Procedures - Upper Extremities

Be aware of distinction between SCAPULAR SPINE and ACROMION PROCESS in diagrams and x-rays

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Describe book position of the hand vs. Mayo position of the hand for a lateral elbow:

Book: lateral Mayo: pronated

Positioning for PA thumb stress test:

Both hands w/thumbs pushed together; CR through the MCP joint

AP oblique flexion hand also known as ___________

Brewerton

Describe positioning for a 40/60 humerus

Done when patient is in a sling; ex: for a right humerus do an RAO and RPO oblique

PA stress view of the thumb also known as _________

Eaton

Describe patient position for a lateral wrist exam:

Elbow flexed 90 on the table; hand in "karate-chop" position with thumb slightly abducted

Another name for condyloid joint?

Ellipsoid

Joint type: radiocarpal

Ellipsoidal

T/F: AP humerus with internal and external rotation shows the shoulder girdle 90 degrees apart.

False

T/F: On a lateral forearm, the distal radius and ulna will not be superimposed

False

T/F: The CR does not need to be centered to the middle of the film for hand views

False

T/F: if there is suspected fracture of the humerus, rotate the bone to ensure a good image

False

T/F: the Grashey method is not used at Mayo

False

T/F: you should rotate the humerus regardless if there is trauma or not

False

T/F: SID never matters when using a slip-on grid

False: always use the correct SID that matches the sticker on the grid

T/F: A PA view is included as part of the thumb routine

False; always AP unless the thumb is casted/healing

T/F: The most distal bone gets to go first in the name of the joint

False; proximal

Film size and CR for Zanca view?

Film size: 10 x 12 CW CR directed to AC joint w/ 15 degree cephalic angle * shows AC joint free from superimposition

Film size and CR for Scap Y/Neer view:

Film size: 10 x 12 CW CR: at surgical neck *respiration suspended

Film size and CR for unilateral axial clavicle:

Film size: 10 x 12 CW CR: centered at midclavicle with 15 degree cephalic angle * suspend on inspiration

Film size & CR for AP scapula:

Film size: 10 x 12 LW CR: 2 inches inferior to corocoid process *At Mayo: breathing suspended **Textbook: shallow breathing

Film size and CR for landscape axial clavicle:

Film size: 14 x 17 CW CR: centered at MSP, with 15 degree cephalic angle * suspend on inspiration

CR and film size for carpal tunnel view of the wrist:

Film size: 8 x 10 LW CR directed 1 inch distal to base of the third metacarpal; need 25-30 degree cephalic angle

Describe positioning for a carpal tunnel view of the wrist:

Forearm parallel with the IR, wrist extended so palm is perpendicular with the IR, slight internal rotation so pinky is perpendicular with the IR

What does a carpal tunnel view best demonstrate?

Fractures on the scaphoid or the hook of the hamate; pisiform is in profile

Positioning and CR for AP Oblique Hand (ball-catcher's method)?

From AP, both hands internally rotated 45 degrees, fingers extended or flexed in a natural position CR - at MCP joints

Describe patient positioning for AP oblique external rotation of the elbow:

From AP, externally rotate 45 degrees (radial side closest to the table). Keep shoulder, elbow, and wrist in the same plane.

Describe patient positioning for AP oblique internal rotation of the elbow:

From AP, internally rotate 45 degrees. (ulnar side will be closest to the table). Keep shoulder, elbow, and wrist in same plane.

Describe positioning for an AP thumb view

From PA, internally rotate until the posterior surface of the thumb is on the IR

Patient positioning for PA Oblique scapula:

From a right lateral position, rotate forward 20 degrees; keep arm from affected side at a 90 degree abduction on the table

Inferosuperior tangential carpal tunnel of the wrist is also known as ______________

Gaynor-Hart method

Alternative name for Trapezium?

Greater multangular

Ball & socket joint

Greatest freedom of movement; ex: shoulder joint

Fourth & fifth metacarpal articulates with what carpal bone?

Hamate

What is the hook-like process of the hamate called?

Hamulus

What lesion is best demonstrated with the Stryker notch view?

Hill-Sach's lesion

What two things result from multiple dislocations?

Hilsach & Bankart legions

What does the Rafert modification to the axillary shoulder view demonstrate?

Hilsax (?) defect

Having the elbow resting on the table will do what to the scapula for an AP scapula view?

Place it in AP position rather than obliqued

When doing a Scap Y or Neer view on an affected left shoulder, the patient will be _________ on the table and ____________ upright w/the bucky

RPO; LAO

When using the 40/60 method for a right humerus, the _______ position takes the place of the AP humerus and the _________ position takes the place of the lateral humerus

RPO; RAO

Which fossa is above the capitulum on the humerus?

