Chapter 4 Upper Limb Workbook

12. Why is it important to keep the affected digit parallel to the image receptor (IR) for the PA oblique and lateral projections ? A. To prevent distortion of the phalanx B. To prevent distortion of the joints C. To demonstrate small, nondisplaced fractures D. All of the above

D. All of the above

16. True/False: If the posterior fat pad of the elbow not visible radiographically, it suggests that a nonobvious radial head or neck fracture is present.

False (a nonvisible fat pad suggests a negative exam)

4. True/False: 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 shield all patients

6. The name of the joint between the proximal and distal phalanges of the first digit is the

interphalangeal joint

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

lateral in extension

8. The best position to evaluate the posterior fat pads of the elbow joint is :

lateral, flexed 90°

11. Where is the central ray centered for a PA oblique projection of the second digit?

proximal interphalangeal (PIP) joint

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

tangential inferosuperior or Gaynor-Hart projection

14. What is the only difference among the four radial head lateral projections of the elbow ?

the rotational position of the hand and wrist

17. True/False : The entire metacarpal and trapezium must be demonstrated on all projections of the thumb

true

17. True/False: Excessive kVp may obscure the visibility of a fat pad .

true

23. True/False: Slight superimposition of the distal third, fourth, and fifth metacarpals may occur with a well positioned PA oblique projection of the hand

true

9. True/False: In addition to the ulnar and radial collateral ligaments , the following five additional ligaments are also important in stabilizing the wrist joint. A. Dorsal radiocarpal B. Palmar radiocarpal C. Triangular fibrocartilage complex (TFCC) D. Scapulolunate E. Lunotriquetral

true

5. True/False: 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 exposures)

4. If the patient cannot fully extend the elbow for the AP projection, what alternative projection(s) should be performed ?

two AP projections (partially flexed), one with humerus parallel to the IR and one with forearm parallel to IR

9. Which special projection (s) of the elbow 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)

12. Of the two positions listed in the previous question, which is most commonly performed to detect a fracture of the scaphoid bone ?

ulnar deviation

22. A minimum of _____ inch(es) of the forearm should be included radiographically for a PA projection of the hand

1 inch minimum

33. During the PA axial scaphoid projection with central ray angle and ulnar flexion, the central ray must be angled _____ to _____ (distally or proximally)

10° to 15° proximally

base of first metacarpal

14. A

trapezium

14. B

scaphoid

14. C

trapezoid

14. D

capitate

14. E

hamate

14. F

hamulus (hamular process)

14. G

Triquetrum

14. H

pisiform

14. I

Body of first metacarpal (thumb)

15. A

carpometacarpal joint of first digit

15. B

Trapezium

15. C

Scaphoid

15. D

Lunate

15. E

radiocarpal (wrist) joint

15. F

26. What type of CR angle is required for the AP axial projection (Brewerton method) ?

15° proximal towards the ulna

radial tuberosity

21. A

radial neck

21. B

capitulum

21. C

lateral epicondyle

21. D

olecranon fossa

21. E

medial epicondyle

21. F

trochlea

21. G

coronoid tubercle

21. H

olecranon process

21. I

superimposed humeral epicondyles

21. J

radial head

21. K

radial neck

21. L

radial tuberosity

21. M

outer ridges of trochlea and capitulum

21. N

trochlear sulcus (groove)

21. O

trochlear notch

21. P

radial tubercle (tuberosity)

22. A

radial neck

22. B

radial head

22. C

capitulum

22. D

lateral epicondyle

22. E

coronoid process

22. F

trochlea

22. G

olecranon process

22. H

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

25° to 30°

29. How much rotation is required for an oblique projection of the wrist ?

45°

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

45°

12. 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° away from shoulder

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

45° laterally

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

45° toward shoulder

28. The hand is flexed _____° in relation to the IR for the AP axial projection (Brewerton method).

65°

15. Which IR size should be used for a thumb projection ?

8 x 10 inch portrait

Fifth carpometacarpal (CMC) joint

8. A

Body of third metacarpal

8. B

Head of fifth metacarpal

8. C

Fourth metacarpophalangeal (MCP) joint

8. D

Head of proximal phalanx of fifth digit

8. E

base of middle phalanx of fourth digit

8. F

distal interphalangeal joint (DIP) of fourth digit

8. G

Body of middle phalanx of second digit

8. H

proximal interphalangeal joint (PIP) of second digit

8. I

Body of distal phalanx of first digit

8. J

interphalangeal joint (IP) of first digit

8. K

metacarpophalangeal joint (MCP) of first digit

8. L

head of first metacarpal

8. M

Second carpometacarpal (CMC) joint

8. N

first carpometacarpal (CMC) joint

8. O

13. What is the amount of elbow flexion required for the trauma lateral projection ( Coyle method ) to demonstrate the coronoid process ?

