Category Archives: Imaging Techniques Relative to Rehabilitation

A brief presentation of imaging techniques of interest to the physiatrist must necessarily be selective. Because the diagnosis and initial treatment of fractures are primarily the responsibility of the orthopedic surgeon, with the rehabilitation professional typically involved only later in the course, a full discussion of fractures is not presented in this chapter. Only those fractures that bring patients under the long-term care of the physiatrist are included (e.g., vertebral fractures with the potential to damage the spinal cord). Similarly, tumors and infectious processes are de-emphasized. Rather, emphasis is placed on imaging degenerative musculoskeletal processes, spine and head trauma, stroke, and degenerative central nervous system (CNS) diseases commonly seen by the physiatrist. We will also cover imaging in sport medicine as this is a rapidly changing area in radiology and review the current applications of diagnostic ultrasound in the evaluation of musculoskeletal disorders.

In the past two decades, computed tomography (CT) and magnetic resonance imaging (MRI) have become the most sophisticated imaging modalities for evaluating the musculoskeletal system and the CNS. Therefore, this chapter focuses mainly on the recent applications of CT and MRI in the imaging of musculoskeletal and neural pathology of interest to the physiatrist. In the final section, we will introduce some relatively new imaging technologies of interest to the physiatrist, including advanced MRI methods and ultrasound imaging (USI).

The role of plain film examinations in the assessment of abnormalities of specific joint disorders is well established in the medical literature. A brief review of the most commonly performed radiographic examinations of the extremities will be done when addressing the specific subject.

Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH) is not really an arthropathy because it spares synovium, articular cartilage, and articular osseous surfaces. It is a fairly common ossification process involving ligamentous and tendinous attachments to bones and occurs in 12% of the elderly (55). It most commonly affects the thoracic spine but also may involve the pelvis, […]

Calcium Pyrophosphate Dehydrate Deposition Disease

It is also known as pseudogout and has the classic triad of pain, cartilage calcification, and joint destruction. Chondrocalcinosis at the knee, wrist, or symphysis pubis is virtually diagnostic of calcium pyrophosphate dehydrate deposition disease (CPPD) (Fig. 6-42). FIGURE 6-42. Chondrocalcinosis. Frontal radiograph of the right knee. Calcifications (arrows) are present within the medial and […]

Gout Imaging

Gout is a metabolic disorder that most commonly involves the feet, especially the first metatarsophalangeal joint, as well as the ankles, knees, hands, and elbows in asymmetric fashion. It is produced by a deposition of monosodium urate crystals in tissues with a poor blood supply, such as cartilage, tendon sheaths, and bursae. The radiographic features […]

Rheumatoid Arthritis Imaging

Rheumatoid arthritis is a connective tissue disorder of unknown etiology that can affect any synovial joint in the body. It is a bilaterally symmetric inflammatory degenerative disease that involves the following joints in order of decreasing frequency: : Small joints of the hands and feet, with the exception of the distal interphalangeal joints Knees Hips […]

Age-Related Changes and Dementing Disorders

The aging brain is characterized on CT or MRI as demonstrating volume increases in both cortical sulci and ventricles (Fig. 6-96). T2-weighted MR images also frequently display small areas of hyperintense signal along the anterolateral margins of the anterior horns of the lateral ventricles. These changes may or may not be associated with neurologic findings. […]

White Matter Diseases

White matter diseases can be divided into demyelinating diseases, in which the white matter is normally formed and then pathologically destroyed, and dysmyelinating diseases, in which there is usually a genetically determined enzymatic disorder that interferes with the normal production or maintenance of myelin (86). The enzymatic disturbances are relatively rare; therefore, their imaging characteristics […]

Osteoarthritis Imaging

Osteoarthritis or degenerative joint disease (DJD) is an asymmetric, usually bilateral mechanical degenerative process that involves joints significantly involved in weight bearing, such as the hip, knee, and spine, and those involved in frequent repetitive mechanical trauma, such as the distal interphalangeal joints of the fingers, trapezium–first metacarpal joint, trapezium- scaphoid joint, and metatarsophalangeal joint […]

Spinal Trauma

Although much spinal trauma is well visualized on plain films, CT has a number of advantages over this modality. These include the demonstration of fractures not seen in plain films, an accurate determination of the amount of spinal canal encroachment by fracture fragments (Fig. 6-66A,B), the identification of neural foramen impingement by fractures involving its […]

Other Ankle Abnormalities

Technetium-99 scintigraphy has been valuable for detecting stress fractures of metatarsal and tarsal bones, and CT has high accuracy for detecting osteochondral fracture. In foot pain of undetermined etiology, however, MRI is an excellent screening modality because it permits direct evaluation of all osseous and soft-tissue structures. MRI is superior to any other modality in […]

Complications of Brain Injury

Brain injuries may be accompanied by a number of late or long-term complications. These secondary brain injuries include cerebral herniations, which may occur under the falx cerebri or through the tentorium. Herniations can cause compression of adjacent brain substance or vessels, with the production of secondary signs and symptoms (Fig. 6-93). Penetrating injuries or fractures […]