RAD 112 Exam 3

How many bones are in each hand and wrist?

27

How many phalanges are in the hand?

14

How many metacarpals are there?

5

How many carpals are there?

8

What are the most Distal bones of the hand?

The phalanges

The 2nd-5th digits have how many phalanges and joints?

3 joints and 3 phalanges each

How many phalanges and joints does the 1st digit (thumb) have?

2 phalanges and 2 joints

The first metacarpal articulate with what carpal bone?

Trapezium

The second metacarpal articulate with what carpal bone?

Trapezoid

The third metacarpal articulate with what carpal bone?

capitate

The fourth and fifth metacarpal articulate with what carpal bone?

hamate

The metacarpals articulate with the phalanges at their distal end forming what joint?

metacarpophalangeal joint

The metacarpals articulate with carpals at the proximal end forming what joint?

carpometacarpal joint

What is the distal row of the carpal bones?

• Trapezium

• Trapezoid

• Capitate

• Hamate

What is the proximal row of the carpal bones?

• Scaphoid

• Lunate

• Triquetrum

• Pisiform

What is the most frequently fractured carpal bone?

The scaphoid

The Scaphoid and Lunate articulates with what bone?

The radius

What concial projections are located at the extreme distal ends of both the radius and ulna?

Styloid Process

Is the head of the Ulna located more distal or proximal?

Distal

Is the head of the radius located more distal or proximal?

proximal

What are the two palpable regions of the elbow?

Lateral and Medial epicondyle

What is the wrist joint called?

Radiocarpal joint

What kind of joint is the radiocarpal (wrist) joint?

ellipsoidal (condyloid) type synovial joint

What joint is the most freely moveable?

synovial (diathrodial)

What type of joints are the 1st-5th MCP?

Ellipsoidal (condyloid type)

What type of joints are the 2nd-5th CMC?

Plane (gliding type)

What type of joints are the 1st-5th IP?

Ginglymus (Hinge)

What type of joint is the 1st CMC?

Sellar (Saddle)

What type of joints are the intercarpals?

Plane (Gliding)

The elbow joint is apart of what classification?

The synovial (diarthoidal)

What is the elbow joint generally considered?

Ginglymus (Hinge)

What joint is between the Radius and Ulna and considered apart of the elbow joint?

Proximal radioulnar (pivot or trochoidal type)

What bone is best demonstrated in the ulnar deviation projection?

Scaphoid

What bones is best demonstrated in the radial deviation projection?

Lunate, Trriquetrum, Pisiform and Hamate (Medial Side)

What fat stripe is visible on a PA and Oblique wrist?

Scaphoid fat stripe

What fat stripe is visible on a lateral wrist?

Pronator fat stripe

What fat pad/stripes are visible on an elbow?

Anterior and Posterior fat pad and supinator fat stripe

For a small to medium dry plaster cast how much kV is added?

+ 5-7

For a large or wet plaster cast how much kV is added?

+ 8-10

For a fiberglass cast how much kV is added?

+ 3-4

Dislocation

displacement from joint

Subluxation

partial dislocation

Sprain

rupture or tearing of connective tissue

Contusion

bruise, without fx

Fracture

• simple (closed) fracture

• compound (open) fracture (breaks through skin)

Comminuted fracture

splintered or crushed

Impacted fracture

fragments driven into each other

What are common fractures in children?

Buckle and green stick fracture

Baseball/Mallet fracture

Large bone avulsion mallet injuries disrupt the joint surface and the fingertip migrates palmarly (subluxation)

If someone falls and attempt to catch themselves, they will most likely have what type of outward fracture?

Colle’s Fracture

If someone falls and land on their hand, they will most likely have what type of inward fracture?

Smith’s Fracture

In a colle’s fracture the distal fragment moves in what direction?

Posteriorly

In a Smith’s fracture the distal radius fragment moves in what direction?

Anteriorly

What is a Boxer’s fracture?

