*Basic Procedures- Exam 1 Wrist

The ____ is a fibrous band under which the median nerve passes and can become compressed, a condition known as carpal tunnel syndrome

Flexor retinaculum

(Scaphoid anatomy) holding the digits flexed in a "clenched-fist" fashion also can help overcome _____. Other positioning methods help open the articulations between the surrounding ____.

Foreshortening Carpals

Distal row (Lateral to medial) of carpals:

Greater multangular (trapezium) Lesser multangular (trapezoid) Capitate (Os magnum) Hamate (unciform) "Some Lovers Try Positions That They Cannot Handle"

The wrist has ____ carpal bones

8

The carpal interspaces are best demonstrated in the _____ of the wrist. Due to the _____ of the interspaces. They are more parallel with the divergence of the X-ray beam.

AP projection Obliquity

Patient positioning for PA wrist:

Part position: Rest arm on table. Shoulder, arm, forearm & wrist in the same plane. Place pronated wrist on IR Arch fingers slightly Shield patient Remove jewelry

AP Oblique wrist info:

Projection: AP Oblique with medial rotation Film Size: 10x12 inches Table top (non grid) SID: 40 inches Central ray: perpendicular to midcarpal area

Lateral wrist info:

Projection: Lateral (lateromedial) Film Size: 10x12 inches Table top (non grid) SID: 40 inches or 100 cm Central ray: perpendicular to wrist joint

Ulnar deviation (scaphoid) info:

Projection: PA Film Size: 10x12 Tabletop (non grid) SID: 40-48 inches Central ray: directed perpendicular to the scaphoid bone

Carpal tunnel is also called=

Carpal sulcus

The ____ is a concave arch at the wrists palmer aspect where the median nerve and the flexor tendons pass

Carpal sulcus (carpal tunnel)

The gaynor-hart method is a view designed to image the _____ or ____

Carpal tunnel Canal

Structures demonstrated for PA wrist: (4)

Carpals in PA projection Distal radius & ulna Proximal metacarpals Ulna slightly obliqued

Structures demonstrated for PA Oblique wrist: (2)

Carpals on Lateral side aspect of wrist Especially scaphoid & trapezium

Structures demonstrated for Gaynor-Hart method:

Tangential image of carpal canal

Articulates with the 1st metacarpal=

Trapezium

Other word for Greater Multangular=

Trapezium

Other word for Lesser Multangular=

Trapezoid

Other word for Triangular=

Triquetral or triquetrium

Other word for Hamate=

Unciform

Other word for Lunate=

Semilunar

Which is the best view(s) of the pisiform?

AP Oblique wrist & Gaynor-Hart method

Structures demonstrated AP Oblique wrist: (3)

Best view of pisiform Separates pisiform from adjacent carpals Triquetrum, lunate, and hamate also demonstrated

The largest of the carpal bones=

Capitate

Has a "hook" shaped process called the hamulus arising from its anterior surface=

Hamate (Hamulus on hamate)

Routine wrist series:

PA PA oblique Lateral Ulnar deviation

The carpal bones are always named proximal row 1st ____ to ____. Then the distal row ____ to ____.

Lateral Medial Lateral Medial

What view demonstrates anterior & posterior fracture displacement?

Lateral wrist

The carpal bones are held together by ____

Ligaments

Described as a half moon or crescent shaped bone=

Lunate

The flexor retinaculum is a fibrous band under which the _____ passes and can become compressed, a condition known as _____.

