Bontrager Chapter 4 Upper Limb

The second to fifth metacarpophalangeal joints are

Ellipsoidal (condyloid type) joints that allow movement in four directions-flexion, extension, abduction, and adduction

A radiograph of an AP projection of the elbow reveals that there is complete separation of the proximal radius and ulna. What positioning error has been committed?

Excessive lateral rotation

A radiograph of an AP oblique elbow with medial rotation reveals that the radial head is superimposed over part of the coronoid process. What positioning error has been committed?

Excessive medial rotation

A radiograph of a PA oblique of the hand reveals that the midaspect of the fourth and fifth metacarpals is superimposed. What specific positioning error has been committed?

Excessive rotation of the hand and/or wrist

radial collateral ligament

Extends from the styloid process of the radius primarily to the lateral side of the scaphoid., but also has attachments to the trapezium

Fat pads are _______ but located within the _______.

Extrasynovial(outside of the synovial sac), but located within the joint capsule

Rheumatoid arthritis is three times more common in men than women. T or F

False

The Folio method is performed to rule out a nondisplaced fracture of the thumb. T or F

False

Each of the four fingers has ___ bones. How are they labeled? How many bones does the thumb have? How are they labeled?

Fingers have three bones labeled proximal, middle, and distal. The thumb only has two labeled proximal and distal.

The Trapezium is the ____ carpal in the _____ row. What shape is it?

First carpal in the distal row. It is four sided and irregularly shaped.

The joint between the first metacarpal and the proxiamal phalanx of the thumb is called what?

First metacarpophalangeal (MCP) joint

A patient comes to radiology with a possible tear of the ulnar collateral ligament of the wrist. The patient complains of discomfort near the thumb region. Basic thumb projections do not demonstrate any type of fracture or dislocation. Which one of the following projections can be performed to confirm an injury to the ulnar collateral ligament?

Folio method

An ellipsoidal joint allows movement in ____ directions.

Four

A patient with a history of carpal tunnel syndrome comes to radiology. The physician wants to rule out abnormal calcifications in the carpal sulcus. Which of the following projections would best demonstrate this region?

Gaynor-Hart method

*All* IP joints are

Ginglymus (hinge type) with movement in two directions only- flexion and extension

The elbow joint

Ginglymus (hinge) joint that is synovial, which means freely movable(diarthrodial).

The forth and fifth MC join with which bone?

Hamate

Which carpal articulates with both the fourth and fifth metacarpals?

Hamate

The last or fourth carpal in the distal row on the medial aspect is the? How is it distinguished?

Hamate. It is easily distinguished by the hook-like process called the hamulus, or hamular process, which projects from the palmar surface.

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

Hamulus, or hamular process

The bones of the upper limb can be divided into what four main groups?

Hand and wrist, forearm, arm, shoulder girdle

Which of the following bony structures is found on the distal aspect of the ulna? a. Coronoid process b. Head c. Olecranon process d. All of the above

Head

A ginglymus joint can also be referred to as a _____ joint.

Hinge

The forearm generally should not be radiographed in what position?

In a pronated position(PA projection), which appears to be the most natural position

How should the original kV range be changed with a fiberglass cast applied for a wrist or forearm radiographic procedure?

Increase 3 to 4 kV

An upper limb cast requires ______ exposure.

Increased. The increase depends on thickness and type of cast.

A radiograph of the PA scaphoid projection reveals extensive superimposition of the scaphoid and adjacent carpals. Which of the following factors can lead to this problem?

Insufficient ulnar deviation

What is the name of the joint found between the proximal and distal phalanges of the first digit?

Interphalangeal

The thumb only has two phalanges, so the joint in between these two is called what?

Interphalangeal (IP) joint

ulnar collateral ligament

Is attached to the styloid process of the ulna and fans out to attach to the triquetrum and the pisiform

The first MCP (metacarpophalangeal) joint

Is generally classified as an ellipsoidal joint(condyloid) although it has limited abduction and adduction movements because of its wider less rounded head.

