,FUNDAMENTALS OF
MUSCULOSKELETAL
IMAGING
FOURTH EDITION
,ELBOW Routine Radiologic Examination Series
AP Lateral Internal Oblique External Oblique
WRIST
HAND
PA Lateral Oblique PA
HAND
KNEE
Lateral Oblique AP Lateral
ANKLE
KNEE
Intercondylar Fossa Patellofemoral Joint AP AP Oblique
ANKLE
FOOT
Lateral AP Lateral Oblique
, Routine Radiologic Examination Series
CERVICAL SPINE
SHOULDER
AP External Rotation AP Internal Rotation AP Open-Mouth AP Lower C-Spine
THORACIC SPINE
CERVICAL SPINE
Lateral Right Oblique Left Oblique AP
THORACIC SPINE
STERNUM
Lateral PA Oblique Lateral PELVIS AP
LUMBAR SPINE
AP Lateral Right Oblique Left Oblique
TMJ
HIP
AP Lateral Transcranial Submentovertex
,Contemporary Perspectives in Rehabilitation
Steven L. Wolf, PT, PhD, FAPTA, Editor-in-Chief
Vestibular Rehabilitation, 3rd Edition
Susan J. Herdman, PT, PhD, FAPTA
Richard A. Clendaniel, PT, PhD
Pharmacology in Rehabilitation, 4th Edition
Charles D. Ciccone, PT, PhD
Modalities for Therapeutic Intervention, 4th Edition
Susan L. Michlovitz, PT, PhD, CHT, and Thomas P. Nolan, Jr., PT, MS, OCS
Wound Healing: Alternatives in Management, 3rd Edition
Joseph M. McCulloch, PT, PhD, CWS, FAPTA
Luther C. Kloth, PT, MS, CWS, FAPTA
Spinal Cord Injury Rehabilitation
Edelle Field-Fote, PT, PhD
For more information on each title in the Contemporary Perspectives in Rehabilitation series, go to
www.fadavis.com.
,FUNDAMENTALS OF
MUSCULOSKELETAL
IMAGING
FOURTH EDITION
Lynn N. McKinnis, PT, OCS
Butler, Pennsylvania
Concordia Visiting Nurses
Staff Physical Therapist
Cabot, Pennsylvania
St. Francis University
Adjunct Instructor
Department of Physical Therapy
Loretto, Pennsylvania
University of Montana
Faculty Affiliate
School of Physical Therapy & Rehabilitation Science
Missoula, Montana
University of South Florida
Affiliate Instructor
School of Physical Therapy and Rehabilitation Sciences
Tampa, Florida
,F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2014 by F. A. Davis Company
All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, orransmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Printed in the United States of America
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
McKinnis, Lynn N.
Fundamentals of musculoskeletal imaging / Lynn N. McKinnis. — Fourth edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8036-3821-1 (alk. paper)
I. Title.
[DNLM: 1. Musculoskeletal Diseases—diagnosis. 2. Diagnostic Imaging—methods. 3. Musculoskeletal System—injuries. 4. Physical Therapy Modalities
WE 141]
RC925.7
616.7’075—dc23
2013022256
Editor-in-Chief: Margaret M. Biblis
Senior Acquisitions Editor: Melissa A. Duffie
Senior Developmental Editor: Jennifer A. Pine
Manager of Content Development: George W. Lang
Art and Design Manager: Carolyn O’Brien
As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies ndergo changes. The
author(s) and publisher have done everything possible to make this book accurate, up-to-date, and in accord with accepted standards at the time of publication.
The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the bo ok and make no warranty,
expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reade
r in accordance with professional
standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to heck product information
(package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution i s especially urged when
using new or infrequently ordered drugs.
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted y F. A. Davis Company for users
registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC,
222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate sy stem of payment has
been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-3821-1/14 0 + $0.25
, This book is dedicated with love
to my Mom, who finds joy in her work
to my Dad, who takes pride in his work
to my husband, Dave, who lives his work
and to our children, Jesse and Ann,
for whom I wish all these things.
