RAD 121 Test 2 Fingers, Hand, Wrist and Forearm

Forearm Routine

-AP -Lateral

Thumb Routine

-AP -Medial Oblique -Lateral

Elbow Routine

-AP -Medial or Lateral Oblique -90 degree Lateral

Thumb Special - AP Axial Projection (Modified Roberts Method)

-Base of first metacarpal is demonstrated for ruling out Bennett's Fracture -This special projection demonstrates fractures, dislocations, or pathology of the base of the first metacarpal

Metacarpals

-Bones that make up the hand -Numbered 1-5 with the thumb as 1 and the little finger as 5 -Has 3 parts -Head - Distal rounded part -Neck - Tapered just proximal the the head -Body - Shaft, long curved portion -Base - Proximal end, articulates with carpals

Fingers

-Digits which are composed of phalanges -Numbered 1-5 with the thumb as #1 and the little finger as #5

Elbow Special - Radial Head Laterals

-Done for occult fracture of the radial head and neck -4 separate lateral positions -Hand supinated -Hand Lateral -Hand pronated -Hand with maximum internal rotation

What are the 3 joints that make up the Elbow Joint?

-Humerus/Radius -Humerus/Ulna -Proximal radioulnar joint

Proximal Ulna

-Longer than radius -Primarily involved in formation of the elbow joint

Capitulum

-Means little head -Located laterally and articulates with the head of the radius. ("Cap" on the Head of the Radius)

What should be done if the patient cannot fully extend their elbow?

-Obtain 2 Projections -One with the humerus parallel to the IR -One with the forearm parallel to the IR

Special Elbow - Acute Flexion (Jones Method)

-Obtain 2 radiographs -One with Central ray perpendicular to the humerus -One with Central ray perpendicular to the forearm *****Done when patient cannot extend the elbow at all*****

Hand Routine

-PA -Lateral Oblique -Fan Lateral

Fingers (2nd-5th Digits) Routine

-PA -Lateral Oblique -Lateral

Forearm contains what bones?

-Radius on the lateral side or thumb side -Ulna of the medial side

List the Proximal Row of Carpals and what they articulate with.

-Scaphoid - Boat Shaped, Largest bone of proximal row, articulates with the radius -Lunate - moon-shaped, articulates with radius proximally and capitate distally -Triquetrum - Pyramidal shape, articulates with pisiform -Pisiform - Pea shaped, smallest carpal

Trochlea

-Shaped like a pulley or spool, with 2 rim like outer margins -Located medially on the humerus -Articulates with Ulna

Radial and Ulna Styloid Processes

-Small conical projections at the distal end of both the radius and ulna -Radial styloid process extends more distally and both are palpable

List the Distal Row of Carpals and what the articulate with.

-Trapezium - Irregularly shaped between the scaphoid medially and the 1st metacarpal distally - Trapezoid - Wedged-Shaped, smallest carpal in distal row -Capitate (os magnum) - Largest carpal bone, articulates with scaphoid and lunate proximally and 3rd metacarpal distally -Hamate - Hooklike process called hamulus projects from palmar surface

A good Lateral elbow demonstrates what 3 Concentric Arcs/Circles

1. Trochlear sulcus - Smallest 2. Outer Rims of the Capitulum and Trochlea 3. Trochlear or Samilunar Notch -If not in true lateral the arcs will not appear symmetrical and the joint space will not be optimally visualized.

How many phalanges does the thumb have?

2, The Proximal and Distal Phalanx

How many phalanges do digits 2-5 have?

3, The Proximal, Middle, and Distal

What is essential for finding Joint Pathology?

A True Lateral Position

Joint Effusion

Accumulated fluid, synovial or hemorrhagic, in the joint cavity.

The proximal and distal radioulnar joints allow for what to move?

Allows for rotational movement of the hand and wrist

Special Hand - AP Oblique Bilateral (Norgaard Method)

Also known as Ball Catcher's position -Done to evaluate Rheumatoid Arthritis

Carpals

Are the bones that make up the wrist

Anterior Depression - Coronoid Fossa

Area in which the coronoid process is located when the elbow is flexed

Anterior Depression - Radial Fossa

Area in which the radial head is located when the elbow is flexed

Posterior Depression - Olecranon Fossa

Area where the olecranon process is located when the arm is fully extended

Where does the radius and ulna articulate with each other?

At the proximal and distal Radioulnar Joints

Coronoid Process

Beak like process separated from the olecranon process by the trochlear (semilunar) notch

Olecranon Process

Beak like process that is easily palpated on the posterior aspect of the elbow (Funny Bone)

Distal Interphalangeal (DIP) Joint

Between the distal and middle phalanx of the 2nd and 5th digit.

Carpometacarpal (CM) Joint

Between the metacarpal and the appropriate carpal of the distal row of the wrist. -1st MC with trapezium -2nd MC with trapezoid -3rd MC with Capitate -4th and 5th MC with Hamate

Proximal Interphalangeal (PIP) Joint

Between the middle and proximal phalanx of the 2nd and 5th digit.

Interphalangeal (IP) Joint

Between the proximal and distal phalanx of the thumb

Metacarpophalangeal (MCP) Joint

Between the proximal phalanx and the metacarpals of each digit.

Neck

Constricted area located just distal to the head of the radius

Medial Oblique Elbow best demonstrates what?