What is the proper name for the acute flexion elbow projection?

Jones method

The thumb is considered to be on the ________ side when in anatomic position?

Lateral

Which basic projection of the elbow best demonstrates the trochlear notch in profile?

Lateral

Which routine projection of the elbow best demonstrates the olecranon process in profile?

Lateral

ulnar deviation of wrist

Lateral movement of the wrist toward the ulna (little finger)

The three significant fat pads or stripes of the elbow are visualized only through what projection?

Lateral projection

A radiograph of the elbow demonstrates the radius directly superimposed over the ulna and the coronoid process in profile. Which projection of the elbow has been performed?

Medial rotation oblique

The bones that make up the palm of each hand are the _________

Metacarpals

A patient enters the ED with a possible scaphoid fracture. The patient is unable to assume the ulnar deviation position. Which of the following positions should be performed to confirm the diagnosis?

Modified Stecher

Which one of the following is the most common primary malignant bone tumor?

Multiple myeloma

The tapered constricted area just under the head of the radius is called the?

Neck

A lateral elbow radiograph demonstrates about half of the radial head superimposed by the coronoid process of the ulna. Which of the following occurred?

No positioning errors occurred.

Visualization of the posterior fat pad of the elbow is normally what?

Not visible on a negative elbow examination.

What are the two beak-like processes on the proximal ulna called?

Olecranon and the coronoid processes

Which of the following structures is considered to be most posterior? a. Trochlea b. Coronoid process c. Radial tuberosity d. Olecranon process

Olecranon process

Which of the following structures is considered to be most proximal?

Olecranon process

Where is the central ray (CR) placed for a PA projection of the third digit?

At the proximal interphalangeal joint

Where is the CR centered for a PA projection of the hand?

At the third metacarpophalangeal joint

Which of the following structures is considered to be most proximal? a. Head of ulna b. Radial tuberosity c. Olecranon process d. Coronoid process

Olecranon process

Where is the radial styloid process palpated?

On the thumb side of the wrist joint

Radial deviation is used for what les frequent wrist projection?

PA

A patient arrives in radiology with a metal foreign body in the palm of the hand. Which of the following hand routines should be performed on this patient to confirm the location of the foreign body?

PA and lateral in extension projections

The proximal and distal radioulnar joints allow what?

Rotation of the forearm during pronation

Describe the fourth carpal on the proximal row.

The pisiform is pea shaped and the smallest of the carpal bones. It is located anterior to the triquetrum, and is most evident in the carpal canal or tangential projection.

With the radial head projections, what is the only difference between the four projections?

The position of the hand and/or wrist

Olecranon can be palpated where?

The posterior aspect of the elbow joint

The head of the radius is located where, and near what?

The proximal end of the radius near the elbow.

On an AP radiograph of the elbow with no rotation what happens?

The proximal radius is superimposed slightly by the ulna.

The wrist joint is called what?

The radiocarpal joint

Which bone of the forearm is directly involved with the wrist joint?

The radius.

The trapezium is located medial and distal to what bone?

The scaphoid

The capitate is the ____ carpal in the ___ row. Describe its shape.

The third carpal on the distal row. It is the largest carpal. Capitate means large bone. It is identified by its rounded head that fits proximally into a concavity formed by the scaphoid and lunate bones.

What is a good memory trick to remember what T carpal bones are locatated on the thumb side?

The trapezium and trapezoid trap the thumb

What is the medial condyle?

The trochlea

Which part of the humeral condyle articulates with the ulna?

The trochlea

The articulate portion of the humeral condyle is divided into what two parts?

The trochlea(medial condyle) and the capitulum(lateral condyle)

Which forearm bone is primarily involved with the formation of the elbow joint?

The ulna

Which bone of the forearm is more stationary?