80° of flexion

Scaphoid

9. A

Lunate

9. B

Triquetrum

9. C

Pisiform

9. D

Trapezium

9. E

Trapezoid

9. F

Capitate

9. G

Hamate

9. H

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

90°

19. A Bennett fracture involves: A. Base of first metacarpal B. Trapezium bone C. Scaphoid bone D. Fracture extending through first IP joint

A. Base of first metacarpal

3. Circle all pertinent factors that help reduce image distortion during upper limb radiography. A. kVp B. 40 to 44 inches SID C. Milliamperage seconds (mAs) D. Minimal object-image receptor distance (OID) E. Correct central ray placement and angulation F. Use of small focal spot

B. 40 to 44 inches SID D. Minimal object-image receptor distance (OID) E. Correct central ray placement and angulation F. Use of small focal spot

32. Which of the following fractures is not demonstrated in a wrist routine ? A. Barton B. Pott C. Smith D. Colles

B. Pott

19. Which routine projections best demonstrate the scaphoid fat pad ?

PA and Oblique wrist

14. Which projection of the thumb is achieved naturally by placing the palmar surface of the hand in contact with the IR

PA oblique

36. 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

7. What is the positioning routine for the second through fifth digits of the hand ?

PA, PA oblique, and Lateral

2. Indicate whether the following structures are part of the radius (R), ulna (U), or distal humerus (H) Trochlear notch Radial notch Olecranon fossa Trochlea Coronoid tubercle Coronoid process Olecranon process Coronoid fossa

Trochlear notch - ulna Radial notch - ulna Olecranon fossa - distal humerus Trochlea - distal humerus Coronoid tubercle - ulna Coronoid process - ulna Olecranon process - ulna Coronoid fossa - distal humerus

1. Identify the number of bones for each of following. A. Phalanges (fingers and thumb) B. Metacarpals (palm) C. Carpals (wrist) D. Total

a. 14 b. 5 c. 8 d. 27

20. A. Which special positioning method can be performed to demonstrate a Bennett fracture ? B. What degree of central ray angulation is required for this projection ?

a. Modified Robert's Method b. 15° proximal CR angle

5. List the three parts of each metacarpal, starting proximally:

a. base b. body (shaft) c. head

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

a. elbow flexed 90° b. optimal exposure factors used c. in a true lateral position

4. The three parts of each phalanx, starting distally, are the:

a. head b. body (shaft) c. base

7. Match the articulations with the correct joint movement types: a. interphalangeal joints b. carpometacarpal of first digit c. Elbow joint (humeroulnar and humeroradial) d. metacarpophalangeal joint of second to fifth digits e. radiocarpal f. intercarpal joints g. elbow joint h. proximal radioulnar joint

a. interphalangeal joints - ginglymus b. carpometacarpal of first digit - saddle c. Elbow joint (humeroulnar and humeroradial) - ginglymus d. metacarpophalangeal joint of second to fifth digits - ellipsoidal e. radiocarpal - ellipsoidal f. intercarpal joints - plane g. elbow joint - ginglymus h. proximal radioulnar joint - pivot

1. Identify the following technical factors most commonly used for upper limb radiography. A. KVp range: B. Long or short exposure time: C. Large or small focal spot: D. Most common minimum source-image receptor distance (SID): E. Grids are used if the body part measures greater than F. Small-to-medium dry plaster casts: Increase G. Large plaster casts: Increase H. Fiberglass casts: Increase I. Correctly exposed radiographs: Visualize _________ margins and _________ markings of all bones.

a. low to medium (60-80 kVp) b. short exposure time c. small focal spot d. 40 inches e. 10 cm f. 5 to 7 kVp g. 8 to 10 kVp h. 3 to 4 kVp i. soft tissue margins, trabecular markings

10. Identify which positioning modification(s) should be used for a study of the second digit to reduce distortion for each of the following: A. PA oblique projection B. Lateral position

a. perform the medial oblique rather than the lateral oblique to decrease OID b. perform a thumb-down lateral (mediolateral projection) to decrease OID

2. The two portions of the thumb (first digit) are the:

a. proximal phalanx b. distal phalanx

3. The three portions of each finger (second through fifth digits) are the:

a. proximal phalanx b. middle phalanx c. distal phalanx

1. A. In the anatomic position, which of the bones of the forearm is located on the lateral (thumb) side ? В. Which is on the medial side ?

a. radius b. ulna

14. The two important fat stripes or bands around the wrist joint are the:

a. scaphoid fat stripe b. pronator fat stripe

9. List the 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

4. A. The articular portion of the medial aspect of the distal humerus is called the B. The similar structure found on the lateral aspect of the distal humerus is called the

a. trochlea b. capitulum

6. The criteria for evaluating a true lateral position: a. First and smallest arc of true lateral position of elbow b. the intermediate double arc, consisting of the outer ridges of the smaller arc __________, and the larger arc __________ c. the third arc, which is part of the ulna ___________

a. trochlear sulcus (groove) b. smaller = capitulum, larger = trochlea c. trochlear notch

11. 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 ?

