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Textbook
Introduction
1. Cardiopulmonary system
2. Pulmonary system
3. Neuromuscular system
4. Pediatrics
5. Musculoskeletal system
5.1 Anatomy of musculoskeletal system
5.2 Anatomical terminology and exercise training principles
5.3 Joint mechanics and phases of healing
5.4 Upper extremity anatomy
5.5 Special tests of upper extremity
5.6 Comparing clinical presentation and interventions for upper extremity
5.7 Lower extremity anatomy
5.8 Special tests of lower extremity
5.9 Comparing clinical presentation and interventions of lower extremity
5.10 Spine and pelvis anatomy
5.11 Special tests of the spine, pelvis, and temporomandibular joint
5.12 Comparing clinical presentation and interventions for the spine, pelvis, and temporomandibular joint
5.13 Other MSK conditions
5.14 Gait
5.15 Prosthetics
5.16 Orthotics
5.17 Medications, imaging, and fractures
5.18 Surgical protocols
6. Other system
7. Non systems
Wrapping up
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5.17 Medications, imaging, and fractures
Achievable NPTE-PTA
5. Musculoskeletal system
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Medications, imaging, and fractures

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Imaging

There are several types of medical imaging used to assess different tissues and structures in the body. Below are the main types.

PTA role: You don’t order or interpret imaging to make a diagnosis - that’s the role of the supervising PT or physician. You use imaging findings already documented in the chart as background for the established plan of care, and you report any new or changed symptoms (for example, signs suggesting a new fracture) back to the PT.

X-ray (radiography)

  • Best for: Bones, fractures, joint alignment, lung conditions
  • How it works: Uses ionizing radiation to create images of dense structures
  • Common uses:
    • Fractures & dislocations
    • Arthritis
    • Lung infections (e.g., pneumonia)
    • Foreign objects
  • Limitations: limited soft tissue visibility, radiation exposure
  • Interpreting an X-ray
    • High-density tissue (e.g., bone) - absorbs x-rays to a greater degree, and appears white on the film.
    • Low-density tissue (e.g., the lungs) - absorbs X-rays to a lesser degree, and appears black on the film
    • Intermediate density tissue (e.g., muscle and fat) - appears as shades of grey on the x-ray film
Radiograph of lungs
Radiograph of lungs
By - Diego Grez, Radiografía_pulmones_Francisca_Lorca.jpg , CC BY-SA 3.0
/
Wikimedia Commons
/
CC BY-SA 3.0

Computed tomography (CT scan)

  • Best for: Bones, soft tissues, internal bleeding, internal organs, and the brain.
  • How it works: Combines multiple X-rays to create cross-sectional images
  • Common uses:
    • Bone fractures and complex injuries
    • Internal bleeding (trauma)
    • Stroke
    • Tumors
    • Lung and abdominal conditions
  • Limitations: higher radiation exposure than X-rays
  • Interpreting CT scan
    • Dense structures (like bone and calcifications) appear lighter (white).
    • Lucent structures (like air and fat) appear darker (black).
Examples of CT scan
Examples of CT scan
By - Ptrump16, Own work, CC BY-SA 4.0
/
Wikimedia Commons
/
CC BY-SA 4.0

Magnetic resonance imaging (MRI)

  • Best for: Soft tissues, brain, muscles, ligaments, and nerves
  • How it works: Uses strong magnets and radio waves to generate detailed images
  • Common uses:
    • Ligament and tendon injuries
    • Brain and spinal cord conditions
    • Tumors
    • Disc herniations
  • Limitations: expensive, time-consuming, may be contraindicated with certain ferromagnetic metal implants and devices (e.g., some pacemakers, aneurysm clips) - safety depends on the specific implant
  • Interpreting MRI
    • T1 MRI highlights anatomy, provides crisp images, and shows fluids as dark
    • T2 MRI focuses on pathology, making fluids bright, which is ideal for visualizing inflammation, edema
Examples of MRI
Examples of MRI
By - KieranMaher at English Wikibooks, Adapted with permission by Kieran Maher using Graphic Converter from Applied Imaging Technology by Heggie, Liddell & Maher (2000).
/
Wikimedia Commons
/
Public domain

