scorebuilders-26-27: Imaging in Physical Therapy – Flashcards
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x-rays
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It is used to demonstrate bony tissues. Beams pass through the tissues resulting in varying shades of gray on film depending on density of tissue it passed through. - The more DENSE the structure (bone), the more WHITE the structure will appear on the film. It does not demonstrate soft tissues well or at all
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Computed tomography (CT scan)
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It uses plain film x-ray slices that are enhanced by a computer to improve resolution. It is multiplanar so can image in any plane; therefore tissue can be viewed from multiple directions. Typically used to assess complex fractures as well as facet dysfunction, disc disease, or stenosis of the spinal canal or intervertebral foramen. It demonstrate better quality and better visualization of bony structures than plain films. It is also able to demonstrate soft tissue structures, although not as well as MRI
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Computed tomography (CT scan)
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This imaging technique is typically used to assess COMPLEX FRACTURES as well as FACET DYSFUNCTION, DISC DISEASE or STENOSIS of the spinal canal or intervertebral foramen. It demonstrates better quality and better visualization of bony structures than plain films. It is also able to demonstrate soft tissue structures, although not as well as MRI
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Discography
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A radiopaque dye is injected into the disc to identify abnormalities within the disc (annulus or nucleus). The needle is inserted into the disc with the assistance fo radiography (fluoroscopy). This is not commonly used. It requires a high level of skill and proper equipment to perform. Fairly specific technique to identify internal disc disruptions of the nucleus and/or annulus. Expensive, may be painful, since it is invasive, there is a risk of infection
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MRI
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Uses magnetic fields rather than radiation. It offers excellent visualization of tissue anatomy. Utilizes two types of images known as T1 and T2. T1 demonstrates fat within the tissues, and is typically used to assess bony anatomy. T2 suppresses fat and demonstrates tissues with higher water content, and is used to assess soft tissue structures Fairly expensive, and patient with clastrophobia DO NOT tolerate this test well. There is an open imaging technique but quality is inferior to closed. May not be able to use with patients who have metallic implants
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Whiter
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In plain film radiograph (x-rays) the DENSER the structure (bone) is, the __________ the structure (bone) will appear on the film
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Arthrography
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Invasive technique injects water-soluble dye into area and is observed with a radiograph. Dye is observed as it surrounds tissues, demonstrating the anatomy by where fluid moves within the joint Typically used to identify abnormalities within joints such as tendon ruptures. Expensive procedure and carries risks since it is invasive.
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Open MRI
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Type of MRI that is used for patients with claustrophobia who DO NOT tolerate this test well because it is closed technique. The image is inferior when compared to closed.
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Arthrography
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It is an expensive invasive technique that is typically used to identify abnormalities within joints such as tendon ruptures.
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Bone scans
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aka osteoscintigraphy. Chemicals laced with radioactive tracers are injected, and isotopes settles in areas where there is a high metabolic activity of bone. Radiograph is taken which demonstrates any "HOT SPOTS" of increased metabolic activity. Patients with dysfunctions, such as rheumatoid arthritis, possible stress fractures, bone cancer, infection within bone are given this imaging technique because these dysfunctions are known to have an increase in metabolic activity of bone in affected region.
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Bone scans
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What imaging tecnique is given to patients with dysfunctions such as rheumatoid arthritis, possible stress fractures, bone cancer, and infection within bone? These dysfunctions are known to have an increase in metabolic activity of bone in affected region
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Diagnostic ultrasound
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This imaging technique utilizes transmission of high-frequency sound waves, similar to therapeutic ultrasound. It is limited by contrast resolution, small viewing field, how deep it penetrates, and poor penetration of bone. Interpretation of data is subjective, so results are dependent on skill of operator. Provides real-time dynamic images and able to assess soft tissue dysfunction. no known harmful effects known
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Myelography
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It is an invasive technique using water soluble dye. Dye is visualized as it passess through vertebral canal to observe anatomy within the region. It is seldom used because of many side effects vs. MRI or CT scan, which provide as good, if not better information. VERY expensive since it is often involves a hospital stay overnight. Traditionally had been used for diagnostic assessment of the discs and stenosis. May still be beneficial to identify stenosis.
