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Radioimaging In Spine Injuries – Xray, CT, MRI

August 14, 2009 By 2 Comments

After clinical evaluation, radioimging is a very important part of spine assessment. Radiographs or xrays are the first imaging modality used. They are handy, easy, does not require special care and reports are almost instant. Their finding  can guide  the approach to further diagnostic investigation. however radiographs do not provide complete information due to their inherent limitations of two dimensional views. Theref0re computed tomogram is necessary and adds to  information in approximately half of all cases.

Radiographs (Xray)

Following xrays are essential in a patient who has multiple injuries

  • Chest x-ray anteroposterior view
  • Pelvis x-ray anteroposterior view
  • Lateral cervical spine x-ray.

Rest of the imaging for spine is done after patient has been stabilized. [Read more...]

Filed Under: Spine Injuries Tagged With: , , , , ,

Xray of Maluniting Supracondylar Fracture Humerus In A Child

August 12, 2009 By Leave a Comment

Supracondylar fractures are very common childhood injuries. Most of the fractures can be treated by conservative means.  Severely displaced fractures are treated by closed reduction and percutaneous pinning.

This Supracondylar Fracture Is Not In Acceptable Position

This Supracondylar Fracture Is Not In Acceptable Position

The image shows a child’s elbow in a plaster having a suprcondylar fracture which is rotated and malpositioned.

Such a union commonly produces cubitus varus.

Filed Under: Orthopaedic Images Tagged With: , ,

What Is Spine Clearance

August 11, 2009 By Leave a Comment

The rate for missed or delayed diagnosis of cervical spine injury is 1-4%. The most frequent reasons for missed injuries are inadequate assessment, inadequate radiographs and misinterpretation of radiographs. Patients who deteriorate from a missed injury may have severe complication like death, quadriplegia other new neurologic deficits.

Therefore, a potential spinal injury should be assumed and the patient protected should be protected unless declared free of spinal injury or definitive treatment is provided. it has been found that neurologic deterioration after admission occurs in 5% of spine injury patients and most of it can be prevented if precautions are observed.

Spine clearance is a combination of clinical patient assessment and radiographic evaluation . [Read more...]

Filed Under: Spine, Spine Injuries Tagged With: , , , , , ,

Bilateral Neglected Congenital Talipes Equino Varus – A Clinical Photograph

August 9, 2009 By 10 Comments

Talipes Equino Varus is a disorder of the foot where the ankle is in equinus (Bent so that toes move away from leg and heel comes closer.) and The heel is turned inwards so that sole faces inwards (varus).

In addition there is adduction of the front of the foot ( A movement that attmpts to bring great toe near the inner side of the ankle.

If no other cause is found, this condition is labeled as  Congenital Talipes Equino varus or CTEV.

Untreated Congenital Talipes Equino varus On Both Feet

Untreated Congenital Talipes Equino varus On Both Feet

It is one of the diseases that children are screened for at birth. It can be managed by manipulations and orthosis if detected early. Some cases require surgery.

It was very common ealirer to find people with neglected CTEV but the incidence has reduced.

This patient is 25 years old male  and has bilateral CTEV not treated out of ignorance.

The man had visited the OPD for some other ailments and did not want any treatment for this condition.

Filed Under: Foot Disorders, Orthopaedic Images Tagged With: , , , ,

What Is ASIA Score and How It Helps In Classification of Spinal Injury

August 7, 2009 By 1 Comment

ASIA socre is the score developed by the American Spinal Injury Association for essential minimal elements of neurologic assessment for all patients with a spinal injury. This is based on scores as assessed by examiner and is popularly called ASIA score.

These minimal elements are strength assessment of ten muscles on each side of the body and pin-prick discrimination assessment at 28 specific sensory locations on each side.

How To Calculate ASIA Score?

ASIA chart

ASIA chart- Click to enlarge

Sensory Examination

The sensory levels are scored on a 0 to 2 scale for each dermatome. If body is divided into two identical halves there are 28 key sensory points to be tested. Each dermatome is tested forlight touch and pinprick sensations and labeld as NT (not testable) if cannot be tested.

Otherwisw, follwing scores are given to each sensory point [Read more...]

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Motor Examination of Spine – Key Muscle Groups In ASIA Score

August 6, 2009 By Leave a Comment

In ASIA Scoring system ten muscle groups innervation by the cervical and lumbosacral spinal cord are tested. The ASIA system does not include the abdominal muscles supplied by thoracic segments because they are not feasible to dleineate one from another and because these levels can be better marked by sensory levels.

It also excludes muscles  like  hamstrings because the segmental levels that innervate them are already represented by other muscles.

However it must be understood that every muscle received innervation from two or more segments. therefore the examination does not determine absolute level of injury but only a gross one.

[Read more...]

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What Is Cauda Equina?