Coronoid Process

Special Wrist - Carpal Canal (Tunnel), Tangential, Gaynor-Hart Method

Demonstrates carpals in an arched arrangement -Possible fractures of the hamulus process of the hamate, pisiform, and trapezium

Wrist Special - PA Radial Deviation

Demonstrates fractures of the Lunate, Triquetrum, Pisiform, and Hamate

Thumb Special - PA Stress

Demonstrates metacarpophalangeal angles and joint spaces at MCP joints

Wrist Special - PA Modified Stretcher Method

Demonstrates possible fractures of the scaphoid -This is an alternative to the ulnar deviation

Special Wrist - Ulnar Deviation (Ulnar flexion)

Demonstrates the Scaphoid

What joint movement is involved with Metacarpophalangeal (MCP) Joints?

Ellipsoidal or Condyloid type -Allows flexion, extension, abduction, adduction

What joint movement is involved with the Radiocarpal (also known as the wrist joint) Joints?

Ellipsoidal or condyloid type

Humeral Condyle of the Distal Humerus

Expanded distal end

Ginglymus or Hinge Joints

Flexion and extension movements -Elbow -Interphalangeal

Ellipsoid or Condyloid Joints

Flexion, Extension, Adduction, Abduction and Circumduction -Wrist

Spheroid or Ball and socket Joints

Flexion, Extension, abduction, adduction, circumduction, and medial and lateral rotation -Shoulder -Hip

Coronoid Tubercle

Found of the medial margin of the coronoid process

Barton's Fracture

Fracture and dislocation of the posterior lip of the distal radius

Bennett's Facture

Fracture of the base of the first metacarpal with subluxation and posterior displacement

Joint Effusion indicates what?

Fracture, dislocation, soft-tissue damage or inflammation

Diarthrosis

Freely movable-most synovial joints with a joint capsule containing synovial fluid, joints of the limbs

What joint movement is involved with the Elbow Joint?

Ginglymus hinge type

What joint movement is involved with Interphalangeal (IP) Joints?

Ginglymus or Hinge type -Allows flexion and extension movement

Trochlear Sulcus

Groove, depressed center portion between the rim like outer margins of the trochlea, appears circular on lateral view

3 parts of the phalanx are what?

Head - Distal rounded part Body - Middle section or shaft Base - Flattened proximal portion

Small chip fractures frequently occur near what?

Joint Spaces

Trochlear Notch

Large concave depression articulating with the distal humerus

Medial epicondyle

Larger than the lateral epicondyle, located of the medial edge of the distal humerus

Head of ulna

Located at the distal end of the ulna, proximal to the styloid process

Body or Shaft

Long midportion of both the radius and ulna

Osteoarthritis

May see DJD (Degenerative Joint Disease) -Gradual deterioration of articular cartilage -Considered a normal part of the aging process

What is another term for scaphoid?

Navicular

Where are the posterior fat pads on a elbow located?

Normally located deep within the olecranon fossa and is not visible on a negative elbow exam

Ulnar Notch

On medial aspect of distal radius where head of ulna sits

What joint movement is involved with the Intercarpal Joints?

Plane or gliding type

What joint movement is involved with the 2nd-5th Carpometacarpal (CM) Joints?

Plane or gliding type -Least amount of movement of the synovial class of joints

Lateral Oblique Elbow best demonstrates what?

Radial head and Neck

What bone articulates directly with the wrist joint?

Radius

Smith's Fracture

Reverse of Colle's fx, transverse fracture of distal radius displaced anteriorly

Trochoid or Pivot Joints

Rotational movements -Proximal and Distal Radioulnar Joints of the forearm

Radial Tuberosity

Rough oval process on the medial and anterior side of the radius just distal to the neck

Head of radius

Round and flat, located at the proximal end of the radius

Sellar or Saddle Joints

Same movements as ellipsoid -First carpometacarpal joint of the thumb, ankle

What carpal is the most fractured?

Scaphoid

What joint movement is involved with the thumb 1st Carpometacarpal (CM) Joints?

Sellar or Saddle type -Allows flexion, extension, abduction, adduction, circumduction, opposition and some rotation

What is another name for the Trochlear notch?

Semilunar notch

Visualization of the posterior fat pad on a lateral elbow image indicates what?

Significant injury, fracture or pathologic process

Plane or Gliding Joints

Sliding or gliding motion -Carpometacarpal -Atlantoaxial

Radial Notch

Small Shallow depression on the lateral side of the proximal ulna that articulates with the head of the radius to form the proximal Radiounlar Joint

Lateral epicondyle

Small projection on lateral aspect of the distal humerus above the capitulum

Correctly exposed images should demonstrate what?

Soft-tissue margins for fat pad visualization and fine trabecular markings of all bones

The upper limb is classified as what type of Joint

Synovial, diarthrodial and freely movable joints

What anatomy must be included on a thumb radiograph as opposed to other fingers?

The phalanges and entire 1st Metacarpal must be included.

What anatomy must be included on 2-5 digit radiograph?

The phalanges and the distal portion of the metacarpal are required

What happens when the hand is pronated?

The radius rotates around the more stationary ulna

What is the forearm performed AP?

To prevent the Ulna and Radius from superimposing

Colle's Fracture

Transverse Fracture of the distal radius, displaced posteriorly, often a second fx at the ulnar styloid also occurs

Boxer's Fracture

Transverse Fracture through the metacarpal neck, most commonly the 5th metacarpal

What indicated elbow trauma?

Visualization of displaced posterior fat pads

Trauma Axial Lateral Elbow (Coyle Method)

-2 projections -One to demonstrate Radial Head -One to demonstrate coronoid process