Spring 2020 Procedures Upper Extremity WRIST

the Gaynor Hart method (original) requires a CR direction of ______ degrees

25 inferosuperior

the proper SID for a magnification wrist series should be ________

40"

when the arm is in flexion the _______ fits into the ______ on the _______ surface

coronoid process coronoid fossa anterior

radial deviation aka ____ aka ulnar ____

flexion extension

ulnar deviation aka ulnar ______ aka radial ____

flexion extension

list distal carpal bones (both names)

greater multangular (trapezium) lesser multangular (trapezoid) capitate (osmagnum) hamate (unciform)

The ______ is considered a medial carpal bone

hamate

what are the 3 carpals that have processes?

hamate scaphoid trapezium

which carpal bone contains a "hook"?

hamate (unciform)

gaynor hart VARIATION: CR is angled toward the ______ approx ___-____ degrees from the LONG AXIS of the FOREARM

hand 20-35

_____ rotation oblique better demonstrates lateral carpal bones

lateral

_____ wrist shows distal radius and ulna w/ superimposition

lateral

the _______ will demonstrate the thumb in the oblique position

PA hand

how many degrees should the arm be flexed for the lateral forearm exam?

90

original gaynor heart method is: a. inferosuperior b. superoinferior

A (anterior surface of the wrist)

what projection/ position shows LATERAL carpal bones best (esp trapezium and scaphoid)

PA oblique lateral rotation

the AP oblique medial rotation of the wrist is the same as the _______ position

PA oblique with ulna up

____ position corrects foreshortening of scaphoid/ navicular

PA ulnar deviation

____ rotation oblique better demonstrates medial carpal bones

medial

variation gaynor heart method is: a. inferosuperior b. superinferior

B

the depression on the lateral side of the wrist, just in front of the radial styloid is termed the _____

snuff box

T/F flex the elbow 90 degrees to rotate the ulna into the lateral position

true

T/F must have at least 90 degree difference in images for upper extremity

true

T/F use the Lateral view to look for anterior/ posterior displacement

true

navicular view is ALWAYS done with _____ deviation

ulnar

which surface of the wrist is placed on the IR for a lateral wrist?

ulnar (pinky)

all navicular positions require the ______ of the wrist

ulnar deviation

______ ______ is the distal radio-ulnar joint space/ shape which recognizes different types of slopes of the distal radius and post trauma alterations of the radius and ulna

ulnar variance

the "ulnar variance" study must be performed _______

with the elbow flexed 90 degrees and in the same plane as the wrist and shoulder

PA lateral ulnar deviation of scaphoid shows slight _____ of scaphoid

elevation

lateral aka

external (rotation)

T/F a voucher will say whether it is a trauma

false

you know it is a MEDIAL oblique if you see the ___ sticking out by itself

pisiform

the PA oblique medial rotation will demonstrate what carpal bone without any superimposition and what is the degree of rotation?

pisiform 45

the PA oblique wrist with medial rotation (ulna rotated up) will demonstrate ______

pisiform without superimposition

what are the typical positions performed for a magnification or 6 view study of wrist?

1) neutral PA 2) neutral lateral 3) PA w/ ulnar deviation 4) PA w/ radial deviation 5) lateral w/ flexion 6) lateral w/ extension

where is the CR directed for carpal bridge and what is the angulation?

1.5 " proximal to wrist jt 45

Gaynor hart (carpal canal): when the wrist cannot be extended to within ____ degrees of VERTICAL it is suggested that the CR be aligned PARALLEL to the PALMAR surface and then angled an additional ___ degrees toward the PALM

15

the stetcher method variation requires a CR angulation toward the elbow of _____ degrees

20

stetcher method- the ___ degree angulation of the wrist will place the _____ at right angles to the IR therefore the _____ will be projected without _____

20 Scaphoid (navicular) Scaphoid self superimposition

CARPE BOSSA: small bony growth on the dorsal surface of the ___ CMCJ. Best shown in _____ position with ____

