PROC 3 - Module 2 Exam

What three wrist procedures are covered in Module 2 Lesson 1?

PA ulnar deviation, PA axial scaphoid (Stecher method), and tangential carpal tunnel (Gaynor-Hart method)

What is the primary anatomy demonstrated by a PA wrist in ulnar deviation?

The scaphoid free from superimposition of the other carpals

Why is the PA ulnar deviation useful for evaluating the scaphoid?

Ulnar deviation projects the scaphoid free from superimposition of the other carpals

How should the patient's upper limb be positioned for a PA wrist in ulnar deviation?

Rest the upper limb on the table with the forearm, wrist, and hand in the same plane

How much should the elbow be flexed for a PA wrist in ulnar deviation?

90°

Where should the wrist be positioned on the IR for a PA ulnar deviation?

Centered to the IR

What IR size can be used for a PA wrist in ulnar deviation?

8 × 10 or 10 × 12 inches

How should the digits be positioned for a PA wrist in ulnar deviation?

Flex the digits slightly

Why are the digits slightly flexed for a PA wrist in ulnar deviation?

To bring the wrist closer to the IR and decrease OID and magnification

How is ulnar deviation produced?

Keep the forearm straight and still while turning the hand as far as possible toward the ulna

Where is the CR directed for a PA wrist in ulnar deviation?

Perpendicular to the scaphoid

Where should the side marker be placed for a PA wrist in ulnar deviation?

On the lateral or thumb side

What anatomy must be included on a properly collimated PA wrist in ulnar deviation?

Distal radius and ulna, carpals, and proximal half of the metacarpals

How should the scaphoid appear on a properly positioned PA wrist in ulnar deviation?

Well visualized with the adjacent joint spaces open

What indicates that a PA wrist in ulnar deviation has no rotation?

The wrist is straight without distortion

How much ulnar deviation should be demonstrated on a PA wrist in ulnar deviation?

Maximum ulnar deviation without moving the rest of the arm

What soft tissue and bone detail should be demonstrated on a PA wrist in ulnar deviation?

Soft tissue and bony trabeculae should be well visualized

What is another name for the PA axial scaphoid projection?

Stecher method

What anatomy does the Stecher method primarily demonstrate?

The scaphoid

Why might a Stecher method be performed?

To evaluate the scaphoid for conditions such as fracture or avascular necrosis

How should the patient's upper limb be positioned for the Stecher method?

Rest the upper limb on the table with the arm, wrist, and hand in the same plane

Where should the wrist be positioned for the Stecher method?

Centered to the IR

What IR size can be used for the Stecher method?

8 × 10 or 10 × 12 inches

What are the two ways to create the required angle for the Stecher method?

Elevate the finger end of the IR 20° and use a perpendicular CR, or keep the IR horizontal and angle the CR 20° toward the elbow

When using an angled IR for the Stecher method, which end of the IR is elevated?

The finger end

How much is the finger end of the IR elevated for the Stecher method?

20°

When the IR is elevated 20° for the Stecher method, what CR angle is used?

A perpendicular CR

Where does the CR enter when using the elevated-IR Stecher method?

The scaphoid

If the IR remains horizontal for the Stecher method, how is the CR angled?

20° toward the elbow

Where does the angled CR enter for the Stecher method?

The scaphoid

How should the scaphoid appear on a correctly performed Stecher projection?

Slightly elongated and projected free of superimposition

What should be open on a correctly performed Stecher projection?

The joint spaces around the scaphoid

What is another name for the tangential carpal tunnel projection?

Gaynor-Hart method

What does the Gaynor-Hart method demonstrate?

The carpal canal

How is the patient positioned for the Gaynor-Hart method?

Seated at the end of the table with the forearm parallel to the long axis of the table

How is the wrist positioned for the Gaynor-Hart method?

Hyperextend the wrist with the long axis of the hand as near vertical as possible

Where is the IR centered initially for the Gaynor-Hart method?

At the wrist joint at the level of the radial styloid

How can the patient maintain wrist hyperextension for the Gaynor-Hart method?

Grasp the fingers with the opposite hand or use tape to hold the fingers back

Why is the hand rotated slightly toward the radial side for the Gaynor-Hart method?

To prevent superimposition of the hamate and pisiform

What IR size can be used for the Gaynor-Hart method?

8 × 10 or 10 × 12 inches

What CR angle is used for the Gaynor-Hart method?

25° to 30° to the long axis of the hand

Where does the CR enter for the Gaynor-Hart method?

The palm approximately 1 inch distal to the base of the third metacarpal

Why is the CR angled 25° to 30° for the Gaynor-Hart method?

To obtain a tangential projection of the carpal bones

How should the carpals appear on a properly positioned Gaynor-Hart projection?

They should form an arch

How should the pisiform appear on a properly positioned Gaynor-Hart projection?

In profile and free of superimposition

What portion of the hamate should be well demonstrated on a Gaynor-Hart projection?

The hamulus of the hamate

What general collimation requirement applies to the Gaynor-Hart projection?

Collimate closely to the area of interest

What two rotations are used for AP oblique projections of the elbow?

