnar notch.
All carpal joint interspaces	should NOT exceed 2mm.
The distal radioulnar articulation	should NOT exceed 2mm.
Capitate	birth to 6mos
Hamate	birth to 6mos
Triquetrum	.5-3.5 yrs
Lunate	1.5-4.5 yrs
Navicular	3-9 yrs
Trapezium	3-9 yrs
Trapezoid	3-9 yrs
Pisiform	7-13 yrs
Distal Radial Epiphysis	.5-2 yrs
Distal Ulnar epiphysis	5.5-9.5 yrs.
Three arcs of carpal alignment	Along proximal of proximal. ALong distal of proximal. Along proximal or distal.
Pie sign(rotational abnormality)	A triangular shape of the lunate with overlap of the capitate.
Pie sign	PA view
Ulnar is 1-2mm	shorter than radius
Ulnar +	More load on the ulna. predisposed to lunate/triquestral ligament damage
Ulnar -	Greater stress upon lunate. Predisposed it AVN(avascular necrosis)
avascular necrosis	Keinbock's Disease
M/C site in the wrist is	accessory ossicle at the distal aspect of ulnar sytloid process.
Os Hamuli Proprium	Ununited hook of Hamate
Carpal Coalition	aka Congenital synostosis
M/C site of carpal coalition	Lunate and triquetrum
Madelung's Deformity	Retarded growth of medial portion of distal radial epiphysis. Ulnar slant.
Bayonette	wrist deformity resulting from posterior subluxation of the ulna.
Patient make OK sign	to help position palm at 45 tilts towards film for medial oblique wrist projection.
Trapezium-Trapezoid joint space is better viewed	Patient make OK sign.
Pronator Quadratus Fat Stripe	Made by pronator quad fascial plane on lateral projection.
Distal radial articular surface slopes	10-15 degrees volarly(to palm)
Carpal Angle	On PA wrist. First line is drawn tangent to the proximal surface of the scaphoid and lunate. Second line drawn tangent to proximal surfaces of the lunate and triquetrum
Carpal angle	NORMAL 128-142 degrees
Standard Hand views	PA hand, Medial Oblique Hand, Lateral Hand
Medial Oblique Hand	palm of hand 45 degrees to film
Norgaard's Projection (Ball Catcher's view)	Used to detect early radiographic changes in RHEUMATOID ARTHRITIS.
Accessory views	Norgaard's Projection, Finger series, Thumb series.
Finger series	PA, Oblique and Lateral
Thumb series	AP, Oblique and Lateral
Diaphyseal is	secondary site to tendinous attachment
Distal phalanx of the 4th digits is	longer and thicker than the 2nd.
Distal Tufts(aka ungual tufts)	Should be uniform. Lysis of the distal tufts is associated with SCLERODERMA as well as with other arthritic and endocrine disorders.
First metacarpal articulates with	Trapezium
Second metacarpal articulates with	Trapezoid
3rd metacarpal articulates with	capitate
4th metacarpal articulates with	hamate on the radial side.
5th metacarpal articulates with	hamate on the ulnar side.
Syndactyly	during 5th fetal week. Results in webbing or fusion. Demonstrated by soft tissue fusion between the fingers and any osseous anomalies of development.
Syndactyly	m/c in males. and M/c developmental anomaly of the hand.
Brachymetcarpy	shortening of metacarpal
Clindactyly	radial or ulnar deviation of the distal phalanx. Radial deviation of the 5th DIP.
Clindactyly of the 5th finger is	trisomy 21 (Down Syndrome)
Kirner deformity(dystelephalangy)	claw like deformity. Autosomal dominant
Symphalangism	absence of the interphalangeal joints with resultant fusion of the phalanges.
Vascular of nutrient canals.	nutrient canals of the hand. Nice smooth margins.
2 sesamoids	base of proximal phalanx of thumb.
1 sesamoid	interphalangeal joint in 72%
1 sesamoid	base of 5th mcp 82%
Sesamoids of thumb	12-14 yrs
Medial sesamoid lies	within adductor pollicics
Lateral sesamoid lies	with flexor pollicis brevis.
Metacarpal sign	PA projection of the hand. Single line drawn tangential to the 4th and 5th mtc head.
Normal MTC	3 mtc falls below(proximal)this line.
Abnormal MTC	Short 4th metacarpal. Juvenile chronic arthritis, sickle cell anemia, trauma, Turner syndrome
Steinberg thumb sign	Tip should protrude thru clenched fist. Marfan's, homocystinuria, or normal variant.
Compact bone is	thickest in the diaphysis. Tapers toward metaphysis
Trabecule are formed along lines of stress	Wolff's law
Short bones	do not have physis
Medullary space of flat bones	diploe(diploic space)
Irregular bones	cranial base and vertebrae.
