Chapter 4: Upper Limb

The smooth, depressed, center portion of the trochlea used for evaluating rotation on a lateral elbow is termed the trochlear:

sulcus

How much rotation of the hands is required for the AP oblique bilateral (Norgaard method) hand projection?

45*

How much rotation of the humeral epicondyles is required for the AP medial oblique projection of the elbow?

45*

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 lateral projections of the hand?

Phalanges

Fracture of distal radius with anterior displacement

Smith fracture

Which routine projection of the elbow will best demonstrate an elevated or visible posterior fat pad?

True lateral with 90 flexion

The interphalangeal joints have a(n) ____ type of joint movement

ginglymus

Which carpal articulates with both the fourth and fifth metacarpals?

hamate

A ginglymus joint can also be referred to as a _____ joint.

hinge

A nonvisible posterior fat pad on a well-exposed, correctly positioned lateral elbow radiograph generally suggests:

negative study for injury

A patient enters the ED in severe pain with a possible dislocation of the elbow. The patient has the elbow flexed more than 90. Which one of the following routines should be performed to confirm the diagnosis? a. Partially flexed AP and limited lateral projections b. Jones method and limited lateral projection c. Coyle method and limited lateral projection d. Lateral elbow only

a. Partially flexed AP and limited lateral projections

A radiograph of a tangential, inferosuperior projection of the carpal canal reveals that the hamate is superimposed overthe pisiform. Which of the following measures will correct this problem? a. Rotate the wrist and hand 10 internally. b. Increase the CR angle. c. Decrease the CR angle. d. Increase the extension of the hand and/or wrist.

a. Rotate the wrist and hand 10 internally.

A patient with a fractured forearm had the fracture reduced and a fiberglass cast placed on the extremity. The orthopedic surgeon orders a postreduction study. The original kV was 60 kV. Which one of the following kV factors should be selected for the postreduction study? a. 63 kV b. 67 kV c. 70 kV d. 75 kV

a. 63 kV

Which of the following projections of the wrist will best demonstrate the wrist joint and intercarpal spaces if the patient can assume this position? a. AP b. PA c. Gaynor-Hart d. 30 PA oblique

a. AP

Which of the following structures is considered to be most lateral? a. Capitulum b. Proximal radioulnar joint c. Trochlea d. Coronoid tubercle

a. Capitulum

A radiograph of a PA oblique of the hand reveals that the midaspect of the fourth and fifth metacarpals is superimposed. What specific positioning error has been committed? a. Excessive rotation of the hand and/or wrist b. Insufficient rotation of the hand and/or wrist c. Incorrect CR angulation d. Fingers of the hand are not parallel to IR

a. Excessive rotation of the hand and/or wrist

Which one of the following is the most common primary malignant bone tumor? a. Multiple myeloma b. Osteochondroma c. Osteosarcoma d. Osteocarcinoma

a. Multiple myeloma

A patient arrives in radiology with a metal foreign body in the palm of the hand. Which of the following hand routines should be performed on this patient to confirm the location of the foreign body? a. PA and lateral in extension projections b. PA and lateral in flexion projections c. PA and fan lateral projections d. PA and Gaynor-Hart method

a. PA and lateral in extension projections

The second most common type of primary cancerous bone tumor is:

osteogenic sarcoma.

Local or generalized infection of bone or bone marrow caused by bacteria introduced by trauma or surgery is a condition termed:

osteomyelitis.

A general positioning rule is to place the long axis of the part ____ to the long axis of the image receptor.

parallel

The two fat stripes of the wrist demonstrated radiographically are known as the scaphoid fat stripe and the _____ fat stripe.

pronator

Which special projection of the wrist will open up the interspaces on the ulnar side of the wrist?

radial deviation

The AP oblique bilateral hands projection ("ball-catcher's position") is performed to evaluate for early signs of:

rheumatoid arthritis.

Which is the most commonly fractured carpal bone?

scaphoid

T/F: The radiographic criteria for a true lateral finger indicate equal concavity of the anterior and posterior aspects of the phalanges.

true

A patient enters the emergency department (ED) with a Smith fracture. Which region of the upper limb must be radiographed to demonstrate this injury?

wrist and forearm

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

Humeral epicondyles

Grids are generally not required unless the anatomy measures greater than _____ cm in thickness.

10

What CR angle is required with the modified Robert's method?

15 proximally (toward the wrist)

How much CR angulation to the long axis of the hand is required for the tangential, inferosuperior projection to demonstrate the carpal sulcus (canal)?

25 to 30

How many carpal bones are found in the wrist?

8

Where is the central ray (CR) placed for a PA projection of the third digit?

At the proximal interphalangeal joint

Where is the CR centered for a PA projection of the hand?