Ultrasound

  • Best for: Soft tissues, pregnancy, blood flow
  • How it works: Uses high-frequency sound waves to create real-time images.
  • Common uses:
    • Pregnancy monitoring
    • Soft tissue injuries (e.g., muscle tears)
    • Blood clots (Doppler ultrasound)
    • Organ imaging (e.g., liver, kidneys)
  • Limitations: poor image quality for bones and deep structures

Nuclear medicine imaging (e.g., PET scan, bone scan)

  • Best for: Organ function, cancer detection, metabolic activity
  • How it works: Uses radioactive tracers to highlight metabolic activity
  • Common uses:
    • Cancer detection (PET scan)
    • Bone metastases (bone scan)
    • Stress fracture/microfracture (bone scan)
    • Thyroid and kidney function
  • Limitations: radiation exposure, high cost

Fluoroscopy

  • Best for: Real-time imaging of movement (e.g., swallowing, joint motion)
  • How it works: Continuous X-ray imaging allows real-time assessment
  • Common uses:
    • Barium swallow for digestive tract
    • Cardiac catheterization
    • Joint injections
  • Limitations: higher radiation exposure than standard X-rays

Example: Choosing the right imaging study

A patient reports a popping sensation and knee instability after twisting the joint during sports. The supervising PT suspects a ligament tear. Which imaging modality is best suited to visualize this soft-tissue injury?

Answer: MRI - it provides the soft-tissue detail needed to visualize ligaments, tendons, and cartilage. X-ray is best for bone, and CT is best for bone and internal bleeding, so neither shows a ligament tear as clearly.

Medications

Medications for musculoskeletal conditions target pain, inflammation, and muscle spasms, encompassing analgesics, anti-inflammatories, muscle relaxants, and any other relevant musculoskeletal symptoms.

PTA role: You don’t prescribe or adjust these medications, but you do monitor patients for the adverse effects below during each session and report changes to the supervising PT. Stop the intervention and notify the PT if you notice signs such as labored or slowed breathing in a patient on opioids, new bone pain or a fall in a patient on long-term corticosteroids (increased fracture risk), or unexplained bruising, black stools, or GI complaints in a patient on NSAIDs.

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
    • Mechanism of action: decrease inflammation, fever, and pain
    • Key adverse effects to monitor: GI ulcers, indigestion, and increased bleeding risk
  • Opioids
    • Mechanism of action: decreases pain in the musculoskeletal system
    • Key adverse effects to monitor: decreased respiration rate (respiratory depression), constipation, and addiction risk with long-term use
  • Corticosteroids
    • Mechanism of action: decrease inflammation in the musculoskeletal system
    • Key adverse effects to monitor: osteoporosis (increased fracture risk with long-term use), high blood pressure, and weight gain/diabetes
  • Baclofen
    • Mechanism of action: decrease spasticity
    • Key adverse effects to monitor: drowsiness, dizziness, fatigue, and muscle weakness; abrupt withdrawal can cause seizures, hallucinations, and rebound spasticity
  • Muscle relaxants
    • Mechanism of action: acts on the central nervous system (CNS) to interfere with the transmission of nerve impulses to muscles, reducing muscle spasms and tension
    • Key adverse effects to monitor: drowsiness, dizziness, muscle weakness, and nausea

Fractures

A fracture is a partial or complete break in the bone. There are many different types of fractures. Bone fractures are often caused by falls, injury, or a direct hit or kick to the body. Overuse or repetitive motions can cause stress fractures.

Types of fractures

  • Open (compound): The bone breaks through the skin, exposing it to the environment
  • Closed (simple): The bone breaks but does not penetrate the skin.
  • Transverse: A straight break across the bone
  • Oblique: A diagonal break at an angle to the bone
  • Spiral: A twisting break that spirals around the bone
  • Greenstick: A partial break that occurs in children’s flexible bones
  • Comminuted: The bone breaks into multiple fragments
  • Stress fracture: A small, hairline crack caused by repetitive stress
  • Impacted fracture: The broken ends of the bone are driven into each other
  • Avulsion fracture: A small piece of bone is pulled away by a tendon or ligament

Salter-Harris fracture

A Salter-Harris fracture is a type of bone fracture that occurs in children and adolescents, involving the growth plate (physis).