Epiphysis	composed of cartilage. Signifies the end of the growth period.
Subchondral bone	Articular cortex and the bone immediately beneath it.
Apophysis	pathologically should be thought of as epiphysis. Site for attachment of ligaments or tendons.IE trochanters tuberosities and tubercles.
Enthesis	actual site of attachment of tendons and ligaments.
Physis	radiolucent area between the epiphysis and metaphysis. aka epiphyseal plate, growth plate, or growth center. Provides longitudinal growth.
Zone of Provisional calcification	junction of metaphysis and physis. Precursor to bone formation.
Metaphysis	between zone of provisional calcification and diaphysis.
Metaphysis	most metabolically active and m/c site for osseous tumors and infection.
Diaphysis aka shaft	lies between both metaphyses. longest part of bone. Provides strength and bone marrow
Periosteum	Membrane on diaphysis and metaphysis.
Epiphyseal periosteum	DOES NOT EXIST.
Inner cambium or periosteum	is metabolically labile.
Endosteum covers	all trabeculae and inner cortical margins. Helps maintain cortical thickness or the diaphysis.
ABCS	Alignment, Bones, Cartilage, and Soft tissue
Clinical data	age, sex, race, history.
Polyostotic	multiple lesions.
Monostotic (More common)	Single lesion.
Monostotic	usually indicate tumor or infection.
Symmetrical and equally distributed lesions	caused by disseminated disease(leukemia)
Asymmetric and haphazardly arragned lesions	metastasis
Chordoma	selectively involves clivus and sacral/coccxygeal junction
Chondroblastoma	occur in the epiphysis
Medullary lesions	within bone. thinning cortex, endosteal scalloping. Fibrous and cartilaginous lesions.
Cortical	denoted by eccentric position of the lesion. Destruction, distortion, or expansion of cortical bone.
Cortical lesions	invoke a periosteal response.
Periosteal	not normally seen on normal radiograph
Extra-osseous lesion	soft tissue tumor. May cause pressure erosion of the adjacent bone.
Most slow-growing tumors are	<6mm at time of discovery.
Aggressive lesions are larger	exceptions:aneurysmal bone cyst, simple bone cyst, Giant Cell tumor, and Fibrous dysplasia
Short lesions (<6cm)	secondary lesions. Metastatic disease.
Long lesions	Primary disorders.
Imperceptible margination	ill-defined, wide zone, AGRESSIVE
Sharp	non-agressive
Cortical thinning	thins towards metaphysis from diaphysis.
Tumors cause	localized cortical thinning.
Osteoporosis	thins all cortices.
Endosteal scalloping	frequently seen in cartilaginous or fibrous tumors(NON-AGRESSIVE)
Multiple myeloma	aggressive
Corical thickening	may occur locally or generally.
Bulging of intact cortex	non-agressive
Permeative or moth-eaten	agressive
Neoplastic bone destruction	caused by pressure of hyperemia-generated resorption.
Geographic	circular or oval. SOAP BUBBLE. NON-AGGRESSIVE
Permeative lesions	are more aggressive than moth-eaten.
Moth-eaten	2-5mm
Permeative	numberous tiny 1mm
Osteoblastic lesions	increased density.
mixed lesions	lytic and blastic patterns. Seen in Mixed metastatic disease.
matrix	is important for categorizing.
Intraosseous Fat	lucency with a central calcification. very rare
Soft tissues lipomas	often found
Stippled calcification	small, discrete, spotty. Enchondromas of hand M/C
Flocculent calcification	"popcorn" larger and spotty.
Arc and ring calcification	in soft tissue mass. CHONDROSARCOMA.
Fibrous	ground glass appearance. FIBROUS DYSPLASIA
Periosteal reaction	Infections/tumors. Takes 10-21 days to show. C
Periosteal reaction	Subperosteal extension of blood, pus, or tumor. Caused by hyperemia, inflammation, and edema.
Sold periosteal reaction	non-aggressive.
Laminated periosteal reaction	Aggressive,layered or onion skinned.
Spiculated	MOST AGGRESSIVE OF PERIOSTEAL REACTIONS hair-on-end or sunburst.
Sunburst	even more aggressive then hair-on-end.
Codman's triange	AGGRESSIVE: new bone at peripheral lesion-cortex junction.
Infectious lesions in soft tissue	obliterate fascial plane lines.
Tumors	displace fascial plane lines.
Soft tissue mass	is smaller than the osseous lesion unless it started in soft tissue first.
Tumors normally	stay out of joints.
