Essentials of Skeletal Radiology 2 Vol. Set

1939 Pages·2004·74.34 MB·English

by  Terry R. Yochum

Yochum and Rowe’s
ESSENTIALS
OF
SKELETAL
RADIOLOGY
Third Edition
Volume One
Volume One
Yochum and Rowe’s
ESSENTIALS OF
SKELETAL RADIOLOGY
Third Edition
Terry R. Yochum Lindsay J. Rowe
B.S., D.C., D.A.C.B.R., F.C.C.R. (C), F.I.C.C., M.App.Sc (Chiropractic), M.D., D.A.C.B.R.,
Fellow, A.C.C.R F.C.C.R. (C), F.A.C.C.R., F.I.C.C., F.R.A.N.Z.C.R.
Director Associate Professor, Diagnostic Radiology
Rocky Mountain Chiropractic Radiological Center Faculty of Medicine
Denver, Colorado University of Newcastle
Newcastle, Australia
Adjunct Professor of Radiology
Southern California University of Health Sciences Senior Staff Specialist Radiologist
Los Angeles, California Department of Medical Imaging
John Hunter Hospital
Instructor of Skeletal Radiology
Newcastle, Australia
Department of Radiology
University of Colorado School of Medicine Consultant Radiologist
Denver, Colorado Pittwater Imaging
Gosford, Australia
Formerly:
Professor of Radiology Formerly:
Colorado College of Chiropractic Research Fellow in Musculoskeletal Radiology
Marycrest International University Veterans Administration Hospital
Denver, Colorado University of California
San Diego, California
Senior Lecturer
Department of Diagnostic Sciences Associate Professor and Chairman
Department of Radiology
Division Head
Northwestern College of Chiropractic
Department of Radiology
Minneapolis, Minnesota
Phillip Institute of Technology—School of Chiropractic
Melbourne, Australia Associate Professor and Chairman
Department of Radiology
Professor and Chairman
Canadian Memorial Chiropractic College
Department of Radiology
Toronto, Canada
Logan College of Chiropractic
St. Louis, Missouri
Assistant Professor of Radiology
National College of Chiropractic
Lombard, Illinois
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04 05 06 07 08
1 2 3 4 5 6 7 8 9 10
DDEEDDIICCAATTIIOONNSS
In a profession now 100 years old, a few giants rise above the spoke. Uncommon words pierced reality and definitions always
crowd. While each giant stands with unique distinction, a common followed with clear examples that even his grandchildren could
underlying principle unites them. Longfellow captured the essence: understand. An artisan of the highest order, no one could experi-
ence his tutelage without being edified while being educated.
The heights of great men reached and kept From his humble beginnings in Holland, Joe Janse experi-
Were not attained by sudden flight, enced poverty and hard times. Supported by the toils of a dedi-
But they, while their companions slept, cated father and mother, two older sisters, and an older brother
Were toiling upward through the night. hampered with a severe kyphoscoliosis of the spine, “Jozias”
Henry Wadsworth Longfellow, never complained because they were no worse off than anyone
“The Ladder of St. Augustine” else. The family migrated to Huntsville, Utah, after converting to
Mormonism in Holland. Father Pieter left in advance of the fam-
ily by nearly a year to work and earn their passage to the New
World. Their newfound religion instilled lasting values of self-
worth and compassion without prejudice and added an eternal
perspective to life. Coupled with forced frugality associated
with near frontier farm life, hard work, and a keen desire for ex-
cellence, Joe excelled in school. He returned to Europe for 3
years as a self-supported missionary for the Mormon church.
Upon his return, he sought direction for his secular life.
Janse’s mother had experienced severe migraine headaches
and relief came only from the hands of a chiropractor. Intrigued,
young Joe investigated. Soon convinced that chiropractic had
a place, he enrolled at the National School of Chiropractic
(Chicago). The Utah townsfolk, including prominent church lead-
ers whom he respected, discouraged the decision. Undaunted,
J.J. (as so many affectionately called him) excelled as a student
and was invited to join the faculty after his graduation and mar-
riage in 1938. For the next 7 years he would excite and guide
his students in the field of chiropractic. He served as Dean of
Students, and stories abound regarding his willingness to help in-
dividuals with their studies, their dissections, and their manipu-
lative techniques.