Salter-Harris fractures are classified into five types based on the location and extent of the fracture:

  • S - Straight across (Type I) Fracture through the growth plate (physis) only → No bone involvement

  • A - Above (Type II) Fracture through the physis and metaphysis (above) → Most common type

  • L - Lower (Type III) Fracture through the physis and epiphysis (below) → Involves joint surface

  • TE - Through everything (Type IV) Fracture through metaphysis, physis, and epiphysis → Crosses entire bone

  • R - Crush (Type V) Crush injury to the growth plate → Often not visible initially, worst prognosis

Five Salter-Harris classification types of pediatric growth plate fractures.
Salter-Harris Fractures
Achievable

Imaging

  • X-ray (radiography)
    • Best for bones, fractures, joint alignment, lungs
    • Uses ionizing radiation; dense tissue appears white, low-density black, intermediate grey
    • Limitations: poor soft tissue detail, radiation exposure
  • Computed tomography (CT Scan)
    • Best for bones, soft tissue, internal bleeding, organs, brain
    • Cross-sectional images from multiple X-rays; dense = white, air/fat = black
    • Limitations: higher radiation than X-ray
  • Magnetic resonance imaging (MRI)
    • Best for soft tissues, brain, ligaments, nerves
    • Uses magnets/radio waves; T1: anatomy (fluid dark), T2: pathology (fluid bright)
    • Limitations: expensive, slow, not for metal implants
  • Ultrasound
    • Best for soft tissues, pregnancy, blood flow
    • Uses high-frequency sound waves, real-time imaging
    • Limitations: poor for bone/deep structures
  • Nuclear medicine imaging (PET, Bone Scan)
    • Best for organ function, cancer, metabolic activity
    • Uses radioactive tracers
    • Limitations: radiation, high cost
  • Fluoroscopy
    • Best for real-time movement (swallowing, joints)
    • Continuous X-ray imaging
    • Limitations: high radiation exposure

Medications

  • NSAIDs
    • Decrease inflammation, fever, pain
    • Side effects: hypertension, GI upset/ulcers, increased bleeding, dizziness
  • Opioids
    • Decrease pain
    • Side effects: decreased HR/respiration, constipation, muscle rigidity, addiction
  • Corticosteroids
    • Decrease inflammation
    • Side effects: hypertension, GI upset, osteoporosis, weight gain, acne
  • Baclofen
    • Decreases spasticity
    • Side effects: muscle weakness, stiffness, abnormal posturing
  • Muscle relaxants
    • Reduce spasms via CNS depression
    • Side effects: drowsiness, weakness, GI upset, dry mouth, blurred vision

Fractures

  • Types of fractures
    • Open (compound): bone through skin
    • Closed (simple): bone does not penetrate skin
    • Transverse, oblique, spiral, greenstick, comminuted, stress, impacted, avulsion
  • Salter-Harris fracture (growth plate, children)
    • Type I: through physis
    • Type II: physis + metaphysis
    • Type III: physis + epiphysis
    • Type IV: physis + metaphysis + epiphysis
    • Type V: crush injury to physis

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Medications, imaging, and fractures

Imaging

There are several types of medical imaging used to assess different tissues and structures in the body. Below are the main types.

PTA role: You don’t order or interpret imaging to make a diagnosis - that’s the role of the supervising PT or physician. You use imaging findings already documented in the chart as background for the established plan of care, and you report any new or changed symptoms (for example, signs suggesting a new fracture) back to the PT.

X-ray (radiography)

  • Best for: Bones, fractures, joint alignment, lung conditions
  • How it works: Uses ionizing radiation to create images of dense structures
  • Common uses:
    • Fractures & dislocations
    • Arthritis
    • Lung infections (e.g., pneumonia)
    • Foreign objects
  • Limitations: limited soft tissue visibility, radiation exposure
  • Interpreting an X-ray
    • High-density tissue (e.g., bone) - absorbs x-rays to a greater degree, and appears white on the film.
    • Low-density tissue (e.g., the lungs) - absorbs X-rays to a lesser degree, and appears black on the film
    • Intermediate density tissue (e.g., muscle and fat) - appears as shades of grey on the x-ray film

Computed tomography (CT scan)

  • Best for: Bones, soft tissues, internal bleeding, internal organs, and the brain.
  • How it works: Combines multiple X-rays to create cross-sectional images
  • Common uses:
    • Bone fractures and complex injuries
    • Internal bleeding (trauma)
    • Stroke
    • Tumors
    • Lung and abdominal conditions
  • Limitations: higher radiation exposure than X-rays
  • Interpreting CT scan
    • Dense structures (like bone and calcifications) appear lighter (white).
    • Lucent structures (like air and fat) appear darker (black).