At the third metacarpophalangeal joint

Fracture of base of first metacarpal

Bennett's fracture

Fracture and dislocation of posterior lip of distal radius

Barton fracture

Transverse fracture through fifth metacarpal neck

Boxer's fracture

Fracture of distal radius with posterior displacement

Colles' fracture

A radiograph of an AP oblique elbow with medial rotation reveals that the radial head is superimposed over part of the coronoid process. What positioning error has been committed?

Excessive medial rotation

What is the proper name for the acute flexion elbow projection?

Jones method

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

Why is it important to keep the phalanges parallel to the IR for a PA oblique projection of the hand?

Prevents foreshortening of phalanges and obscuring of interphalangeal joints

What is the name of the two small depressions found on the anterior aspect of the distal humerus?

Radial and coronoid fossa

A radiograph of a PA projection of the hand reveals that the distal radius and ulna and the carpals were cut off. What should the technologist do to correct this problem?

Repeat the PA projection to include all the carpals and about 1 inch (2.5 cm) of the distal radius and ulna.

Which two structures primarily form the hinge-like structure and movement of the elbow joint?

Trochlea and olecranon process

With the radial head projections, what is the only difference between the four projections?

The position of the hand and/or wrist

Why is it recommended that the medial oblique projection be performed rather than the lateral oblique for the second digit of the hand?

To improve radiographic contrast

What is the purpose of performing the AP partially flexed projections of the elbow?

To provide an AP perspective if patient cannot fully extend elbow

Which two structures form the distal radioulnar joint?

Ulnar notch and head of ulna

Which projection best demonstrates pathology involving the first carpometacarpal joint? a. anteroposterior (AP) thumb, modified Robert's method b. PA oblique thumb c. Norgaard method d. PA scaphoid, ulnar deviation wrist projection

a. anteroposterior (AP) thumb, modified Robert's method

A patient enters the ED with an elbow injury. The partially flexed AP and lateral positions reveal a possible fracture of the coronoid process. The patient's elbow is partially flexed and he refuses to extend it farther. Which one of the following positions should be performed to confirm the fracture of the coronoid process? a. Jones method b. Coyle method with 80 flexion, CR angled 45 away from shoulder c. Coyle method with 90 flexion, CR angled 45 toward the shoulder d. Gaynor-Hart method

b. Coyle method with 80 flexion, CR angled 45 away from shoulder

Which of the following bony structures is found on the distal aspect of the ulna? a. Coronoid process b. Head c. Olecranon process d. All of the above

b. Head

A radiograph of the PA scaphoid projection reveals extensive superimposition of the scaphoid and adjacent carpals. Which of the following factors can lead to this problem? a. Elevation of the hand and wrist b. Insufficient ulnar deviation c. Insufficient CR angle distally d. Slight flexion of the phalanges

b. Insufficient ulnar deviation

Which basic projection of the elbow best demonstrates the trochlear notch in profile? a. AP b. Lateral c. Medial rotation oblique d. Lateral rotation oblique

b. Lateral

Which routine projection of the elbow best demonstrates the olecranon process in profile? a. AP b. Lateral c. Medial rotation oblique d. Lateral rotation oblique

b. Lateral

Which of the following carpals articulates with the radius? a. Triquetrum b. Scaphoid c. Pisiform d. Hamate

b. Scaphoid

Which of the following structures is considered to be most distal? a. Radial head b. Styloid process c. Radial tuberosity d. Capitulum

b. Styloid process

A young child comes to radiology with an elbow injury. The basic elbow projections demonstrate a possible nondisplaced fracture of the coronoid process. Beyond the medial oblique projection, what additional projection(s) can be performed to demonstrate the coronoid process in profile? a. Coyle method with 45 CR angle toward shoulder b. Radial head lateral projections c. Coyle method with 45 CR angle away from shoulder d. Acute flexion projection

c. Coyle method with 45 CR angle away from shoulder

Which of the following best demonstrates the radial head using the trauma lateral Coyle method routine? a. Elbow flexed 80, CR angled 45 away from shoulder b. Elbow flexed 90, CR angled 30 toward shoulder c. Elbow flexed 90, CR angled 45 toward shoulder d. Elbow flexed 90, CR perpendicular to image receptor

c. Elbow flexed 90, CR angled 45 toward shoulder

A patient enters the ED with a possible scaphoid fracture. The patient is unable to assume the ulnar deviation position. Which of the following positions should be performed to confirm the diagnosis? a. Gaynor-Hart b. Jones c. Modified Stecher d. Coyle

c. Modified Stecher

Which of the following structures is considered to be most proximal? a. Head of ulna b. Coronoid process c. Olecranon process d. Radial tuberosity

c. Olecranon process

Which of the following actions will lead to the proximal radius crossing over the ulna? a. Supination of the hand b. Placing epicondyles parallel to image receptor c. Pronation of the hand d. External rotation of elbow

c. Pronation of the hand

Which one of the following structures is NOT part of the ulna? a. Styloid process b. Radial notch c. Ulnar notch d. Coronoid tubercle

c. Ulnar notch

Which of the carpal bones is considered to be the largest?

