procedures upper extremity

Divisions

1. Phalanges

2. Metacarpals

3. Carpals

Phalanges

14 in each hand

Metacarpals

5 in each hand

Carpals

8 in each wrist. (short bones)

Radius

On side of thumb

Ulna

Side of pinky

Digits

1-5 laterally & medically

Phalanges are how many digits

2-5

Distal phalanges

Finger nail area

Intermediate phalanges

Middle of finger

Proximal phalanges

From knuckle to middle of finger

Carpal

Big part of hand

Carpals

Part of big hand to wrist

Where are the sesmoid bones

Near thumbs, big toe,

What is the first digit

Thumb

Metacarpal bones are composed of..

The palm of the hand. They have a head body and base

MCP

Metacarpal phalangeal joints

CMC

Carpal metacarpal

Carpal abbreviation

Steve (scaphoid), left (lunate), the( triquetrum), party (pisiform)to ( trapezium) take ( trapezoid), carol(capitate) , Home (hamate)

Scaphoid is

Largest in the carpals & most commonly fractured

Radio-carpal joints

Articulation between the carpals and distal radius

The radiocarpal joints are classified as

synovial, diarthrotic, ellipsoidal

Interphalangeal joints are classified as

Synovial, diarthrotic, or freely moveable, hinge.

Hand projections

1. PA

2. Lateral (extension, fan)

3. PA oblique

DIP

Distal interphalangeal

PIP

Proximal interphalangeal

What do you want to see in upper extremities

Joint spaces

PA hand

1. Palm on IR

2. Forearm on table, straight

3. Extend and separate digits to prevent soft tissue overlap

4. THIRD MCP JOINT TO IR

   1. CR perpendicular to third MCP

What you want to see in PA hand

1. No rotation of hand

2. Equal metacarpal and phalangeal on both sides

3. Equal amount of soft tissue on both sides of phalanges

4. Expand and spread fingers out slightly

PA oblique

1. Forearm on table

2. Hand on angle, pinky on table

3. Possible sponge

4. 45° angle

5. CR perpendicular to third MCP Joint

What is required for PA oblique

1. Evidence of proper elimination

2. Fingertips to distal radius and ulna

3. Digits separated with no overlap of their soft tissues

4. 45 degree

Lateral Extension

1. Forearm on table

2. Elbow 90° degrees

3. Karate chop with thumb out

4. Radial ulnar superimposed (overlap)

5. MCP JOINT CENTERED TO IR

6. CR perpendicular to 2nd MCP

Lateral Fan

1. Forearm on table with elbow flexed 90°

2. okay sign / fan the hand out

3. Radial n ulnar superimposed & perpendicular to IR

4. MCP JOINT CENTERED TO IR

5. CR PERPENDICULAR TO 2ND MCP

6. KEEP PINKY STRAIGHT

What is required in a lateral hand

1. Proper collimation

2. Anatomy from fingertips to distal radius and ulna

3. Extended digits

4. True lateral position

Digits 2-5 projections

1. PA

2. Lateral

3. PA oblique

PA digits 2-5

1. Palm facing down on table

2. Fingers are extended

3. CR perpendicular to IR

4. Enters pt at PIP joint

What is required for a PA digit 2-5

1. Evidence of proper collimation

2. Fingertips to distal portion of adjoining metacarpal

3. Open IP and MCP joint spaces

4. No overlap

5. No rotation

In a PA digit we do xray the whole hand regardless

PA oblique

1. Palm resting on 45 degrees sponge or resource

2. Separate fingers if possible

3. CR perpendicular to PIP joint of affected digit

What is required for a PA oblique

1. Evidence of proper collimation

2. Entire digit included in image from distal to adjoining metacarpal

3. Digits rotated 45 degrees

4. Open IP and MCP joint spaces

Lateral digits

1. Karate chop but with single digit

2. Rest of digits put into a fist

3. Enters at PIP joint of affected area

What is required in a lateral digit xray

1. Proper collimation

2. True lateral position

3. No obstruction of proximal phalanx or MCP joint by adjacent digits

Thumb projections

1. AP

2. Lateral

3. PA oblique

AP thumb

1. Hand in extreme medial rotation

2. Posterior surface ON the IR (nail)

3. MCP joint to IR

4. Hold remaining digits back with tape or opposite hand

5. CR perpendicular to MCP joint

What is required for an AP thumb?