Radial

AP TMC joint also known as ___________

Robert

Positioning and CR for AP TMC joint exam?

Same as AP thumb, but with shoulder, elbow, and wrist all in the same plane. CR at TMC joint

What is the only view of the shoulder that will show dislocations in all 4 directions?

Scap Y

largest bone in the proximal row of wrist bones?

Scaphoid

The radius articulates with what two carpal bones?

Scaphoid & lunate

Name bones in the proximal row of carpals, lateral to medial:

Scaphoid, Lunate, Triquetrum, Pisiform

Another name for saddle joint?

Sellar

Alternative name for lunate?

Semilunar

What structure separates the ulna from all the carpals?

The articular disk

When the wrist is placed in a lateral position for a lateral elbow projection, how will the radial tuberosity be positioned?

The radius will point anteriorly

Monteggia fracture

a fracture at the shaft of the ulna that causes anterior radial head dislocation at the elbow (Monteggia = ulna fracture)

Where is the anterior fat pad?

above inner elbow

Which end of the clavicle is more lateral: acromial end or sternal end?

acromial end

carpal boss

amall bony growth on the dorsal surface of the third CMC joint; best demonstrated on carpal flexion

From a lateral position, if the wrist is internally rotated then the radius will be ____________ in relation to the ulna

anterior

If the wrist is internally rotated from a lateral position, the scaphoid will be ___________ in relation to the pisiform

anterior

The ___________ surface of the scapula has the corocoid process

anterior

the subscapular fossa is on the ________ surface of the scapula

anterior

What does the lateral wrist exam best demonstrate?

anterior/posterior fractures

Almost all shoulder dislocations are ___________ and _____________

anterior; medial

For a lateral hand view, there will be INTERNAL rotation if the radius is __________ to the ulna and the 5th metacarpal moves ___________

anterior; posterior

When patient is lying flat on the table, the __________ rim of the GH joint is medial in relation to the ____________ rim

anterior; posterior

95% of shoulder dislocations are dislocated ___________

anteriorly

What is a neutral shoulder view?

arm not rotated internally or externally; will be an internal oblique somewhere between external and internal

CR for navicular view?

at scaphoid

Where is the CR for the PA wrist-ulnar deviation?

at scaphoid

The inferosuperior axial shoulder (Lawrence view) is also called what?

axillary shoulder

What lesion is best demonstrated with the Westpoint view?

bankhart lesion

Condyloid joint

biaxial joint; allows for flexion/extension, ab/adduction, circumduction (movement in all four directions)

Pivot joint

bony processes surrounded by rings of ligaments. Rotational movement around an axis

What carpal bone is very posterior on a PA wrist?

captitate

What does an AP wrist exam best demonstrate?

carpal interspaces

The ulna is wide ___________

distally

When is the Coyle method utilized?

done for trauma cases when patient cannot extend elbow

Which way should you rotate the 3rd digit for a lateral view?

either direction; whichever is more comfortable

If the radial head is too POSTERIOR on a lateral elbow, then the __________ joint is too low

elbow

If the radial head is too PROXIMAL on a lateral elbow, then the __________ joint is too low

elbow

Joint type: metacarpophalangeal

ellipsoidal

Obliquing the affected side away from the IR for a clavicle view will result in ___________

elongation

Purpose of a PA thumb stress test?

evaluate TMC joint under stress; demonstrates subluxation/dislocation

The elbow must be (flexed/extended) for the olecranon process to be visualized in the olecranon fossa

extended

Joint type: carpometacarpal (2nd-5th digit)

gliding

Joint type: intercarpal

gliding

For external rotation of the arm, what tubercle will be in profile laterally?

greater

Describe the position of the tubercles when the arm is in neutral position

greater tubercle in partial profile humeral head in partial profile

If the glenoid is medial to the base of the corocoid fossa, the CR angle is too ___________

medial (angle too large)

What does a PA internal oblique wrist best demonstrate?

medial carpals

Which edge of the scapula will be free from superimposition of the ribs on a PA oblique scapula?

medial edge

The radial tuberosity is on the ________ (medial/lateral) end of the (distal/proximal) radius

medial; proximal

CR for 40/60 humerus:

mid-humerus

When performing an axillary clavicle on an asthenic patient, _______ angle is needed

more (30 degrees)

Which process is more proximal (superior) on the ulna: olecranon or coronoid?

olecranon

Which fossa of the humerus is on the distal posterior aspect?

olecranon fossa

Where is the supinator fat stripe?

on anterior proximal forearm

What does internally rotating the wrist do for a carpal tunnel image?