The ulna. Remember the radius rotates around.

A patient enters the ED with a possible Bennett's fracture. Which of the following routines should be performed to confirm this diagnosis?

Thumb

The digits are numbered starting with the thumb as ___ and ending with the little finger as ____.

Thumb as one

The Folio method requires a bilateral projection of the thumbs be taken with one single exposure. T or F

True

The radiographic criteria for a true lateral finger indicate equal concavity of the anterior and posterior aspects of the phalanges. T or F

True

Which routine projection of the elbow will best demonstrate an elevated or visible posterior fat pad?

True lateral with 90° flexion

Which wrist ligament is attached to the styloid process of the ulna and continues to the triquetrum and pisiform?

Ulnar collateral ligament

Which one of the following structures is NOT part of the ulna?

Ulnar notch

Which two structures form the distal radioulnar joint?

Ulnar notch and head of ulna

Nuclear medicine bone scans

Useful for demonstrating osteoporosis myelitis, metastatic bone lesions, stress fractures, and cellulitis.

A patient enters the emergency department (ED) with a Smith fracture. Which region of the upper limb must be radiographed to demonstrate this injury?

Wrist and forearm

What does capitulum mean?

a little head

Which projection best demonstrates pathology involving the first carpometacarpal joint?

anteroposterior (AP) thumb, modified Robert's method

The joint found between the base of the third metacarpal and carpal bone is the:

carpometacarpal

The wrist joint

ellipsoidal (condyloid) - most freely moveable. Only the radius articulates with the wrist - at the scaphoid and lunate carpal bones.

The CR placement for an AP projection (modified Robert's method) of the thumb is at the:

first carpometacarpal joint.

The interphalangeal joints have a(n) ____ type of joint movement.

ginglymus

What does the capitulum articulate with?

head of radius

The expanded distal end of the humerus

humeral condyle

medial epicondyle of humerus

located on the distal end of the humerus superior to the trochlea

A nonvisible posterior fat pad on a well-exposed, correctly positioned lateral elbow radiograph generally suggests:

negative study for injury.

What is the deep posterior depression of the humerus?

olecranon fossa

The second most common type of primary cancerous bone tumor is:

osteogenic sarcoma.

Local or generalized infection of bone or bone marrow caused by bacteria introduced by trauma or surgery is a condition termed:

osteomyelitis

What does trochlea mean?

pulley

When radiographs are taken with the IR directly directly on the floating table top what should happen?

SID must be increased generally 3-4 inches compared to radiographs taken in the Bucky tray.

Which special projection of the wrist will open up the interspaces on the ulnar side of the wrist?

Radial deviation

What can visualization of the supinator fat stripe on the elbow indicate?

Radial head or neck fractures that are not obviously apparent

The small, shallow depression located on the lateral aspect of the proximal Ulna is the _______ __________.

Radial notch

The head of radius articulates with the ulna at the ______ forming what?

Radial notch forming the radioulnar joint

The rough oval crosses of the medial and anterior side of the radius, just distal to the neck is called the?

Radial tuberosity

To prevent superimposition of the radius and ulna what should be done?

Radiograph with a supinated hand in a AP projection

The first carpometalcarpal joint

Saddle(sellar) type joint. This joint allows great range of movement including flexion, extension, abduction, adduction, circumduction, opposition, and some degree of rotation.

What is the most commonly fractured carpal bone?

Scaphoid

Which carpal bone is 4?

Scaphoid

Which is the most commonly fractured carpal bone?

Scaphoid

Which of the following carpals articulates with the radius?

Scaphoid

What are the two important fat stripes within the wrist joint?

Scaphoid fat stripe, and the pronator fat stripe.

The correct term for the wrist is scaphoid or navicular?

Scaphoid, although sometimes it is called navicular like the tarsal in the foot.

The trapezoid is the _____ carpal on the ____ row. What shape is it?

