Trigger 5, RAD ANA: Upper Extremities

Ma'am Daph's Hand-Outs

• hand and wrists

• forearm

• arm

• shoulder girdle

• hand and wrists

• forearm

• arm

• shoulder girdle

main groups of upper extremities:

27 bones

there are, how many bones on each hand and wrists?

14 bones

on each hand and wrists, there are 27 bones. the phalanges (fingers and thumb) have, how many?

5 bones

on each hand and wrists, there are 27 bones. the metacarpals (palm) have, how many?

8 bones

on each hand and wrists, there are 27 bones. the carpals (wrist) have, how many?

phalanges

• the most distal bones of the hand

• singular: phalanx

• each digit consists of two or three separate small bones called as, what?

metacarpals

these bones make up the palm of each hand

carpals

consists the bones of wrists

digit

• each finger and thumb is called as, what?

• are numbered, starting with the thumb as 1 and ending with the little finger as 5.

proximal, middle, and distal

each of the four fingers (digits 2, 3, 4, and 5) is composed of three phalanges, which are the?

proximal and distal

the thumb, or first digit, has two phalanges, which are the?

• distal rounded head

• body (shaft)

• expanded base

parts of phalanx

interphalangeal (IP) joint

the thumb has only two phalanges, so the joint between them is called the:

first metacarpophalangeal (MCP) joint.

the joint between the first metacarpal and the proximal phalanx of the thumb is called:

• distal interphalangeal (DIP) joint

• proximal interphalangeal (PIP) joint

• metacarpophalangeal (MCP) joint

• joints of the second to fifth digits

• each of the second through fifth digits has three phalanges, and they have three joints each.

• starting from the most distal portion of each digit, the joints are called:

metacarpophalangeal (MCP) joints

the metacarpals articulate with the phalanges at their distal ends and are called as:

carpometacarpal (CMC) joints

at the proximal end, the metacarpals articulate with the respective carpals which are called as:

trapezium

• first metacarpal articulate with what specific carpal?

• a four-sided, irregularly shaped bone that is located medial and distal to the scaphoid and proximal to the first metacarpal.

trapezoid

• second metacarpal articulate with what specific carpal?

• wedge-shaped

• also four-sided, is the smallest bone in the distal row

capitate

• third metacarpal articulate with what specific carpal?

• largest of the carpal bones

• is identified by its large rounded head that fits proximally into a concavity formed by the scaphoid and lunate bones.

hamate

• fourth and fifth metacarpal articulate with what specific carpal?

• last carpal in the distal row

hamulus

• hamate is easily distinguished by the hook-like process which projects from its palmar surface

• hamular process

scaphoid

• beginning on the lateral, or thumb side

• a boat-shaped bone, is the largest bone in the proximal row and articulates with the radius proximally.

• most frequently fractured carpal bone

lunate

• moon-shaped

• is the second carpal in the proximal row

• it articulates with the radius

• It is distinguished by the deep concavity on its distal surface, where it articulates with the capitate of the distal row of carpals

triquetrum

• third carpal of the proximal row

• has three articular surfaces and is distinguished by its pyramidal shape and anterior articulation with the small pisiform.

pisiform

• pea-shaped

• smallest carpal bone

• located anterior to the triquetrum and is most evident in the carpal canal or tangential projection

tangential projection

the anteriorly located pisiform and the hamulus process of the hamate are visualized best through what projection?

carpal sulcus

• carpal tunnel, carpal canal

• It is where the major nerves and tendons pass

scaphoid lunate triquetrum pisiform trapezium trapeziod capitate hamate

steve left the party to take carol home

• radius

• ulna

bones of the forearm:

• proximal radioulnar joint

• distal radioulnar joint

responsible for rotational movement of the wrist and hand

styloid process

• small conical projections located at the extreme distal ends of both the radius and the ulna

thumb side of the wrist joint

radial styloid process can be palpated on which side of the wrist joint?

ulnar notch

• a small depression on the medial aspect of the distal radius

• where the head of ulna fits to form the distal radioulnar joint

distal radioulnar joint

the head of the ulna fits into the ulnar notch to form, what joint?