opens up space between hamate and pisiform

The _________ surface of the scapula has the acromion process

posterior

Where is the posterior fat pad?

posterior elbow

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

to minimize OID

Why is a PA wrist-ulnar deviation performed?

to open the joint spaces surrounding the scaphoid & correct foreshortening of the scaphoid`

If there is a large gap between the pisiform and the hamulus in a carpal tunnel image, what error is occurring?

too internally rotated

the scapulohumeral joint is also called the ___________ joint

glenohumeral

The internal oblique wrist best demonstrates the _______ carpals

medial

Trochlea is on the __________ side of the arm when in anatomic position

medial

Which epicondyle of the humerus is very prominent when palpated?

medial

What are the two main methods used in the Rafert modification that differ from the regular axillary method?

- arm in extreme external rotation - CR angled 15 degrees medially from long axis of the body

AP Obliques (internal or external) need what additional items in the image?

- mag marker - EXT or INT marker

What three views are performed as part of Mayo's trauma humerus routine?

1. AP neutral 2. inferiosuperior (axillary lateral) 3. lateral distal only

What are the three positions done for a trauma humerus (non-Mayo?)

1. AP neutral 2. lateral distal only humerus 3. transthoracic lateral

What are the three carpal articulations?

1. Carpometacarpal (CMP) 2. Intercarpal 3. Radiocarpal

Describe the two views that will be included for an AP elbow with partial flexion

1. Humerus parallel with the IR, forearm raised 2. Forearm parallel with the IR, humerus raised

How many views are typically done with a motion series of the wrist, and what are they?

1. PA 2. Lateral 3. Ulnar deviation 4. Radial deviation 5. Dorsal flexion 6. Palmar flexion

What are the two positioning options for the Stecher method (navicular view)?

1. Use 20 degree cephalic (proximal) angle 2. Use angle board with no tube angle

Describe the two projections that are performed for the Coyle method:

1. free radial head from superimposition (90 degree flexion w/45 degree cephalic angle) 2. free coronoid process from superimposition (80 degree flexion w/45 degree caudal angle)

What are the two CR options for the AP TMC joint exam?

1. no tube angle; centered at TMC joint 2. 15 degree cephalic angle; centered at TMC joint (aka Modified Robert)

Three parts of the elbow joint proper?

1. proximal radioulnar joint 2. humeroulnar joint 3. humeroradial joint

Describe the two methods to achieve a PA oblique hand position

1. tilt patient's hand at 45 degree angle 2. use angle board + 2 inch wedge and place the IR on top. (make sure thickest portion is closest to the patient)

Film size and CR for AC joints?

10 x 12 CW CR directed to AC joint *need arrow pointing down to indicate weights *preferred 72 inch SID

What degree of CR angulation should be used if patient cannot elevate the unaffected arm for a transthoracic lateral humerus?

10-15 degree cephalic angle

CR & film size for AP humerus exam

14 x 17 LW film in the table CR at mid-humerus to include shoulder & elbow joint

CR and film size for lateral humerus:

14 x 17 LW film in the table CR at mid-humerus to include shoulder & elbow joint

If a PA axial clavicle is performed (non-Mayo routine), then a __________ angle is needed

15 degree CAUDAL

For an AP scapula view, how much should the patient be obliqued from an AP supine position?

15-35 degrees away from the affected side

What joint spaces will be used to check for rotation on a PA hand?

2,3,4,5 MCP joints

How many bones in the hand?

27

CR for lateromedial or fan lateral projection of the hand?

2nd MCP joint

The heads of which metacarpals will overlap for a PA oblique hand view?

3-5

How many images are taken total for an AC joint routine?

4; one AP on each side, then AP weight-bearing

How many carpals in the wrist?

8

CR & film size for oblique images of the elbow:

8 x 10 LW film CR at elbow joint, no angulation

For the Coyle method, a ____________ degree flexion is used as well as a 45 degree ___________ angle to demonstrate the coronoid process

80 degree; caudal

For the Coyle method, a __________ degree flexion is used as well as a 45 degree ___________ angle to demonstrate the radial head

90 degree; cephalic

What are the routine and trauma views for the clavicle?

AP & AP Axial

A 40/60 humerus takes the place of what two views?

AP Grashey and Scap Y

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

AP elbow with partial flexion

What two shoulder projections are 90 degrees apart?

AP grashey and scap Y (or Neer)

What are the views for a trauma shoulder?

AP neutral, AP Oblique neutral, axillary, neer view

What are the views for a routine shoulder?

AP oblique internal, external optional: axillary & neer view

Describe a total elbow series:

AP/lateral/flexion lateral/extension lateral All done on 14 x 17 film

What should be done if the patient cannot fully flex their wrist for a carpal tunnel view?