a. ulnar deviation b. radial deviation

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

athrography

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

metacarpophalangeal

7. The joints between the metacarpals and the phalanges are the

metacarpophalangeal (MCP) joint

5. The deep depression located on the posterior aspect of the distal humerus is the

olecranon fossa

3. To position the patient properly for an AP projection of the elbow, the epicondyles must be _______ to the IR .

parallel

3. Which joint permits the forearm to rotate during pronation?

proximal radioulnar joint

10. 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

12. Which is the most commonly fractured carpal bone ?

scaphoid

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

steve left the party to take carol home

13. 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

13. How does the forearm appear radiographically if pronated for a posteroanterior (PA) projection ?

the proximal radius crosses over the ulna

List the correct pathology term for each of the following definitions A. Fracture and dislocation of the posterior lip of the distal radius B. Most common type of primary malignant tumor occurring in bone C. Reduction in the quantity of bone or atrophy of skeletal tissue D. Sprain or tear of the ulnar collateral ligament E. An abnormality of the cartilage affecting long bones F. Transverse fracture extending through the distal aspect of the metacarpal neck, most often the fifth metacarpal G. Hereditary condition marked by abnormally dense bone H. Transverse fracture of the distal radius with posterior displacement of the distal fragment

A. Fracture and dislocation of the posterior lip of the distal radius - barton fracture B. Most common type of primary malignant tumor occurring in bone - multiple myeloma C. Reduction in the quantity of bone or atrophy of skeletal tissue - osteoporosis D. Sprain or tear of the ulnar collateral ligament - skier's thumb E. An abnormality of the cartilage affecting long bones - achondroplasia F. Transverse fracture extending through the distal aspect of the metacarpal neck, most often the fifth metacarpal - boxer's fracture G. Hereditary condition marked by abnormally dense bone - osteopetrosis H. Transverse fracture of the distal radius with posterior displacement of the distal fragment - colles fracture

2. Match the clinical indication or disease to its radiographic appearance. A. Narrowing of joint space with periosteal growths on the joint margins B. Fluid-filled joint space with possible calcification C. Possible calcification in the carpal sulcus D. Soft tissue swelling and loss of fat-pad detail visibility E. Mixed areas of sclerotic and cortical thickening along with radiolucent lesions

A. Narrowing of joint space with periosteal growths on the joint margins - osteoarthritis B. Fluid-filled joint space with possible calcification - bursitis C. Possible calcification in the carpal sulcus - carpal tunnel syndrome D. Soft tissue swelling and loss of fat-pad detail visibility - osteomyelitis E. Mixed areas of sclerotic and cortical thickening along with radiolucent lesions - osteopetrosis

21. Where is the central ray centered for a PA projection of the hand ? A. Third MCP joint B. Midaspect of third metacarpal C. Second MCP joint D. Third PIP joint

A. Third MCP joint

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

AP and lateral

5. Which routine projection of the elbow best demonstrates the radial head, neck, and tuberosity with slight (if any) superimposition the ulna ?

AP oblique with 45° lateral rotation

7. Which projection of the elbow best demonstrates the coronoid process in profile ?

AP oblique with 45° medial rotation

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

AP projection (with the hand slightly arched)

3. For the following types of pathologic conditions , indicate whether the analog manual exposure factors should be increased (+), decreased (-), or remain the same (0) as compared with the manual exposure factors . Advanced Paget disease Joint effusion Advanced rheumatoid arthritis Osteoporosis Osteopetrosis Bursitis

Advanced Paget disease - increased (+) Joint effusion - same (0) Advanced rheumatoid arthritis - decreased (-) Osteoporosis - decreased (-) Osteopetrosis - increased (+) Bursitis - same (0)

34. How much are the hand and wrist elevated from the IR for the modified Stecher method ? A. None B. 10° C. 20° D. 15°

C. 20°

18. Where is the central ray centered for an AP projection of the thumb ? A. first interphalangeal (IP) joint B. midaspect of proximal phalanx C. first metacarpophalangeal (MCP) joint D. first proximal interphalangeal (PIP) joint

C. first metacarpophalangeal (MCP) joint

20. Which routine projection best demonstrates the pronator fat stripe ?

Lateral wrist

27. The AP axial projection (Brewerton method) is commonly used to evaluate for early signs of:

Rheumatoid arthritis

10. Which is the largest of the carpal bones ?

capitate

2. The general rule for collimation for upper limb radiography states:

collimation borders should be visible on all four sides if the image receptor is large enough to allow this without cutting off essential anatomy

8. ellipsoidal joints are classified as freely movable, or _____ and allow movement in ___ directions

diarthrodial, 4

8. How much of the metacarpals should be included for PA projection of the digits ?

distal aspect of the metacarpals

31. 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

18. True/False: Trauma or infection makes the anterior fat pad more difficult to see on a lateral elbow radiograph .

false

2. True/False: For a forearm study, the technologist needs to include only the joint closest to the site of the injury

false

6. True/False: 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)

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

fan lateral

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

hamulus/hamular process