Understanding Stress Views For Orthopaedics Xrays
January 21, 2008 by Dr Arun Pal Singh
Filed under Musculoskeletal Radiology
Stress views are special Xray views in which the part examined xrayed after applying requisite stress. Stress views are important in the evaluation of ligamentous tears and joint stability.
For example in the hand is usually ordered if disruption of the ulnar collateral ligament of the first metacarpophalangeal joint, is suspected, also called gamekeeper’s thumb. In the lower limb, the stress views of the knee and ankle joints are frequently obtained.
Evaluation of knee instability due to ligament injuries may require this technique in cases of suspected tear of the medial collateral ligament, and less frequently for evaluating insufficiency of the anterior and posterior cruciate ligaments.
To obtain a stress film of the knee joint for evaluation of the medial collateral ligament, the patient is positioned supine with the knee flexed about 15° to 20°. With the thigh fixed, pressure is applied against the medial aspect of the leg below the knee, forcing the knee into valgus.
The films thus obtained show the anteroposterior projection. To obtain a stress film of the knee joint for evaluation of the anterior cruciate ligament, the patient is positioned on his side, with the knee flexed 90°.Pressure is applied against the posterior aspect of the upper leg. The films show the lateral projection.
Evaluation of ankle ligaments also requires stress radiography.
Inversion and anterior-drawer stress films are most frequently obtained. Sometimes an eversion stress examination may be required. To obtain an inversion stress film of the ankle joint, position the patient supine with the lower leg fixed, and apply pressure on the lateral aspect of the foot, adducting the heel and forcing the foot into varus position.
The stress views are also important in judging radiological union of the fracture. The fracture is xrayed under opposite stresses and any opening or closing of fracture is noted. If such phenomenon is present, the fracture has not united as yet.
Tags: radiology, special xrays, stress views, xray
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