Upper Extremity Exam

The Upper Limb consists of these 4 bone groups

Hand and wrist, Forearm, Arm, and Shoulder Girdle

The Hand and Wrist group consists of

27 total bones: Phalanges, metacarpals, and carpals

What are the parts of a phalanx

head, body/shaft, and base

Digit 1 is the

thumb

Digit 5 is the

pinky

Term for the joint between the first digits phalanges

IP or Interphalangeal joint

Term for the joint between the proximal and middle phalanges

PIP or Proximal Interphalangeal joint

Term for the joint between the middle and distal phalanges

DIP or Distal Interphalangeal joint

Term for the joint between the proximal phalanges and metacarpals

MCP or Metacarpophalangeal joint

Term for the joint between the metacarpal and carpals

CMC or Carpometacarpal joint

Radial Deviation

movement of thumb toward the wrist

Ulnar Deviation

movement of pinky toward the wrist

What is the purpose for a bone age study

to determine skeletal maturity and future bone growth

Parts of the forearm

Radius and Ulna

What side is the radius on?

the thumb side

what side is the Ulna on?

the pinky side

What position are the bones in during supination?

Parallel

What position are the bones in during pronation

crossed over

The elbow is the articulation between the

distal humerus, radius, and ulna

What are the 3 concentric arcs found on a lateral elbow

trochlear sulcus, outer ridges of the capitulum and trochlea, and trochlear notch on the ulna

medial or internal oblique of the elbow shows

a superimposed radius/ulna, can clearly see the c of the ulna

lateral or external oblique of the elbow shows

a separated radius and ulna, clearly shows the radial head

Classification of the IP Joint

Hinge type, synovial

Classification of a MCP Joint

Condyloid/Ellipsoidal, Synovial

Classification of the 1st CMC Joint

Saddle, Synovial

Classification of the 2nd-5th CMC Joint

Plane/Gliding, Synovial

Classification of the IC (interarpal) Joint

Plane/Gliding, Synovial

Classification of the Elbow Joint (humerus/ulna and radius)

Hinge, Synovial

Classification of the Forearm Joint (radial head and proximal ulna)

Pivot, synovial

Name the 2 fat pads of the wrist

Scaphoid fat stripe and pronator fat stripe

Name the 3 Elbow Fat Pads

Posterior fat pad, Anterior Fat Pad, and Supinator fat stripe

Routine Finger Imaging Series

PA, PA Oblique, and Lateral

Finger Imaging SID

40 in

Finger Imaging IR Location

Table TopF

Finger Imaging Light Field Size

8×10 or smaller

Finger Imaging Technique

60 kVp @ 1.2 mAs

Finger Imaging CR Location

PIP

Which digits get medial oblique and mediolateral lateral in Finger Imaging

digit 2

Which digits get lateral oblique and lateromedial lateral in Finger Imaging

digits 3-5

Why is full extension important?

To open up joint spaces

Thumb Imaging Series Includes

Routine: AP, PA Oblique, and Lateral

Special: AP Axial (Modified Robert’s) and PA Stress (Folio)

Thumb Imaging SID

40 in

Thumb Imaging IR Location

Table top

Thumb Imaging Light Field Size

8×10 or smaller

Thumb Imaging Technique

60 kVp @1.2 mAs

Thumb Imaging CR Location

1st MCP Joint

What position is the thumb in naturally when the palm is flat of the table

Oblique

Hand Imaging Series Includes

Routine: PA, PA Oblique, “Fan” Lateral

Alternate: Lateral in Extension and Flexion

Special: AP Axial - Brewerton Method

Hand Imaging SID

40 in

Hand Imaging IR Location

Table top

Hand Imaging Light Field Size

8×10 or 10×12

Hand Imaging Technique

60 kVp @ 2-3 mAs

Hand Imaging CR Location

3rd MCP Joint

Hand Imaging CR Location for Lateral Image

2nd MCP Joint

Wrist Imaging Series Includes

Routine: PA, PA Oblique, Lateral (Lateromedial)