head of ulna

• located near the wrist at the distal end of the ulna

• in pronation, BLANK and the styloid process are easily felt and seen on the “little finger” side of the distal forearm.

head of radius

is located at the proximal end of the radius near the elbow joint

body (shaft)

the long midportion of both the radius and the ulna is called, what?

radius

• the shorter of the two bones of the forearm,

• is the only one of the two that is directly involved in the wrist joint

• the bone that rotates around the more stationary ulna

radial tuberosity

rough oval process on the medial and anterior side of the radius.

ulna

• the longer of the two bones of the forearm

• is primarily involved in the formation of the elbow joint

• olecranon process

• coronoid process

beak-like process of ulna:

olecranon process

can be palpated easily on the posterior aspect of the elbow joint

coronoid tubercle

medial margin of the coronoid process opposite the radial notch (lateral) is commonly referred as, what?

trochlear notch

• semilunar notch

• large concave depression, or notch, that articulates with the distal humerus

radial notch

• small, shallow depression located on the lateral aspect of the proximal ulna

proximal radioulnar joint

• the head of the radius articulates with the ulna at the radial notch, forming what joint?

• combines with the distal radioulnar joint to allow rotation of the forearm during pronation.

humeral condyle

the expanded distal end of the humerus

• trochlea

• capitulum

the articular portion of the humeral condyle is divided into:

trochlea

• pulley

• shaped like a pulley or spool

• it has two rimlike outer margins and a smooth depressed center portion (trochlear sulcus/groove)

• located more medially and articulates with the ulna.

trochlear sulcus

• trochlear groove

• this depression of the trochlea, which begins anteriorly and continues inferiorly and posteriorly, appears circular on a lateral end-on view

• on a lateral elbow radiograph, it appears as a less dense (more radiolucent) area

capitulum

• little head

• is located on the lateral aspect and articulates with the head of the radius

• lateral epicondyle

• medial epicondyle

two epicondyles are important in evaluation for true lateral position of the elbow

lateral epicondyle

the small projection on the lateral aspect of the distal humerus above the capitulum.

medial epicondyle

is larger and more prominent than the lateral epicondyle and is located on the medial edge of the distal humerus.

proximal to the circular appearance of the trochlear sulcus

In a true lateral position, the directly superimposed epicondyles (which are difficult to recognize) are seen, what?

• coronoid fossa

• radial fossa

shallow anterior distal humerus depressions:

coronoid fossa

shallow anterior distal humerus depression

• receives coronoid process

radial fossa

shallow anterior distal humerus depression

• receives radial head

olecranon fossa

• deep posterior depression of the distal humerus

• the olecranon process of the ulna fits into this depression when the arm is fully extended.

• flexed 90 degrees

• apperance of the three concentric arcs

good criterion by which to evaluate a true lateral position of elbow:

ginglymus (hinge) joint

all interphalangeal (IP) joints are, what type of synovial joint?

two directions only

• flexion

• extension

all interphalangeal (IP) joint movements are, what?

ellipsoidal (condylar) joints

• 2nd to 5th MCP joints are, what type of synovial joint?

• flexion, extension, abduction, adduction, and circumduction

saddle (sellar) joints

• 1st CMP joints are, what type of synovial joint?

• allows a great range of movement (flexion, extension, abduction, adduction, circumduction, opposition, and some degree of rotation)

plane (gliding) joints

• 2nd to 5th CMP joints, and intercarpal joints are, what type of synovial joint?

• least of movement (flexion, extension, abduction, adduction, circumduction, opposition, and some degree of rotation)

• movement limited by a tight fibrous capsule.

ulnar deviation

• turning or bending the hand and wrist from its natural position toward the side of the ulna

• movement of the wrist “opens up”

• best demonstrates carpals of the radial/lateral side of wrists

  • scaphoid, trapezium, and trapezoid.