,
, FOREWORD
Many of us tend to measure time in units that seem to accel- chapters easier. As Lynn McKinnis points out so cleverly
erate as a function of our own aging processes. It is hard to within her preface when she employs a swimming analogy,
believe that this fourth edition of Fundamentals in Muscu- the depth and comprehension are progressive. Security
loskeletal Imaging by Lynn McKinnis spans 17 years since the acquired in the shallow end will build confidence in deepe
first edition was published. At that time we approached this waterswhile all the time the instructor is there to coach.
project with some trepidation since we questioned the recep- In implementing this process, she has maintained the tra-
tivity of educators, students, and clinicians to the relevance dition so much a part of the entireContemporary Perspectives
and importance of this content for the armamentarium of in Rehabilitation serieschallenging the reader to problem
health-care providers in general and physical therapists and solve while updating relevant references and source materials.
physical therapy assistants in particular. However, our appre- This effort is supported through many changes including th
hension has been more than allayed with respect to muscu- addition of approximately 300 new line drawings and images,
loskeletal pathologies. Inevitably the need to familiarize expanded imaging evaluations for almost all clinical chapters,
health-care professional students and clinicians with visual- and conversion of the bound-in student CD to an expanded
izations of the musculoskeletal system has been prompted and enhanced online resource that includes additional ques-
by continuous advances in imaging technology. Moreover, tions, an expanded searchable glossary, and, for the first time
educators and clinicians have discovered that imaging can be a feature permitting the viewer to analyze MRI sequences.
used as a vehicle to facilitate communication with referring Consumer expectations from the therapists who so duti-
or collaborating physicians and other health professionals fully dedicate services continue to rise. As we strive for more
or as a conduit for evidence to demonstrate the relationship respect and participation in decision-making for our patients,
of intervention to improvement. Such evidence serves to there is a growing need for us to understand all aspects of the
facilitate decisions from third party payers regarding num- patient history on the one hand and foster our confidence i
bers of treatment sessions. The mounting sophistication an conveying our knowledge and impressions to referral sources
clarity with which we understand the pathologies of our pa- on the other. One of the most obvious vehicles for achieving
tients have emerged from enhanced imaging. This evolutio success in this endeavor is through communications regard-
has gained recognition and our past readers have developed ing the meaning of the pictures we and our patients are
an insatiable thirst for more knowledge in the use and under- shown. The growth in information accessibility amongst ou
standing of advanced imaging procedures. Undoubtedly, this consumers and their abilities to use electronic resources to
strong inquiry process has contributed substantially to the better understand this information has become evident and
emerging popularity of this text. Accordingly, it is not sur- will only escalate. This emerging sophistication in assimilat
prising that today most education programs use this text for ing information is in its infancy, and our ability to not only
their students and many practitioners consider it a “funda- anticipate their inquiry but respond confidently and compre
mental” document for their libraries. hensively has become a presumed expectation. While our
A considerable effort has been undertaken to make thi learning curve to do so within categories such as genomics,
fourth edition even better than the third. Each clinical chapter bioengineering, and regenerative rehabilitation continues to
follows a logical sequence in which basic osteology and con- grow, perhaps we have reached a point where this responsi-
nective tissue structures are outlined and labeled. This effo bility can be achieved in the field of imaging, particularl
serves as a foundation upon which more sophisticated imag- when musculoskeletal diagnoses are involved. If this premise
ing procedures, including computerized tomography (CT) is correct, then let Fundamentals in Musculoskeletal Imaging
scans and magnetic resonance imaging (MRI) are added. Spe- serve as our compass.