1. Overlap of soft tissue profile of the palm over mid shaft of 1st metacarpal

2. Open/Expand IP and MCP

Lateral thumb

1. Palm on surface of IR

2. Thumb in line with IR

3. Center MCP joint to IR

4. CR perpendicular to MCP joint of thumb

What is required of a lateral thumb xray

1. Proper collimation

2. Distal tip of thumb to trapezium

PA oblique thumb

1. Palm surface on IR

2. Ulnar-deviate hand slightly

3. Align long axis of thumb parallel

4. Center MCP joint to IR

5. CR perpendicular to MCP joint

What is required of PA oblique thumb?

1. Proper collimation

2. Distal tip of the thumb to the trapezium

3. Proper rotation of phalanges, soft tissue, and first metacarpal

4. Open IP and MCP joint spaces

Wrist projections

1. PA

2. PA lateral

3. PA oblique

4. PA ulnar deviation

5. Scaphoid (PA axial)

6. Carpal canal (tangential)

PA Wrist

1. Upper extremity on table

2. Entire upper extremity in same plane

3. Elbow flexed 90 degrees

4. Wrist placed in center of IR

5. Flex digits into a fist

6. CR perpendicular to midcarpal area

What is required in a PA wrist

1. Proper collimation down to midcarpal to mid wrist

2. Distal ends of radius and ulna, carpals, and proximal half of metacarpals

3. No rotation in carpals, metacarpals radius, and ulna

4. Open radioulnar joint space

PA oblique

1. distal radius and ulna, carpals and proximal,half of metacarpals

2. 45 degree rotation

3. Carpals on lateral side of wrist

What is required of a PA oblique wrist?

1. Pinky on table in line with grid

2. Rotate 45 degrees

3. CR perpendicular to midcarpal area, just distal to radius

Lateral Wrist

1. Upper extremity on table

2. Karate chop with thumb out

3. Elbow flexed 90 degrees

4. Radial and ulnar styloid superimposed and perpendicular to IR

5. CR perpendicular to wrist joint

What is required of lateral wrist X-ray

1. Proper collimation

2. Distal radius and ulna, carpals, and proximal half of metacarpals

3. Superimposed distal radius and ulna

Super imposed metacarpals

PA Ulnar Deviation

1. Palm on surface of IR

2. Elbow straight but wrist turned 90 degrees

3. Pinky towards ulna

4. Wrist placed in center of IR

5. CR perpendicular to the scaphoid

What is required of a PA ulnar deviation

1. No rotation of wrist

2. Scaphoid is open for angle

3. Collimate mid wrist to midcarpal

PA axial scaphoid

1. Upper extremity resting (raised)

2. Wrist placed in center of IR

3. adjust IR so that finger is elevated 20 degrees. CEPHALIC 20° angle

What is required of PA axial scaphoid

1. Proper collimation

2. No rotation of wrist

3. Scaphoid has some space with raise

Tangential carpal tunnel (gaynor-hart method)

1. forearm resting on table and aligned parallel with long axis of table

2. Hyperextended wrist

3. Center IR to joint @level of radial styloid

4. Grab digits with opposite hand to maintain extended position

What is required of a tangential carpal tunnel

1. CR angled 25/30°

2. CR enters at point distal to the base of the third metacarpal

3. Collimation is radiation field of 1inch around all anatomy

4. WANT TO SEE opening at wrist when bent

AP forearm

1. Lay arm on table, forearm away from IR

2. Elbow extended with hand supinated

3. Humeral epicondyles equidistant from IR

4. Long axis of forearm aligned parallel

Lateral Forearm

1. 90° upper extremity

2. Thumb side up

3. Ulnar and radial styloid processes superimposed

4. Karate chop thumb up

Ball catcher view AP oblique

1. Palms opened up

2. Distal ends of radius and ulna to all fingers

3. 45° & center of MCP joints

   *erosive arthropathies such as rheumatoid arthritis