Align the CR to match the angle of the metacarpals, then add 15 degrees cephalic angle

Where is the neck on the scapula?

Area where the bone gets thinner, going more medially

Describe patient position for AP forearm

Arm extended on table with shoulder/elbow/wrist all in the same plane, hand supinated.

Describe patient position for a PA wrist

Arm resting on table, fingers flexed slightly (mostly resting)

Describe patient position for an AP wrist exam:

Arm resting on table, hand supinated with digits elevated using a small angle block in order to place the carpals close to the IP

CR & film size for AP Oblique or AP shoulder

CR - 1 inch below corocoid process film size - 10 x 12 CW

CR & film size for PA and PA oblique hand views?

CR - at 3rd MCP joint film size - 8 x 10 OR 10 x 12 (best judgment)

CR and film size for AP elbow with partial flexion

CR - at elbow joint 14 x 17 CW film

CR and film size for AP elbow

CR - at elbow joint 8 x 10 LW film

CR & film size for AP or lateral forearm

CR - mid-forearm 14 x 17 CW film

CR and film size for PA wrist

CR - on mid-carpals, distal to styloid process of the ulna 8 x 10 LW film

CR and film size for AP wrist

CR - perpendicular to carpals 8 x 10 LW film

CR & film size for PA external oblique wrist

CR - perpendicular to mid-carpals 8 x 10 LW film

CR and film size for PA internal oblique wrist:

CR - perpendicular to mid-carpals 8 x 10 LW film

CR and film size for lateral wrist:

CR - perpendicular to the carpals, making sure to be distal to the styloid processes 8 x 10 LW film

CR and film size for axillary shoulder projection

CR - through the axilla, directed to shoulder; angled 25-30 degrees medially from the long axis of the body Film size: 10 x 12 CW in slip-on grid (use longitudinal rotated 90 degrees)

CR for transthoracic lateral humerus:

CR at surgical neck *need shallow breathing!

CR and film size for Stryker Notch:

CR: 10 degrees cephalic, centered on shoulder joint/corocoid process film size: 10 x 12 LW

CR and film size for Westpoint view:

CR: 25 degrees inferior to horizontal & 25 degrees medially from parallel, on shoulder joint film size: 10 x 12 CW

CR and film size for Coyle method of the elbow:

CR: elbow joint film size: 10 x 12 CW

CR & film size for PA oblique scapula:

CR: mid-scapula film size: 10 x 12 CW

Third metacarpal articulates with what carpal bone?

Capitate

What is the largest of all wrist bones?

Capitate

Lateral condyle of the humerus is also known as the __________________

Capitulum

Describe the two compression views that can also be done with a motion study of the wrist:

Compression PA and lateral; done with hands in a fist

The wrist is what type of joint?

Condyloid

Which fossa is above the trochlea on the humerus?

Coronoid

Purpose of AP TMC joint exam?

Demonstrates unobstructed view of the TMC joint in the AP position; looking for Bennett's fracture, a fracture at the base of the first metacarpal

What does an AC joint exam demonstrate?

Dislocation, separation, and function of the AC joint

Westpoint view is also known as?

Inferosuperior axial

When doing a Scap Y or Neer view on an affected right shoulder, the patient will be _________ on the table and _____________ upright w/the bucky

LPO; RAO

What will less or more obliquity do to the appearance of the scapula on an AP scapula image?

Less obliquity = slight superimposition over the ribs but more lateral

Alternative name for Trapezoid?

Lesser multangular

Where is the CR centered for all thumb radiographs?

MCP joint

What bones form the palm of the hand?

Metacarpals

Colles' fracture

Most common fall fracture of the wrist, or FOOSH fracture (fall on outstretched hand). Occurs on the distal radius with posterior displacement

Alternative name for scaphoid?

Navicular

This carpal bone is important to treat even if fracture is not confirmed. Otherwise, bone may not receive proper blood supply.

Navicular

Describe the non-Grashey method for AP shoulder?

No obliquity; patient flat against the IR

AP oblique hand also known as _____________

Norgaard

What type of finger view is used to visualize joints?

Oblique

What two processes will be in profile for a lateral elbow?

Olecranon & coronoid processes

Location of the anatomical snuff box?

On posterior surface of the hand at the base of the thumb, most visible when thumb is abducted

Difference between Scap Y and Neer view?

Only difference is a 15 degree caudal angle w/Neer view

Alternative name for Capitate?

Os magnum

What views are included for a routine wrist exam?

PA and lateral

Combined routine hand/wrist order:

PA hand/wrist combined external oblique hand lateral wrist

What are the 3 views included for the finger routine?