Pigmented villonodular synovitis	in joint
Cause boney erosions	Degenerative cyst(geode), Rheumatoid arthritis, Gout, Pigmented Villondular synovitis
Standard Hip serives	Frog leg lateral, and AP Pelvis.
Accessory view	AP spot hip. Only done when there are questions for the AP Pelvis projection.
Frog leg	pt makes a figure 4 with involved hip. Don't not use w/elderly.
Acetabular notch	break in acetabular surface superomedially.
Sourcil(eyebrow)	Bony condensation in the roof of the acetabulum.
Kohler's Teardrop	not a true anatomical structure. Lateral border represents the anterior aspect of the acetabular fossa and its medial border the quadrilateral surface of innominate bone.
Inferior pubic rami	are further apart and more horizontal in women.
The pubic symphysis	should align w/ midline of sacrum
Kohler's teardrop and obturator foramen	should be symmetric
Gluteal crease	should overly the pubic symphysis in non-rotated pts.
Femoral Acetabular joint space	Superior 3-6mmMedial 4-13mmAxial 3-7mm
Phleboliths	below level of ischial spines. Seens after 30 yrs.
Injection depot	Form if fat necrosis occurs after an injection.
Triradiate cartilage	under 15 yrs. Represents growth centers of ischium, superior pubic rami, and ilium. Should fuse at 14 yrs. of
Ischiopubic Synchondrosis(Van Neck's Disease)	Growth plates of pubic rami and ischium. Fuses between 4-8 yrs. Disappears around 16 yrs
Iliac spophysis(aka Iliac Epiphysis)	Stages of ossification of the epiphysis indicates spinal maturity.(Risser's Sign)
Risser's Sign	measurement of the progression of spinal maturity. Appears first laterally near ASIS and progresses medially to PSIS.
Rider's bone	ASIS, ISCH TUBES, AIIS. Could be evulsion fractures.
Os acetabuli	supeerolateral margin of the acetabular roof. Unrelated to roof of acetabulum
Paraglenoid sulcus	m/c in females. Due to pressure of superior gluteal artery.
Pubic ears	Extend inferiorly from pubic bone.
Vascular channels	Y or v shaped grooves.
Bilarteral Iliac Horns	congenital anomaly. AKA Nail patella syndrome, HOOD, Fong's or osteoonychodysplasia.
Nail Patella syndrome aka Bilarteral Iliac Horns, Fong's, HOOD	Tetrad of dysplastic fingernails, hypoplastic or absent patellae, elbow dysplasias, and bilateral iliac horns. Osseous projections from the posterior iliac fossa
Herniation Pits aka Pitt's pits	Erosions within the femoral neck. Have sclerotic margin. Should NOT be seen below INTERTROCHANTERIC LINE.
Femoral acetabular impingement	inflammation caused by irregular joint capsules.
Wards Triangle.	Inferior portion of femoral neck.
3 groups of trabeculae that form wards triangle	Principal, secondary Compressive, and principal tensile group.
Obturator Internus fat plane	inside of the pelvic brim just opposite to acetabulum. rare
Iliopsoas fat plane	Medial to the femoral neck and extends toward the lesser trochanter.
Gluteus medius	lateral to the capsular fat planes
Capsular fat plane	just lateral to the femoral neck.
Pubic width	Males 4.8-7.2mmFemales 3.8-6mm Never more than 10mm
Teardrop distance(medial joint space)	Normal: 6-11mm with no more than 2mm difference side to side.
Waldenstron	widening due to joint diffusion.
Femoral angle	foot should be medially roated 15 degrees. Normal 120-130.
Less than 120	coxa vara
Greater than 130	Coxa valga
Center edge angle (CE angle of Wiberg)	Vertical line thru center of femoral head. another is drawn trhought the upper acetabular margin. NORMAL 20-40 degrees.
<20	hip dysplasia, acetabular dysplasia, and DDH
Kohler's Line	Drawn from pelvic brim to lateral obturator foramen. Normal: Medial acetabulum should fall lateral to this line
Protrusio acetabuli	Medial acetabulum is located medial to Kohler's line. Dash board fracture
Shenton's Line	Curved line along undersuface of the femoral neck and is continued along under the superior pubic rami. Normal: should be continuous
Skinner's Line	thru and parallel to femoral shaft. Second line is drawn perpendicular to the first, thru the proximal aspect of the greater trochanter.
Skinner's line	normal:fovea capitus should lie at or above the level to the 2nd line.
Klein's Line	Line is drawn parallel and off the cortex of the lateral femoral neck.
Klein's line	Line should overlap the femoral head equally on both sides. This line may be drawn on frog leg. Usually occurs in 13-15yr males that are overweight
Dysplasia of the hip	Allows femor to dislocate superior and inferior . Occurs at birth.