cific pathologies with which students and clinicians will then
deal follow immediately thereafter. These building blocks a STEVEN L. WOLF, PT, PhD, FAPTA, FAHA
craftily structured so that irrespective of which anatomical Series Editor, Contemporary Perspectives in Rehabilitation
region the reader first embarks, their assimilation of th series
developing content will make comprehension of subsequent
ix
MUSCULOSKELETAL
IMAGING
FOURTH EDITION
,ELBOW Routine Radiologic Examination Series
AP Lateral Internal Oblique External Oblique
WRIST
HAND
PA Lateral Oblique PA
HAND
KNEE
Lateral Oblique AP Lateral
ANKLE
KNEE
Intercondylar Fossa Patellofemoral Joint AP AP Oblique
ANKLE
FOOT
Lateral AP Lateral Oblique
, Routine Radiologic Examination Series
CERVICAL SPINE
SHOULDER
AP External Rotation AP Internal Rotation AP Open-Mouth AP Lower C-Spine
THORACIC SPINE
CERVICAL SPINE
Lateral Right Oblique Left Oblique AP
THORACIC SPINE
STERNUM
Lateral PA Oblique Lateral PELVIS AP
LUMBAR SPINE
AP Lateral Right Oblique Left Oblique
TMJ
HIP
AP Lateral Transcranial Submentovertex
,Contemporary Perspectives in Rehabilitation
Steven L. Wolf, PT, PhD, FAPTA, Editor-in-Chief
Vestibular Rehabilitation, 3rd Edition
Susan J. Herdman, PT, PhD, FAPTA
Richard A. Clendaniel, PT, PhD
Pharmacology in Rehabilitation, 4th Edition
Charles D. Ciccone, PT, PhD
Modalities for Therapeutic Intervention, 4th Edition
Susan L. Michlovitz, PT, PhD, CHT, and Thomas P. Nolan, Jr., PT, MS, OCS
Wound Healing: Alternatives in Management, 3rd Edition
Joseph M. McCulloch, PT, PhD, CWS, FAPTA
Luther C. Kloth, PT, MS, CWS, FAPTA
Spinal Cord Injury Rehabilitation
Edelle Field-Fote, PT, PhD
For more information on each title in the Contemporary Perspectives in Rehabilitation series, go to
www.fadavis.com.
,FUNDAMENTALS OF
MUSCULOSKELETAL
IMAGING
FOURTH EDITION
Lynn N. McKinnis, PT, OCS
Butler, Pennsylvania
Concordia Visiting Nurses
Staff Physical Therapist
Cabot, Pennsylvania
St. Francis University
Adjunct Instructor
Department of Physical Therapy
Loretto, Pennsylvania
University of Montana
Faculty Affiliate
School of Physical Therapy & Rehabilitation Science
Missoula, Montana
University of South Florida
Affiliate Instructor
School of Physical Therapy and Rehabilitation Sciences
Tampa, Florida
,F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2014 by F. A. Davis Company
All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, orransmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Printed in the United States of America
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
McKinnis, Lynn N.
Fundamentals of musculoskeletal imaging / Lynn N. McKinnis. — Fourth edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8036-3821-1 (alk. paper)
I. Title.
[DNLM: 1. Musculoskeletal Diseases—diagnosis. 2. Diagnostic Imaging—methods. 3. Musculoskeletal System—injuries. 4. Physical Therapy Modalities
WE 141]
RC925.7
616.7’075—dc23
2013022256
Editor-in-Chief: Margaret M. Biblis
Senior Acquisitions Editor: Melissa A. Duffie
Senior Developmental Editor: Jennifer A. Pine
Manager of Content Development: George W. Lang
Art and Design Manager: Carolyn O’Brien
As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies ndergo changes. The
author(s) and publisher have done everything possible to make this book accurate, up-to-date, and in accord with accepted standards at the time of publication.
The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the bo ok and make no warranty,
expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reade
r in accordance with professional
standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to heck product information
(package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution i s especially urged when
using new or infrequently ordered drugs.
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted y F. A. Davis Company for users
registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC,
222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate sy stem of payment has
been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-3821-1/14 0 + $0.25
, This book is dedicated with love
to my Mom, who finds joy in her work
to my Dad, who takes pride in his work
to my husband, Dave, who lives his work
and to our children, Jesse and Ann,
for whom I wish all these things.