capitate

Which special projection of the wrist is ideal for demonstrating possible calcification in the dorsal aspect of the carpals?

carpal bridge

The joint found between the base of the third metacarpal and carpal bone is the:

carpometacarpal

What is the distance between the tabletop and Bucky tray on most floating tabletop type of tables? a. 1/2 to 1 inch (1.3 to 2.5 cm) b. 1 to 2 inches (2.5 to 5.1 cm) c. 2 to 3 inches (5 to 7.6 cm) d. 3 to 4 inches (8 to 10 cm)

d. 3 to 4 inches (8 to 10 cm)

From a pronated position, which of the following is required for a PA oblique projection of the fourth digit of the hand? a. 45 medial rotation b. 30 to 35 lateral rotation c. 30 to 35 medial rotation d. 45 lateral rotation

d. 45 lateral rotation

Which of the following sets of exposure factors would be best for an adult upper limb study using an analog (film-screen) system? a. 80 kV, 600 mA, 1/60 sec, large focal spot, high-speed screens b. 64 kV, 200 mA, 1/20 sec, large focal spot, detail-speed screens c. 78 kV, 600 mA, 1/60 sec, large focal spot, detail-speed screens d. 64 kV, 300 mA, 1/30 sec, small focal spot, detail-speed screens

d. 64 kV, 300 mA, 1/30 sec, small focal spot, detail-speed screens

Which routine projection of the elbow best demonstrates the radial head and tuberosity free of superimposition? a. AP b. Lateral c. AP oblique with medial rotation d. AP oblique with lateral rotation

d. AP oblique with lateral rotation

A patient comes to radiology with a possible tear of the ulnar collateral ligament of the wrist. The patient complains of discomfort near the thumb region. Basic thumb projections do not demonstrate any type of fracture or dislocation. Which one of thefollowing projections can be performed to confirm an injury to the ulnar collateral ligament? a. Norgaard method b. Modified Robert's method c. Gaynor-Hart method d. Folio method

d. Folio method

A patient with a history of carpal tunnel syndrome comes to radiology. The physician wants to rule out abnormal calcifications in the carpal sulcus. Which of the following projections would best demonstrate this region? a. Coyle method b. Jones method c. Carpal bridge d. Gaynor-Hart method

d. Gaynor-Hart method

A lateral elbow radiograph demonstrates about half of the radial head superimposed by the coronoid process of the ulna.Which of the following occurred? a. The hand was pronated rather than in a true lateral position. b. The hand and wrist were rotated laterally and not in a true lateral position. c. The shoulder was not dropped sufficiently to the tabletop level. d. No positioning errors occurred.

d. No positioning errors occurred.

Which of the following structures is considered to be most posterior? a. Coronoid process b. Radial tuberosity c. Trochlea d. Olecranon process

d. Olecranon process

A patient enters the ED with a possible Bennett's fracture. Which of the following routines should be performed to confirm this diagnosis? a. Finger b. Wrist c. Forearm d. Thumb

d. Thumb

Which wrist ligament is attached to the styloid process of the ulna and continues to the triquetrum and pisiform? a. Radial collateral ligament b. Dorsal radiocarpal ligament c. Palmar radiocarpal ligament d. Ulnar collateral ligament

d. Ulnar collateral ligament

The first metacarpophalangeal joint has a(n) ____ type of joint movement.

ellipsoidal

The radiocarpal (wrist) joint possesses a(n) ____ type of joint movement.

ellipsoidal

A radiograph of an AP projection of the elbow reveals that there is complete separation of the proximal radius and ulna. What positioning error has been committed?

excessive lateral rotation

T/F: Rheumatoid arthritis is three times more common in men than women.

false

T/F: The Folio method is performed to rule out a nondisplaced fracture of the thumb.

false

The CR placement for an AP projection (modified Robert's method) of the thumb is at the:

first carpometacarpal joint.

An ellipsoidal joint allows movement in ____ directions.

four

How should the original kV range be changed with a fiberglass cast applied for a wrist or forearm radiographic procedure?

increase 3 to 4 kV

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

interphalangeal

Which carpal bone is the smallest?

pisiform

The first carpometacarpal joint is classified as a____ joint.

sellar

T/F: Carpal tunnel syndrome is more common in middle-aged women than in middle-aged men.

true

T/F: Nuclear medicine is generally more sensitive than radiography for assessing bones of the upper limb for either metastatic bone lesions or stress fractures.

true

T/F: One of the early signs of rheumatoid arthritis is soft tissue swelling near the ulnar styloid process.

true

T/F: The Folio method requires a bilateral projection of the thumbs be taken with one single exposure.

true

A "skier's thumb" is an injury of the:

ulnar collateral ligament.

The bending or forcing of the hand laterally with the hand pronated in a posteroanterior (PA) projection is known as:

ulnar deviation