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Category: 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.

Spondylolysis and Spondylolisthesis

Spondylolysis and Spondylolisthesis

Spondylolysis is a defect in the pars interarticularis, commonly involving the L5 and occasionally the L4 vertebrae. Most spondylolysis is thought to be produced by repetitive stress. The gravitational and muscular loads acting across the steep incline of the upper surface of the sacrum can be resolved into a shearing component, which tends to displace the L5 vertebral body forward on S1, and a compressive component at right angles to the superior surface of S1 (Fig. 6-63). In accordance with…

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Lumbar Spinal Stenosis and Foraminal Stenosis

Lumbar Spinal Stenosis and Foraminal Stenosis

Like cervical stenosis, lumbar spinal stenosis is frequently precipitated by disc degeneration with subsequent marginal osteophytosis of the vertebral body ends, hypertrophic degeneration of the facet joints, and bulging of the ligamenta flava. Lumbar stenosis may be lateral, central, or combined. The lower lumbar vertebrae normally have shorter pedicles that cause the superior articular processes to intrude into the spinal canal to cut off narrow lateral recesses (Fig. 6-61A–E). The lateral nerve roots of the next spinal nerve to exit…

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Contusions and Intraparenchymal Hemorrhage

Contusions and Intraparenchymal Hemorrhage

Focal parenchymal injuries such as contusions and intraparenchymal hemorrhage usually develop as a result of contact of the brain with the osseous walls of the cranial cavity. The coup-type injuries occur at the point of contact, and the contrecoup injuries occur on the opposite side of the brain. Contusions often occur in areas where the walls of the cranial cavity are irregular, such as the anterior and middle cranial fossae. Therefore, frontal and temporal lobe contusions are common as the…

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Other Knee Abnormalities

Other Knee Abnormalities

Patellar tendinitis (jumper’s knee) is demonstrated by MRI as an area of edema within the patellar ligament (i.e., tendon) at its patellar (Fig. 6-28) or tibial tuberosity attachment. There is also associated edema in the adjacent subcutaneous fat or the infrapatellar fat pad. FIGURE 6-28. Sagittal T2-weighted fat suppressed image of patellar tendinitis. The arrow points to the increased signal intensity within the proximal tendon fibers and the adjacent infrapatellar fat pad. . Ischemic necrosis about the knee most commonly…

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Subdural Hematoma

Subdural Hematoma

Subdural hematoma is most commonly caused by acceleration- deceleration shearing stresses that rupture the bridging veins that extend from the movable brain to the fixed dural venous sinuses. The blood accumulates in a pre-existing but essentially volumeless subdural space. Normally, the pressure of the CSF holds the arachnoid in contact with the dura, thereby creating a real interval that is without significant volume. Because the subdural space is a real space surrounding all external surfaces of the brain, subdural hemorrhage…

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Collateral Ligament Injuries

Collateral Ligament Injuries

The collateral ligaments are best visualized by coronal MR images (Fig. 6-27). The medial collateral ligament appears as a narrow low–signal-intensity band extending from the medial epicondyle of the femur to an attachment on the anteromedial aspect of the tibia 5 to 6 cm below the joint line. It is overlaid at its tibial attachment by the tendons of the pes anserinus, which are separated from it by an intervening anserine bursa that is not visualized unless it is inflamed….

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Lumbar Disc Herniation

Lumbar Disc Herniation

The correlation of lumbar disc herniation with a patient’s complaints of low back pain or sciatica is not always clearly established. It has been estimated that as many as 20% of patients with radiologic findings of disc herniation are asymptomatic (67). Furthermore, when disc herniation occurs in symptomatic patients, other findings are often present that also could explain the clinical findings. Lumbar disc herniations occur most frequently posterolaterally because the annulus is thinnest in the posterior quadrants but reinforced in…

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Epidural Hematoma

Epidural Hematoma

Epidural hematoma is caused by tears of the middle meningeal artery or vein, or of a dural venous sinus. The blood accumulates in the interval between the inner table of the calvarium and the dura by gradually stripping the dura from its bony attachment. CT visualizes the epidural hematoma as a well-localized biconvex radiodense mass (83) (Fig. 6-88). It is commonly, though not invariably, associated with a skull fracture. It causes mass effect upon the adjacent brain parenchyma with effacement…

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Cruciate Ligament Injuries

Cruciate Ligament Injuries

The cruciate ligaments are best visualized by sagittal or oblique sagittal MR images that display the full length of the ligaments (Fig. 6-24A). On straight sagittal images, the slender nature of the anterior cruciate ligament and its oblique course cause a volume-averaging effect that averages fat signal intensity about the ligaments with the normal low signal intensity of the ligament so that the anterior cruciate ligament frequently does not appear as a complete signal void. Furthermore, straight sagittal images typically…

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Cervical Spinal Stenosis and Foraminal Stenosis

Cervical Spinal Stenosis and Foraminal Stenosis

Cervical spinal stenosis can be congenital or acquired. In the less common congenital stenosis, a small spinal canal is produced by short pedicles and thick laminae (62). It commonly remains asymptomatic until degenerative changes are superimposed on the congenital stenosis later in life. Acquired stenosis can be produced by a host of hyper- trophic degenerative changes often collectively referred to as cervical spondylosis. These include osteophytic lipping of the posterior margins of the vertebral body ends bordering the disc, hypertrophic…

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