Overutilization of musculoskeletal imaging can be just as deleterious as underutilization. In fact, it has been shown that overutilization of imaging can actually lead to harm. It’s essential that clinicians recognize when imaging is necessary, and if so, which imaging modality it most appropriate. Fortunately, there are well-established guidelines to aid in this process. Most are based on a sound hypothesis from the history and physical exam. This course covers basic principles of diagnostic imaging modalities as they apply to the health care provider when evaluating sports injuries. The emphasis is on plain film radiography. Other types of imaging, including contrast films, magnetic resonance imaging, and computed tomography will also be introduced as deemed clinically relevant.
Dr. Boyles is a clinical assistant professor of physical therapy at the University of Puget Sound in the Pacific Northwest. Dr. Boyles’ primary area of instruction is orthopedics, which includes evaluation and intervention, manual therapy treatment techniques for the spine and extremities, introduction to joint mobilization, spine manipulation, and clinical radiology. Currently, he serves as a clinical instructor at the University of Puget Sound on-site clinic and acts as a research faculty mentor. Dr. Boyles is a Fellow of the American Academy of Orthopaedic Manual Physical Therapy and a Certified Orthopaedic Clinical Specialist. His research interests predominantly include manual physical therapy of the spine and extremities. In 2010, Dr. Boyles received the Rose Award for Excellence in Research awarded by the Orthopaedic Section of the APTA.
This chapter covers the Ottowa Ankle and Foot rules to determine if a fracture is present, specifically the sensitivity and specificity of the tests. Bob Boyles then discusses fracture classification using the Danis-Weber and the Lague-Hansen Classification systems. Participants will learn to apply the various rules and classification systems to injuries to determine the nature of the injury and appropriateness of imaging.
Imaging of the hip and pelvis can easily identify immature skeletal structures, and fractures, which can further cause hematomas, and possible urethral and bladder injuries. This chapter will describe the use of imaging in pelvic fractures, pelvic stress fractures, and osteitis pubis. The participant will be able to discuss methods for identifying high yield areas for hip trauma, such as hip dislocations, widening of joint space, femoral neck or intertrochanteric fractures, and pelvis or acetabular fractures. The chapter concludes with the discussion of a case study.
The knee can be imaged using both plain films and MRI scans. The MRI scan is used for identifying ligament, cartilage, and tendon injuries. In this chapter, the participant will learn to apply the Pittsburgh Knee Rule and Ottawa Knee Rule. Several diagnoses are covered, including loose bodies, fractures, ligamentous injuries and cartilage injuries.