Median nerve Carpal tunnel syndrome

The carpal sulcus is a concave arch at the wrists palmer aspect where the ____ and the ____ pass

Median nerve Flexor tendons

Proximal row (Lateral to medial) of carpals:

Navicular (scaphoid) Lunate (semilunar) Triangular (triquetral, triquetrium) Pisiform "Some Lovers Try Positions That They Cannot Handle"

Evaluation criteria for PA wrist: (3)

No rotation of distal radius, carpals & metacarpals Distal radius, ulna, carpals, and proximal 1/2 of metacarpals Radioulnar articulation "opened"

Other word for Capitate=

Os Magnum

Patient positioning for ulnar deviation:

Patient position: seated at table with arm extended, hand in pronation. Part position: keeping the forearm still, turn the hand outward until the wrist is in extreme ulnar deviation

PA wrist info:

Patient position: seated Film Size: 10x12 inches Table top (non grid) SID: 40 inches or 100 cm Central ray: perpendicular to midcarpal area

Patient positioning for Lateral wrist:

Patient position: seated Part position: Lateral. Flex elbow 90 degrees. Place wrist on IR ulna side down. Shoulder, arm, elbow & wrist in the same plane on table. Adjust wrist in true Lateral position.

Patient positioning for AP Oblique wrist:

Patient position: seated Part position: Semisupinated position. Place supinated wrist on IR (dorsal surface). Rotate it medially (internally) 45 degree angle with IR.

Patient positioning for Stecher method:

Patient position: seated at table with arm extended. Hand in pronation. Part position: Raise films distal end so the IR is elevated at 20 degrees. Center carpals to IR.

Patient positioning for PA Oblique wrist:

Patient position: seated. Shoulder, wrist & elbow in the same plane Part position: Semiprone Oblique. Place pronated wrist on IR. Rotate it laterally (externally) 45 degrees

Patient positioning for Gaynor-Hart:

Patient positioning: forearm parallel to long axis of the table Part position: Hyperextend the wrist. Placing long axis of hand vertical. Rotate land slightly to radial side. Hold fingers back with support.

For the Gaynor-Hart method the ____ is free from superimposition

Pisiform

PA oblique wrist info:

Projection: PA Oblique with Lateral rotation Film Size: 10x12 inches Table top (non grid) SID: 40 inches or 100 cm Central ray: perpendicular to approx level of mid-carpal area

Stecher method (Scaphoid) info:

Projection: PA axial Film Size: 10x12, LW Table top (non grid) SID: 40-48 inches or 100 cm Central ray: vertical, when IR is placed on 20 degree sponge. (If no sponge available, direct central ray 20 degrees toward elbow)

Gaynor-Hart (carpal canal) info:

Projection: tangential Film Size: 10x12 inches SID: 40-48 inches Central ray: directed 25-30 degrees toward the forearm, entering app. 1 inch distal to the base of the 3rd metacarpal

Structures demonstrated for Lateral wrist: (4)

Proximal metacarpals Carpals Distal radius & ulna **Demonstrates anterior & posterior fracture displacement

Evaluation criteria for AP Oblique wrist: (4)

Proximal portion of metacarpals Pisiform in profile free of superimposition Carpals hamate and triquetrum Distal radius & ulna

Has a tubercle extending from its anterolateral margin allowing for ligament attachment=

Scaphoid

Is the most commonly fractured of all carpal bones=

Scaphoid

Other word for navicular=

Scaphoid

The ____ is the most commonly fractured carpal bone

Scaphoid

Radiographic projections of the ____ are designed to correct foreshortening, which occurs because the distal end lies close to the ____ aspect of the wrist, while the proximal end lies in a dorsal orientation.

Scaphoid Palmar

Evaluation criteria for PA wrist Oblique: (4)

Scaphoid and trapezium well demonstrated Proximal metacarpals Carpals Distal radius & ulna slightly overlapped

Small, triangular depression that is seen when the thumb is abducted=

Snuff box (part of the scaphoid)

Evaluation criteria for Lateral wrist: (3)

Superimposed proximal 2-5 metacarpals Superimposed carpals Superimposition of distal radius & ulna

Specialty views of wrist:

Stecher Ulnar deviation

Structures demonstrated for ulnar deviation:

The scaphoid free of foreshortening, adjacent articular spaces opened

Structures demonstrated for Stecher method:

The scaphoid is placed at right angles to the CR, projecting it free of self-superimposition (foreshortening)

The scaphoid has a ____ extending from its ____ margin allowing for ____ attachment

Tubercle Anterolateral Ligament