Special: PA/PA Axial Scaphoid with Ulnar Deviation, PA Scaphoid (Modified Stecher), Bilateral PA Stress( “Clenched PA”), PA - Radial Deviation, Carpal Canal Tunnel, Carpal Bridge

Wrist Imaging SID

40 in

Wrist Imaging IR Location

Table top

Wrist Imaging Light Field Size

8×10 or 10×12

Wrist Imaging Technique

60 kVp @ 2-3 mAs

Wrist Series CR Location 

Midcarpal area

Forearm Imaging Series Includes

Routine: AP and Lateral (Lateromedial)

Forearm Imaging SID

40 in

Forearm Imaging IR Location

Table Top

Forearm Imaging Light Field Size

14×17

Forearm Imaging Technique

64 kVp @ 2-3 mAs

Forearm Imaging CR Location

Mid-Forearm

Forearm Imaging needs to include

both the elbow joint and carpals

Elbow Imaging Series Includes

Routine: AP (fully extended), AP Oblique (Lateral or Medial) and Lateral (Lateromedial)

Alternate: AP - Partial extension, AP - acute flexion

Special: Trauma axial lateral - Coyle Method, Radial Head Lateral

Elbow Imaging SID

40 in

Elbow Imaging IR Location

Table Top

Elbow Imaging Light Field Size

8×10 or 10×12

Elbow Imaging Technique

64 kVp @ 2-3 mAs

Elbow Imaging CR Location

Mid-elbow joint

Humerus Imaging Series Includes

Routine: AP, Rotational Lateral (Lateromedial or Mediolateral)

Special: Horizontal Lateral, Transthoracic Lateral

Humerus Imaging SID

40 in

Humerus Imaging IR Location

Bucky or Tabletop depending on thickness

Humerus Imaging Light Field Size

14×17

Humerus Imaging Technique

Grid: 70 kVp @ 6-8 mAs

Non-Grid: 66 kVp @ 4 mAs

Humerus Imaging CR Location

Mid-Humerus

Lateromedial Lateral has hand in what position

back of hand on side - rotated to thumb posterior

Mediolateral Lateral hand positioning

arm moved behind the body in ‘chicken wing’

Shoulder Imaging Series Includes

Routine: AP with External and Internal Rotation

Special: Non-Trauma: Inferosuperior Axial - Lawrence Method, PA Axial Transaxillary - Modified Bernageau, Inferosuperior Axial - Clements Modification, Superiorinferior Transaxillary, AP Oblique Glenoid Cavity - Grashey, Apical AP Axial, Tangential Intertubercular (Bicipital) Sulcus - Fisk Modification

Special: Trauma: AP - Neutral Rotation, Transthoracic Lateral, AP/PA Oblique - Scapular Y Lateral, Tangential Supraspinatus Outlet - Neer, AP Apical Oblique Axial - Garth

Shoulder Imaging SID

40 in

Shoulder Imaging IR Location

Wall/Table Bucky

Shoulder Imaging Light Field Size

10×12 landscape

Shoulder Imaging Technique

Grid: 75 kVp @ 6-10 mAs

Shoulder Imaging CR Location

one inch inferior to coracoid process or 2 inches inferior to AC joint

Shoulder External Rotation hand position

palm forward

Shoulder Internal Rotation hand position

palm rotated to lateral with thumb in back

Shoulder Neutral Rotation Hand position

palm on thigh

Clavicle Imaging Includes

AP and AP Axial

Clavicle Imaging SID

40 in

Clavicle Imaging IR Location

Wall/Table Bucky

Clavicle Imaging Light Field Size

10×12

Clavicle Imaging Technique

75 kVp @ 8 mAs

Clavicle Imaging CR Location

Midclavicle

Acromioclavicular (AC) Joints Includes

AP Bilateral with and without weights - Pearson method

AC Joint Imaging SID

40 or 72 in

AC Joint Imaging IR Location

Wall bucky

AC Joint Imaging Light Field Size

14×17 to be bilateral. Unilateral is smaller and only includes one side at a time