RADR 1311: Upper Extremities

number of phalanges

14

number of metacarpals

5

Number of carpel bones

8

Number of bones in the hand

27

The two portions of the thumb are?

Proximal & Distal Phalanx

The three portions of each finger are the?

Proximal, Middle, and Distal Phalanx

The three parts of each phalanx starting distally are?

Head, Body(Shaft), Base

The three parts of each metacarpal starting proximally are?

Base, Body(Shaft), Head

What is the name of the joint between the proximal and distal phalanges of the first digit?

Interphalangeal(IP) Joint

What is the joint between the metacarpals and the phalanges called?

Metacarpophalangeal(MCP) Joint

Which is the largest of the carpal bones?

Capitate

What is the name of the hooklike process extending anteriorly from the hamate?

Hamulus or Hamular process

Which is the most commonly fractured carpal bone?

Scaphoid

List one of the mnemonics that uses the first letter of each of the preferred terms of the eight carpal bones.

Steve Left The Part To Take Carol Home

In the anatomic position, which of the bones of the forearm is located on the lateral (thumb) side?

Radius

In the anatomic position, which of the bones of the forearm is located on the medial(pinkey) side?

Ulna

Indicate wheter the following structures are part of the Radius, Ulna, or Distal Humerous.

A. Trochlear notch

B. Radial notch

C. Olecranon fossa

D. Trochlea

E. Coronoid tubercle

F. Coronoid process

G. Olecranon process

H. Coronoid fossa

A. Trochlear notch - Ulna

B. Radial notch - Ulna

C. Olecranon fossa - Distal Humerous

D. Trochlea - Distal Humerous

E. Coronoid tubercle - Ulna

F. Coronoid process - Ulna

G. Olecranon process - Ulna

H. Coronoid fossa - Distal Humerous

Which joint permits the forearm to rotate during pronation?

Proximal Radioulnar Joint

The articular portion of the medial aspect of the distal humerus is called the what?

The similar structure found on the lateral aspect of the distal humerus is called the?

Trochlea

Capitulum

The deep depression located on the posterior aspect of the distal humerus

Olecranon fossa

The criteria for evaluating a true lateral position of the elbow are the appearance of three concentric arcs. these include the (A) First and small of the arcs. (B) The intermediate double arc, consisting of the outer ridges of the___________. (C) The third arc, which is part of the Ulna.

A. Trochlear Sulcus (groove)

B. Capitulum & Trochlea

C. Trochlear notch

State what the joint movement type is for the following articulations.

A. Interphalangeal

B. Carpometacarpel of first digit

C. Elbow join (humeroulnar & humeroradial)

D. Metacarpophalangeal of second - fifth digits

E. Radiocarpal

F. Intercarpal

G. Elbow join

H. Proximal radioulnar joint

A. Interphalangeal - Ginglymus(Hinge)

B. Carpometacarpel of first digit - Saddle

C. Elbow joint (humeroulnar & humeroradial) - Ginglymus (Hinge)

D. Metacarpophalangeal of second through fifth digits - Ellipsoidal

E. Radiocarpal - Ellipsoidal

F. Intercarpal - Plane

G. Elbow joint - Ginglymus(Hinge)

H. Proximal radioulnar joint - Pivot

Ellipsoidal joints are classified as freely movable, or ______________________, and allow movement in ___________________ directions.

Diathrodial

4 directions

T/F In addition to the ulnar and radial collateral ligaments, the following five addition ligaments are also important in stability of the wrist joint. A. Dorsal radiocarpal, B. Palmar radiocarpal, C. Triangular fibrocartilage complex, D. Scapulolunate, E. Lunotriquetral

True

Which ligament of the wrist extends from the styloid process of the radius to the lateral aspect of the scaphoid and trapezium bones?

Radial Collateral Ligament

What is the name of the two special turning or bending positions of the hand and wrist that demonstrate medial and lateral aspects of the carpal region?

Ulnar Deviation

Radial Deviation

Of the Ulnar or Radial Deviations which is most commonly performed to detect a fracture of the scaphoid bone?

Ulnar Deviation

How does the forearm appear radiographically if pronated for a PA projection?

The proximal Radius crosses over the Ulna

The two important fat stripes or bands around the wrist joint are called what?

Scaphoid fat stripe

Pronator fat stripe

The fat pads around the elbow joint are valuable diagnostic indicators if the what three technical/positioning requirements are met with the lateral position.

Elbow flexed 90 degrees

Optimal exposure factors used

In a true lateral position

T/F If the posterior fat pad of the elbow is not visible radiographically, it suggests that a non obvious radial head or neck fracture is present.