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diagnostic testing
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-utilized for correlation with history and tests and measures to determine pt's primary physical therapy Dx as well as identify any medical conditions that may be a contributing factor or comorbidity
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X-rays
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-used to demonstrate bony tissues. Beams pass through the tissues resulting in varying shade of gray on film depending on density of tissue it passed through. The more dense the structure (bone) the whiter the structure will appear on film
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What is readily available, relatively inexpensive, and shows bony anatomy very well
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X rays
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what requires two different projections, since structures may be superimposed on each other, making it difficult to identify pathology with on view. Typical views are anterior posterior and lateral, although other views may be used
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x rays
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what is used for viewing dysfunction and/or disease of bones. Does not demonstrate soft tissues well or at all
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x rays
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Computed Tomography (CT) scan
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-uses plain film x-ray slices that are enhanced by a computer to improve resolution. It is multi planar so can image in any plane; therefore, tissue can be viewed from multiple directions
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what is typically used to assess complex fractures as well as facet dysfunction, disc disease, or stenosis of the spinal canal or intervertebral foramen.
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CT Scans, CT demonstrates better quality and better visualization of bony structures than plain fils. CT also demonstrates soft tissue structures, although not as well as MRI
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what is fairly expensive and patient is exposed to radiation
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CT scans
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discograph
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-radiopaque dye is injected into the disc to identify abnormalities within the disc (annulus or nucleus). The needle is inserted into the disc with the assistance of radiography (fluoroscopy)
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what type of imaging offers excellent visualization of tissue anatomy.
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MRI-Utilizes two types of images: T1 demonstrates fat within the tissues and is typically used to assess bony anatomy, while T2 suppresses fat and demonstrates tissues with high water content. T2 is used to assess soft tissue structures
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what type of imaging is fairly expensive and pts with claustrophobia do not tolerate this test well.
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MRI
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antrography
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-invasive technique that injects water soluble dye into area, and is observed with a radiograph. Dye is observed as it surrounds tissues, demonstrating the anatomy where fluid moves within joint
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what type of imaging typically used to identify abnormalities within joints such as tendon ruptures
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antrography
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diagnostic ultrasound
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-utilizes transmission of high-frequency sound waves, similar to therapeutic ultrasound
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myelography
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-invasive technique using water soluble dye. Dye is visualized as it passes through vertebral canal to observe anatomy within region
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what type of imaging is Seldom used due to side effects versus MRI or CT scan, which provide as good if not better, information.
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myelography
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laboratory tests
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-laboratory tests are typically used to screen patients, assist with making a diagnosis or for monitoring
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Electrodiagnostic testing
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Electroneuromyography (ENMG) and nerve conduction velocity (NVC) tests are commonly used to assess and/or monitor musculoskeletal conditions
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symptoms observed - degenerative joint disease / OA
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-pain and stiffness upon rising, -pain eases through the morning, -pain increases with repetitive bending activities, -pain increases with repetitive bending activities, -constant awareness of discomfort with episodes of exacerbation
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symptoms observed - facet joint dysfunction
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-stiff upon rising, pain eases within an hour, -loss of motion accompanied by pain, -patient will describe pain as sharp with certain movements, -movement in pain free range usually reduces symptoms, -stationary positions increase symptoms
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symptoms observed - discal, with nerve root compromise
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-no pain in reclined or semi reclined position, -pain increases with increasing weight bearing activities
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what type of condition describes pain as shooting, burning, or stabbing
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discal, nerve root compromise
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symptoms observed - spinal stenosis
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-pain is related to position, -flexed positions decrease pain and extended positions increase pain, -describes symptoms as a numbness, tightness, or cramping
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In what type of condition does walking for any distance brings on symptoms
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spinal stenosis, -pain may persist for hours after assuming a resting position
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symptoms observed - vascular claudication
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-pain is consistent in all spinal positions, -pain is brought on by physical exertion but pain is relieved promptly with rest (1-5 minutes)
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-pt usually has decreased or absent pulses with ____________ ______________________
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vascular claudication
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symptoms observed - neoplastic disease
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-pt describes pain as gnawing, intense, or penetrating, -pain is not resolved by changes in position, time of day, or activity level, -pain will wake the pt
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cranium - posture changes
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extended on upper c-spine
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mandible - posture changes
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elevated and retruded
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TMJ - posture changes
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posterior close packed position
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maxillomandibular - posture changes
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increased freeway space with significant posterior intercuspation
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hyoid - posture changes
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elevated (suprahyoids shorten, infrahyoids lengthens)
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tongue - posture changes
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drops to the floor of mouth
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upper cervical spine - posture changes
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extended (can compress neuromuscular structures)
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middle and lower cervical spine - posture changes
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lordosis decreased (flexed positioning)
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first and second rib - posture changes
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elevated
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scalenes, suboccipital, sternocleidomastoids, longus colli, upper trapzius, levator scapular - posture changes
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shorten
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pectorals major and minor - posture changes
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shorten, creating rounded shoulder position
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scapular stabilizers, rectus capitis anterior - posture changes
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stretched
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longus capitis - posture changes
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stretched suboccipital region, shorten C2-C6
