Chapter 4-Upper Extremities
other name for scaphoid
navicular
in the anatomic position, which of the bones of the forearm is located on the lateral (thumb) side?
radius
what the the only difference among the four radial head lateral projections of the elbow?
the rotational position of the hand and wrist
in the anatomic position, which of the bones of the forearm is located on the medial (pinky) side?
ulna
which wrist ligament is attached to the styloid process of the ulna and continues to the triquetrum and pisiform?
ulnar collateral ligament
which of the following structures is not part of the ulna? styloid process, radial notch, ulnar notch, or coronoid tubercle?
ulnar notch
which two structures form the distal radioulnar joint?
ulnar notch and head of ulna
other name for hamate
unciform
what is the total number of bones that make up the hand and wrist?
27
reverse of a colles' fracture
smith's fracture
which carpal is most commonly fractured?
scaphoid
true or false: excessive kV (analog imaging) may obscure the visibility of a fat pad
true
true or false: guardians of young pediatric patients who are undergoing upper limb studies can be asked to hold their child during the radiographic study
true
true or false: slight superimposition of the distal third, fourth, and fifth metacarpals may occur with a well-positioned PA oblique projection of the hand
true
A radiograph of the carpal canal (inferosuperior) projection reveals that the pisiform and hamulus are superimposed. What must be done to correct this positioning error on the repeat exposure?
rotate wrist laterally 5 degrees to 10 degrees
what kind of joint movement is the carpometacarpal of first digit?
saddle
what is the most commonly fractured carpal bone?
scaphoid
which is the most commonly fractured carpal bone?
scaphoid
which of the following carpals articulates with the radius?
scaphoid
which two carpal bones are located most anteriorly as seen on the lateral wrist radiograph?
scaphoid and trapezium
the two important fat stripes or bands around the wrist joint are?
scaphoid fat stripe and pronator fat stripe
joint movement type for: first CMC joint
sellar(saddle)
other name for lunate
semilunar
joint movement type for: radiocarpal joint
ellipsoidal
joint movement type for: third CMC joint
ellipsoidal
what kind of joint movement is the metacarpophalangeal of second to fifth digits?
ellipsoidal
what kind of joint movement is the radiocarpal joint?
ellipsoidal
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
true or false: for a forearm study, the tech needs to include only the joint closest to the site of the injury
false
true or false: if the posterior fat pad of the elbow is not visible radiographically, it suggests that a nonobvious radial head or neck fracture is present
false
true or false: lead gonadal shielding is not required for upper limb radiographs if the patient can sit upright for these exams
false
true or false: trauma or infection makes the anterior fat pad more difficult to see on a lateral elbow radiograph
false
true or false: anterior and posteriori fat pads of the elbow are best seen on correctly positioned and correctly exposed AP elbow projections
false (lateral)
which projection of the elbow best demonstrates: olecranon process in profile
lateral elbow
which projection of the elbow best demonstrates: trochlear notch in profile
lateral elbow
which lateral projection of the hand best demonstrates a possible foreign body in the palm of the hand?
lateral in extension
which routine projection best demonstrates the pronator fat stripe?
lateral wrist
the best position to evaluate the posterior fat pads of the elbow joint is what?
lateral, flexed 90 degrees
other name for trapezoid
lesser multangular
what is the synonym for the trapezoid?
lesser multangular
where the central ray centered for a PA oblique projection of the second digit?
proximal interphalangeal joint
what are the two portions of the thumb (first digit)
proximal phalanx and distal phalanx
what are the three portions of each finger (second through fifth digits)
proximal phalanx, middle phalanx, and distal phalanx
which joint permits the forearm to rotate during pronation?
proximal radioulnar joint
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
which special projection of the wrist will open up the interspaces on the ulnar side of the wrist?
radial deviation
which joint is between the forearm and the carpals?
radiocarpal
a radiograph of an AP elbow projection demonstrates total separation between the proximal radius and ulna. what must be done to correct this positioning error on the repeat exposure?
rotate upper limb medially
for the upper extremity, do you do long or short exposure time?