PA, 45 degree oblique, lateral

What views are included for a trauma wrist exam (5 views total?)

PA, lateral, both obliques, navicular

What are the views for a routine hand?

PA, oblique, fan lateral

For a Scap Y image, the patient is rotated too __________ if the scapula is not superimposing the humerus and the body of the scapula is not lateral

PA/AP

For any finger view, where is the CR centered for digits 2-5?

PIP joint

Describe patient position for a PA internal oblique wrist view:

Patient arm on table, hand/wrist internally rotated 45 degrees

Describe patient position for the Grashey method?

Patient either upright against the bucky or supine on table; shoulder obliqued 45 degrees, with affected side closest to the IR

Describe positioning for lateral distal only humerus (lateromedial):

Patient lying on the table, holding the IR against their side. Elbow is flexed and flat against the IR, hand pointing up

Describe positioning for transthoracic lateral projection of the humerus:

Patient obliqued against the IR; unaffected arm raised over the head; beam will shoot through the thorax and visualize the affected arm nearest the IR

Patient positioning for Stryker Notch:

Patient prone on table, affected elbow pointing straight up, slightly past perpendicular to the table

Describe patient positioning for the Westpoint view:

Patient prone on table, with 3 inch block under the affected arm to get the humerus level with the table. IR is parallel to the shaft of the humerus above the shoulder

Describe patient position for a lateral forearm exam

Patient sitting with arm on table, elbow flexed 90 degrees. Shoulder, elbow, and wrist all in the same plane. Elbow and wrist are lateral

Describe patient positioning for a lateral elbow exam:

Patient sitting with arm on table; shoulder, elbow, and wrist all in the same plane. Elbow flexed 90 degrees. Elbow joint lateral and hand PRONATED (at Mayo)

Describe patient position for the axillary shoulder:

Patient supine on table, arm abducted 90 degrees to stick straight out; arm externally rotated to get epicondyles parallel with the table. Turn patient's head away from the affected shoulder

Describe patient positioning for a lateral humerus exam:

Patient supine on table, rolled 15 degrees; pronate the hand and medially rotate to bring the epicondyles of the humerus perpendicular to the film

Patient position for AP scapula:

Patient supine on the table, humerus abducted 90 degrees and hand/elbow touching the table above the head

Positioning for axial clavicle:

Patient upright against the bucky; arms resting at side, no rotation

What carpals are very anterior on the medial side?

Pisiform & hamate

What two bones are NOT part of the wrist joint proper?

Pisiform & ulna

Describe positioning for a lateral view of the thumb

Start with the hand pronated and rotate internally until thumb is in true lateral position

Phrase to remember the order of carpal bones?

Steve left the party to take Carol home

Describe positioning for an oblique view of the thumb

Thumb will be in an oblique position when hand is rested in PA; just abduct the unaffected fingers.

Where should the CR be aligned on the slip-on grid?

To the white line

What is the purpose of the Grashey method?

To visualize an open glenohumeral joint

Boxer fracture

Transverse fracture at the head of the fifth metacarpal. Result of a fist hitting a hard surface

First metacarpal articulates with what carpal bone?

Trapezium

What carpals are very anterior on the lateral side?

Trapezium & scaphoid

What carpal bones from the distal row superimpose on one another on a PA wrist?

Trapezium and trapezoid

Name bones in distal row of carpals, lateral to medial:

Trapezium, Trapezoid, Capitate, Hamate

Second metacarpal articulates with what carpal bone?

Trapezoid

What is alternative to the axillary view if the patient absolutely cannot abduct their arm?

Trauma Velpeau

Alternative name(s) for triquetrum?

Triquetral, Cuneiform, Triangular

Medial condyle of the humerus is also known as the ____________

Trochlea

Another name for pivot joint?

Trochoid

T/F: AC joint exams are always bilateral

True

T/F: All upper extremity joints are synovial

True

T/F: At Mayo, Scap Y's are performed but are called Neer views

True

T/F: Carpals do not articulate directly with the ulna

True

T/F: For any finger view, the CR needs to be centered to anatomy AND the middle of the image receptor

True

T/F: In a true AP elbow, there will be slight superimposition of the proximal radius and ulna

True

T/F: Scapular Y and Neer view are two different projections

True

T/F: The anatomical neck of the humerus is superior to the surgical neck

True

T/F: The first and second digits should NOT touch for a fan lateral view of the hand

True

T/F: We do not rotate the arm for trauma views

True

T/F: for an AP oblique internal rotation of the elbow, the radial head/neck/tuberosity will superimpose the ulna

True

T/F: for the AP external oblique of the elbow, the radial head will be free from superimposition