By 1945, the business manager of the school (the president
had passed away) asked Janse to assume the role of president and
Joseph (Jozias) Janse, D.C. was charged to lead the college out of proprietorship into a non-
(1909–1985) profit status, a bold move at the time. In the 1950s, Dr. Janse was
brought up short by a talented lawyer challenging the validity of
chiropractic education because of the absence of an educational
Through the hectic hallowed halls of college, first as a stu- standard developed and maintained by a nationally recognized
dent, then as a resident, and finally as a faculty member, accrediting body. As a result, Janse pioneered the creation of the
Dr. Joseph Janse was before us as the example of dedica- Council on Chiropractic Education (CCE) and led the charge to
tion and commitment to a cause. He was more than a college pres- gain accreditation from the North Central Accrediting Association
ident (National College of Chiropractic 1945–1983). He was more in 1974. He also pioneered, with his close friend Dr. Fred W. Ilii,
than a person of international renown in politics, education, re- from Geneva, Switzerland, the early research on the movement
search, and chiropractic. Foremost, he was a teacher! Always con- of the sacroiliac joints. This work served as a foundation for ad-
cerned, “Did you get that?” he would ask, arms raised, elbows ditional study to document true movement of these joints and
bent, and a stiffened right forefinger pointing toward heaven. You describe their relationship to gait and posture. He generated the
would think he was asking a higher power if it understood what he motivation for the development of specialty councils and spe-
was explaining until he brought his eyes back to focus on his stu- cialty certification boards on a national level and was one of the
dents. He studied their faces waiting for the lights to go on inside. first three board-certified chiropractic radiologists. He placed the
The English language never received such an exercise as when he school in deep debt to finance a new campus in Lombard,
v
vi I Yochum & Rowe’s Essentials of Skeletal Radiology
Illinois, in the 1960s and then proceeded to become the most The accolades could continue, but the legacy is clear. His inspir-
prolific fund-raiser in the history of the National College to meet ing example allowed no room for mediocrity or compromise. His
the financial challenge. A beautiful campus, debt free, now commitment to excellence remains unparalleled. How well he is
stands as a monument to his dedicated stewardship, leadership, represented by one of his favorite poems:
and untiring efforts.
Some memorable quotes come to mind when we think back Oh for the silent doer of the deed,
to the times of his motivational lectures on life’s principles and One who is happy with the deed’s own reward,
chiropractic philosophy. When asked, “What is it that you do?” One who in people’s plight of night
Janse would respond, “I am a chiropractor, nothing more, but in- has solitary certitude of that which is right.
cidentally, my friend, nothing less.” Perhaps his most memo-
rable quote came from Rudyard Kipling, which speaks of the Similarly, the creators of this book and its revisions have been
great spirit of understanding and fellowship that Joseph Janse driven to bring to pass a text worthy of his emulation. We dedi-
held for his chiropractic colleagues. cate the product of our labors to the life of Dr. Joseph Janse in
the hope that its readers may come to understand the value of
Here’s to the men and women of my own breed, “toiling upward through the night.”
Good or bitter bad, as though they may be,
At least they hear the things I hear, TERRY R. YOCHUM
And see the things I see. LINDSAY J. ROWE
Few children have the privilege of entering the same profession as Chiropractic and Logan College of Chiropractic in the area of clin-
their father. I consider it a real honor to be a second-generation ical practice, nutrition, and the Nimmo technique. He had a keen
chiropractor following in my father’s footsteps. Kenneth Emil interest in orthopedics and nutrition, with a special love for radi-
Yochum, D.C., my father and best friend, provided the impetus to ology. In 1980, Dr. Yochum was honored to be invited to present
enter this great profession of chiropractic. a lecture for the International College of Chiropractic in
Melbourne and Sydney, Australia. He was one of the first five cer-
tified instructors in the receptor tonus (RT) technique (Nimmo
technique), a topic on which he frequently lectured.
Dr. Yochum’s untimely death in 1989 deprived his family of
his love and guidance and many students of his great clinical ex-
pertise. Kenneth E. Yochum was a man of great character and
integrity who always put the best interest of his patients before
any personal need or gain. What a privilege it was to have been
raised in a chiropractic family with such a great role model as a
father and leader in the chiropractic profession. He lived his life
by a number of spirited commitments. I can remember him say-
ing many times, “Son, right is right and wrong is nobody.” He
spent his life attempting to always do the right thing for his pa-
tients and family. A leader in his community in every way, he
stood as the pillar of his practice and family. So many times he
told me that “chiropractic was worth making a difference for—
extend yourself to make it better.” His most memorable quota-
tion involves living one’s life as a reflective leader. He said that
I, as his son, should “make dust—not eat dust.” How thankful I
am to have had a father who cared so much about the chiroprac-
tic profession and his family to have extended himself so sin-
cerely, seemingly at every turn within his personal life.
A motivated student of radiology and an excellent radiographic
technician, he produced radiographs of the finest quality in his
clinical practice in St. Louis. In fact, his name follows many films
Kenneth E. Yochum, D.C.
in all three editions of this book, cases that came directly from his
(1914–1989)
practice.
Kenneth E. Yochum was a very proud man and this was re-
flected in all aspects of his professional and personal life. His
K
enneth E. Yochum was a resident of South St. Louis, commitment to excellence was untiring and that driving spirit
Missouri. He graduated from Cleveland High School in was given to me by this great man. His influence upon my life
1933 and the Missouri Chiropractic College in 1936. He still continues. He is greatly missed by the entire Yochum fam-
was married to Cecelia G. Yochum for 48 years, father of Kay and ily and it is befitting that the third edition of the Yochum and
Terry, and grandfather to five children. He practiced in South St. Rowe textbook be dedicated to his memory.
