of this entity. This is contrary to osteogenic sarcoma,
where the osteoid is situated centrally. Unfortunately,
these two entities may be confused histologically. With
maturation, the mineralization of heterotopic ossifica-
tion will often completely ossify with marrow induc-
tion. An area of heterotopic ossification immediately
adjacent to bone may result from an avulsion injury.
This is termed periostitis ossificans.- Calcific deposits may be seen not only in tendons and
ligaments, but also in chronic inflammation of a bursa
(calcific bursitis). These calcifications are usually
hydroxyapetite bound, and have a pasty appearance.
They may be linear or globular. Depending on the
location of the symptoms, radiographs, CT or ultra-
sound may be utilized for diagnosis.
SITE SPECIFIC PLAIN RADIOGRAPHY:
STANDARD AND SPECIAL VIEWS
- Each institution has its own set of plain film series and
as such, it is useful to know what views are included
in a given radiologic examination. The referring
physician may then request a specific view that may
be crucial for the diagnosis of the suspected pathol-
ogy, or the radiologist may add or vary the study
according to the initial findings and the pathology sus-
pected. In the setting of acute joint trauma, a three
view minimum is usually required. Two perpendicular
views suffice for the long bone shafts, and two views
are usually adequate for fracture follow-up.
SHOULDER
- Internal and external rotation views in the anteropos-
terior(AP) projection are included in most shoulder
series. Axillary or trans-scapular-Y view are common
third projections obtained, needed for a perpendicular
view of the glenoid. Grashey, outlet (angulated trans-
scapular) and West Point views may be obtained for
evaluation of the glenohumeral joint space, anterior
acromial shape and subacromial space, and antero-
inferior glenoid rim respectively.
ELBOW
- Anteroposterior and lateral views are standard. The
lateral view should be obtained with the elbow in 90°
of flexion. Bilateral oblique views may be used for
soft tissue calcification or acute fracture, and an angu-
lated radial head view may show a nondisplaced frac-
ture.
HAND/WRIST- Posteroanterior, lateral, and oblique views usually con-
stitute a hand series. The basic wrist series consists of
four projections, those above as well as a navicular
(scaphoid) view to lay the bone out on its long axis. The
carpal tunnel view will show fractures of the hook of the
hamate, and the ball catcher view may reveal widening
of the scapholunate space, implying a ligament tear.
CERVICAL/LUMBAR SPINE- Anteroposterior and lateral views are the basic series,
and oblique views are obtained to evaluate the facet
joints. Flexion and extension views may be added to
evaluate for instability. In the cervical spine, the open
mouth view shows alignment of the first two vertebral
segment lateral masses and the odontoid base. The
Fuchs view shows the odontoid tip. The swimmer’s
view shows the lower cervical and upper thoracic seg-
ments that may be obscured by shoulder soft tissues
on the conventional lateral projection. A coned lateral
view of the L5-S1 disc is often useful, and this level is
subject to distortion from beam angulation on the
standard lateral lumbar film.
THORACIC SPINE- Anteroposterior and lateral views are standard. A
swimmer’s view is frequently obtained to evaluate the
upper thoracic segments. The thoracic facets are best
assessed with CT.
PELVIS- The most common view of the pelvis is the AP pro-
jection. Inlet/outlet and bilateral Judet (lateral
oblique) views may also be obtained, but these are
usually reserved for significant acute pelvic trauma.
The PA view is preferred over an AP projection for
imaging the SI joints because of their oblique orien-
tation.
HIP- Anteroposterior and frog-leg lateral views are stan-
dard. While these provide two views of the proximal
femur, they show the acetabulum in only one projec-
tion. A true acetabular lateral may be obtained with an
axial lateral (Johnson lateral) view.
110 SECTION 2 • EVALUATION OF THE INJURED ATHLETE