True

T/F: if anatomy is not centered in the middle of the IR for a hand view, it may not be repeated

True

T/F: in a true AP forearm, there will be slight overlap of the proximal radius and forearm

True

T/F: only trauma views will utilize a neutral arm position

True

T/F: the Stecher method of the PA wrist-ulnar deviation view is preferred at Mayo

True

T/F: the long axis of the hand should be parallel with the edge of the IR for hand exams

True

T/F: the patient always needs to be upright for an AC joint exam

True

T/F: there will be slight overlap of the proximal radius and ulna for an AP elbow

True

T/F: you should NEVER use a foam block to push on the affected finger

True

T/F: on the AP forearm, the proximal radius will be free from superimposition

True (by the book) False (in real life)

T/F: A clavicle may be done upright or supine

True; check RIMS sheet for indication

T/F: Both the styloid processes of the radius and ulna are on the same end

True; distal

T/F: Scap Y is a shoulder projection

True; do not need to see inferior angle of the scapula on the image

Alternative name for Hamate?

Unciform

Positioning for AP unilateral clavicle:

Upright against the bucky, no rotation, arms resting at side.

Describe patient position for a Scap Y or Neer view

Upright w/the bucky, obliqued 45-60 degrees with affected side nearest the bucky

What is special about Morrey views of the elbow?

Use a 14 x 17 film; no other change (regular AP and lateral elbow) - used to visualize elbow replacement or other hardware

What should be used as an alternative positioning method for a PA Oblique finger view if motion is occurring?

Use a 2 inch block under the 17-degree angle board to position the IR at an angle, then place the hand in a PA position

What should be done for PA internal/external oblique wrists if the patient is shaky?

Use an angle board & 2 inch block to create the 45 degree angle

the shoulder girdle consists of the _________ and ___________

clavicle and scapula

When performing a Neer view, the affected side will be placed __________ the IR if done upright; for table, the affected side is placed ___________ the IR

closest to; further from

Carpal sulcus

concavity within the carpal bones

Saddle joint

consists of one concave and one convex surface; allows flexion/extension, ab/adduction, circumduction

Which process is demonstrated well on an internal oblique elbow?

coronoid

which fossa of the humerus articulates with the ulna?

coronoid fossa

What process of the ulna will be seen in profile for an AP oblique internal rotation of the elbow?

coronoid process

The anterior surface of the scapula is also called the __________ surface. The posterior surface is also called the ____________

costal; dorsal

Purpose of doing a motion series of the wrist?

demonstrates the stability of total wrist arthroplasties, ligament damage, carpal boss

What does the lateral hand view best demonstrate?

displacement of metacarpals anteriorly & posteriorly

The styloid process of the radius is on the (distal/proximal) end

distal

The ulnar head is (proximal/distal)

distal

What are the structures that must be demonstrated for all hand views?

distal phalanges through 1 inch of distal forearm

What structures need to be included for all thumb views?

distal phalanx through the CMC joint

What structures should be included for any finger view, digits 2-5?

distal phalanx through the MCP joint

What anatomy needs to be demonstrated for all wrist exams?

distal radius/ulna through carpals

For an AP humerus, there needs to be slight ________ rotation to ensure the epicondyles are parallel with the film

external

If the lesser tubercle is too lateral on an AP humerus image, then there is _________ rotation occurring

external

If there is not enough superimposition the radius and ulna in an AP elbow, there is _________ rotation

external

The navicular and what view are ALWAYS done together at Mayo?

external oblique

Which way should digits 3-5 be rotated for a PA oblique view?

externally (45 degrees)

Which way should you rotate the 4th or 5th digits for a lateral view?

externally (lateromedial) *make sure fingers are parallel to the film

Flexor retinaculum

fibrous band that connects to the scaphoid and trapezium on the lateral side and the hamate and pisiform on the medial side

Film size and CR for unilateral clavicle:

film size: 10 x 12 CW CR directed mid-clavicle * suspend on expiration

Film size and CR for landscape clavicle:

film size: 14 x 17 CW CR directed to MSP * suspend on expiration

In an AP elbow with partial flexion (humerus parallel), which portion of the arm will be foreshortened?

forearm

Obliquing the affected side toward the IR for a clavicle view will result in ____________

foreshortening

Galeazzi fracture

fracture of the radius shaft that causes posterior dislocation of the ulna at the wrist (Galeazzi fracture = radius fracture)

Bankart legion

fracture that occurs on the glenoid labrum (anteroinferior rim of the glenoid)

Hilsach legion

fracture that occurs on the posteriolateral aspect of the humoral head

Another name for hinge joint?