3rd lateral flexion

the radiograph for a carpal bridge requires an angle of _____ degrees ________

45 superoinferior

scaphoid fractures account for ____% of all carpal injuries

60

the ______ position of the wrist will best demonstrate all carpal interspaces

AP

The _____ projection demonstrates the carpal interspaces than does ____ projection due to oblique direction off they interspaces, they are more closely parallel with the divergence off the X-ray beam

AP PA

STETCHER VARIATION: if 20 degree angle sponge in unavailable the use of _____ angle is acceptable but not preferred

CR

What projection is the lateral wrist

Lateromedial

What is the routine protocol for wrist (on voucher)

PA Lateral PA oblique (lat rotation) PA oblique (med rotation or AP med rot obl)

Where do you center the CR for PA wrist

Perpendicular to the midcarpal area (don't make first)

Why do you slightly arch/cup the hands at the MCPJs by flexing the digits

Places wrist in close contact with the IR (closes the gap)

What 3 joints have to be in the same plane to permit right angle rotation of the ulna and radius in the lateral position

Shoulder Elbow Wrist

the carpal canal will demonstrate which surface of the carpal bones the best?

anterior

which carpal bone is the largest of all carpal bones?

capitate

PA medial ulnar deviation of scaphoid shows slight _____ of scaphoid

depression

the lateral wrist position will demonstrate what anatomic structures superimposed on each other?

distal radius and ulna

name 2 specific structures that should be superimposed for the lateral forearm?

distal radius and ulna (radial head over coronoid process)

very important to use ULNAR DEVIATION for all views of the SCAPHOID bc it will demonstrated the navicular without ______

foreshortening

medial aka

internal (rotation)

what shows superimposed distal radius and ulna and superimposition of the metacarpals

lateral wrist

rotate wrist 45 degrees ___/ _____ for PA oblique wrist

laterally externally

the typical routine lateral wrist is the ______ projection

lateromedial

name any specific bony structure within the elbow joint

medial epicondyle

lest all proximal carpal bones (both names)

navicular (scaphoid) lunate (semilunar) triquetrum (triangular) pisiform (ospisiform)

stetcher method is done to view the ______

navicular (schaphoid)

what anatomy must be included when performing a routine forearm (from what to what)?

olecranon of ulna to radial styloid

Gaynor hart (carpal canal) method: where is the CR directed? what is the CR angle? what is it angled to?

palm of hand at about 1" distal to base of metacarpal 25-30 long axis of hand

for oblique wrist rest _____ surface on the IR and place ______ in the center of IR after rotation

palmar scaphoid

when the wrist is placed in a PA or AP position, an imaginary line drawn through the styloid processes should be what to the IR

parallel

when the wrist is placed in a lateral position, an imaginary line drawn through the styloid processes should be what to the IR

perpendicular

where is the CR directed for PA oblique wrist?

perpendicular to midcarpal area (just distal to the radius)

for both the AP and lateral forearm, where should the CR be directed?

perpendicular to the midpoint of forearm

where is the CR directed for lateral wrist

perpendicular to wrist joint

the carpal bridge will demonstrate which surface of the carpal bones best?

posterior

the CR should enter ______ for a PA projection of the wrist

posterior wrist at midcarpal region

3 ways to perform trauma wrist 1) _____ when they can't turn wrist on medial surface 2) _______ for oblique medial and lateral (will cause some distortion) 3) AP instead of ____

shoot through lateral CR angulation 45 (degrees) PA

when performing the Gaynor-Hart method (alternative) for carpal canal, the projection is

superioinferior

the true stetcher method will incorporate _______________

the pts wrist placed on the IR which is on a 20 degree angle sponge

what carpal articulates with the first metacarpal

trapezium (greater multangular)

name 2 articulating structures of the navicular

trapezium and radial styloid

______: A serious injury or shock to the body; modifications may include variations in positioning, minimal movement of the body part, etc.

trauma

how does the stetcher method demonstrate the navicular?

w/o self superimposition