Medial rotation and lateral rotation

How does the AP oblique elbow with medial rotation begin?

Extend the arm as for a regular AP elbow with the entire arm in the same plane

Where is the IR centered for an AP oblique elbow with medial rotation?

To the elbow joint

How should the hand be positioned for an AP oblique elbow with medial rotation?

Pronate the hand

How much is the elbow rotated for an AP oblique elbow with medial rotation?

45° medially

What surface of the elbow is placed 45° to the IR for the medial oblique?

The anterior surface

Where is the CR directed for an AP oblique elbow with medial rotation?

Perpendicular to the elbow joint

What IR size is used for an AP oblique elbow with medial rotation?

8 × 10 or 10 × 12 inches

What anatomy is best demonstrated in profile on a medial oblique elbow?

The coronoid process

How should the medial humeral epicondyle appear on a medial oblique elbow?

Elongated

How should the radial head and neck appear on a medial oblique elbow?

Superimposed over the ulna

What should happen to the elbow joint on a correctly positioned medial oblique?

It should be open and centered to the CR

What additional anatomy should be demonstrated on a medial oblique elbow?

The trochlea and the olecranon process within the olecranon fossa

What image-detail criteria should be demonstrated on a medial oblique elbow?

Good soft tissue and bony trabeculae

How does the AP oblique elbow with lateral rotation begin?

With the arm extended, straight, and in the same plane

How should the hand be positioned for an AP oblique elbow with lateral rotation?

Supinate the hand

How much is the elbow rotated for an AP oblique elbow with lateral rotation?

45° laterally

What surface is placed 45° from the IR for a lateral oblique elbow?

The posterior surface

What fingers should touch the table when the elbow is correctly positioned for a lateral oblique?

The first and second digits

Where is the CR directed for an AP oblique elbow with lateral rotation?

Perpendicular to the elbow joint

What IR size is used for an AP oblique elbow with lateral rotation?

8 × 10 or 10 × 12 inches

What anatomy should be free from the ulna on a lateral oblique elbow?

The radial head, neck, and tuberosity

How should the lateral humeral epicondyle appear on a lateral oblique elbow?

Elongated

What structure is well visualized because of lateral rotation on a lateral oblique elbow?

The capitulum

What should happen to the elbow joint on a correctly positioned lateral oblique?

It should be open and centered to the CR and IR

What image-detail criteria should be demonstrated on a lateral oblique elbow?

Good soft tissue and bony trabeculae

Why might an AP elbow with partial flexion be necessary?

Trauma may prevent the patient from fully extending the elbow

How many images are required for an AP elbow in partial flexion?

Two

What two images are required for an AP elbow in partial flexion?

AP distal humerus and AP proximal forearm

Why are two projections required for an elbow in partial flexion?

The humerus and forearm cannot both be parallel to the IR at the same time, so each must be imaged separately

For the AP distal humerus with partial flexion, what part must be parallel to and in contact with the IR?

The humerus

How can you make the humerus level for an AP distal humerus with partial flexion?

Lower the patient on a chair or stool or raise the table until the humerus is level

How should the forearm be positioned for the AP distal humerus with partial flexion?

Elevated and supported

Why should the forearm be supported during an AP distal humerus with partial flexion?

The injured patient may have difficulty holding it still

How should the hand be positioned for an AP distal humerus with partial flexion if possible?

Supinated

What should be centered to the IR for an AP distal humerus with partial flexion?

The humeral condyles

Where is the CR directed for an AP distal humerus with partial flexion?

Perpendicular to the humerus and centered to the elbow joint

What IR size is used for an AP distal humerus with partial flexion?

8 × 10 or 10 × 12 inches

How should the distal humerus appear on an AP distal humerus partial-flexion image?

Without rotation or distortion

How should the proximal radius appear on an AP distal humerus partial-flexion image?

Superimposed over the ulna

How should the elbow joint appear on an AP distal humerus partial-flexion image?

Closed

What part will be distorted on an AP distal humerus partial-flexion image?

The proximal forearm

Why is the proximal forearm distorted on the AP distal humerus partial-flexion image?

The forearm is angled relative to the IR

For the AP proximal forearm with partial flexion, what part must be parallel to and in contact with the IR?

The forearm

What surface of the forearm is placed on the IR for the AP proximal forearm with partial flexion?

The dorsal surface

How should the hand be positioned for the AP proximal forearm with partial flexion if possible?

Supinated

What should be centered to the IR for the AP proximal forearm with partial flexion?

The humeral condyles

Where is the CR directed for an AP proximal forearm with partial flexion?

Perpendicular to the long axis of the forearm and centered to the elbow joint

What IR size is used for an AP proximal forearm with partial flexion?

8 × 10 or 10 × 12 inches

How should the proximal radius and ulna appear on an AP proximal forearm partial-flexion image?

Without rotation or distortion

How should the radial head, neck, and tuberosity appear on an AP proximal forearm partial-flexion image?

Slightly superimposed over the proximal ulna

How should the elbow joint appear on an AP proximal forearm partial-flexion image?

Partially open

What part will be distorted on an AP proximal forearm partial-flexion image?

The humerus