August 5, 2009 By 1 Comment

cauda-equinaThe cauda equina is a structure within the lower end of the spinal column of most vertebrates, that consists of nerve roots and rootlets from above.

In humans, the spinal cord stops growing in infancy but the bones of the spine continue growing. At  the birth the spinal cord ends at L3 level but in adults it ends at about the level of the vertebra L1/L2 . However there is some variation in adults and the cord may end anywhere between vertebrae T12 to L3.

Individual spinal nerve roots arise from the spinal cord as they do closer to the head, but as the differential growth occurs the top end of the nerve stays attached to the spinal cord and the lower end of the nerve exits the spinal column at its proper level.

This results in a “bundle”-like structure of nerve fibres that extends caudally from the end of the spinal cord, gradually declining in number further down as individual pairs leave the spinal column.

At the base of the Cauda Equina, there are approximately 10 fiber pairs, 3-5 lumbar, 5 sacral, and the single coccygeal nerve. [Read more...]

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Xray of Tuberculosis of Hip Joint

August 4, 2009 By 11 Comments

Tuberculosis of bone and joint is quite common in India. Spine is the most common involvement of musculoskeletal tuberculosis. Hip is the next most common joint.

Because of endemicity most of the diagnoses are made on basis of clinical examination and radiological appearance.

Tubercular Arthrits of Hip

Tubercular Arthrits of Hip

In the image a lesion on femoral head and acetabulum is being seen. This kind of lesion is called “Kissing Lesion” [arrow]and is hallmark of infection.

Tuberculosis of hip joint if recognized in very early stage resolves completelt by antitubercular chemotherapy. The xray shows the diseas ein advanced stage where the joint has already been destroyed. In such cases a residual pain/deformity/dysfunction is left in spite of treatment.

Filed Under: Musculoskeletal Infections, Musculoskeletal Radiology, Orthopaedic Images Tagged With: , ,

Sensory Examination of The Spine – Key Sensory Points In ASIA Score

August 4, 2009 By 2 Comments
Distribution of Sensory Dermatomes

ASIA Score -Distribution of Sensory Dermatomes

A dermatome is a patch of skin that is innervated by a given spinal cord level. While each spinl nerve has a specific dermatomal point for testing that nerve. The image above is from American Spinal Injury  Association and outlines the distribution of different spinal nerves which can be used for testing them and conducting a spinal examination

it must be noted that the outline is supposed to be rough guide and there may be overlaps of different dermatones especially in the transitional areas. Moreover,  the dermatomes can expand or contract following an injury, depending on plasticity of the spinal cord.

Key Sensory Points

ASIA names key sensory points which are easy to measure.

C2 to C4

  • C2 dermatome covers the occiput and the top part of the neck.
  • C3 covers the lower part of the neck to the clavicle bone.
  • C4 covers the area just below the clavicle.

C5 to T1

These dermatomes are all situated in the arms.

  • C5 covers the lateral arm at and above the elbow.
  • C6 covers the forearm and the radial  side of the hand.
  • C7 is the middle finger,
  • C8 is the lateral aspects of the hand
  • T1 covers the medial side of the forearm.

T2 to T12

  • T2 covers the axillary and chest region and upper medial aspect of arm.
  • T3 to T12 covers the chest and back to the hip girdle.
    • The nipples are situated in the middle of T4.
    • T10 is situated at the umbilicus.
    • T12 ends just above the hip girdle.

L1 to L5

  • L1 innervates hip girdle and groin area
  • L2 and 3 cover the front part of the thighs.
  • L4 and L5 cover medial and lateral aspects of the lower leg.

S1 to S5

  • S1 covers the heel and the middle back of the leg.
  • S2 covers the back of the thighs.
  • S3 cover the medial side of the buttocks and S4-5 covers the perineal region.
  • S5 forms  the lowest dermatome and represents the skin immediately at and adjacent to the anus.
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Understanding Spinal injury – Vertebral level and Spinal Level

August 3, 2009 By 5 Comments

The spine consists of a series of vertebral segments. The spinal cord itself has neurological segmental levels marked by the spinal roots. A spinal root is named after the vertebra it exits from. When traced back to cord spinal cord segmental levels do not necessarily correspond to the bony vertebral level.

Let us have a look at vertebrrae and nerve root numbers

  • Cervical – 7  vertebrae and 8 cervical roots. This discrepancy is because there ar total 8 nerve roots exiting from the cervical vertebrae
  • Thoracic 12 vertebrae and 12 roots
  • Lumbar – 5 vertebrae and 5 nerve roots
  • Sacral – 5 vertebrae and 5 nerve roots

The spinal cord segments are not necessarily situated at the same vertebral levels. This has been caused by difference in vertebral height and height of spinal segment. Thus while  first cervical spinal segment is within C1 vertebra, the T12 cord comes to lie at the T8 vertebra. [Read more...]

Filed Under: Spine Tagged With: , , , , ,
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