Second carpal on the distal row. It is wedge shaped and the smallest carpal in the DISTAL row(Remeber pisiform is the smallest carpal).

The first carpometacarpal joint is classified as a____ joint.

Sellar

Lateral rotation of the elbow does what on an AP projectio?

Separates the radius and ulna.

Because the scaphoid is the most commonly fractured carpal bone a projection of ulnar deviation is known as what?

Special scaphoid projection

What is a carpal bone mnemonic?

Steve left the party to take carol home

For trauma patients radiographs of the upper limb can be taken directly on the ______

Stretcher

Which of the following structures is considered to be most distal? a. Capitulum b. Radial head c. Radial tuberosity d. Styloid process

Styloid process

Which of the following structures is considered to be most distal? a. Radial tuberosity b. Radial head c. Styloid process d. Capitulum

Styloid process

All joints of the upper limb are classified as ________ and are therefore ________.

Synovial and are freely movable(diarthrodial)

Carpal tunnel syndrome is more common in middle-aged women than in middle-aged men. T or F

T

The long part of the humerus is called what?

The body or shaft

The long midportion of both the radius and the ulna is called what?

The body(shaft)

What is the lateral condyle?

The capitulum

carpal sulcus

The carpal bones that make up the wrist form an arch which is convex on the dorsal side of the hand and concave on the palmar side.

What is the concave area of the carpal sulcus sometimes referred to?

The carpal tunnel or canal. This is where the major nerves and tendons pass.

The head of the ulna is located where, and near what?

The distal end of the ulna and near the wrist.

What are the three joints located in each of the four fingers?

The distal interphalangeal(DIP) joint, the proximal interphalangeal(PIP) joint, and the metacarpophalangeal(MCP) joint.

styloid process are located where in the forearm?

The extreme distal ends of both the radius and the ulna

What are the three concentric arcs that appear in a true lateral elbow?

The first and smallest is the trochlear sulcus, the second intermediate arc appears double lined as the outer ridges of the capitulum and trochlea, The trochlear notch of the ulna is the third arc.

The trapezium is proximal to what?

The first metacarpal.

A memory trick for capitulum

The head of the radius wears a capitulum

intercarpal joints

The intercarpal joints between the various carpals only have plane(gliding) movement.

The lunate is the second carpal on the ______ row. What shape is it? What does it articulate with?

The lunate is the second carpal on the proximal row. It is moon shaped and articulates with the radius. It is distinguished by its deep concavity on its distal surface, where it articulates with the capitate of the distal row of carpals.

Which of the two epicondyles is larger and more prominent?

The medial epicondyle

Coronoid process is located where?

The one located inferior to the Olecranon

Which bone is shorter, the radius or the ulna?

Radius

What happens during pronation?

Radius crosses over the ulna

A radiograph of a PA projection of the hand reveals that the distal radius and ulna and the carpals were cut off. What should the technologist do to correct this problem?

Repeat the PA projection to include all the carpals and about 1 inch (2.5 cm) of the distal radius and ulna.

The AP oblique bilateral hands projection ("ball-catcher's position") is performed to evaluate for early signs of:

rheumatoid arthritis.

lateral epicondyle of humerus

small projection located on the lateral side of the distal humerus

The smooth, depressed, center portion of the trochlea used for evaluating rotation on a lateral elbow is termed the trochlear:

sulcus

A radiograph of a tangential, inferosuperior projection of the carpal canal reveals that the hamate is superimposed over the pisiform. Which of the following measures will correct this problem?

Rotate the wrist and hand 10° internally.

What are the two shallow anterior depressions on the humerus?

Coronoid fossa and the radial fossa

The second through fifth carpometacarpal joints

Are plane(gliding) joints. These allow the least amount of movement of the synovial joints.

How are the metacarpals numbered?

1-5 starting with thumb, just like the fingers.

Grids are generally not required unless the anatomy measures greater than _____ cm in thickness.

