Positioning - upper extremities

What two carpal bones on the lateral side of the wrist should be clearly demonstrated in the image of the PA oblique projection of the wrist?

- scaphoid

- trapezium

radial neck

Name the structure.

radial tuberosity of radius

Name the structure.

the body of the radius

name the structure

the radius distally includes:

1) the radial styloid process

radial styloid process

Name the structure.

the distal humerus includes:

- (2) condyles

- (2) epicondyles

- trochlea - the medial aspect

- capitulum - lateral aspect

- coronoid fossa - anterior

- olecranon fossa - posterior

AP Projection: Forearm

-14 x 17

-lengthwise

-done on table top w/ 40" SID

-use a small focal spot

-in a supinated position

-patient is seated at 90 degrees

-you can fully extend the limb, the entire limb needs to be within the same space

-long axis of IR is parallel with the forearm

-the epicondyles should be equidistant

CR: perpendicular to the mid shaft

the radial head is located proximally and the ulnar head is located distally:

TRUE or FALSE

TRUE

good lateral position: forearm

3 important lateral forearm positioning points

1) elbow flexed at 90 degrees

2) hand and wrist in true lateral position

3) humerus should be resting on the table top

*if the above three points are met, a good lateral position of the forearm will most always result*

lateral projection: forearm (lateromedial)

-flex elbow 90 degrees on medial side [thumb is up]

-depress shoulder

-both joints shown

-CR: to midpoint of forearm

-Shows: bones of forearm, elbow joint, and proximal row of carpals

basic routine: elbow

-Ap - supine

- (2) AP obliques

*medial rotation

*lateral rotation

-lateromedial - lateral position

optional images of the elbow:

- (2) AP's - partial fexion

- axiolateral - greenspan & norman method (coyle method) vs. radial head series

AP projection of the elbow

- 10 x 12

- lengthwise

- sfs

- 40 " SID

- supinated position

- fully extend the limb, the entire limb in the same plane, epicondyles need to be parallel

- elbow is centered

- CR: perpendicular to the joint

Lateromedial Projection: Elbow

- 10 x 12

- lengthwise

- sfs

- 40 " SID

- done in the lateral position

- pt. seated at 90 degrees

- flex elbow 90 degrees & depress the shoulder

- hand and wrist are lateral

- center to the space

- CR: perpendicular to the elbow joint

AP oblique projection: elbow (medial)

- 10 x 12

- lengthwise

- sfs

- 40 " SID

- medial (rotation) oblique position

- pt. seated at 90 degrees

- fully extend the limb, medially rotate

- anterior surface is 45 degrees

- elbow is centered

- CR: perpendicular to joint

AP oblique projection: elbow (lateral)

- 10 x 12

- lengthwise

- sfs

- 40 " SID

- lateral oblique position

- need to fully extend the limb, and laterally rotate

- the posterior surface needs to be 45 degrees

- elbow needs to be centered

- CR: is perpendicular to the joint

AP projection: elbow (for a partially flexed elbow)

- 10 x 12

- lengthwise

- sfs

- 40 " SID

- a partial flexion position - proximal forearm

- pt. needs to be seated at 90 degrees

- limb needs to be partial flexed

- the forearm needs to be within the same plane

- epicondyles are parallel

- CR: perpendicular to proximal forearm

axiolateral projection: elbow (greenspan & norman method) when demonstrating the radial head fx

- done in lateral position

- pt. seated at 90 degrees

- flex the elbow at 90 degrees & depress the shoulder

- hand and wrist need to be pronated

- center to the space

-CR: elbow joint, needs to be 45 degrees medially

axiolateral projection: elbow (greenspan & norman method) when demonstrating the coronoid process

- done in a lateral position

- pt. seated at 90 degrees & depress the shoulder

- hand and wrist need to be pronated

- center to the space

- CR: to the elbow joint, 45 degrees distally

lateral epicondyle of humerus

Name the structure.

Which structure articulates with the trochlea?

proximal ulna

radial tuberosity of radius

medial prominence just below the head of the radius; site of attachment of the biceps brachii

Scaphoid Series PA and PA Axial Rafert-Long method wrist

- 10 x 12

- lengthwise

- seat the pt. at the end of the radiographic table, with the arm and forearm resting on the table

- position the wrist on the IR for a PA projection

- without moving the forearm, turn the hand outward until the wrist is in extreme ulnar deviation

- CR: is perpendicular and with multiple cephalad angles, and should directly enter the scaphoid

- there must be no rotation of the wrist

- scaphoid with adjacent articular areas open

- maximum ulnar deviation

- bony trabecular detail and surrounding the soft tissues

Carpal Canal Tangential (Gaynor-Hart Method)

SID: 40 in

Position: Hyperextend wrist, long axis of hand as vertical as possible

Pull fingers back with band

CR: 1 in distal to base of third metacarpal at 25 - 30 degree angle

posterior fat pads in elbow:

- covers the largest area and lives within the olecranon fossa of the posterior humerus

supinator fat pad of the elbow:

- is positioned anterior to and parallel with the anterior aspect of the proximal radius

What two bony landmarks are palpated for positioning of the elbow?

humeral epicondyle

humeral epicondyle

name the structure

for the AP projection of a forearm, how should the elbow be positioned?

needs to be fully extended

If the hand is pronated for the AP projection of the forearm, the image will demonstrate the:

radius and ulna crossing over each other

For the lateral projection of the forearm, the elbow should be flexed:

90 degrees

for the AP projection of the elbow, why should the hand be positioned with the palm facing up?

to prevent rotation of the bones of the forearm

for the lateral projection of the elbow, how should the hand be adjusted?

lateral with the thumb side up

How should the humeral epicondyles appear in the image of the lateral projection of the elbow?

superimposed

How much medial rotation of the elbow is needed to position it for AP oblique projections?