False (A nonvisible fat pad suggests a negative exam)

T/F Excessive kV may obscure the visibility of a fat pad

True

T/F Trauma or infection makes the anterior fat pad more difficult to see on a lateral elbow radiograph

False

Which routine projections best demonstrate the scaphoid fat pad?

Posterioanterior and oblique wrist

Which routine projection best demonstrates the pronator fat stripe?

Lateral wrist

What are the most commonly used technical factors for upper limb radiography for the follow.

A. kV range (analog and digital)

B. Exposure time (Long or short)

C. Large of small focal spot

D. Most common minimum souce image receptor distance (SID)

E. Grid use on body parts measured greater than _____

F. Type of intensification screens most commonly used for analog imaging

G. Small-to-Medium dry plaster casts. Increase _______ kV

H. Large plaster casts. Increase ____________ kV

I. Fiberglass casts. Increase ___________ kV

J. Correctly exposed radiographs. Visualize ____________ margins and ___________ markings of all bones.

A. 60-70kV for analog, 60-80kV for digital

B. Short exposure

C. Small focal spot

D. 40in(102cm)

E. 10 cm

F. Detail screen (analog)

G. 5-7kV

H. 8-10kV

I. 3-4kV

J. Soft Tissue, trabecular

The general rule for collimation for upper limb radiography states what?

Collimation borders should be visible on all four sides if the IR is large enough to allow this without cutting off essential anatomy.

What factors help reduce image distortion during upper limb radiography?

40-44in(102-113cm) SID

Minimal object image receptor distance (OID)

Correct central ray placement and angulation

Use of small focal spot

T/F Lead (protective) shielding is only required for upper limb studies performed on patients who are of childbearing age or younger.

False. A good practice is to provide shielding for all patients

T/F Guardians of young pediatric patients who are undergoing upper limb studies can be asked to hold their child during the radiographic study

True (Ensure that adults are given a lead apron to wear during exposure)

What is the radiographic procedure that uses contrast media injected into the joint capsule to visualize soft tissue pathology of the wrist, elbow, and shoulder joints?

Anthrography

What is the positioning routine for 2nd through 5th digits of the hand?

PA, PA oblique, and lateral

How much of the metacarpels should be included in for a PA projection of the digits?

Distal aspect of metacarpels

What are the two radiographic criteria used to determine whether rotation is present on a PA projection of the digits?

Symmetric appearance of both sides of the shafts of phalanges and distal metacarpels.

Equal amounts of tissue on each side of the pahlanges.

Which positioning modifications should be used for a study of the second digit to reduce distortion for each of the following.

A. PA oblique

B. Lateral position

A. Perform the medial oblique rather than the lateral oblique in order to decrease OID.

B. Perform a thrumb-down lateral (mediolateral projection) to decrease OID

Where is a central ray centered for a PA Oblique projection of the second digit?

Proximal Interphalangeal Joint (PIP joing)

Why is it important to keep the affected digit parallel to the image receptor (IR) for the PA oblique and lateral projections?

To prevent distortion of the phalanx.

To prevent distortion of the joints.

To demonstrate small, nondisplaced fractures near the joint.

Why is the anteroposterior (AP) projection of the thumb recommended instead of the PA?

The AP position produces a decrease in OID and increased resolution

Which projection of the thumb is achieved naturally by placing the palmar surface surface of the hand in contact with the cassette?

PA Oblique

Which IR size should be used for a thumb projection?

8x10in(18-24cm)

A sesamoid bone is frequently found adjacent to the ____________________ joint of the thumb.

Metacarpophalangeal Joint (MCP)

T/F The entire metacarpal and trapezium must be demonstrated on all projections of the thumb.

True

Where is the central ray centered for an AP projection of the thumb?

1st Metacarpophalangeal Joint

What does a Bennett's fracture involved?

Base of first metacarpal

Which special positioning method can be performed to demonstrate a Bennett's fracture?

What degree of central ray angulationral position is required for this projection?

Modified Robert's method

15 degrees proximal

Where is the central ray centered for a PA projection of the hand?

Third MCP joint

A minimum of ___________ inches(____________cm) of the forearm should be included radiographically for a PA projection of the hand.

1in(2.5cm)

T/F Slight superimposition of the distal third, fourth, and fifth metacarpals may occur with a well positioned PA oblique projection of the hand

True

Which preferred lateral position of the hand best demonstrates the phalanges without excessive superimposition?

Fan Lateral

Which lateral projection of the hand best demonstrates a possible foreign body in the palm of the hand?

Lateral in extension

What is the proper name for the position referred to as the "ball-catcher's position"?