Magnetic resonance imaging (MRI)

  • Best for: Soft tissues, brain, muscles, ligaments, and nerves
  • How it works: Uses strong magnets and radio waves to generate detailed images
  • Common uses:
    • Ligament and tendon injuries
    • Brain and spinal cord conditions
    • Tumors
    • Disc herniations
  • Limitations: expensive, time-consuming, may be contraindicated with certain ferromagnetic metal implants and devices (e.g., some pacemakers, aneurysm clips) - safety depends on the specific implant
  • Interpreting MRI
    • T1 MRI highlights anatomy, provides crisp images, and shows fluids as dark
    • T2 MRI focuses on pathology, making fluids bright, which is ideal for visualizing inflammation, edema

Ultrasound

  • Best for: Soft tissues, pregnancy, blood flow
  • How it works: Uses high-frequency sound waves to create real-time images.
  • Common uses:
    • Pregnancy monitoring
    • Soft tissue injuries (e.g., muscle tears)
    • Blood clots (Doppler ultrasound)
    • Organ imaging (e.g., liver, kidneys)
  • Limitations: poor image quality for bones and deep structures

Nuclear medicine imaging (e.g., PET scan, bone scan)

  • Best for: Organ function, cancer detection, metabolic activity
  • How it works: Uses radioactive tracers to highlight metabolic activity
  • Common uses:
    • Cancer detection (PET scan)
    • Bone metastases (bone scan)
    • Stress fracture/microfracture (bone scan)
    • Thyroid and kidney function
  • Limitations: radiation exposure, high cost

Fluoroscopy

  • Best for: Real-time imaging of movement (e.g., swallowing, joint motion)
  • How it works: Continuous X-ray imaging allows real-time assessment
  • Common uses:
    • Barium swallow for digestive tract
    • Cardiac catheterization
    • Joint injections
  • Limitations: higher radiation exposure than standard X-rays

Example: Choosing the right imaging study

A patient reports a popping sensation and knee instability after twisting the joint during sports. The supervising PT suspects a ligament tear. Which imaging modality is best suited to visualize this soft-tissue injury?

Answer: MRI - it provides the soft-tissue detail needed to visualize ligaments, tendons, and cartilage. X-ray is best for bone, and CT is best for bone and internal bleeding, so neither shows a ligament tear as clearly.

Medications

Medications for musculoskeletal conditions target pain, inflammation, and muscle spasms, encompassing analgesics, anti-inflammatories, muscle relaxants, and any other relevant musculoskeletal symptoms.

PTA role: You don’t prescribe or adjust these medications, but you do monitor patients for the adverse effects below during each session and report changes to the supervising PT. Stop the intervention and notify the PT if you notice signs such as labored or slowed breathing in a patient on opioids, new bone pain or a fall in a patient on long-term corticosteroids (increased fracture risk), or unexplained bruising, black stools, or GI complaints in a patient on NSAIDs.

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
    • Mechanism of action: decrease inflammation, fever, and pain
    • Key adverse effects to monitor: GI ulcers, indigestion, and increased bleeding risk
  • Opioids
    • Mechanism of action: decreases pain in the musculoskeletal system
    • Key adverse effects to monitor: decreased respiration rate (respiratory depression), constipation, and addiction risk with long-term use
  • Corticosteroids
    • Mechanism of action: decrease inflammation in the musculoskeletal system
    • Key adverse effects to monitor: osteoporosis (increased fracture risk with long-term use), high blood pressure, and weight gain/diabetes
  • Baclofen
    • Mechanism of action: decrease spasticity
    • Key adverse effects to monitor: drowsiness, dizziness, fatigue, and muscle weakness; abrupt withdrawal can cause seizures, hallucinations, and rebound spasticity
  • Muscle relaxants
    • Mechanism of action: acts on the central nervous system (CNS) to interfere with the transmission of nerve impulses to muscles, reducing muscle spasms and tension
    • Key adverse effects to monitor: drowsiness, dizziness, muscle weakness, and nausea

Fractures

A fracture is a partial or complete break in the bone. There are many different types of fractures. Bone fractures are often caused by falls, injury, or a direct hit or kick to the body. Overuse or repetitive motions can cause stress fractures.