short
sprain or tear of the ulnar collateral ligament?
skier's thumb
sprain or tear of the ulnar collateral ligament
skiers thumb
for the upper extremity, do you do large or small focal spot?
smal focal spot
arthrography is a radiographic study of:
soft-tissue structures within certain synovial joints
which of the following structures is considered to be the most distal? radial head, styloid process, radial tuberosity, or capitulum
styloid process
in what position should the hand be for an AP elbow projection?
supinated
the criteria for evaluated a true lateral position of the lebow are the appearance of three concentric arcs. these arcs include:
the first and smallest of the arcs-trochlear sulcus (groove) the intermediate double arc, consisting of the outer ridges of: a. the smaller arc-capitulum b. the larger arc-trochlea c. the third arch, which is part of the ulna-trochlear notch
how many bones does the hand have?
27
accumulated fluid within the joint cavity
joint effusion
other name for capitate
os magnum
a minimum of ___ in of the forearm should be included radiographically for a PA projection of the hand
1 inch
the fat pads around the elbow joint are valuable diagnostic indicators if the following three technical/position requirements are met with the lateral position. what are those 3?
1. elbow flexed 90 degrees 2. optimal exposure factors used 3. in a true lateral position
During the PA axial scaphoid projection with the central ray angle and ulnar flexion, the central ray must be angled:
10 to 15 degrees proximally
How many phalanges (fingers and thumb) are there?
14
how many bones make up the phalanges of the hand?
14
what degree of central rat angulation is required for a modified roberts method?
15 degrees proximal
if the patient cannot fully extend the elbow for the AP projection of the forearm, what alternative projections should be performed?
2 AP projections, one with humerus parallel to the IR and one with forearm parallel to the IR
what the SID for upper extremities?
40
how much rotation is required for an oblique projection of the wrist?
45 degrees
how much rotation of the distal humerus is required to the AP medial oblique projection of the elbow?
45 degrees
how much is the upper limb rotation for a lateral (rotation) oblique projection of the elbow?
45 degrees laterally
how much and in which direction should the central rat be angled for the trauma axial lateral projection (coye method) involving the radial head?
45 degrees toward shoulder
how many metacarpals (palm) are there?
5
how many bones make up the carpal region?
8
how many carpal bones are found in the wrist?
8
how many carpals (wrist) are there?
8
how much and in which direction should the central rat be angled for he trauma axial lateral projection (coyle method) involving the coronoid process?
80 degrees of flexion
the elbow generally should be flexed _____ for routine positions of the wrist
90
which routine projections are required for a study of the forearm?
AP and lateral
which projection of the elbow best demonstrates: coronoid tubercle
AP elbow
which projection of the elbow best demonstrates: olecranon process seated in olecranon fossa
AP elbow
which routine projection of the elbow best demonstrates the radial head, neck, and tuberosity with slight (if any) superimposition of the ulna?
AP oblique with 45 degree lateral rotation
which projection of the elbow best demonstrates the olecranon process in profile?
AP oblique with 45 degrees of medial rotation
which basic projection of the elbow best demonstrates the radial head and tuberosity free of superimposition?
AP oblique with lateral rotation
which projection of the elbow best demonstrates: capitulum and lateral epicondyle in profile
AP, lateral rotation oblique
which projection of the elbow best demonstrates: radial head and tuberosity without superimposition
AP, lateral rotation oblique
which projection of the elbow best demonstrates: coronoid process in profile
AP, medial rotation oblique
what is the name of the joint found between the proximal and distal phalanges of the first digit?
NOTE FIRST DIGIT interphalangeal
what projection of the thumb is achieved naturally by placing the palmar surface of the hand in contact with the cassette?
PA oblique
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 with radial deviation
what is the positioning routine for the second through fifth digits of the hand?
PA, PA oblique, and lateral
what is a pneumonic for the eight carpal bones?
