Imaging of Pain E-Book , livre ebook

Imaging of PAIN

Steven D. Waldman, MD, JD
Clinical Professor of Anesthesiology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States
Robert S.D. Campbell, FRCR
Consultant Musculoskeletal Radiologist, Department of Radiology, Royal Liverpool University Hospital, Liverpool, United Kingdom
Saunders
Front matter
Imaging of PAIN

Imaging of PAIN
STEVEN D. WALDMAN, MD, JD , Clinical Professor of Anesthesiology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States
ROBERT S. D. CAMPBELL, FRCR , Consultant Musculoskeletal Radiologist, Department of Radiology, Royal Liverpool University Hospital, Liverpool, United Kingdom
Copyright

IMAGING OF PAIN
ISBN: 978-1-4377-0906-3
Copyright ©2011 by Saunders, an imprint of Elsevier Inc.
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Waldman, Steven D.
Imaging of pain / Steven D. Waldman, Robert S.D. Campbell. – 1st ed.
p. ; cm.
ISBN 978-1-4377-0906-3
1. Pain–Imaging. I. Campbell, Robert S. D., 1961- II. Title.
[DNLM: 1. Pain–diagnosis. 2. Diagnostic Imaging–methods. WL 704 W164i 2010]
RB127.W3483 2010
616′.0472–dc22
2010012846
Acquisitions Editor: Pamela Hetherington
Developmental Editor: Julia Bartz
Project Manager: Vijay Antony Raj Vincent / David Saltzberg
Design Direction: Ellen Zanolle
Publishing Services Manager: Radhika Pallamparthy
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication
For my wife, Maggie, and my children, Alex and Sarah. I thank them for all their generous support and tolerance.
RC
In loving memory of David Waldman
1909-2009
SDW
Contributors
Assistant Editor

Andrew Dunn, FRCR , Consultant Musculoskeletal Radiologist, Royal Liverpool University Hospital, Liverpool, United Kingdom
Contributing Authors

Hifz-ur-Rahman Aniq, MBBS, FRCR , Consultant Radiologist, Royal Liverpool University Hospital, Prescott Street, Liverpool, United Kingdom

Kumar S.V. Das, MRCP, DMRD, FRCR , Consultant Neuroradiologist, Neuroradiology Department, The Walton Centre, Lower Lane, Fazakerley, United Kingdom

Andrew J. Grainger, MRCP, FRCR , Consultant Musculoskeletal Radiologist, Leeds Teaching Hospitals, Chapel Allerton Orthopaedic Centre, Leeds, United Kingdom

Theodore T. Miller, MD, FACR , Attending Radiologist, Hospital for Special Surgery, Professor of Radiology, Weill Medical College of Cornell University, New York, New York

James J. Rankine, MD , Consultant Radiologist, Leeds Teaching Hospitals, Leeds, United Kingdom
Preface

Steven D. Waldman, M.D.


Figure P1 Pool of darkness. Copyright Julie Meese.
It is really hard to know who wants a picture of pain more … the patient in pain or the physician treating the patient’s pain. Efforts to measure, quantify, or take a picture of pain are nothing new. For a brief time in 1895, it seemed that Wilhelm Roentgen had in fact discovered a way to take a picture of pain. But it did not take long for physicians to figure out that it was only a picture of a hand!
Fast forward 100 years, and where are we? Articles in both the lay press and scientific literature suggest that functional MRI and diffusion tensor imaging can now show the physician and patient alike a picture of pain. But are these highly sophisticated imaging modalities, in fact, showing us a picture of pain any more than the x-ray of Roentgen’s hand did? Well, at one level the answer must be a loud and emphatic yes, but at another level, the answer unfortunately remains an embarrassed and barely audible no.


Figure P2 Wilhelm Roentgen’s X-ray photograph of his wife’s hand.
At this point in our discussion, it is probably time to ask the obvious. If you can’t take a picture of pain, why bother to write a book about taking a picture of pain? This is a very good question that I will try to briefly answer. The short answer is: See the first sentence of this Preface. The slightly longer answer is that like every other physician who treats patients in pain, I want to see a picture of my patient’s pain with an eye (pardon the pun) to treating it. Like those physicians who came before me, I want something tangible to exterminate or extirpate. When I see a patient in pain, I immediately want to search out the pain and get rid of it. The harder it is for me to “find” the patient’s pain, the harder I want to look for it. Hence, the desire to image the patient’s pain and to write a book to aid others on a similar quest.
Throughout this text, Rob Campbell and I have tried to put together pictures of what we believe a number of common and sometimes not so common pain syndromes look like. We have endeavored to guide the reader in choosing the best and, whenever possible, least invasive imaging modalities to aid in diagnosing the condition causing the patient’s pain. Since, in a clinical situation many painful conditions can mimic one another, we have provided the reader with a comprehensive differential diagnosis, with an emphasis on how appropriate imaging can often help the clinician avoid going down the wrong diagnostic path. We have purposefully avoided discussing the cost of “taking a picture of pain,” because both of Rob and I are thoroughly convinced that the cost of undiagnosed or improperly diagnosed pain (in terms of both patient suffering and cost to society) far exceed the cost of an x-ray, CT, or MRI. Rob has worked tirelessly to accumulate the excellent images in this book that are illustrative of the painful conditions presented. Our editors at Elsevier have designed an easily readable text with the images laid out for ready reference by the reader. We both hope this text helps you in your efforts to treat pain and expands your differential diagnosis of some of the less commonly encountered painful conditions we have presented.
Table of Contents
Front matter
Copyright
Dedication
Contributors
Preface
PART 1: Imaging Modalities Used in the Diagnosis of Pain
Chapter 1: Radiography
Chapter 2: Fluoroscopy
Chapter 3: Ultrasonography
Chapter 4: Nuclear Medicine and Positron Emission Tomography
Chapter 5: Computed Tomography
Chapter 6: Magnetic Resonance Imaging
PART 2: Spine
The Cervical Spine
Chapter 7: Anatomy: Special Imaging Considerations of the Cervical Spine
Chapter 8: Arnold-Chiari Malformation Type I
Chapter 9: Arnold-Chiari Malformation Type II
Chapter 10: Klippel-Feil Syndrome
Chapter 11: Atlanto-Occipital Abnormalities
Chapter 12: Hyperextension Injuries of the Cervical Spine
Chapter 13: Hyperflexion Injuries of the Cervical Spine
Chapter 14: Degenerative Intervertebral Disc Disease of the Cervical Spine
Chapter 15: Intervertebral Disc Bulging of the Cervical Spine
Chapter 16: Intervertebral Disc Herniation of the Cervical Spine
Chapter 17: Facet Arthropathy of the Cervical Spine
Chapter 18: Acquired Spinal Stenosis of the Cervical Spine
Chapter 19: OPLL Syndrome
Chapter 20: Multiple Sclerosis of the Cervical Spinal Cord
Chapter 21: Syringomyelia of the Cervical Spinal Cord
Chapter 22: Traumatic Syrinx of the Cervical Spinal Cord
Chapter 23: Spontaneous Epidural Hematoma of the Cervical Spine
Chapter 24: Rheumatoid Arthritis of the Cervical Spine <