ginglymus

Joint type: humeroradial

hinge

Joint type: humeroulnar

hinge

Joint type: interphalangeal

hinge

Using a 15-30 degree cephalic angle for an axial clavicle exam will make the clavicle appear more ___________

horizontal

In an internal oblique elbow radiograph, there will be __________ (increased/decreased) superimposition of the radius and ulna

increased

The deltoid tuberosity sits where in relation to the surgical neck of the humerus?

inferior

The _________ rim of the glenoid cavity is more LATERAL than the _________ rim

inferior; superior

The anterior aspect of the arm is the same side as the (inner/outer) elbow

inner

If there is too much superimposition of the proximal radius and ulna in an AP elbow, there is _________ rotation occurring

internal

Which way should the 2nd digit be rotated for a PA oblique view?

internally (45 degrees)

Which way should you rotate the 2nd digit for a lateral view?

internally (mediolateral)

Describe patient position for a lateromedial projection of the hand

karate-chop position with thumb abducted; ulnar side of the forearm touching the IR

subacromial bursae

largest in shoulder; under the acromion process between the shoulder joint

For a Scap Y image, the patient is rotated too _________ if ribs are superimposing the arm and scapula; coronoid process may also be superimposing the ribs

lateral

Is the thumb more medial or lateral?

lateral

Structures on what side are best demonstrated with a PA external oblique wrist?

lateral

The AP clavicle best demonstrates the ___________ half of the clavicle

lateral

The great tubercle will be __________ on a properly positioned AP humerus

lateral

The greater tubercle of the humerus is more (lateral/medial) to the lesser tubercle

lateral

If the glenoid is lateral to the base of the corocoid fossa, the CR angle is too _________

lateral (angle too small)

This kind of image helps the radiologist identify fat pads, which can help indicate if there is a fracture

lateral elbow image

Which of the following projections of the humerus demonstrates the lesser tubercle in profile medially?

lateral humerus

Lesser tubercle will be more ___________ on an axillary shoulder

lateral/superior

Capitulum is on the ___________ side of the arm when in anatomic position

lateral; cap on the head of the radius, which follows the thumb

If the arm is abducted less than 90 degrees for an axillary shoulder view, use __________ angle on the tube

less

When performing an axillary clavicle on a hypersthenic patient, _________ angle is needed

less (15 degrees)

External rotation in a axillary shoulder projection will demonstrate the _________ tubercle anteriorly

lesser

A properly positioned lateral humerus will demonstrate what tubercle in profile?

lesser tubercle (in profile medially)

For internal rotation of the arm, what tubercle will be in profile medially?

lesser; greater tubercle will be superimposed on the femoral head

The axial clavicle best demonstrates the __________ side of the clavicle

medial

If the heads of the metacarpals are superimposing on the carpals in a carpal tunnel radiograph, what error is occurring?

palm is not perpendicular with the IR

If the metacarpal heads are too far down (too inferior on the radiograph) for a carpal tunnel exam, or the hook of the hamulus is too , what error is occurring?

palm pulled too far back (past perpendicular)

In a truly AP forearm, the humeral epicondyles will be __________ to the film

parallel

Joint spaces will only be open if they are _____________ with the IR and perpendicular to the CR

parallel

When there is external rotation of the humerus, the epicondyles are _______________ to the IR

parallel

Carpal tunnel

passage between the sulcus and the flexor retinaculum

Describe patient positioning for a PA external oblique wrist:

patient arm on table, rotate wrist/hand 45 degrees. Ensure wrist is not flexed

Describe patient positioning for a PA wrist-ulnar deviation:

patient in PA wrist position, but with fingers pointed toward the ulna

Patient positioning for the lateral scapula view:

patient obliqued 45-60 degrees toward the affected side against the upright bucky, with elbow flexed 90 degrees and hand behind the back

Describe patient positioning for AP humerus exam:

patient supine in table with arm in anatomical position; roll patient 15 degrees to affected side to get shoulder close to the table. Abduct the arm.

Describe positioning for a trauma Velpeau view:

patient supine on table with arm in neutral sling position. film in a grid similar to axillary view, w/ patient's elbow anterior to the shoulder. CR through axilla.

