Fingers, thumb, hand, wrist
A minimum of ___ inch _____cm of the forearm should be included radiographically for a pa projection of the hand
1 inch, 2.5 cm
Grids are used if the body part measures greater than
10 cm
During the pa axial scaphoid projection with central Ray angle and ulnar flexion the central Ray must be angled
10 to 15 ° proximally
# of phalanges in one hand
14
What degree of central Ray angulation is required for this projection
15° proximal
The hand and wrist is elevated ____from the ir for the modified Stecher method
20°
How much central Ray angulation to the long axis of the hand is required for the carpal canal (tunnel) projection
25-30°
Total number of bones on each hand
27
SID
40 inches
Pertinent factors that help reduce image distortion during upper limb radiography
40-44 inches sid Minimal object image receptor distance Correct central Ray placement and angulation Use of a small focal spot
How much rotation is required for an oblique projection of the wrist
45
How much central Ray angulation from the long axis of the forearm is required for the carpal bridge (tangential) projection
45°
# of metacarpal bones in one hand
5
Analog
50-70 kv
Digital
55-80 kv
# of Carpal bones in one hand
8
IR size
8 x 10 inches
The elbow generally should be flexed____ ° for the routine positions of the wrist
90
The hand and wrist form a ____° angle to the forearm with the carpal bridge (tangential) projection
90°
Boxers fracture
A break in one or more metacarpal bones usually the fourth or fifth caused by a punching motion Such a fracture is often distal, angulated, and impacted Pain and swelling at mcp joint Casting at a 45° angle or surgery place pins
A bennetts fracture involves
Base of first metacarpal
Mallet finger
Baseball finger Deformity in which the finger tip is curled in and cannot straighten itself Due to injury to extensor digitorium tendons at distal interphalangeal joint
Type of intensification screens most commonly used for analog imaging
Detail screens
Distal interphalangeal joint
Dip
Cr for the routine projections of the fingers (2nd through 5th digit) is
Directed at PIP joint
Cr for the routine projections of the thumb is
Directed at first mcp joint
Cr for routine projections of the wrist is
Directed to mid carpal area
Gout
Disorder of purine metabolism Des position of urate crystals in joint spaces Middle Aged men Acute onset of exteme pain in small joints with redness and swelling
How much of the metacarpals should be included for pa projection of the digits
Distal aspect of metacarpals
Colles fracture
Due to foosh > 40 yrs female (esp osteoporosis) Fx fragment: upward dorsal angulation (fork like appearance)
To see fractures of the hamate and abnormalities of the tissues in the canal what projection/ method would you use
Gaynor hart method or tangential inferosuperior
1st to 5th ip joints
Ginglymus (hinge)
Shielding
Gonadal
Hooklike process extending anteriorly from the hamate
Hamulus
Fiberglass cast
Increase 3-4 kv
Small to medium plaster cast
Increase 5-7 kv
Large plaster cast
Increase 8-10 kv
Joint between the proximal and distal phalanges of the first digit
Interphalangeal joint
Potts fracture
Is not demonstrated in a wrist routine
What is the proper name for the position referred to as the ball catchers position
Norgaard method
Routine projections for fingers
Pa Pa oblique Lateral
Routine projections for hand
Pa Pa oblique Lateral (fan) Lateral (extension and flexion)
Routine projections for wrist
Pa (ap) Pa oblique Lateral
Which projection of the thumb is achieved naturally by placing the palmar surface of the hand in contact with the cassette
Pa oblique
Proximal interphalangeal joint
Pip
2nd to 5th cmc joints
Plane (gliding)
Intercarpals
Plane (gliding)
Rheumatoid arthritis
Systemic inflammatory disease Symmetric joint involvement Affects synovial membranes Pannus ( granulation tissue or abnormal layer of fibrobascular tissue) develops in joint spaces and erodes into the articulate cartilage and bone
Which special projection of the wrist helps rule out abnormal calcifications in the carpal sulcus
Tangential inferosuperior or gaynor hart method