,
, FOREWORD
Many of us tend to measure time in units that seem to accel- chapters easier. As Lynn McKinnis points out so cleverly
erate as a function of our own aging processes. It is hard to within her preface when she employs a swimming analogy,
believe that this fourth edition of Fundamentals in Muscu- the depth and comprehension are progressive. Security
loskeletal Imaging by Lynn McKinnis spans 17 years since the acquired in the shallow end will build confidence in deepe
first edition was published. At that time we approached this waterswhile all the time the instructor is there to coach.
project with some trepidation since we questioned the recep- In implementing this process, she has maintained the tra-
tivity of educators, students, and clinicians to the relevance dition so much a part of the entireContemporary Perspectives
and importance of this content for the armamentarium of in Rehabilitation serieschallenging the reader to problem
health-care providers in general and physical therapists and solve while updating relevant references and source materials.
physical therapy assistants in particular. However, our appre- This effort is supported through many changes including th
hension has been more than allayed with respect to muscu- addition of approximately 300 new line drawings and images,
loskeletal pathologies. Inevitably the need to familiarize expanded imaging evaluations for almost all clinical chapters,
health-care professional students and clinicians with visual- and conversion of the bound-in student CD to an expanded
izations of the musculoskeletal system has been prompted and enhanced online resource that includes additional ques-
by continuous advances in imaging technology. Moreover, tions, an expanded searchable glossary, and, for the first time
educators and clinicians have discovered that imaging can be a feature permitting the viewer to analyze MRI sequences.
used as a vehicle to facilitate communication with referring Consumer expectations from the therapists who so duti-
or collaborating physicians and other health professionals fully dedicate services continue to rise. As we strive for more
or as a conduit for evidence to demonstrate the relationship respect and participation in decision-making for our patients,
of intervention to improvement. Such evidence serves to there is a growing need for us to understand all aspects of the
facilitate decisions from third party payers regarding num- patient history on the one hand and foster our confidence i
bers of treatment sessions. The mounting sophistication an conveying our knowledge and impressions to referral sources
clarity with which we understand the pathologies of our pa- on the other. One of the most obvious vehicles for achieving
tients have emerged from enhanced imaging. This evolutio success in this endeavor is through communications regard-
has gained recognition and our past readers have developed ing the meaning of the pictures we and our patients are
an insatiable thirst for more knowledge in the use and under- shown. The growth in information accessibility amongst ou
standing of advanced imaging procedures. Undoubtedly, this consumers and their abilities to use electronic resources to
strong inquiry process has contributed substantially to the better understand this information has become evident and
emerging popularity of this text. Accordingly, it is not sur- will only escalate. This emerging sophistication in assimilat
prising that today most education programs use this text for ing information is in its infancy, and our ability to not only
their students and many practitioners consider it a “funda- anticipate their inquiry but respond confidently and compre
mental” document for their libraries. hensively has become a presumed expectation. While our
A considerable effort has been undertaken to make thi learning curve to do so within categories such as genomics,
fourth edition even better than the third. Each clinical chapter bioengineering, and regenerative rehabilitation continues to
follows a logical sequence in which basic osteology and con- grow, perhaps we have reached a point where this responsi-
nective tissue structures are outlined and labeled. This effo bility can be achieved in the field of imaging, particularl
serves as a foundation upon which more sophisticated imag- when musculoskeletal diagnoses are involved. If this premise
ing procedures, including computerized tomography (CT) is correct, then let Fundamentals in Musculoskeletal Imaging
scans and magnetic resonance imaging (MRI) are added. Spe- serve as our compass.
cific pathologies with which students and clinicians will then
deal follow immediately thereafter. These building blocks a STEVEN L. WOLF, PT, PhD, FAPTA, FAHA
craftily structured so that irrespective of which anatomical Series Editor, Contemporary Perspectives in Rehabilitation
region the reader first embarks, their assimilation of th series
developing content will make comprehension of subsequent
ix