Gliding joint

permits least amount of movement; is a sliding movement between two surfaces

When there is internal rotation of the humerus, the epicondyles are ____________ to the IR

perpendicular

What carpals does the PA internal oblique wrist best demonstrate?

pisiform (free from superimposition) hamate

What bones will be superimposed on a PA wrist?

pisiform and triquetrum

What carpal bones from the proximal row superimpose on one another on a PA wrist?

pisiform and triquetrum

Distal radioulnar joint is what type of joint?

pivot

Joint type: radioulnar (proximal or distal)

pivot

From a lateral position, if the wrist is externally rotated then the radius will be _____________ in relation to the ulna

posterior

If the wrist is externally rotated from a lateral position, the scaphoid will be __________ in relation to the pisiform

posterior

For a lateral hand view, there will be EXTERNAL rotation if the radius is ___________ to the ulna and the 5th metacarpal moves ___________

posterior; anterior

On the scapula, the acromion process is __________ and the corocoid process is ___________

posterior; anterior

With the hand/wrist pronated for a lateral elbow exam, the radial tuberosity will be easily identified ______________(anteriorly/posteriorly)

posteriorly

The head of the radius is on the _________ end

proximal

The radial head is (proximal/distal)

proximal

What does the transthoracic lateral projection of the humerus demonstrate?

proximal half of the humerus

The radius crosses the ulna over what area of the forearm during pronation?

proximal third

The trochlear notch is the large, semilunar notch on the _________

proximal ulna

The radius is wide __________

proximally

Which fossa of the humerus articulates with the radius?

radial fossa

The ulnar notch is located on the distal end of the ___________

radius

Which forearm bone is on the lateral side?

radius

What kind of dislocation is the most common of the entire body?

shoulder

What effect does flexing the fingers slightly for a PA wrist or elevating the fingers slightly for an AP wrist have on the image?

reduces OID on wrist and makes joint spaces appear more open

What is the advantage of the Stecher method?

reduces foreshortening of the scaphoid

Describe the benefit of doing an alternative Lordotic position for an axial clavicle?

results in less distortion because less tube angle is needed (0-15 degrees) to free the clavicle from the ribs

For a ___________ (left, right) shoulder exam, the patient will be RPO

right

Joint type: carpometacarpal (1st digit)

saddle

Most commonly fractured carpal bone?

scaphoid; can be difficult to visualize

The glenoid cavity is on the lateral end of the ___________

scapula

The shoulder girdle consists of the __________ and _________

scapula and clavicle

The female clavicle is _________ and ________ curved than the male clavicle

shorter; less

If the radial head is too ANTERIOR on a lateral elbow, then the __________ joint is too low

shoulder

Bursae

small sacs of synovial fluid which reduce friction and relieve pressure between tissues

Another name for ball & socket joint?

spheroid

What shoulder joint is the only joint between the trunk of the body and upper extremity?

sternoclavicular joint

The lesser tubercle attaches to what muscle?

subscapularis

The scapular notch is on the ________ border of the scapula

superior

Will the hand be supinated or pronated for an AP elbow?

supinated

The greater tubercle attaches to what muscles?

supraspinous, infraspinous, teres minor

on the posterior surface of the scapula, the __________ fossa is superior and the ___________ fossa is inferior, separated by spine

supraspinous; infraspinous

All the shoulder joint articulations are _________ and __________

synovial and diarthrodial

What is the Pearson method for AC joints?

taking images with and without weights

In a properly positioned axillary shoulder, the glenoid fossa shoulder project where?

the base of the corocoid process

The humeroradial joint consists of the articulation of what two structures? On what side?

the capitulum and the head of the radius lateral side

What is the anatomical snuff box used to locate?

the scaphoid

What does the caudal angle utilized on the Neer view help demonstrate?

the supraspinatus outlet region (area between humoral head and acromion)

The humeroulnar joint consists of the articulation of what two structures? On what side?

the trochlea and the trochlear notch medial side

Which two carpals are superimposed on the PA view of the wrist?

trapezium and trapezoid

Which carpals are best seen on a PA external oblique wrist?

trapezium, trapezoid, scaphoid

What joint space will be open for a properly positioned PA external oblique wrist?

trapezium/trapezoid

The articular disk of the ulna articulates with what carpal bone?

triquetrum

Hinge joint

two surfaces shaped to be "molded" to each other; permits flexion/extension movement

The coronoid process is located on the proximal _________ and is anterior (points straight out)

ulna

The radial notch is on the proximal end of what bone?

ulna

Which forearm bone is on the medial side?

ulna

The styloid process is located on the distal _________ and on the _________ side

ulna; medial (near pinky)

The olecranon process is on the posterior proximal __________ and forms what?

ulna; the elbow

If a patient has a sling, should an AP Oblique shoulder be performed upright or supine on the table?

upright

Purpose of the AP Oblique Hand (ball-catcher's method)?

visualizes fractures at the base of the fifth metacarpal; see early rheumatoid arthritis

The distal radius is ________ (wider/narrower) than the distal ulna

wider

If the radial head is too DISTAL on a lateral elbow, then the ____________ joint is too low

wrist

List anatomy that needs to be included on an AP and lateral forearm

wrist joint, radius, ulna, elbow joint