Musculoskeletal X-ray Dr lai quoc thai Dr lai quoc thai People's Hospital 115 Content • Bone and joint anatomy • Systematic approach • Viewing principles • Musculoskeletal Pathology Xrays Dr lai quoc thai People's Hospital 115 Musculoskeletal Xray Bone anatomy • Most bones develop from cartilaginous ossification centres to form a diaphysis (shaft), or epiphysis (end). During bone growth the diaphysis and epiphysis are separated by the epiphyseal line (growth plate) which fuses later in life. The zone adjacent to the growth plate on the diaphyseal side is called the metaphysis. • Sesamoid: A sesamoid bone is a bone that ossifies within a tendon. • Apophysis: An apophysis is a normal developmental outgrowth of a bone which arises from a separate ossification centre, and fuses to the bone later in development Dr lai quoc thai People's Hospital 115 Musculoskeletal Xray Bone anatomy example - Knee Long bones comprise diaphysis, metaphysis and epiphysis The growth plate separates the metaphysis from the epiphysis until fusion in adult life A sesamoid is a bone that ossifies within a tendon An apophysis is a normal bony outgrowth of a bon Dr lai quoc thai People's Hospital 115 Musculoskeletal Xray Descriptive terms example - metacarpal The metacarpal bone shown has a base, shaft, neck and head Many bones also have proximal and distal articular surfaces When describing abnormalities of an articular surfaces remember to mention whether it is proximal or distal Dr lai quoc thai People's Hospital 115 Musculoskeletal Xray Bone structure Cortex v medulla example - Tibia and fibula Cortex denser - therefore whiter Medulla - note the fine trabecular pattern Dr lai quoc thai People's Hospital 115 Musculoskeletal Xray Joint anatomy • Most joints are synovial and comprise two articulating bones lined with hyaline cartilage and contained by a synovial lined capsule. • Although soft tissues such as cartilage and capsular structures are of low density, and therefore less well-defined on X-ray images Dr lai quoc thai People's Hospital 115 Musculoskeletal Xray Joint anatomy example - Knee Certain peri-articular soft tissues such as ligaments and tendons, or even cartilaginous structures such as the meniscus, can be seen on X-ray If there is narrowing of a joint - this implies abnormal thinning of cartilage Dr lai quoc thai People's Hospital 115 Musculoskeletal Xray Systematic approach Systematic checklist • Patient and image data • Bone and joint alignment • Joint spacing • Cortical outline • Bone texture • Soft tissues Dr lai quoc thai People's Hospital 115 Musculoskeletal Xray Bone and joint alignment Clinical information Trauma to forefoot Clinically evident dislocation X-ray performed to exclude underlying fracture Alignment Loss of bone alignment at the middle toe metatarsophalangeal joint due to dislocation Alignment and joint spacing elsewhere is norma Dr lai quoc thai People's Hospital 115 Musculoskeletal Xray [...]... Check the cortical outline (white lines) of ALLbones visible on every X- ray available Check for any breach in this outline (red line ! ) Do not stop when you find one abnormality - keep going until your eyes have covered all bones ke s lo cu us M Dr lai quoc thai Bone texture People's Hospital 115 t le al ay Xr Bone texture example - Proximal femur Well defined trabecular pattern visible forming the femoral... lesion ay Xr The current X- ray shows an obvious displaced fracture(#) of the femoral shaft ball ke s lo cu us M Dr lai quoc thai Keep your Hospital 115 People's eye on the t le al ay Xr Clinical information Elderly woman - mechanical fall Right hip pain Shortened and externally rotated right leg ke s lo cu us M Dr lai quoc thai Look forHospital 115 People's the unexpected t le al ay Xr Clinical information... 115 People's the unexpected t le al ay Xr Diagnosis Minor rotator cuff disease 'Pancoast' tumour - apical lung cancer (cause of distal pain - referred from brachial plexus) ke s lo cu us M Dr lai quoc thai Artifact People's Hospital 115 t le al ay Xr Clinical information Wrist pain after a fall Suspected carpal bone fracture Diagnosis The jewellery artifact makes it impossible to exclude bone injury... distribution in the hands t le al ay Xr ke s lo cu us M Dr lai quoc thai People's Hospital 115 t le al ay Xr ke s lo cu us M Dr lai quoc thai People's Hospital 115 t le al ay Xr ke s lo cu us M Dr lai quoc thai People's Hospital 115 t le al ay Xr ke s lo cu us M Kellgren and Lawrence (K&L) criteria of knee osteoarthritis Dr lai quoc thai People's Hospital 115 t le al ay Xr ke s lo cu us M Dr lai quoc thai... ay Xr ke s lo cu us M Dr lai quoc thai Right v left People's Hospital 115 t le al ay Xr Clinical information Right groin pain after a fall Shortened and externally rotated right leg Diagnosis Fractured neck of right femur ke s lo cu us M Dr lai quocv old New thai People's Hospital 115 t le al The old image demonstrates the cause of the fracture - the bone has been weakened by a lytic bone lesion ay Xr... People's Hospital 115 t le al ay Xr Clinical information Severe knee pain following a fall from height Diagnosis Tibial plateau fracture Viewing principles us M 2 views are better than 1 Check all available images Compare with the other side (if imaged) If available ALWAYS compare with old X- rays ke s lo cu • • • • Dr lai quoc thai People's Hospital 115 t le al ay Xr Clinical information Twisting injury... radiographic hallmarks are:  Soft tissue swelling  Osteoporosis  Joint space narrowing  Marginal erosions  Proximal and bilateral symmetry in the hands al ay Xr ke s lo cu us M Dr lai quoc thai People's Hospital 115 t le al ay Xr ke s lo cu us M Dr lai quoc thai People's Hospital 115 t le al ay Xr Dr lai quoc thai People's Hospital 115 us M HLA-B27 Spondyloarthropathies ke s lo cu Include: 4 type • Ankylosing... le al ay Xr Clinical information Longstanding forefoot pain Diagnosis Osteoarthritis of the 1st metatarsophalangeal joint Note also the large osteophytes - a sign of osteoarthritis ke s lo cu us M Dr lai quoc thai Cortical outline People's Hospital 115 t le al Clinical information Punched brick wall when drunk Diagnosis Fractured ring finger metacarpal bone - a so called 'boxer's fracture ay Xr Cortical... Lawrence (K&L) criteria of knee osteoarthritis Dr lai quoc thai People's Hospital 115 t le al ay Xr ke s lo cu us M Dr lai quoc thai People's Hospital 115 t le al ay Xr ke s lo cu us M Dr lai quoc thai People's Hospital 115 t le al ay Xr Dr lai quoc thai People's Hospital 115 us M Rheumatoid arthritis ke s lo cu • Rheumatoid arthritis (RA) is a common arthritis of unknown aetiology which causes synovial... lai quoc thai People's Hospital 115 Alignment (is there subluxation or dislocation?) Bone mineralisation ke osteopenia present?) (is sclerosis or Cartilage (including a search for t le erosions, plus loss of joint space) Soft tissues (is there soft tissue al swelling, tophi of gout, calcification in the soft tissues as in scleroderma?) ay Xr us M Dr lai quoc thai People's Hospital 115 Arthritis ke s