Steve Left The Party To Take Carol Home
match each of the structures labeled on figs with correct term
a-3 b-9 c-2 d-5 e-1 f-8 g-6 h-7 i-4
match each of the carpal bones labeled
a-8 b-1 c-5 d-4 e-3 f-6 g-7 h-2
identify the carpals and other structures
a-body of first metacarpal b-carpometacarpal joint of first digit c-trapezium d-scaphoid e-lunate f-radiocarpal joint
fill in the names and parts of the following bones and joints of the right hand as labeled in figure 4.1
a. fifth carpometacarpal (CMC) joint b. body of third metacarpal c. head of fifth metacarpal d. fourth metacarpophalangeal (MCP) joint e. head of proximal phalanx of fifth digit f. base of middle phalanx of fourth digit e.. head of proximal phalanx of fourth digit f. base of middle phalanx of fourth digit g. distal interphalangeal (DIP) joint of fourth digit h. body of middle phalanx of second digit i. proximal interphalangeal (PIP) joint of second digit j. body of distal phalanx of first digit k. IP joint of first digit l, metacarpophalangeal (MCP) joint of first digit m. head of first metacarpal n. second carpometacarpal (CMC) joint o. first carpometacarpal (CMC) joint
identify the parts labeled
a. radial tubercle (tuberosity) b. radial neck c. radial head d. capitulum e. lateral epicondyle f. coronoid process g. trochlea h. olecranon process
identify the parts labeled
a. radial tuberosity b. radial neck c. capitulum d. lateral epicondyle e. olecranon fossa f. medial epicondyle g. trochlea h. coronoid tubercle i. olecranon process j. superimposed humeral epicondyles k. radial head l. radial neck m. radial tuberosity n. outer ridges of trochlea and capitulum o. trochlear sulcus (groove) p. trochlear notch
two radiographic criteria used to determine whether rotation is present on the PA projection of the digits
a. symmetric appearance of both sides of the shafts of phalanges and distal metacarpals b. equal amounts of tissue on each side of the phalanges
an abnormality of the cartilage affecting long bones
achondroplasia
where is the CT centered for a PA projection of the second digit?
affected PIP joint
where are the coronoid and radial fossae located?
anterior aspect of distal humerus
which alternative projection to the routine PA wrist best demonstrates the intercarpal joint spaces and wrist joint?
anteroposterior projection
radiographic procedure that uses contrast media injected into the joint capsule to visualize soft tissue pathology of the wrist, elbow, and shoulder joints
arthrography
fracture and dislocation of the posterior lip of the distal radius
bartons fracture
a bennett's fracture involves what?
base of first metacarpal
what are the three parts of each metacarpal, starting proximally?
base, body (shaft), and head
fracture of the base of the first metacarpal
bennett's fracture
what type of fracture is best demonstrated with a modified robert's method?
bennett's fracture
transverse fracture extending through the distal aspect of the metacarpal neck, most often the fifth metacarpal
boxers fracture
fluid-filled joint space with possible calcification
bursitis
inflammation of the fluid-filled sacs enclosing the joints
bursitis
what is the largest carpal bone?
capitate
which of the carpal bones is considered to be the largest?
capitate
the similar structure to the trochlea that is found on the lateral aspect of the distal humerus is called the?
capitulum
which of the following structures is considered to be the most lateral? capitulum, proximal radioulnar joint, trochlea, or coronoid tubercle
capitulum
painful disorder of hand and wrist from compression of the medial resulting nerve
carpal tunnel syndrome
possible calcification in the carpal sulcus
carpal tunnel syndrome
the joint found between the base of the third metacarpal and carpal bone is the
carpometacarpal
Why should a forearm never be taken as a PA projection?
causes the proximal radius to cross over the ulna
which special projections of the elbow should be performed instead of the routine AP if the patient's elbow is tightly flexed and cannot extend at all?
central rat perpendicular to humerus and central rat perpendicular to forearm (acute flexion projections)
transverse fracture of the distal radius with posterior displacement of the distal fragment
colles fracture
the general rule for ollimation for upper lime 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
Situation: A pediatric patient with a possible radial head fracture is brought into the emergency room. It is too painful for the patient to extend the elbow beyond 90° or rotate the hand. What type of special projection could be performed on this patient to confirm the diagnosis without causing further discomfort?