Lateral migration of the femoral head is measured by	Horizontal line of Hilgenreiner(Y-Y line)
Acetabular roof in infants	27.5
Upper limit of normal in acetabular roof is	30. A measurement stronger suggest acetabular dysplasia.
Proximal migration of femur	measured by observing the shortening of the vertical distance from the femoral metaphysis to Hilgenreiner's line.
Shenton's line is drawn between the	medial border of the neck of the femur and the superior border of the obturator foramen.
Standard knee series	AP Knee, Lateral Knee, Tunnel Knee.
Accessory view	Tangenital Patella(Sunrise patella); Bilateral AP weightbearing knees; Oblique Knee
Ap Knee	15 degrees of internal rotation of foot
Lateral Knee	Bend knee 30-35degrees of flexion.
Tunnel knee	45 degree flexion
Femorotibial joint space	should measure between 5-11mm
Tangential Patella	used to delineate the medial and lateral patellofemoral joint space 45 caudad tube tilt
Medial femoral condyle is	larger and rounder then its lateral counterpart
Distal Femoral Epiphysis	5mm at birth and has fringe like margins
Os cyamella	Ossicle in popliteus tendon on Lateral side.
Hypoplastic and absent patella	Normal ossification doesn't happen until 4 yrs. Assciated with Fong's
Bipartite Patella	Superolateral aspect. Bilaterally 80% of the time
Posterior Femur	Secondary to muscle pull of the gastrocs or adductor magnus.
Blumensaat's line	dense white line representing the surface of the intercondylar notch.
Soft tissue	suprapatellar tendon and infrapatellar ligament.
bursa	not usually seen around knee
Harris' (Growth arrest) line	Can see multiple w/severe Leukemia. Resolution of arrested growth. Appears as horizontal linear opacities. M/C in metaphyseal region of long bone.
Hoffa's Fat Pad	infrapatellar fat pad. between inferior pole of the patella and the tibial plateaus.
Ludloff's patch	Sector-shaped radiolucency in the anterior aspect of the distal femoral epiphysis. m/c 16 yrs old.
Patellar alta	patellar ligament greater than 20% longer than patella.Results in improper quadraceps muscle action. Chondromalacia patella
Patella Baja	Too low. JRA, Polio, and achondroplasia
Os Fabella	sesamoid bone is located within the tendon of the lateral head of the gastroc or posterior to the lateral condyle of the femur. Seen after 15 and is bilateral 2/3-3/4. AP view.
Sinding Larsen johannsend syndrome	just like osgood-schlater's but at inferior patellar pole.
Pellegrini-Steida	Calcification of the Medial collateral ligament of the knee. Due to previous trauma.
Intercondylar notch	Common site for intraarticular loose bodies to hide.
Medial Patellofemoral joint space	shorter and more vertical than lateral
Lateral patellofemoral joint space	longer and more horizontal than medial.
Patellar Tooth sign	Enthesopathic degenerative change of anterior surface of patella. usually with loss of patellofemoral joint space.
Ankle series	AP Ankle, Medial Oblique Ankle, Lateral Ankle.
Accessory view Ankle	Inversion and eversion stress views.
Ap Ankle	requires 15 degress of internal rotation and dorsiflexion.
Lateral Ankle	achilles tendon- Kagers Triangle.
Tibial Plafind	underside of distal tibia.
Anterior calliculi of medial malleolus is	longer then the posterior.
Lateral malleolus is	1cm distal and 1cm posterior to the medial malleolus
Medial clear space	3-4mm
lateral clear space	medial cortex of the lateral malleolus and the cortical surface to hf peroneal groove of the tibia. Should measure no more than 5mm or show a difference of 2mm when compared.
Medial Oblique view of the ankle	important view in the assessment of the post-traumatic ankle for the detecting subtle fractures of the distal fibular, posterior tibia, talar dome, and the base of the 5th Metatarsal.
stress views should be taken	1 or 2 hrs of the injury under anesthesia.
Talus tilts	6-7 degrees but can up to 20 degrees.
Talar Beak	osseous projection of the talar neck.
Calcaneal apophysis SEVER"S DISEASE	looks fragmented and sclerotic, but not.
Tarsal Coalition	Congential union(fibrous or osseous). Predisposed to degenerative arthrisit. M/C are the talocalcaneal and calcaneonavicular joints.
Os peroneum	Adjacent to the cuboid
Os Tibiale Externum	Just medial to the navicular
Os Trigonum	Posterior the the ankle joint.
Os Supranavicular	Superior to the navicular.

Created by: DixieDoll

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