RAD 155 Ch. 4 (Finger to Elbow)

Focus Area: Anatomy and procedures of the upper limb: Finger, Thumb, Hand, and Wrist.

Bones in hand: 27 in each hand.
Phalanges (Fingers): 14 in each hand.
Metacarpals (Palms): 5 in each hand.
Carpals (Wrists): 8 in each wrist.
Bones in forearm: 2 in each forearm.
- Radius: Located anterior of the forearm.
- Ulna: Located posterior of the forearm.

Composition:.
- 3 phalanges in 2-5 digits.
  - Distal, Middle & Proximal
- 2 phalanges in the thumb (1st digit).
Naming: Based on location (e.g., distal phalanx of the third digit).

Role: Form the palm of the hand.
Identification: Numbered laterally to medially; heads are distal and articulate with phalanges; bases articulate with carpals.
Carpometacarpal Joint: Saddle shaped joint at base of thumb connecting Trapezium to first metacarpal bone.

Arrangement: Two rows of four carpals.
- Proximal Row (lateral to medial): Scaphoid, Lunate, Triquetrum, Pisiform. (Steve Left The Part)
  - Scaphoid: largest, most commonly fractured carpal bone; Blood supply branch; boat shaped.
  - Lunate: moon shaped; aligns with the radius.
  - Triquetrum: triangular-shaped; lies under smallest carpal bone.
  - Pisiform: small, pea-shaped; sits on top of the triquetrum.
  Distal Row (lateral to medial): Trapezium, Trapezoid, Capitate, Hamate.(To Take Carol Home)
  - Trapezium: irregular, saddle-shaped.
  - Trapezoid: located under second digit; smallest bone in distal.
  - Capitate: largest carpal bone; lies under third digit.
  - Hamate: shaped as a hook; lies between 4th & 5th digit.

Mnemonic for Carpals: "Steve Left The Party To Take Carol Home".

Smaller extremities are done table top
Larger parts (chest, abdomen, pelvis, spine, skull, femur, humerus) need the bucky
- The bucky (grid) cleans up the scatter radiation coming off the larger parts

Fat Pads: Soft tissue located around joints to help cushion bones and cartilage during movement.
Carpal Tunnel: Passageway for the median nerve.
Trochlear notch: Indentation on the ulna with the radius at the elbow joint, allowing greater range of motion.
Radial notch: Shallow depression on the ulna that allows the radius to rotate, enabling forearm movement.
Coronoid process: Process of ulna that provides stability to the elbow joint.
Medial: Towards midline of the body.
Lateral: Towards the sides of the body (outward).
Ulnar Deviation: Movement of the wrist resulting in an outward bending of the wrist towards the ulna.
Radial Deviation: Movement of the wrist resulting in an inward bending of the wrist towards the radius.

IR/Collimated Field Size: Adjust according to anatomy with particular focus on radiation protection.
- IR Size Hand: 10 x 12 inches for fingers; 14 x 17 inches for the entire hand
- IR Size Wrist: 10 x 12 inches
- IR Size Forearm: 14 x 17 inches
SID: 40 inches for all projections to ensure optimal image quality.
Patient Preparation: Remove artifacts (watches, rings, etc.).
- Explain and demonstrate positions
- Breathing instructions not required for digits,hand, and wrist procedures
- No motion, so tell patient to not move
Kilovoltage peak (kVp): Controls how strong the X-ray beam is when taking a picture inside your body;
- High kVp means the X-rays can go through thicker parts like bones
- Low kVp is better for seeing softer tissues like muscles
Hand & Finger kVp: The kVp range for a hand X-ray is usually 50–60 kVp
Elbow kVp: The kVp range for an elbow X-ray is typically 60–70 kVp

Digits 2-5: PA, PA Oblique, Lateral projections.
- 50-55 kVp
- 1 inch of collimated field on all sides of digits.
- PA: Finger spread in contact with the IR.
- PA Oblique: Finger spread in contact with IR 45-degree angle.
- Lateral 2 & 3 Digits: Extended lateral in contact with IR (mediolateral projection).
  - 4 & 5 Digits: Extended medial in contact with IR (lateromedial projection).
Digit 1 (Thumb): AP, PA Oblique & Lateral
- 50-55 kVp
- AP: Internal rotation, with the palm facing up.
- PA Oblique: Thumb is already naturally oblique.
- Lateral: Position the thumb in a lateral view, mediolateral.
Hand: PA, PA Oblique, Lateral; Extension; Fan projections.
- 55-60 kVp
- Fan Position
Wrist: PA, PA Oblique, Lateral, PA axial & Tangential Carpal Tunnel projections.
- 60-65 kVp

Bennett's Fracture (Slap): First metacarpal fracture ;
Boxer’s Fracture (Punch): Fifth metacarpal fracture, typically resulting from a punch or impact injury.
Colles' Fracture: Distal radius with posterior displacement; commonly occurs from a fall on an outstretched hand.
Smith’s Fracture: Distal radius with anterior displacement; often associated with a fall onto a flexed wrist.

Consists of two long bones Ulna & Radius
Ulna is on medial side
Radius is on lateral side
- Humerus examinations require removal of bra in female patients and a gown provided
Elbow Joint:
ONLY TWO projections
- AP: Elbow extended with hand supinated; CR midpoint
- Lateral: Lateromedial projection; flexed 90 degrees; CR midpoint
- 55-60 kVp
- Collimated field size: 2 inches distal to wrist joint and proximal to the elbow joint, & 1 inch on the sides
Fun Fact: Your foot is the exact same size as your forearm.
- Size 6? Use a 8x10
- Size 8? Use a 10 x 12
- Size 14? Use a 14 X 17

Monteggia: Fracture of proximal third of ulna with dislocation of radial head
Supracondylar fracture: Most common in children; Fracture of distal humerus above humeral condyles.

Preparation for Test: Understanding anatomy and related procedures is crucial as test includes 100 questions covering Chapters 4 & 5.