Norgaard method

The "ball catcher's position" is commonly used to evaluate for early signs of what?

Rheumatoid Arthritis

The elbow generally should be flexed ______________ degrees for the routine positions of the wrist.

90 degrees

How much rotation is required for an oblique porjection of the wrist?

45 degrees

Which alternative projection to the routine PA wrist best demonstrates the intercarpal joint spaces and wrist joint?

AP projection (with hand slightly arched)

Which positioning error is involved if a majority of the carpal bones are superimposed in a PA oblique wrist projection?

Excessive lateral rotation from PA

What fracture is not demonstrated in a wrist routine?

Pott's

During the PA axial scaphoid projection with the central ray angle and ulnar flexion, the central ray must be angled:

10-15 degrees proximally

How much are the hand and wrist elevated from the IR for the modified Stecher method?

20 degrees

How much central ray angulation to the long axis of the hand is required for the carpal canal (tunnel) projection?

25-30 degrees

Which special projection of the wrist best demonstrates the interspaces on the ulnar side of the wrist between the lunate, triquetrum, pisiform, and hamate bones?

PA projection with radial deviation

Which special projection of the wrist helps rule out abnormal calcifications in the carpal sulcus?

Tangential inferosuperior or Gaynor-Hart projection

How much central ray angulation from the long axis of the forearm is required for the carpal bridge (tangential) projection?

45 degrees

The hand and wrist form a ________ angle to the forearm with the carpal bridge (tangential) projection.

90 degree

Fracture and dislocation of the posterior lip of the distal radius

Barton's fracture

Most common type of primary malignant tumor occuring in bone

Multiple myeloma

Reduction in the quantity of bone or atrophy of skeletal tissue

Osteoporosis

Sprain or tear of the ulnar collateral ligament

Skier's thumb

An abnormality of the cartilage affecting the long bones

Achondroplasia

Transverse fracture extending through the distal aspect of the metacarpal neck, most often the fifth metacarpal

Boxer's fracture

Hereditary condition marked by abnormally dense bone

Osteopetrosis

Transverse fracture of the distal radius with posterior displacement of the distal fragment

Colles' fracture

Narrowing of joint space with periosteal growths on the joint margins

Osteoarthritis

Fluid-filled joint space with possible calcification

Bursitis

Possible calcification in the carpal sulcus

Carpal tunnel syndrome

Soft tissue swelling and loss of fat-pad detail visibility

Osteomyelitis

Mixed areas of sclerotic and cortical thickening along with radiolucent lesions

Osteopetrosis

For the following types of pathologic conditions, indicate wheter the manual exposure factors should be increased, decreased, or remain the same.

A. Advanced Paget's disease

B. Joint effusion

C. Advanced rheumatoid arthritis

D. Osteoporosis

E. Osteropetrosis

F. Bursitis

A. Advanced Paget's disease - +

B. Joint effusion - 0

C. Advanced rheumatoid arthritis - -

D. Osteoporosis - -

E. Osteropetrosis - +

F. Bursitis - 0

Which routine projections are required for a study of the forearm?

AP and lateral

T/F For a forearm study, the technologist needs to include only the joint closest to the site of the injury

False

To position the patient properly for an Ap projection of the elbow, the epicondyles must be _______________ to the IR.

Parallel

If the patient cannot fully extend the elvow for the AP projection what alternative projection(s) should be performed?

Two AP projections (partially flexed), on with humerus parallel to IR and one with forearm parallel to IR

Which routine projection of the elvow best demonstrates the raidal head, neck, and tuberosity with slight (if any) superimposition of the ulna?

Ap ovlique with 45 degree lateral rotation

T/F Lead(gonadal) shielding is not required for upper limb radiographs if the patient can sit upright for these exams.

False (because of scatter, divergent rays, or both reaching gonads)

Which projection of the elvow best demonstrates the coronoid process in profile?

AP oblique with 45 degree medial rotation

The best position to evaluate the posterior fat pads of the elbow joint is what?

Lateral, flexed 90 degrees

Which special projection(s) of the elvow should be performed instead of the routine AP if the patient's elbow is tightly flexed and cannot extend at all?

Two projections--central ray perpendicular to humerus and central ray perpendicular to forearm (acute flexion projections)

How much is the upper limb rotated for a lateral (rotation) oblique projection of the elbow?

45 degrees laterally

How much and in which direction should the CR be angled for the trauma axial lateral projection (Coyle method) involving the radial head?

45 degrees towards shoulder

How much and in which direction should the central ray be angled for the trauma axial lateral projection (Coyle method) involving the coronoid process?

45 degrees away from shoulder