Positioning: forearm, wrist, hand
The second through fifth MCP joints are what kind of joint?
Ellipsoidal, condyloid (allows 4 primary direction movement and circumduction)
The wrist joint is what kind of joint?
Ellipsoidal, condyloid (allows 4 primary direction movement and circumduction)
What should be visualized in a PA hand radiograph?
Entirety of hand and wrist and about an inch (2.5 cm) of the forearm
Where does the ulnar collateral ligament attach?
Fans out to attatch to the triquetrium and pisiform from the ulnar styloid process
Paget disease exposure factor adjustment
increase
Number of carpals in each hand
8
Radial deviation
Movement of the hand at the wrist joint to the side of the radius (away from the ulna)
Ulnar deviation
Movement of the hand at the wrist joint to the side of the ulna (away from the radius)
Why would a lateral extension and flexion hand series be used instead of a faN?
Alternative to localize foreign bodies of the hand and fingers
Centering PA, PA axial scaphoid with ulnar deviation
Angle CR 10-15 deg proxmially along long axis of forearm (toward the elbow with CR perpendicular to long axis of scaphoid) Center to scaphoid
CMC joint
Carpometacarpal joint
Centering for: PA fingers PA oblique fingers Lateromedial/mediolateral fingers
CR perpendicular to IR Centered on PIP joint of finger of interest
Centering for: AP thumb PA oblique thumb (with medial or lateral rotation)
CR perpendicular to IR Centered on first MCP joint
Centering PA hand PA oblique hand
CR perpendicular to IR Centered on third MCP joint
Centering Lateral extension/flexion hand series
CR perpendicular to IR Centered through the 2nd-5th MCP joints
Centering Lateromedial elbow
CR perpendicular to IR Directed at mid-elbow joint (medial to easily palpated posterior surface of olecranon process)
Centering Fan lateral hand
CR perpendicular to IR Directed to second MCP joint
Centering for PA stress thumb (AKA Folio method)
CR perpendicular to IR directed to midway between MCP joints
Centering PA wrist with radial deviation
CR perpendicular to IR, directed to midcarpal area
Centering AP elbow
CR perpendicular to the IR, directed at mid-elbow joint (2 cm or 3/4 inch distal to midpoint of epicondylar line)
Centering Norgaard/"ball-catcher's"
CR perpendicular to the IR, directed to the midpoint between both hands in line with the 5th MCP joints
Why would a carpal bridge be done?
Check for calcification or other pathology of the dorsal aspect of the carpal bones
Why would an AP elbow projection be needed?
Check for fractures or dislocations at the joint
Why would a lateromedial wrist projection be needed?
Check for fractures or dislocations of the distal radius or ulna Specifically anteroposterior fragment displacements for Barton's, Colles, or Smith's fractures
Why would a full hand radiograph be needed?
Check for fractures, dislocations, or foreign bodies of the phalanges, metacarpals, and all joints
Why would a PA wrist projection with radial deviation be done?
Check for possible fractures of the carpal bones on the ulnar side of the wrist, especially the lunate, triquetrum, pisiform, and hamate
Why would a PA or PA axial scaphoid with ulnar deviation be needed?
Check for possible fractures of the scaphoid
Why would a PA stress thumb image need to be done?
Check for sprain or tearing of the ulnar collageral ligamen tof the thumb at the MCP joint as a result of acute hyperextension of the thumb; also referred to as a "skier's thumb" injury
Why would a lateral "fan" image be taken of a hand?
Checking for fractures and dislocations of the phalanges, anterior/posterior displaced fractures, and dislocations of the metacarpals; typically preferred if the phalanges are the area of interest
Bursitis exposure factor adjustment
none
Carpal tunnel syndrome exposure factor adjustment
none
Joint effusion exposure factor adjustment
none
Osteomyelitis exposure factor adjustment
none
Tumors (malignant and benign) exposure factor adjustment
none
What differentiates nuclear medicine from regular radiography?
nuclear medicine focuses more on physiologic elements rather than anatomical, so nuc med better visualizes certain conditions
Colles fracture
Transverse fracture of the distal radius in which the distal fragment is displaced posteriorly; associated ulnar styloid fracture is seen in 50-60% of cases
Smith's fracture
Transverse fracture of the distal radius with the distal fragment displaced anteriorly (Reverse of Colles fracture)
Boxer's fracture
Transverse fracture that extends through the metacarpal neck; most commonly seen in the 5th metacarpal
What concentric arc of the elbow is used to evaluate rotation?
Trochlear sulcus
Barton's fracture
A fracture and dislocation of the posterior lip of the distal radius involving the wrist joint
The head of what bone fits into its notch to form the distal radioulnar joint?
Ulna
What ligament is attached to the ulnar styloid process?
Ulnar collateral ligament
Evaluation criteria of a PA scaphoid with ulnar deviation?
Ulnar deviation is evidenced by only minimal, if any, superimposition of the distal scaphoid
Number of phalanges in each hand
14
Total number of bones in each hand
27
What is the number of images needed for checking for occult fractures of the radial head or neck? What are they?
4 Elbow at 90 deg with: hand supinated/max external rotation, hand lateral, hand pronated, and hand with maximum internal rotation
What bone(s) does the hamate articulate against?
4th and 5th metacarpal bones
Number of metacarpals in each hand
5
What should be seen on a good lateral image of an elbow?
About 1/2 of the radial head should be superimposed by the coronoid process, the olecranon process should be visualized in profile
What is the Jones method?