A patient enters the er with a possible foreign body in the dorsal aspect of the wrist. Initial wrist radiographs are inconclusive in demonstrating the location of the foreign body. What additional projection can be performed to demonstrate the region of the wrist
Tangential projection Carpal bridge
What digit is the first digit
Thumb
Why is it important to keep the affected digit parallel to the ir for the pa oblique and lateral projections
To prevent distortion of the phalanx To prevent distortion of the joints To demonstrate small, nondisplaced fractures near the joint
True or false: slight superimposition of the distal third, forth, and fifth metacarpals may occur with a well positioned pa oblique projection of the hand
True
Pa, pa oblique, lateral, and special views of wrist
lengthwise only
Ir crosswise
Multiple exposures
Mechanism
Foosh (fall on out stretched hand) causing transverse fracture though the middle of the scaphoid
Smith fracture
Aka reverse colles fracture Falling in the back of flexed hand Fx fragment (palmar) displacement
Routine projections for thumb
Ap Pa oblique Lateral
A patient with a trauma injury enters the er with an evident colles fracture. Which positioning routine should be used to determine the extent of the injury
Ap and lateral forearm projections to include wrist
Special projections for hand
Ap oblique bilateral (norgaard method)
Which alternative projection to the routine pa wrist best demonstrates the intercarpal joint spaces and wrist joint
Ap projection
Special projections for thumb
Ap, modified roberts method Pa stress (folio method)
Pa stress "skiers thumb": thumb
CR Directed to midway between mcp joints (Tape and rubberband) 7° Collateral ligament
Largest of carpal bones
Capitate
Collimation
Collimate on four sides if the ir is large enough to allow this without cutting off essential anatomy
Scaphoid fracture Epidemiology
Common in young men not common in children or in patients beyond middle age
Ap - modified Roberts method thumb
Cr directed 15° proximally (towards wrist) entering the first cmc joint Base of 1st metacarpal and trapezium must be clearly visualized
Fan lateral: hand
Cr directed to second mcp joint
Lateral flexion extension: hand
Cr directed to second to fifth mcp joints
Pa: hand Pa oblique: hand
Cr directed to third mcp joint
Ap oblique bilateral (norgaard method): hand
Cr to midpoint between both hands at level of fifth mcp joints Bilateral hands In 45° oblique position
Ap oblique bilateral hand
Crosswise only
Pa stress thumb
Crosswise only
Bennetts fracture
Fracture at the base of 1st metacarpal Wide displacement Fragment held in place by strong ligament (Orif-open reduction internal fixation)
1st to 5th mcp joints
Ellipsoidal (condyloid)
True or false : lead shielding is only required for upper limb studies performed on patients who are child bearing age or younger
False
Which preferred lateral position of the hand best demonstrates the phalanges without excessive superimposition
Fan lateral
Which lateral projection of the hand best demonstrates a possible foreign body in the palm of the hand
Lateral in extension
Ap axial modified Roberts method thumb
Lengthwise only
Pa, pa oblique, fan lateral, and lateral flexion and extension hand
Lengthwise only
Radial deviation demonstrates
Lunate, triquetrum, pisiform, and hamate
A sesamoid bone is frequently found adjacent to the _______ joint of the thumb
Metacarpophalangeal
Joints between the metacarpals and phalanges
Metacarpophalangeal joints
Which special positioning method can be preformed to demonstrate a bennetts fracture
Modified Roberts method
Two portions of the thumb
Proximal phalanx Distal phalanx
Three portions of each finger
Proximal phalanx Middle phalanx Distal phalanx
The ball catchers position is commonly used to evaluate for early signs of
Rheumatoid arthritis
Most common broken carpal bone
Scaphoid
Ulnar deviation demonstrates
Scaphoid
Carpals
Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate
Special projections for wrist
Scaphoid views -cr angle, ulnar deviation -modified stecher method Radial deviation Carpal canal inferosuperior Carpal bridge
1st cmc joint
Sellar (saddle)
long or short exposure time
Short
Ir lengthwise
Single exposure
Large or small focal spot
Small
Correctly exposed radiographs visualize _____ margins and ______ markings of all bones
Soft tissue, trabecular