A fracture in the fifth metacarpal

Barton’s Fracture

Involves subluxation or dislocation of the carpal bones & distal radius; almost always requires surgery

What is the most common fracture of the thumb?

Bennett’s Fracture

Nursemaid fracture

A dislocation of the radial head

Where is the CR centered in the 2nd-5th fingers?

at the PIP

What is demonstrated in a PA radiograph of the 2nd-4th digits?

Entire finger and minimum 1/3 of MCP demonstrated

What is the SID for hand/wrist/digit radiographs?

40; Increase to 44 to compensate for OID

Where is the CR centered for a PA oblique 45 degree? (digit)

to the PIP

In a PA oblique 45 degree the 2nd digits is rotated?

In a medial rotation

In a PA oblique 45 degree how are the 3rd-5th digits rotated?

In a lateral rotation

What is best demonstrated in an Oblique and Lateral finger radiograph?

Entire phalanx and MCP joint

Where is the CR centered for a lateral finger?

to the PIP

Where is the CR centered for a AP thumb?

the first MCP joint

What is best demonstrated in a AP thumb?

The entire thumb and first CMC joint

In a PA 45 oblique where is the CR centered?

the first MCP joint

What is best demonstrated in a PA 45 oblique?

The entire thumb and the joints partially open

Where is the CR centered on a Lateral thumb?

the first MCP joint

In an AP axial projection modified Robert’s method (Lewis modification) where is the CR centered?

10-15 degree proximal to first MCP Joint

What is best demonstrated in a Modified Robert’s method?

The base of first metacarpal; used to rule out Bennett fracture

What projection would you use to demonstrate a Bennet’s fracture?

Modified Robert’s Method

What is a PA Stress (Folio Method) projection used for?

Bilateral stress projection used for possible ulnar collateral ligament injury

Where is the CR centered for a PA hand?

Third MCP joint

What is demonstrated in a PA hand?

Entire hand and carpals

Where is the CR centered for a PA hand oblique?

Third MCP joint

What is best demonstrated in a PA hand oblique?

Entire hand and carpals

Where is the CR centered for a fan lateral hand?

The MCP Joint of the second digit

What is best demonstrated in a fan lateral?

Entire hand and carpals

What are lateral hand projections best used for?

Best for foreign bodies or when injury prevents finger separation

What is best demonstrated in a AP oblique bilateral 45 degree (Ball-catcher’s position)?

very early bony erosions and joint space narrowing at the MCP and proximal interphalangeal

Where is the CR centered for a PA/PA oblique and lateral wrist projection?

Midcarpal area

What is best demonstrated in a PA wrist projection?

Distal radius, ulna and carpals

How is a PA oblique wrist rotated?

Away from the midline

What is the modified Stecher method?

A scaphoid projection with the hand elevated 20 degree with or without an ulnar deviation

Where is the CR centered for a Modified Stecher projection?

Perpendicular to scaphoid

Where is the CR centered for a Radial deviation?

Perpendicular to midcarpals

Where is the CR centered for a Tangential, Inferosuperior projection: Gaynor Hart Method?

25-30 degree to long axis of hand to enter 1” distal to base of 3rd metacarpal

How do you rotate a Tangential, Inferosuperior projection: Gaynor Hart Method?

wrist 10 degrees towards radius

What is best demonstrated in a Tangential, Inferosuperior projection: Gaynor Hart Method?

the carpal sulcus

Where is the CR centered for a AP forearm?

To mid forearm; Epicondyles are parallel to IR

What is best demonstrated in a mid forearm projection?

Carpals to mid forearm

How is the wrist positioned in a lateral forearm?

In a true lateral

How is the elbow angled in a lateral forearm?

flexed 90 degrees

Where is the CR centered for a lateral forearm?

To the midforearm

What is best demonstrated in a lateral forearm?

Carpals and distal humerus

In what projection is the head of ulna superimposed over the radius?

Lateral forearm

In what projection is there superimposition of the distal radioulnar joint?

AP forearm

Where is the CR centered for a AP fully extended elbow?

to mid-elbow joint