Types of fractures

  • Open (compound): The bone breaks through the skin, exposing it to the environment
  • Closed (simple): The bone breaks but does not penetrate the skin.
  • Transverse: A straight break across the bone
  • Oblique: A diagonal break at an angle to the bone
  • Spiral: A twisting break that spirals around the bone
  • Greenstick: A partial break that occurs in children’s flexible bones
  • Comminuted: The bone breaks into multiple fragments
  • Stress fracture: A small, hairline crack caused by repetitive stress
  • Impacted fracture: The broken ends of the bone are driven into each other
  • Avulsion fracture: A small piece of bone is pulled away by a tendon or ligament

Salter-Harris fracture

A Salter-Harris fracture is a type of bone fracture that occurs in children and adolescents, involving the growth plate (physis).

Salter-Harris fractures are classified into five types based on the location and extent of the fracture:

  • S - Straight across (Type I) Fracture through the growth plate (physis) only → No bone involvement

  • A - Above (Type II) Fracture through the physis and metaphysis (above) → Most common type

  • L - Lower (Type III) Fracture through the physis and epiphysis (below) → Involves joint surface

  • TE - Through everything (Type IV) Fracture through metaphysis, physis, and epiphysis → Crosses entire bone

  • R - Crush (Type V) Crush injury to the growth plate → Often not visible initially, worst prognosis

Key points

Imaging

  • X-ray (radiography)
    • Best for bones, fractures, joint alignment, lungs
    • Uses ionizing radiation; dense tissue appears white, low-density black, intermediate grey
    • Limitations: poor soft tissue detail, radiation exposure
  • Computed tomography (CT Scan)
    • Best for bones, soft tissue, internal bleeding, organs, brain
    • Cross-sectional images from multiple X-rays; dense = white, air/fat = black
    • Limitations: higher radiation than X-ray
  • Magnetic resonance imaging (MRI)
    • Best for soft tissues, brain, ligaments, nerves
    • Uses magnets/radio waves; T1: anatomy (fluid dark), T2: pathology (fluid bright)
    • Limitations: expensive, slow, not for metal implants
  • Ultrasound
    • Best for soft tissues, pregnancy, blood flow
    • Uses high-frequency sound waves, real-time imaging
    • Limitations: poor for bone/deep structures
  • Nuclear medicine imaging (PET, Bone Scan)
    • Best for organ function, cancer, metabolic activity
    • Uses radioactive tracers
    • Limitations: radiation, high cost
  • Fluoroscopy
    • Best for real-time movement (swallowing, joints)
    • Continuous X-ray imaging
    • Limitations: high radiation exposure

Medications

  • NSAIDs
    • Decrease inflammation, fever, pain
    • Side effects: hypertension, GI upset/ulcers, increased bleeding, dizziness
  • Opioids
    • Decrease pain
    • Side effects: decreased HR/respiration, constipation, muscle rigidity, addiction
  • Corticosteroids
    • Decrease inflammation
    • Side effects: hypertension, GI upset, osteoporosis, weight gain, acne
  • Baclofen
    • Decreases spasticity
    • Side effects: muscle weakness, stiffness, abnormal posturing
  • Muscle relaxants
    • Reduce spasms via CNS depression
    • Side effects: drowsiness, weakness, GI upset, dry mouth, blurred vision

Fractures

  • Types of fractures
    • Open (compound): bone through skin
    • Closed (simple): bone does not penetrate skin
    • Transverse, oblique, spiral, greenstick, comminuted, stress, impacted, avulsion
  • Salter-Harris fracture (growth plate, children)
    • Type I: through physis
    • Type II: physis + metaphysis
    • Type III: physis + epiphysis
    • Type IV: physis + metaphysis + epiphysis
    • Type V: crush injury to physis

More from Musculoskeletal system

  • Anatomy of musculoskeletal system
  • Anatomical terminology and exercise training principles
  • Joint mechanics and phases of healing
  • Upper extremity anatomy
  • Lower extremity anatomy