Preface

This book may be the first collaborative effort by a physical therapist and a radiologist, but it shouldn't be the last. Combining the unique perspectives of two professionals can result in a text that is richer than what could have been accomplished solo. And there is an unusual symmetry in the collaboration between a radiologist, who has the least amount of contact with the patient, and the physical therapist, who has the most amount of contact with the patient. The radiologist sees the patient, in minute detail, from the inside out, while the physical therapist sees the patient, in physical totality, from the outside in.

Together the authors have a wealth of experience to share with you. Lynn McKinnis is a physical therapist and orthopedic clinical specialist with more than 30 years of clinical and teaching experience. Her own textbook, Fundamentals of Musculoskeletal Imaging, is used in most PT teaching programs throughout the country. Michael Mulligan is a Professor of Radiology at the University of Maryland School of Medicine with more than 25 years of experience in all areas of musculoskeletal imaging. Their combined knowledge will help you treat the patient, not just the imaging findings.

This Handbook is meant to be a practical guide to the role of imaging in musculoskeletal diagnosis. It is not intended to be a comprehensive reference for all musculoskeletal pathology. Rather, it will clarify the most appropriate imaging choices for those conditions seen most frequently by primary practitioners and those in primary access roles, such as physical therapists, physician assistants, and nurse practitioners.

A practical guide is necessary in these times. The overutilization of imaging in recent decades is well documented. Directives by governments, insurers, and professional medical societies to address overutilization have been enacted. The result is a body of research dedicated to identifying what imaging is necessary, as well as what is not necessary, for given conditions. The evidence is in. It is no longer a mystery concerning what imaging modality—if any—will effect the best patient outcome.

The task at hand is to make this research easily accessible. This Handbook compiles all the available evidence, digests it, organizes it, and presents it in a condensed format that is quickly accessed.

Start with Chapter 1, “Introduction to Diagnostic Imaging,” to get an overview of the field of diagnostic imaging. Each imaging modality, from conventional radiography to all the advanced modalities, is explained and defined by its technology, clinical advantages, and disadvantages. This chapter also explains the search patterns used to analyze images and define pathology.

The remaining Chapters 2 through 10 cover the extremity joints and regions of the spine. Each chapter is organized in the same format. Fast Facts outlines the most common degenerative, traumatic, or athletic injuries at that joint. A brief pictorial Review of Anatomy is next. An explanation of Available Imaging Guidelines follows. This section includes the imaging research from various institutions in the United States, Canada, and Australia, simplified into tables, algorithms, or clinical decision trees with links to the original sources. The heart of each chapter includes the Routine Radiographic Evaluation, Basic MRI Protocol, Basic CT Protocol, and Basic Ultrasound Protocol for that specific joint. It is a wonderful chance for the clinician to see each joint evaluated by each modality, and visually appreciate what each modality has to offer. In addition, search pattern information and observations are presented with each modality's images to illuminate the diagnostic potential of that modality. Finally, the chapters conclude with What Does It Look Like? Illustrated Pathology, which presents several of the most common pathologies with images, clinical information, and treatment overviews.

The authors hope that this Handbook helps you to better understand musculoskeletal diagnostic imaging, whether you are the clinician ordering the diagnostic imaging, or the clinician who can collaborate knowledgably with others on the health-care team. In this world of hard knocks with all the resulting musculoskeletal injuries, this book indicates a clear path to help health-care providers get their patients back on their feet, and back to their lives.

Lynn McKinnis PT, OCS
Michael Mulligan, MD