Chapter 4, Upper limbs

fracture of distal radius with posterior displacement

colles fracture

transverse fracture through fifth metacarpal neck

boxers fracture

fracture of distal radius with anterior displacement

smith fracture

fracture and dislocation of posterior lip of distal radius

barton fracture

fracture of base of first metacarpal

Bennetts fracture

how many carpal bones are found in the wrist

8

the joint found between the base of the third metacarpal and carpal bone is the

carpometacarpal

what carpals articulates with the radius

scaphoid

which carpal bone is considered to be the largest

capitate

which carpal articulates with both the fourth and fifth metacarpals

hamate

what is the most commonly fractured carpal bone

scaphoid

what carpal bone is the smallest

pisiform

what body structures is found on the distal aspect of the ulna

head

what two structures primarily form the hinge-like structure and movement of the elbow joint

trochlea and olecranon process

what are the names of the two small depressions found on the anterior aspect of the distal humerus

radial and coronoid fossa

what two structures form the distal radioulnar joint

ulnar notch and head of ulna

what two bony landmarks are palpated for positioning of the AP elbow

humeral epicondyles

the smooth, depressed, center portion of the trochlea used for evaluating rotation on a lateral elbow is termed the trochlear

sulcus

the radoiocarpal (wrist) joint possesses an _________ type of joint movement

ellipsoidal

the first metacarpophalangeal joint has an _________ type of joint movement

ellipsoidal

a ginglymus joint can also be referred to as a _____ joint

hinge

the bending or forcing of the hand outwardly with the hand pronated in a posteroanterior (PA) projection is known as

ulnar deviation

a nonviable posterior fat pad on a well-exposed, correctly positioned lateral elbow radiograph generally suggests:

negative study for injury

A general positioning rule is to place the long axis of the part ____ to the long axis of the image receptor.

parallel

From a pronated position, which of the following is required for a PA oblique projection of the fourth digit of the hand?

45-degree lateral rotation

Why is it recommended that the PA oblique (with medial rotation) projection be performed rather than the PA oblique (with lateral rotation) for the second digit of the hand?

Minimizes object image–receptor distance (OID)

Where is the CR centered for a PA projection of the hand?

at the third metacarpophalangeal joint

Why is it important to keep the phalanges parallel to the IR for a PA oblique projection of the hand?

Prevents foreshortening of phalanges and obscuring of interphalangeal joints.

Which specific anatomy is better visualized with a fan lateral as compared with the other lateral projections of the hand?

phalanges

Which of the following projections of the wrist will best demonstrate the wrist joint and intercarpal spaces?

AP

How much rotation of the humeral epicondyles is required for the AP medial oblique projection of the elbow?

45 degrees

How much CR angulation to the long axis of the hand is required for the tangential, inferosuperior projection to demonstrate the carpal sulcus (canal)?

25 to 30 degrees

what is the purpose of performing the AP partially flexed projections of the elbow

to provide an AP perspective if the patient cannot fully extend the elbow

Which routine projection of the elbow best demonstrates the radial head and tuberosity free of superimposition?

AP oblique with external rotation

which routine projection of the elbow best demonstrates the olecranon process in profile

lateral

which basic projection of the elbow best demonstrates the trochlear notch in profile

lateral

A radiograph of the elbow demonstrates the radius directly superimposed over the ulna and the coronoid process in profile. Which projection of the elbow has been performed?

medial (internal) rotation oblique

A patient enters the emergency department (ED) with a Smith fracture. Which region of the upper limb must be radiographed to demonstrate this injury?

wrist and forearm

A radiograph of a PA oblique of the hand reveals that the midshaft of the fourth and fifth metacarpals is superimposed. What specific positioning error has been committed?

excessive rotation of the hand and/or wrist laterally

A radiograph of an AP oblique elbow with medial rotation reveals that the radial head is superimposed over part of the coronoid process. What positioning error has been committed?

excessive medial rotation

A patient with a fractured forearm had the fracture reduced and a fiberglass cast placed on the extremity. The orthopedic surgeon orders a postreduction study. The original (analog) kVp was 60 kVp. Which one of the following kVp factors should be selected for the postreduction study?

63 kVp

A patient arrives in radiology with a metal foreign body in the palm of the hand. Which of the following hand routines should be performed on this patient to confirm the location of the foreign body?

PA and lateral in extension projection

what is the name of the joint found between the proximal and distal phalanges of the first digit

interphalangeal

The interphalangeal joints have a(n) ____ type of joint movement.

ginglymus

the first carpometacarpal joint is classified as a _____ joint

saddle

Which wrist ligament is attached to the styloid process of the ulna and continues to the triquetrum and pisiform?

ulnar collateral ligament

The two fat stripes of the wrist demonstrated radiographically are known as the scaphoid fat stripe and the _____ fat stripe.

pronator

What is the approximate distance between the tabletop and Bucky tray on most floating tabletop types of tables?