Acute elbow flexion series
Centering for AP axial projection for thumb (AKA modified Robert's)
CR directed 15 deg proximally (toward the wrist), entering at first CMC joint
Why would you need an AP axial projection of a thumb?
Best demonstrates fractures, dislocations, or pathology of the base of the first metacarpal and trapezium
What is very common with malignant bone tumors?
Bone metastases
Centering Gaynor-Hart/Carpal Canal projection
CR angled 25-30 deg to the long axis of the hand
How do you know a finger is in a true lateral?
Can be indicated by concave appearance of the anterior surface of the shaft of the phalanges
Which carpal bone is the largest of the carpal bones?
Capitate bone
Rheumatoid arthritis
Chronic systemic disease with inflammatory changes throughout the connective tissues; earliest change is soft tissue swelling that is most prevalent around the ulnar styloid of the wrist; three times more common in women than men
Carpal tunnel syndrome
Common painful disorder of the wrist and hand that results from the compression of the median nerve as it passes through the center of the wrist *most commonly observed in middle-aged women*
What are the two depressions on the anterior aspect of the humerus called?
Coronoid fossa Radial fossa
Osteoporosis exposure factor adjustment
Decrease
DIP joint
Distal interphalangeal joint
Positioning for Coronoid process/axial mediolateral projection
Elbow flexed at 80 deg from extended CR angled 45 deg from shoulder into the mid-elbow joint
Positioning for Radial head/axial lateromedial projection
Elbow flexed at 90 deg if possible with the hand pronated CR directed at a 45 deg angle toward the shoulder
What soft tissue structures may be seeon on a lateromedial elbow image?
Elevated or displaced fat pads
Bennett's fracture
Fracture of the base of the first metacarpal bone, extending into the carpometacarpal joint, complicated by subluxation with some posterior displacement
The IP joints are what kind of joint?
Ginglymus, hinge (two-way motion)
Why are grids not typically used for appendages?
Most of the structures being radiographed are smaller than 10 cm
What adjustment needs to be made when taking radiographs of an individual with a fiberglass cast?
Increase kV factor by 3 or 4
IP joint
Interphalangeal joint
What elbow position best visualizes the radial head, radial neck, and capitulum of the humerus?
Lateral oblique of the elbow (elbow rotated externally)
How should the appendage to be radiographed be positioned in relation to the IR?
Long edge of the object/part parallel to the long edge of the IR
What projection best visualizes the coronoid process of the ulna and the trochlea in profile?
Medial oblique of the elbow (internal rotation of the elbow)
Multiple myeloma
Most common primary cancerous bone tumor
Other names for the AP oblique bilateral hand image?
Norgaard method "ball-catcher's position"
What needs to be done for an AP elbow when the patient cannot fully extend the elbow?
Obtain two projections if the elbow is flexed near 90 deg but not acutely, angling the CR 10-15 deg into the elbow joint If the joint is flexed more than 90 deg, use the acute flexion projection
What should be done when positioning an elbow for an AP projection?
Palpate the humeral epicondyles to ensure that the enterepicondylar plane is parallel to the IR
Which carpal bone is the smallest?
Pisiform
What soft tissue structure (not normally visible on a typical radiograph) of the elbow helps diagnose pathologic processes at the joint?
Posterior fat pad
What is the Gaynor-Hart method and what does it check?
Projection that rules out abnormal calcification and bony changes in the carpal sulcus that may impinge on the median nerve (such as carpal tunnel syndrome) using a band to pull the hand back towards the posterior forearm
POP joint
Proximal interphalangeal joint
The first CMC joint of the thumb is what type of joint?
Saddle, sellar
What carpal bone is the largest in the proximal row, boat-shaped bone that articulates with the radius proximally?
Scaphoid bone
What carpal bone is the most frequently fractured?
Scaphoid bone
What two soft tissue structures are important to the wrist joint?
Scaphoid fat stripe Pronator fat stripe
Osteogenic sarcoma (osteosarcoma)
Second most common type of primary cancerous bone tumor
Why would an axial lateromedial and mediolateral projection series of the elbow be needed?
Special projections taken for pathologic processes or trauma to the area of the radial head or coronoid process of the ulna; effective projections when the patient can't fully extend the elbow for medial or lateral oblique projections
Skier's thumb
Sprain or tear of ulnar collateral ligament of the thumb
How should the elbow be positioned for an AP oblique?
The interepicondylar plane aproximately 45 deg to the IR
When looking at the tube, why is there a 3-4 inch distance reading disparity?
The longer number is reading the distance from the tube to the bucky tray, which is about 3-4 inches below a floating table top
What is an alternate way to do a PA scaphoid image?
Use a foam wedge with a slight angle (some may be as much as 20 deg) and deviate the hand if possible CR is directly perpendicular to the IR, no angling is done with the tube
What is the best way to maintain a consistent and steady 45 deg angle of the hands in a ball-catcher's?
Use foam blocks that help hold them still
Why would an AP oblique bilateral hand image be taken?
Used to evaluate for early evidence of RA at the second through fifth PIP and MCP joints
What trick can be used to prevent foreshortening of the phalanges and obscuring of the interphalangeal joints?
Using a radiolucent foam block to support the hand being radiographed
Rheumatoid arthritis (RA) exposure factor adjustment
decrease
Osteomyelitis
local or generalized infection of bone or bone marrow that may be caused by bacteria introduced by trauma or surgery
MCP joint
metacarpophalangeal joint
