Musculoskeletal Radiology
Since musculoskeletal complaints are very common, it is important for primary care providers to be familiar with when and how to order radiographic studies. Radiographs or “good old-fashioned X-rays” can be a useful extension of, but not a substitute for,
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Musculoskeletal Radiology David Olysav
Since musculoskeletal complaints are very common, it is important for primary care providers to be familiar with when and how to order radiographic studies. Radiographs or “good old-fashioned X-rays” can be a useful extension of, but not a substitute for, a good history and physical examination. This chapter provides guidance regarding the appropriate ordering of studies as well as outlining a few pitfalls that can be encountered. General approach to ordering X-ray studies [1] 1. X-rays should always be done in cases of significant trauma. 2. Patients who can be clinically diagnosed with common conditions do not need to be X-rayed, but if the condition does not respond as expected, X-ray should be considered. 3. Always perform X-rays of both the site of pain and the possible origin of the pain when radiculopathy is suspected (such as the neck or back). 4. A primary care provider ordering X-rays should personally review the films, as the provider has more clinical information than the radiologist interpreting the film. Similarly, providing more detailed information to the interpreting radiologist when ordering the film may help him or her better interpret the results. 5. Isolated bony tenderness, when not located at a tendinous insertion site, should be X-rayed. 6. If X-ray results are negative, but clinical suspicion for serious pathology remains, consider additional studies (such as bone scans for suspected neoplasm, computed axial tomography (CT), Magnetic resonance imaging (MRI), etc.). 7. Be aware that sometimes, even negative X-rays do have a “therapeutic” benefit for patients.
D. Olysav (*) Division of Orthopaedics, Department of Surgery, SIU School of Medicine, Springfield, IL 62794, USA e-mail: [email protected] J.M. Daniels and M.R. Hoffman (eds.), Common Musculoskeletal Problems: A Handbook, DOI 10.1007/978-1-4419-5523-4_12, © Springer Science+Business Media, LLC 2010
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Ordering X-Rays for Specific Body Areas C-Spine Patients with possible C-spine trauma need to be stabilized and imaged before any further evaluation is done. These films will typically be ordered in an emergency room or trauma setting, and in some cases, CT scans have replaced or supplemented radiographs for this purpose. Patients with nontraumatic C-spine complaints can be evaluated using AP and lateral films. Oblique views are typically not necessary, but an open-mouth odontoid view may be helpful when upper cervical (C1 or C2) injury is suspected, with major trauma, or in patients with trisomy 21 or rheumatoid arthritis.
LS Spine The LS spine can be adequately visualized with AP and lateral views, with the addition of a coned LS spine view, which helps evaluate the SI join and spinal alignment.
Shoulder AP view of the shoulder, scapular “Y” view, and an AP of the scapula are usually adequate for visualizing the shoulder and can be done without having to move the patient’s shoulder. The AP shoulder view shows the scapula, clavicle, and proximal humerus, while the Y view shows
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