Knee Trauma

Acute knee trauma? - #orderwhat #kneepain @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg

Acute knee trauma, fall or twisting injury with:

No focal tenderness or effusion and able to walk => no study indicated

Focal tenderness, effusion or unable to walk => X-ray then MRI if needed.

Suspect tibial plateau fracture on xray => CT knee

Suspect posterior dislocation => X-ray and MRI and possibly angiography. 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon

Ankle Trauma?

Suspect Ankle Fracture

Summary:

Ankle radiograph if patient meets Ottawa Rules: 

Can’t bear weight immediately after injury 

OR 

Point tenderness over medial malleolus, posteroinferior lateral malleolus, talus or calcaneus 

OR 

Cannot walk 4 steps in emergency department



If one of these describes the patient, an ankle radiograph is appropriate.

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon

Dyspnea, suspected cardiac origin?

Dyspnea of suspected cardiac origin

Summary:

Chest xray and transthoracic echocardiography (possibly followed by a stress: echo, SPECT or PET or Cardiac MRI) 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon

Neck adenopathy?

What to do with neck adenopathy?

Summary:  

Adult, afebrile, single or multiple node(s) =  CT neck with contrast (or MRI neck with contrast,  if needed*)

Adult, febrile, single node =  CT neck with contrast (or MRI neck with contrast,  if needed*)

Adult pulsatile neck mass = CTA and CT neck with contrast (or MRI neck with contrast,  if needed*)

Adult with cancer history and nodes = Neck PET and CT with contrast

Child (up to age 14), afebrile or febrile, single or multiple node(s) = Neck ultrasound (Then CT neck with contrast (or MRI neck with contrast,  if needed*))

* This decision is usually based on renal function and contrast reactions 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Developmental dysplasia of the hip?

Developmental dysplasia of the hip

Summary:

Younger than 4-6 months with definite or equivocal physical exam findings = Ultrasound hips

Younger than 4-6 months, female, breech delivery or positive family history  without physical exam findings = Ultrasound hips

Older than 4-6 months with clinical suspicion (limited abduction or abnormal gait) = Single frontal AP hip radiograph 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Knee pain without trauma. Is there an effusion? Degenerative changes?

Imaging for knee pain without trauma. Is there an effusion? Degenerative changes?

Summary

Child, adolescent or adult knee pain without trauma = knee X-ray  

Child, adolescent or adult knee pain without trauma and knee X-ray is negative or shows effusion or secondary signs of trauma = MRI knee without contrast

Adult knee pain without trauma and knee X-ray shows avascular necrosis = possibly MRI without contrast if it directs therapy

Adult knee pain without trauma and knee X-ray shows degenerative changes, crystalline arthropathy or chondrocalcinosis = Probably NOTHING 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Acute hip pain, suspect fracture?

Imaging of acute hip pain, suspect fracture?

Summary:

First study middle aged or elderly = Xray hip, AP and cross table lateral and Xray pelvis, AP view BOTH

Negative or indeterminate radiograph, then = MRI hip/pelvis or CT hips

(Note if fracture and minimal trauma, eval bone density with DEXA scan)

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com