• special scaphoid projection

radial deviation

• a less frequent PA wrist projection

• movement that opens

• movement of the wrist “opens up”

• best demonstrates the carpals on the opposite, or ulnar, side of the wrist

  • hamate, pisiform, triquetrum, and lunate.

hand supinated for an AP projection

to prevent superimposition of the radius and ulna that may result from these pivot-type rotational movements, the forearm is radiographed with:

assess associated soft tissues, such as certain accumulations of fat

importance of visualizing fat pads

around certain joints of the upper and lower limbs.

for diagnostic purposes, the most important fat pads or bands are located, where?

scaphoid fat stripes

• wrist joint fat ripe that is visualized on PA and oblique projections

• It is elongated and slightly convex in shape and is located between the radial collateral ligament and adjoining muscle tendons immediately lateral to the scaphoid.

• absence or displacement of this fat stripe may be the only indicator of a fracture on the radial aspect of the wrist.

pronator fat stripe

• second fat stripe is visualized on the lateral view of the wrist.

• normally visualized approximately 1 cm (1/4 inch) from the anterior surface of the radius

• subtle fractures of the distal radius can be indicated by displacement or obliteration of the plane of this fat stripe

lateral projection

the three significant fat pads or stripes of the elbow are visualized only on the, what projection?

because of their superimposition over bony structures.

why are fat pads or stripes of the elbow only visualised on the lateral side and not on AP?

anterior fat pad

• is formed by the superimposed coronoid and radial pads, is seen as a slightly radiolucent teardrop shape located just anterior to the distal humerus

• visible only on a true lateral elbow projection flexed 90°

posterior fat pad

• located deep within the olecranon fossa

• normally is not visible on a negative elbow examination

supinator fat stripe

• a long thin stripe just anterior to the proximal radius

• It may indicate the diagnosis of radial head or neck fractures that are not obviously apparent

bone metastases

refers to transfer of disease or cancerous lesions from one organ or part that may not be directly connected.

bursitis

• inflammation of the bursae or fluid-filled sacs that enclose the joints

• the process generally involves the formation of calcification in associated tendons, which causes pain and limited joint movement.

carpal tunnel syndrome

• is a common painful disorder of the wrist and hand that results from compression of the median nerve as it passes through the center of the wrist

• it is most commonly found in middle-aged women

fracture

a break in the structure of bone caused by a force (direct or indirect).

barton’s fracture

fracture & dislocation of posterior lip of distal radius.

bennett’s fracture

frature of the base of the first metacarpal

boxer’s fracture

• transverse fracture that extends through the metacarpal neck

• common in 5th metacarpal

colle’s fracture

transverse fracture of the distal radius in which distal fragment is displaced posteriorly

smith’s fracture

• reverse of colle’s fracure

• transverse fracture of distal radius with distal fragment displaced anteriorly

joint effusion

• refers to accumulated fluid (synovial/hemorrhagic) in joint cavity

• sign for possible fracture, dislocation, soft tissue damage or inflammation

osteoarthritis

• degenerative joint disease (DJD)

• a noninflammatory joint disease characterized by gradual deterioration of articular cartilage with hypertrophic bone formation

osteomyelitis

local or generalized infection of bone/bone marrow that may be caused by bacteria introduced by trauma or surgery

osteopetrosis

• a hereditary disease marked by abnormally dense bone

• known as the marble bone

osteoporosis

refers to reduction in the quantity of bone or atrophy of skeletal tissue.

paget’s disease

• osteitis deformans

• common chronic skeletal disease

• chracterized by bone destruction followed by reparative process of production of soft bones that tend to fracture easily

rheumatoid arthritis

chronic systemic disease with inflammatory changes throughout the connective tissues

skier’s thumb

refers to a sprain or tear of the ulnar collateral ligament of the thumb

humerus

• the largest & longest bone of the upper limb

• articulates with scapula at the shoulder joint

lesser tubercle

the process directly below the anatomic neck on anterior surface

greater tubercle

the larger lateral process to which the pectoralis major & supraspinatus muscle attach

intertubercular (bicipital groove)

deep groove between lesser & greater tubercle

surgical neck

the tapered area below the head & tubercles