Rad Pos: Upper Extremity

how many bones in hand and wrist? how many in each group?

• 27 in all

• 8 carpels

• 5 metacarpals

• 14 phalanges

11 step basic pre-imaging checklist

1. verify name, DOB, and pregnancy

2. verify what you are imaging

3. get history asking for injury to determine any limited range of motion

4. patient seated 90 degrees to table

5. lap shield

6. 40 in SID

7. parallel lightfield and IR

8. centering

9. collimation

10. all anatomy in view

11. marker

avulsion fracture

when a small piece of bone tears away from the main bone because a pulling force from a attached tendon or ligament is too strong

carpal and metacarpal articulations

• The first metacarpal articulates with the trapezium and forms a sellar, or saddle, joint.

• The second metacarpal articulates with the trapezoid.

• The third metacarpal articulates with the capitate.

• The fourth and fifth metacarpals articulate with the hamate.

types of synovial movement in second through fifth carpometacarpal joints.

plane, or gliding

largest proximal row carpal

scaphoid or navicular

most frequently fractured carpal

scaphoid or navicular

Carpal with deep cavity of distal surface

lunate or semilunar

Carpals with three articular surfaces and pyramidal shape

Triquetrum

Smallest carpal

pisiform

Carpal between scaphoid, and first metacarpal

trapezium

Smallest bone in distal row

trapezoid

Largest carpal

capitate

Name for hook-like palmer process of hamate

hamulus

Shorter forearm bone

radius

What allows radius to rotate around ulna

the joined radial head and capitulum

humeroradial and humeroulnar type of synovial movement

hinge or ginglyus

Proximal radioulnar joint type of synovial movement

pivot or trochoid

SID for upper limb (in and cm)

40 in or 100 cm

Common kV for upper extremity

50-70 kV / low-medium

Upper limb positioning principles

• patient sideways at end of table

• Position table top, near shoulder, height to support arm

• Use gonadal shielding when possible

• Keep long access part parallel to long access of exposed IR

• CR perpendicular to the part or IR unless specific angle required

Exposure time and focal spot

short exposure time and small focal spot

Projections for basic finger exam

PA, PA oblique, lateral

Four projections to image entire radial head

1. Hand supinated with maximum external rotation

2. Hand in a true lateral position

3. Hand pronated

4. Hand with maximum internal rotation

PIP? Located?

proximal interphalangeal joint

Joint between proximal and middle phalanx

DIP? Location?

distal interphalangeal joint

joint between distal and middle phalanx

What should be visible in a PA finger

distal, middle, and proximal phalanges

mid metacarpals

largest, loongest bone in upper limb

humerus

frequently fractured part of humerus

surgical neck

bones of shoulder girdle

clavicle and scapula

what bone connects upper limb to the trunk and carries scapula during movement

clavicle

difference between female and male clavicles

female: shorter, less curved

male: longer, thicker, more curved, greater muscle attachment

scapula borders

superior, medial, lateral

scapula angles

superior, lateral, inferior

scapula surfaces

anterior/ventral/costal, posterior/dorsal

which surface of scapula is the subscapular fossa on

anterior surface

what side of scapula do the acromion and coracoid process project from

lateral

supscapular notch is locater near which boarder

superior

Which view of scapula resembles a Y

lateral

Scapulohumeral type of movement

Synovial, diarthrodial ball-and-socket joint

Sternoclavicular type of movement

Synovial, diarthrodial plane or gliding joint

Acromioclavicular

Synovial, diarthrodial plane or gliding joint

Dislocation

Displacement of a bone so that it is no longer in contact with its normal articulation

Common dislocation sites

shoulder, hip, patella, and fingers, including the thumb

Subluxation

partial dislocation

sprain

Forced twisting of a joint that causes partial tearing of supporting ligaments without dislocation

Contusion

A bruise-type injury that may be associated with an avulsion fracture

Apposition

describes how fractured bone fragments make contact with one another

Anatomic apposition

The fragment ends make end-to-end contact.

Lack of apposition

The fragments are aligned but pulled apart and not touching.

Bayonet apposition

The fragments overlap and the shafts contact, but the fracture ends do not meet.

Simple or Closed Fracture

does not break through the skin

Compound or Open Fracture

a portion of the bone protrudes through the skin

open fractures may also be_?

comminuted

Incomplete Fracture

does not traverse the entire bone, so the bone is not separated into two pieces

Complete Fracture

extends through the entire cross-section of the bone and separates it into two pieces

Comminuted Fracture

when the bone is crushed at the impact site, producing two or more fragments