45 degrees

Which AP oblique projection positioning movement (medial rotation or lateral rotation) requires the hand to be pronated?

medial rotation

for the AP distal humerus projection (partially flexed elbow), what part of the upper extremity should be parallel and in contact with the IR?

the distal humerus

in the AP distal humerus projection (partially flexed elbow) image, what part of the upper extremity will appear greatly foreshortened in the image?

the proximal radius and ulna

For the AP proximal forearm projection (partially flexed elbow), what part of the upper extremity should be parallel and in contact with the IR?

radius and ulna

in the AP proximal forearm projection (partially flexed elbow) image, what part of the upper extremity will appear greatly foreshortened in the image?

the distal humerus

what position is the hand in for the axiolateral projection (Coyle method) of the elbow?

hand should be pronated for the axiolateral projection (Coyle method) of the elbow

what specific anatomy is best demonstrated on the axiolateral projection (Coyle method) of the elbow when the central ray is directed 45 degrees towards the shoulder?

an open elbow joint between the radial head and the capitulum

where is the centering point for the central ray for the AP projection of the thumb?

the first metacarpophalangeal joint

which projection of the thumb requires the patient to rotate the hand into extreme internal rotation?

AP projection

where is the centering point for the central ray for the PA projection of the third digit of the hand?

the proximal interphalangeal joint (PIP) to the third digit

explain why the hand should be rotated into extreme internal rotation until the lateral surface of the index finger is in contact with the IR, rather than positioning that finger with its medial surface toward the IR, for the lateral projection of the index finger

to minimize the OID

Name the four bones that should be completely seen in the image of the AP projection of the thumb:

- distal phalanx

- proximal phalanx

- the first metacarpal

- trapezium carpal

describe how and where the central ray should be directed for the PA projection of the hand:

needs to be perpendicular to the third metacarpophalangeal joint

What surface of the hand should be in contact with the IR for the PA projection of the hand?

anterior (palmar) surface

From the prone position, how many degrees should a hand be rotated for the PA oblique projection of that hand? For the lateral projection?

- 45 degrees

- 90 degrees

For the best demonstration of all digits how should the thumb and index finger be positioned with respect to the IR for the PA oblique projection of the hand?

needs to be elevated from the IR and parallel with the plane of the IR

for the PA projection of the wrist, why should the hand be slightly arched by flexing the fingers?

to place the anterior surface of the wrist in contact with the IR

describe how and where the central ray should be directed for the PA projection of the wrist:

perpendicular to the midcarpal area

In addition to the eight carpal bones, what other bones should be seen in the image of the PA projection of the wrist?

- distal radius

- distal ulna

- proximal metacarpals

how many degrees from the prone position should the wrist be rotated for the PA oblique projection of the wrist?

45 degrees

which projection of the wrist requires the superimposition of the radial and ulnar styloid processes?

lateral

which surface of the wrist should be in contact with the IR for the lateral projection of the wrist?

ulnar (medial)

in which projection of the wrist should the metacarpals appear superimposed in the image?

lateral

for the PA oblique projection of the wrist, which side of the wrist should be elevated from the IR?

lateral (radial) side

how should the hand be positioned for the lateral projection of the forearm?

- true lateral

- thumb side up

PA oblique projection of the hand:

name the projection.

another name for triquetrum:

triangular or cuneiform

which of the following articulates with the bases of the metacarpal bones?

carpals

Which two structures articulate to form the proximal radioulnar joint?

the head of the radius and the radial notch of the ulna

How may bones are in the human body?

206 bones

how many bones in the axial skeleton?

80 bones

how many bones in the appendicular skeleton?

126 bones

Osteology

Study of bones

compact bone

dense, hard layers of bone tissue that lie underneath the periosteum

spongy bone

Layer of bone tissue having many small spaces and found just inside the layer of compact bone.

trabeculae

supporting bundles of bony fibers in cancellous (spongy) bone

medullary cavity

cavity within the shaft of the long bones filled with bone marrow

Periosteum

A dense fibrous membrane covering the surface of bones (except at their extremities) and serving as an attachment for tendons and muscles.

Endosteum

membranous lining of the hollow cavity of the bone

Ossification

process of bone formation

intermembranous ossification

bones develop from fibrous membranes in the embryo; creates the flat bones, such as the skull, clavicles, mandible, and sternum

primary ossification

begins before birth and forms long central shaft in long bones

secondary ossification

-occurs after birth when a separate bone begins to develop at both ends of each long bone

-near the age of 21

Long bones are:

-longer than they are wide

-typically known for being the limbs

Short bones are:

cube shaped; carpals and tarsals

flat bones:

These bones are thin, flat, and curved. They form the ribs, breastbone, and skull.

Irregular bones include

-peculiar shapes

-vertebrae, pelvic bones, and certain facial bones

Sesamoid bones are:

small and flat

develop inside tendons near joints of kneecap, hands, and feet

arthritis

inflammation of a joint

Arthology is the study of

joints

small to medium dry plaster cast

Increase mAs 50%-60% or +5-7 kV

Large or wet plaster cast

Increase mAs 100% or +8-10 kVp

Fiberglass cast

increase mAs 25-30% or +3-4 kVp

Distal phalanx

Name this specific bone.

middle phalanx

Name this specific bone.

Proximal phalanx

Name this specific bone.

Hamate

Name the bone.

Capitate

Name the bone.

Trapezoid (Hand Bone)

Name the bone.

Trapezium

Name the bone.

Scaphoid

Name the bone.

Lunate

Name the bone.

Triquetrum

Name the bone.

Pisiform

Name the bone.