Louis at the Wilmington Chiropractic Clinic for 45 years. Dr.
Yochum presented many lectures at the National College of TERRY R. YOCHUM
Dedications I vii
B
Within a lifetime, a few select individuals will significantly affect ryan Hartley’s early postgraduate training appointments
the life of another. For both of us, Bryan Hartley, M.D., was one alternated between the fields of surgery and radiology.
of those individuals. He was a person who seemed to achieve He held appointments in surgery at the Union Memorial
whatever he wanted in life: an extraordinary professional career, Hospital in Baltimore, Maryland; Launceston General Hospital in
diversified personal interests, and close ties with family and Tasmania; the Royal Children’s Hospital in Melbourne, Victoria;
friends. Bryan was born in Aldershot, England, in 1926 and and as Surgeon Superintendent at the Lyell District Hospital,
studied medicine at Guy’s Hospital Medical School in London. Tasmania. His appointments in radiology were at the Launceston
He was appointed house surgeon at the Royal Infirmary, Edin- General Hospital, St. Vincent’s Hospital, Melbourne, and the
burgh, in 1950, following which he emigrated to Australia. He Royal Hobart Hospital in Tasmania. After a short appointment in
became a flight lieutenant in the R.A.A.F. medical branch and Rome as a radiologist for the Department of Immigration, Bryan
was a Fulbright traveling scholar. He was appointed medical returned to Melbourne to become the director of the Department
officer in the Northern Territory Medical Services in Western of Radiology at the Repatriation General Hospital and held this
Australia and was a resident medical officer at General Hospital position until 1981. At that time, he accepted a position as staff
in Tasmania. radiologist in the Department of Radiology at the Austin Hospital
also in Melbourne, the post he occupied until his death.
In his chosen career of medicine, Bryan Hartley excelled in
both surgery and radiology, holding specialist qualifications in
both fields. This interest in surgery was of considerable advan-
tage to him in radiology, as it enabled him to see a diagnostic
problem in its proper clinical perspective. A unique combination
of clinical understanding, experience, and aptitude for clear ex-
pression made Bryan an outstanding teacher for his many stu-
dents, residents, and colleagues. His boundless enthusiasm and
wry humor provided for stimulating and informative discussions
on almost any topic. His opinions were highly valued, particu-
larly in patient evaluation and treatment.
For both of us, it was Bryan who, by example, provided the
stimulus for developing our knowledge and abilities and advanc-
ing the standards of our profession. His influence on our careers
is reflected not only in the use of his personal case material in
this text but, more important, in the knowledge, expertise, and
teaching methods he so freely shared with us. His untimely death
in 1984 now deprives us and others of the opportunity of sharing
his special gifts. He is survived by his wife, Beverley, and their
children, Lynne and John.
In gratitude we have dedicated the first edition of this book to
Bryan Hartley, M.D.
Bryan Hartley, M.D. TERRY R. YOCHUM
(1926–1984) LINDSAY J. ROWE

FFOORREEWWOORRDD
ttoo tthhee TThhiirrdd EEddiittiioonn
I
t is my privilege to once again provide a foreword for this have a message and a desire to have others hear that message
remarkable new edition of the text Essentials of Skeletal and, through careful and thoughtful planning, they present that
Radiology, by Terry R. Yochum and Lindsay J. Rowe. As message throughout the pages of this text. I know full well what
with the previous editions, this work is characterized by impec- is required to maintain one’s focus during the months and years
cable organization, a text that is extremely user friendly, supple- of the publication process, to stay focused and on time, and I am
mented by vivid illustrations and tabular material that provides aware that both of these authors had the drive to see the process
summaries of the important points discussed in the adjacent through. The result is a text that will bring ample reward to the
paragraphs. What sets this book apart from others is the com- reader, providing him or her with information that will ensure a
pleteness of the coverage of the various disease processes that more complete understanding of the disease process and the abil-
affect the musculoskeletal system. Tumors, infections, metabolic ity to provide correct diagnoses in a more timely fashion. The
and articular disorders, traumatic conditions, and developmental result will be improved patient care, something we all desire.
abnormalities among other things—it is all here in the pages of Terry and Lindsay, congratulations again on a job well done.
this work. The manifestations of these processes are illustrated To the potential readers, here is critical information, now at your
through the use of all imaging methods, ranging from conven- fingertips, presented in a painless fashion. Enjoy!
tional radiography to MRI. The legends that accompany this
illustrative material are clear and to the point. DONALD RESNICK, M.D.
The quality of this text comes as no surprise to me. Both of Professor of Radiology
the authors are experienced and knowledgeable in the ways of University of California, San Diego
musculoskeletal diseases, both are gifted writers, and both share Chief of Osteoradiology Section
a bond of enthusiasm and energy that is required to complete Veterans Affairs Medical Center
San Diego, California
the task. I have known both Terry and Lindsay for many, many
years, and they are formidable clinicians and educators. They
ix