Upper Limb Radiography and Clinical Indications

Flashcards covering clinical indications, radiographical concepts, joint classifications, fat pads, and upper limb anatomy from the lecture transcript.

Bone metastases

Transfer of disease or cancerous lesions from one organ or part that may not be directly connected, representing the most common malignant bone tumors.

Bursitis

Inflammation of the bursae or fluid-filled sacs that enclose the joints, generally involving the formation of calcification in associated tendons.

Carpal tunnel syndrome

A common painful disorder of the wrist and hand resulting from compression of the median nerve as it passes through the center of the wrist.

Barton fracture

Fracture and dislocation of the posterior lip of the distal radius involving the wrist joint.

Bennett fracture

Fracture of the base of the first metacarpal bone, extending into the carpometacarpal joint, complicated by subluxation with some posterior displacement.

Boxer fracture

Transverse fracture that extends through the metacarpal neck, most commonly seen in the fifth metacarpal.

Colles fracture

Transverse fracture of the distal radius in which the distal fragment is displaced posteriorly, with an associated ulnar styloid fracture seen in $50\%$ to $60\%$ of cases.

Smith fracture

Reverse of Colles fracture, characterized as a transverse fracture of the distal radius with the distal fragment displaced anteriorly.

Joint effusion

Accumulated fluid (synovial or hemorrhagic) in the joint cavity, serving as a sign of an underlying condition such as fracture, dislocation, soft tissue damage, or inflammation.

Osteoarthritis

Also known as degenerative joint disease (DJD), a noninflammatory joint disease characterized by gradual deterioration of articular cartilage with hypertrophic bone formation.

Osteomyelitis

A local or generalized infection of bone or bone marrow that may be caused by bacteria introduced by trauma, surgery, or a contiguous source such as a diabetic foot ulcer.

Osteopetrosis

A hereditary disease marked by abnormally dense bone, also known as marble bone, which commonly results in fracture and obliteration of the marrow space.

Osteoporosis

Reduction in the quantity of bone or atrophy of skeletal tissue occurring in postmenopausal women and elderly men, resulting in scanty and thin bone trabeculae.

Paget disease

Also called osteitis deformans, a chronic skeletal disease characterized by bone destruction followed by overproduction of dense yet soft bones; can display a "cotton wool appearance" on radiographs.

Rheumatoid arthritis

A chronic systemic disease with inflammatory changes throughout connective tissues, characterized by early soft tissue swelling around the ulnar styloid and early bone erosions at the second and third MCP joints or third PIP joint.

Scapholunate ligament injury

An injury involving the ligament connecting the scaphoid to the lunate bone, evidenced by a widening of the space between them of $3\text{ to }4\,\text{mm}$ or greater.

Skier's thumb

A sprain or tear of the ulnar collateral ligament of the thumb near the MCP joint of a hyperextended thumb, best demonstrated by the Folio method.

Multiple myeloma

The most common primary cancerous bone tumor, arising from bone marrow or marrow plasma cells and appearing radiographically as multiple "punched-out" osteolytic lesions.

Osteogenic sarcoma

The second most common type of primary cancerous bone tumor, also known as osteosarcoma, which generally affects persons aged $10\text{ to }20\,\text{years}$.

Ewing sarcoma

A common primary malignant bone tumor in children and young adults that arises from bone marrow, producing a stratified "onion peel" appearance on radiographs.

Chondrosarcoma

A slow-growing malignant tumor of the cartilage that often displays dense calcifications within the cartilaginous mass.

Enchondroma

A slow-growing benign cartilaginous tumor most often found in small bones of the hands and feet of adolescents and young adults.

Osteochondroma

The most common type of benign bone tumor (also called exostosis), arising from the outer cortex and growing parallel to the bone pointing away from the adjacent joint.

Ulnar deviation

Wrist joint movement toward the ulnar side that opens up and best demonstrates the carpals on the radial side (scaphoid, trapezium, and trapezoid).

Radial deviation

Wrist joint movement toward the radial side that opens up and best demonstrates the carpals on the ulnar side (hamate, pisiform, triquetrum, and lunate).

Scaphoid fat stripe

An elongated, slightly convex fat stripe visualized on PA and oblique wrist projections, located between the radial collateral ligament and adjoining muscle tendons.

Pronator fat stripe

A fat stripe visualized on the lateral view of the wrist, located approximately $1/4\,\text{inch}\,(1\,\text{cm})$ from the anterior surface of the radius.

Anterior fat pad

A teardrop-shaped fat pad located anterior to the distal humerus, formed by the superimposed coronoid and radial pads, visible on a true lateral elbow flexed $90^\circ$.

Posterior fat pad

A fat pad located deep within the olecranon fossa that is normally non-visible on a negative elbow examination, whose visualization on a $90^\circ$ flexed lateral elbow indicates joint pathology.

Supinator fat stripe

A long, thin fat stripe located just anterior to the proximal radius that can indicate non-apparent radial head or neck fractures.

Arthrography

A diagnostic procedure requiring radiographic contrast medium injected into the joint capsule under sterile conditions to image tendinous, ligamentous, and capsular pathology.

Nuclear medicine bone scan

A highly sensitive procedure assessing physiologic aspects that demonstrates osteomyelitis, metastatic bone lesions, stress fractures, and cellulitis within $24\,\text{hours}$ of onset.

Interphalangeal joints

Ginglymus (hinge) type joints of the hand that allow movement in two directions (flexion and extension) around a transverse axis.

Metacarpophalangeal joints

Ellipsoidal (condyloid) type joints (second to fifth) allowing movement in four directions (flexion, extension, abduction, adduction) plus circumduction.

First carpometacarpal joint

A saddle (sellar) type joint located at the thumb that allows a wide range of movement including flexion, extension, abduction, adduction, circumduction, opposition, and rotation.

Radiocarpal joint

An ellipsoidal (condyloid) type wrist joint where the distal radius articulates directly with the scaphoid and lunate bones.

Ulnar collateral ligament

A wrist ligament attached to the styloid process of the ulna that fans out to attach to the triquetrum and pisiform.

Radial collateral ligament

A wrist ligament extending from the styloid process of the radius primarily to the lateral side of the scaphoid (scaphoid tubercle) and trapezium.

Proximal radioulnar joint

A pivot (trochoidal) type joint located between the head of the radius and the radial notch of the ulna.

Trochlea

The smooth, pulley-shaped medial portion of the humeral condyle that articulates with the ulna.

Capitulum

The rounded lateral portion of the humeral condyle (meaning "little head") that articulates with the head of the radius.

Coronoid fossa

A shallow anterior depression on the distal humerus that receives the coronoid process of the ulna upon complete elbow flexion.

Olecranon fossa

A deep posterior depression of the distal humerus that receives the olecranon process of the ulna when the arm is fully extended.

Three concentric arcs

Radiographic alignment criteria on a true lateral elbow flexed $90^\circ$, consisting of the trochlear sulcus, outer ridges of the capitulum and trochlea, and trochlear notch of the ulna.