coyle method
A radiograph of a PA oblique of the hand reveals that the third, fourth, and fifth metacarpals are superimposed. What must be done to correct this positioning error on the repeat exposure?
decrease obliquity of hand
Ellipsoidal joints are classified as freely movable, or ____________, and allow movement in __________ directions.
diarthrodial;4
how much of the metacarpals should be included for PA projection of the digits?
distal aspects of metacarpals
which joint is between the distal radius and ulna?
distal radioulnar
true or false: placing multiple images on the same digital IP is recommended as long as close collimation is applied for each projection
false, it is recommended that only one projection be placed on a digital IP> the anatomy should be centered on the IP
true or false: lead shielding is only required for upper limb studies performed on patients who are of childbearing age or younger
false: provide shielding for all patients
which preferred lateral position of the hand best demonstrates the phalanges without excessive superimposition?
fan lateral
which joint is between the carpals and the first metacarpal?
first carpometacarpal
which joint is between the first metacarpal and the proximal phalanx of the thumb?
first metacarpophalangeal
where it the central rat centered for an AP projection of the thumb?
first metacarpophalangeal (MCP) joint
which joint is between the middle and distal phalanges of the fourth digit?
fourth distal interphalangeal
joint movement type for: elbow joint
ginglymus
what kind of joint movement is interphalangeal joint?
ginglymus
what kind of joint movement is the elbow joint (humeroulnar and humeroradial)
ginglymus
what kind of joint movement is the elbow joint?
ginglymus
other name for trapezium
greater multangular
which carpal articulates with both the fourth and fifth metacarpals?
hamate
which carpal contains a hooklike process?
hamate
what is the name of the hooklike process extending anteriorly from the hamate?
hamulus of hamular process
which of the following bony structures is found on the distal aspect of the ulna?
head
In an erect anatomic position, which of the following structures is considered most inferior or distal? A. head of ulna B. olecranon process C. radial tuberosity D. head of radius
head of ulna
what are the three parts of each phalanx, starting distally?
head, body (shaft) and base
which two bony landmarks are palpated for positioning of the elbow?
humeral epicondyles
what is the major disadvantage of performing a PA projection of the thumb rather than an AP?
increased OID
a radiograph of an AP oblique-medial rotation reveals that the coronoid process is not in profile and the radial head is not superimposed over the ulna. what specific positioning error was involved?
insufficient medial rotation
the name of the joint between the proximal and distal phalanges of the first digit is called what?
interphalangeal joint
which joint is between the two phalanges of the first digit (thumb)?
interphalangeal joint
which basic projection of the elbow best demonstrates the olecranon process in profile?
lateral
which basic projection of the elbow best demonstrates the trochlear notch?
lateral
Which two bony landmarks are palpated to assist with positioning of the upper limb?
lateral and medial epicondyle
where is the coronoid tubercle located?
medial aspect of coronoid process
a radiograph of the elbow demonstrates the radius directly superimposed over the ulna and the coronoid process in profile, which projection of the elbow has been performed?
medial rotation oblique
A sesamoid bone is frequently found adjacent to the ____________________ joint of the thumb.
metacarpophalangeal
what is the special positioning method to demonstrated a bennett's fracture?
modified robert's method
most common type of primary malignant tumor occurring in bone
multiple myeloma
a nonvisible posterior fat pad on a well-exposed, correctly positioned lateral elbow radiograph generally suggests:
negative study for injury
what is the proper name for the position referred to as the ball-catchers position?
norgaard method
the deep depression located on the posterior aspect of thet distal humerus is the?
olecranon fossa
which of the following structures is considered to be the most posterior? coronoid process, radial tuberosity, trochlea, or olecranon process
olecranon process
which of the following structures is considered to be the most proximal? head of ulna, coronoid process, olecranon process, or radial tuberosity
olecranon process
which is the AP projection of the thumb recommended instead of PA?
produces a decreased in OID and increased resolution
in what position should the hand be for an AP medial rotation oblique elbow position?