10

How much CR angulation to the long axis of the hand is required for the tangential, inferosuperior projection to demonstrate the carpal sulcus (canal)?

25° to 30°

How many bones are located within the hand and wrist?

27

What is the distance between the tabletop and Bucky tray on most floating tabletop type of tables?

3-4in or 8-10cm

Upper limb SID

40-44 in(102-112cm)

How much rotation of the hands is required for the AP oblique bilateral (Norgaard method) hand projection?

45*

How much rotation of the humeral epicondyles is required for the AP medial oblique projection of the elbow?

45°

From a pronated position, which of the following is required for a PA oblique projection of the fourth digit of the hand?

45° lateral rotation

How many metacarpals are there?

5 in each hand

A patient with a fractured forearm had the fracture reduced and a fiberglass cast placed on the extremity. The orthopedic surgeon orders a postreduction study. The original kV was 60 kV. Which one of the following kV factors should be selected for the postreduction study?

63 kV

How many carpal bones are there?

8

For proper positive or negative diagnosis of the posterior fat pad of the elbow it must be flexed at ____

90*

Accurate lateral of the elbow

90* flexion

CR should be ____ or ______ to the part and IR.

90* or perpendicular unless an angle is indicated

Visualization of the posterior fat pad of the elbow on a 90* flexed lateral elbow radiograph indicates what?

A change within the joint has caused its position to change, suggesting the presence of a joint pathologic process.

Each phalanx has what three parts?

A proximal expanded base, intermediate shaft(body), and a distal rounded head.

Each metacarpal bone consists of three major regions. What are these?

A proximal expanded base, intermediate shaft(body), and a distal rounded head. Just like the digits.

Ulnar notch

A small depression on the medial aspect of the distal radius.

Which of the following projections of the wrist will best demonstrate the wrist joint and intercarpal spaces if the patient can assume this position?

AP

Which routine projection of the elbow best demonstrates the radial head and tuberosity free of superimposition?

AP oblique with lateral rotation

How should the forearm be radiographed?

AP with the hand supinated or palm up(anatomic position).

What are the three significant fat pads of the elbow?

Anterior fat pad, posterior fat pad, and supinator fat stripe.

The third MC joins with what bone?

Capitate

Which of the carpal bones is considered to be the largest?

Capitate

Which of the following structures is considered to be most lateral?

Capitulum

Which of the following structures is considered to be most lateral? a. Proximal radioulnar joint b. Coronoid tubercle c. Capitulum d. Trochlea

Capitulum

Which special projection of the wrist is ideal for demonstrating possible calcification in the dorsal aspect of the carpals?

Carpal bridge

The scaphoid is the first _______ on the ______ row. It is also sometimes referred to as the _______.

Carpal on the proximal row. It is sometimes referred to as the navicular.

The bones that make up the wrist are the __________

Carpals

At the proximal end of the metacarpals, articulations occur with the carpals forming ____________ Joints.

Carpometacarpal(CMC) joints

Medial rotation(pronated hand) of the elbow does what on an AP of the elbow?

Completely superimposes ulna on the radius

Arthrography

Contrast medium is injected to image tendinous, ligamentous, and capsular pathology associated with diarthrodial joints.

Which of the following sets of exposure factors would be best for an adult upper limb study using an analog (film-screen) system? a. 64 kV, 300 mA, 1/30 sec, small focal spot, detail-speed screens b. 64 kV, 200 mA, 1/20 sec, large focal spot, detail-speed screens c. 80 kV, 600 mA, 1/60 sec, large focal spot, high-speed screens d.78 kV, 600 mA, 1/60 sec, large focal spot, detail-speed screens

Correcta. 64 kV, 300 mA, 1/30 sec, small focal spot, detail-speed screens

A young child comes to radiology with an elbow injury. The basic elbow projections demonstrate a possible nondisplaced fracture of the coronoid process. Beyond the medial oblique projection, what additional projection(s) can be performed to demonstrate the coronoid process in profile?

