Accurate Prognosis in Personal-Injury Cases Using George's Line
Dynamic Chiropractic ~ March 26, 2010
The AMA's Guides to the Evaluation of Permanent Impairments uses George's Line to rate neck impairments. A moderate (3.5 mm) break in George's Line on the flexion and extension lateral X-ray films is a permanent impairment, equivalent to a post-surgical fusion of two cervical vertebra. Most chiropractors see small anterolisthesis and/or retrolisthesis on the films and ignore it or fail to appreciate its significance. Since 35 percent to 45 percent of trauma patients have this injury, it is very likely you have failed to diagnose it many, many times. By failing to diagnose this injury, you have failed to accurately, thoroughly and honestly describe your patient's injuries to the claim adjusters and attorneys, who will use the facts in your patient chart as the basis for the personal-injury settlement. These people need you, the doctor, to give them all the facts so a fair settlement can be reached. The jury also needs to understand whether your patient had this injury in order to decide how much to award your patient in a trial verdict.
Do Chiropractors Adhere to Guidelines for Back Radiographs? A Study of Chiropractic Teaching Clinics in Canada
Spine 2007 (Oct 15); 32 (22): 2509-2514
The results suggest a strong adherence to radiography guidelines for patients with a new episode of low back pain who presented to chiropractic teaching clinics. Although a high proportion of patients had red flags, radiography utilization was lower than rates reported in previous studies suggesting that adherence to guidelines may help prevent unnecessary radiography.
Reliability and Validity of Lumbosacral Spine Radiograph Reading by Chiropractors, Chiropractic Radiologists, and Medical Radiologists
Spine Journal 2002 (Sep 1); 27 (17): 1926-1933
Small differences with little clinical relevance were found. All the professional groups could adequately detect contraindications to chiropractic treatment on radiographs. For this indication, there is no reason to restrict interpretation of radiographs to medical radiologists. Good professional relationships between the professions are recommended to facilitate interprofessional consultation in case of doubt by the chiropractors.
Radiographic Anomalies That May Alter Chiropractic Intervention Strategies Found in a New Zealand Population
J Manipulative Physiol Ther 2004 (Nov); 27 (9): 554-559
The 5 most frequently occurring anomalies in descending order were degenerative joint disease (23.8%), posterior ponticle (13.6%), soft tissue abnormalities (13.5%), transitional segments (9.8%), and spondylolisthesis (7.8%). Other noteworthy occurrences because of their generalized status as absolute contraindications to adjustment are fracture (6.6%), malignant tumor (0.8%-3.1%), abdominal aortic aneurysm (0.8%) and atlantoaxial instability (0.6%).
Sacral Stress Fractures:
Tracking Down Nonspecific Pain in Distance Runners
PHYSICIAN AND SPORTSMEDICINE 2003 (Feb); 31 (2)
Sacral stress fractures are an underrecognized cause of low-back and gluteal pain in distance runners. The combination of low bone density and increased activity blurs the boundary between fatigue and insufficiency fractures in many runners. MRI is the preferred radiologic technique because of its ability to localize the site of injury and rule out tumors, disk disease, or sacroiliitis. By identifying the condition early, clinicians contribute to a favorable outcome and help most athletes return to full activity in 12 to 14 weeks.
MRI of the Temporomandibular Joint
A wide variety of conditions affect the temporomandibular joint (TMJ) including congenital anomalies, ankylosis, arthritis, and internal disk derangement (1). TMJ disease is common, affecting between 4 and 28 percent of the population. Young females in particular commonly present with TMJ complaints (2).
Diagnostic Imaging of Meniscal Injuries
Radiographic examination of the knee is often unrewarding, despite physical and orthopedic findings that clearly indicate an abnormality. Much of the supporting anatomy of the knee is invisible with conventional radiography, but more sophisticated techniques can be used to demonstrate these important structures. Magnetic resonance imaging is able to delineate the cruciate ligaments and menisci, providing the clinician a more complete and accurate view of the patient’s condition.
The Azygos Lobe
This normal variant occurs in less than 5% of the population. Despite it's characteristic shadow, it often alarms physicians not familiar with it's apearance. The azygos lobe forms when the azygos vein fails to migrate over the apex of the lung during fetal life.
Joint Pain in Children
A Seven Article Series By Deborah Pate, DC, DACBR
Joint pain is a common complaint in children but seldom a symptom of serious joint disease. How can you determine if a child with knee pain has just a strain/sprain or a more serious joint disease, such as Lyme disease, rheumatic fever, or juvenile rheumatoid arthritis? This series of articles reviews the more common joint disorders affecting children.
Approaches to Differential Diagnosis in Musculoskeletal Imaging
There are already plenty of good books out there on introductory musculoskeletal radiology. Why did I write this syllabus? Because, it seemed to me that most of these books were doing a great job of telling one about diseases, but not how to approach their diagnosis. Most books tell you the names of lots of disorders and the findings you see in each of them. This is handy if you already know what disorder a patient has, and you just want to learn more facts about it.
Back Pain in Children
A commonly held belief in pediatrics is that back pain in children is rare, and its presence almost always heralds a serious underlying disorder. In reality, this belief only holds true in the prepubertal child, in whom back pain is rare, and if present often has a serious underlying cause. In adolescent children, chronic back pain may be found in up to 13% of them, but the underlying cause is often a sports induced injury. The job of the family practitioner or pediatrician seeing a child with back pain is to distinguish the serious from the non serious causes of back pain.
Paediapaedia: An Imaging Encyclopedia of Pediatric Disease
Paediapaedia is aimed at the radiology resident learning pediatric radiology for the first time, the pediatric radiology fellow mastering pediatric radiology for the first time, and for the general radiologist who does a small amount of pediatric imaging on a daily basis. Paediapaedia is meant to be a handbook of pediatric radiology. It is designed to let you get at the information you need easily and rapidly. It is meant to put the information you need most often at your fingertips.
Anatomy Using Joint Fluoroscopy
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