pronated
narrowing of joint space with periosteal growths on the joint margins
osteoarthritis
local or generalized infection of bone or bone marrow
osteomyelitis
soft tissue swelling and loss of fat-pad detail visibility
osteomyelitis
mixed areas of sclerotic and cortical thickening along with radiolucent lesions
osteopetrosis
a reduction in the quantity of bone or atrophy of skeletal tissue
osteoporosis
reduction in the quantity of bone or atrophy of skeletal tissue
osteoporosis
hereditary condition marked by abnormally dense bone
osteoporosis also
which positioning modifications should be used for a study of the second digit to reduce distortion for PA oblique projection and lateral position?
pa oblique-perform the medial oblique rather than lateral to decreased OID lateral position-perform a thumb-down lateral (mediolateral projection) to decrease OID
A general positioning rule is to place the long axis of the part ____ to the long axis of the image receptor.
parallel
to position the patient properly for an AP projection of the elbow, the epicondyles must be _______ to the IR
parallel
the long axis of the anatomic part being imaged should be placed where?
parallel to long axis of IR
How should the humeral epicondyles be aligned for a lateral projection of the elbow?
perpendicular to image receptor
which specific anatomy is better visualized with a fan lateral as compared with the other laterl projections of the hand?
phalanges
which carpal bone is the smallest?
pisiform
what kind of joint movement is the proximal radioulnar joint?
pivot
a radiograph of a lateral projection of the elbow reveals that the epicondyles are not superimposed and the trochlear notch is not clearly seen. what must be done to correct this positioning error on the repeat exposure?
place humerus/forearm in the same horizontal plane
joint movement type for: intercarpal joints
plane
what kind of joint movement is the intercarpal?
plane
what routine projections best demonstrate the scaphoid fat pad?
posteroanterior and oblique wrist
how does the forearm appear radiographically if pronated for a posteroanterior projection?
the proximal radius crosses over the ulna
where is the CT placed for a PA projection of the hand?
third MCP joint
why is it important to keep the affected digit parallel to the image receptor for the PA oblique and lateral projection?
to prevent distortion of the phalanx, to prevent distortion of the joints, and to demonstrate small, nondisplaced fractures near the joint
what is the purpose of performing the partially flexed projections of the elbow?
to provide an AP perspective if patient cannot fully extend elbow
why is it important to keep the long axis of the digit parallel to the IR?
to reduce distortion of the phalanges, to properly visualize joints, and to demonstrate small fractures
why should the hand be slightly arched for a PA projection of the wrist?
to reduce the OID of the carpal bones
which carpal articulates with the base of the thumb?
trapezium
other name for triquetrum
triquetral, cuneiform, or triangular
the articular portion of the medial aspect of the distal humerus is called the?
trochlea
which two structures primarily form the hingelike structure and movement of the elbow joint?
trochlea and olecranon process
identify whether the following structures are part of the radius (R), ulna (U), or distal humus (H) by listing the appropriate letter next to the structure
trochlear notch-U radial notch-U olecranon fossa-H trochlea-H coronoid tubercle-U coronoid process-U olecranon process-U coronoid fossa-H
the smooth, depressed, center portion of the trochlea used for evaluation rotation on a lateral elbow is termed the:
trochlear sulcus
true or false: in addition to the ulnar and radial collateral ligaments, the following five additional ligaments are also important in stabilizing the wrist joint: dorsal radiocarpal, palmar radiocarpal, triangular fibrocartilage complex, scapulolunate, and lunotriquetral
true
true or false: the entire metacarpal and trapezium must be demonstrated on all projections of the thumb
true
true or false: to visualize fat pads surrounding the elbow, exposure factors must be adjusted to see both bony and soft tissue structures
true
which bone of the upper limb contains the coronoid process?
ulna
of the two positions listed in the previous question, which is most commonly performed to detect a fracture of the scaphoid bone?
ulnar deviation
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 and radial deviation
situation: a patient with a possible barton's fracture enters the emergency room. which positioning routine should be performed to confirm the diagnosis?
wrist
situation: a patient with a possible smith's fracture enters the ER. which positioning routine should be performed to confirm the diagnosis?
wrist/forearm