Coyle method with 45° CR angle away from shoulder

A patient enters the ED with an elbow injury. The partially flexed AP and lateral positions reveal a possible fracture of the coronoid process. The patient's elbow is partially flexed and he refuses to extend it farther. Which one of the following positions should be performed to confirm the fracture of the coronoid process?

Coyle method with 80° flexion, CR angled 45° away from shoulder

Each finger and thumb is called a what?

Digit

Which of the following best demonstrates the radial head using the trauma lateral Coyle method routine?

Elbow flexed 90°, CR angled 45° toward shoulder

The first metacarpophalangeal joint has a(n) ____ type of joint movement.

Ellipsoidal

The radiocarpal (wrist) joint possesses a(n) ____ type of joint movement.

Ellipsoidal

A general positioning rule for upper limbs is to always place the long axis of the part being imaged __________ to the long axis of the IR.

Parallel

A general positioning rule is to place the long axis of the part ____ to the long axis of the image receptor.

Parallel

For radiologic purposes the first metacarpal is considered what?

Part of the thumb and should be included from distal phalanx to base of the first metacarpal when taking a thumb radiograph.

A patient enters the ED in severe pain with a possible dislocation of the elbow. The patient has the elbow flexed more than 90°. Which one of the following routines should be performed to confirm the diagnosis?

Partially flexed AP and limited lateral projections

How should the humeral epicondyles be aligned for a lateral projection of the elbow?

Perpendicular to image receptor

The most distal bones of the hand are the ___________

Phalanges

Which specific anatomy is better visualized with a fan lateral as compared with the other lateral projections of the hand?

Phalanges

The two or three bones located in each digit is called what? What is the singular term?

Phalanges or phalanx(singular)

What three groups of bones are located in the hand and wrist?

Phalanges(fingers and thumb), Metacarpals(palm), and Carpals(wrist)

Which carpal bone is 1?

Pisiform

Why is it important to keep the phalanges parallel to the IR for a PA oblique projection of the hand?

Prevents foreshortening of phalanges and obscuring of interphalangeal joints

Which of the following actions will lead to the proximal radius crossing over the ulna?

Pronation of the hand

The two fat stripes of the wrist demonstrated radiographically are known as the scaphoid fat stripe and the _____ fat stripe.

Pronator

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

To improve radiographic contrast

What is the purpose of performing the AP partially flexed projections of the elbow?

To provide an AP perspective if the patient cannot fully extend the elbow

The first MC(metacarpal) joins with what bone?

Trapezium

Which carpal bone is 5?

Trapezium

The second MC joins with what bone?

Trapezoid

The third carpal of the proximal row is called what? How many articulate surfaces does it have? What is its shape?

Triquetrum. It has three articulates and a pyramidal shape. Think tri=3=three sides to a pyramid. The triquetrum is distinguished by its shape and articulation with the pisiform, again, think pyramid=articulates with pisiform.

Which two structures primarily form the hinge-like structure and movement of the elbow joint?

Trochlea and olecranon process

The large concave depression, or notch, that articulates with the distal humerus is the ________.

Trochlear notch

The smooth depressed center of the trochlea is called what?

Trochlear sulcus or groove

proximal radioulnar joint

Trochoidal(pivot) joint is considered part of the elbow joint.

Nuclear medicine is generally more sensitive than radiography for assessing bones of the upper limb for either metastatic bone lesions or stress fractures. T or F

True

One of the early signs of rheumatoid arthritis is soft tissue swelling near the ulnar styloid process. T or F

True

radial deviation

to move the thumb side of the wrist away from the body

The forearm consists of what bones?

ulna and radius

A "skier's thumb" is an injury of the:

ulnar collateral ligament.

The bending or forcing of the hand laterally with the hand pronated in a posteroanterior (PA) projection is known as:

ulnar deviation