3 to 4 inches (8 to 10 cm)

How should the original analog kVp range be changed with a fiberglass cast applied for a wrist or forearm radiographic procedure?

increase 3 to 4 kVp

a “skier’s thumb” is an injury of the

ulnar collateral ligament

Local or generalized infection of bone or bone marrow caused by bacteria introduced by trauma or surgery is a condition termed:

osteomyelitis

the second most common type of primary cancerous bone tumor is

osteogenic sarcoma

what is the most common primary cancerous bone tumor

multiple myeloma

The CR placement for an AP axial projection (modified Robert’s method) of the thumb is at the:

first carpometacarpal joint

What CR angle is required with the modified Robert’s method?

15-degree proximally (towards the wrist)

how much flexion of the hand (in relationship to the IR) is required for the Brewerton method

65 degrees

which special protection of the wrist will open up the interspace on the ulnar side of the wrist

radial deviation

Which special projection of the wrist is ideal for demonstrating possible calcification in the dorsal aspect of the carpals?

carpal bridge

how should the humeral epicondyles be aligned for a lateral projection of the elbow

perpendicular to image receptor

which routine projection of the elbow will best demonstrate an elevated or visible posterior fat pad

true lateral with 90-degree flexion

with the radial head-lateromedial projections, what is the only difference between the four projections

the position of the hand and/or wrist

how many projections are required for the AP-acute flexion study of the elbow

two

A radiograph of a PA projection of the hand reveals that the distal radius and ulna and the carpals were cut off. What should the technologist do to correct this problem?

Repeat the PA projection to include all the carpals and about 1 inch (2.5 cm) of the distal radius and ulna.

A radiograph of an AP projection of the elbow reveals that there is complete separation of the proximal radius and ulna. What positioning error has been committed?

excessive lateral rotation

A radiograph of a tangential, inferosuperior projection of the carpal canal reveals that the hamular process is superimposed over the pisiform. Which of the following measures will correct this problem?

rotate the wrist and hand 10 degrees internally

A patient enters the ED with a possible Bennett’s fracture. What does this concern

thumb

A patient enters the ED with a possible scaphoid fracture. The patient is unable to assume the ulnar deviation position. Which of the following positions should be performed to confirm the diagnosis?

modified stretcher

A patient enters the ED in severe pain with a possible dislocation of the elbow. The patient has the elbow flexed more than 90 degrees. Which one of the following routines should be performed to confirm the diagnosis?

partially flexed AP and limited lateral projection

A patient with a history of carpal tunnel syndrome comes to radiology. The physician wants to rule out abnormal calcifications in the carpal sulcus. Which of the following projections would best demonstrate this region?

Gaynor-hart method

the Bremerton method is performed to evaluate for early signs of

rheumatoid arthritis

A radiograph of the PA scaphoid projection reveals extensive superimposition of the scaphoid and adjacent carpals. Which of the following factors can lead to this problem?

insufficient ulnar deviation

A lateral elbow radiograph demonstrates about half of the radial head superimposed by the coronoid process of the ulna. Which of the following occurred?

no positioning errors occurred

A patient comes to radiology with a possible tear of the ulnar collateral ligament of the wrist. The patient complains of discomfort near the thumb region. Basic thumb projections do not demonstrate any type of fracture or dislocation. Which one of the following projections can be performed to confirm an injury to the ulnar collateral ligament?

folio method

A young child comes to radiology with an elbow injury. The basic elbow projections demonstrate a possible nondisplaced fracture of the coronoid process. Beyond the medial oblique projection, what additional projection(s) can be performed to demonstrate the coronoid process in profile?

Coyle method with 45-degree CR angle away from shoulder

Nuclear medicine is generally more sensitive than radiography for assessing bones of the upper limb for either metastatic bone lesions or stress fractures.

true

carpal tunnel syndrome is more common in middle-aged women than in middle-aged men

true

one of the signs of rheumatoid arthritis is bony erosion of the heads of the metacarpals

true

rheumatoid arthritis is three times more common in men than women

false

The radiographic criteria for a true lateral finger indicate equal concavity of the anterior and posterior aspects of the phalanges.

true

the Bremerton method requires a 15-degree proximal CR angle towards the ulna

true

what is collet fracture also called

dinner fork fracture

broken wrist break in distal radius where broken ends tilt up or down

colles fracture

smiths fracture is also called

garden spade

fracture that bends bone towards the palm

smiths fracture

what is a boxers fracture

break in the neck of the 5th metacarpal

what fracture is at the base of the 1st metacarpal bone

Bennetts fracture

intra-articular fracture of distal radius involving the wrist joint-surface

bartons fracture

how does bone affected by osteoporosis appear on a radiograph

significantly thinned and faint

how does osteoporosis (marble bone) look on a X-ray

they appear very radiopaque and structureless

what is arthrography

when you inject your patient directly into a joint to visualize the joint space

what does the trapezium articulate with

1st metacarpal (thumb)

how many metacarpals are there total

5 total

how many carpals are there total

8 total

how many phalanges are there total

14 total

what is in the proximal row

scaphoid, lunate, triquetrum and pisiform

what is the smallest carpal

pisiform

what is the largest carpal

capitate

which bone is the most fractured

scaphoid

what articulates with the 4th and 5th metacarpals

hamate

what is the scaphoid also called

navicular