Humerus & Shoulder Girdle & hands exam 3 positioning
Base of the first metacarpal
A Bennett's fracture involves:
1 inch (2.5 cm)
A minimum of ___ inch(es) (___ cm) of the forearm should be included radiographically for a PA projection of the hand.
superior
A posterior dislocation of the humerus projects the humeral head __ to the glenoid cavity with the special projection described in the previous question
metacarpophalangeal
A sesamoid bone is frequently found adjacent to the ___ joint of the thumb.
Synovial
All the joints of the shoulder girdle are classified as being ________.
more
An asthenic patient requires __ CR angle for an AP axial clavicle projection than a hypersthenic patient
osteoporosis
Atrophy of skeletal tissue
40 to 44 inches (102 to 113 cm) SID Minimal object image receptor distance (OID) Correct central ray placement and angulation Use of small focal spot
Circle all pertinent factors that help reduce image distortion during upper limb radiography.
impingement syndrome
Compression between the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch
Hills-Sachs defect
Compression fracture of the articular surface of the humeral head
10 to 15, proximally
During the PA axial scaphoid projection with central ray angle and ulnar flexion, the central ray must be angled ___ degrees ___ (distally or proximally)
The proximal radius crosses over the ulna
How does the forearm appear radiographically if pronated for a posteroanterior (PA) projection?
20 degrees
How much are the hand and wrist elevated from the IR for the modified Stecher method?
45 dgrees
How much central ray angulation from the long axis of the forearm is required for the carpal bridge (tangential) projection?
25-30 degrees
How much central ray angulation to the long axis of the hand is required for the carpal canal (tunnel) projection?
Distal aspect of metacarpals
How much of the metacarpals should be included for PA projection of the digits?
45 degrees
How much rotation is required for an oblique projection of the wrist?
8
Identify the number of bones in the carpals
5
Identify the number of bones in the metacarpals
14
Identify the number of bones in the phalanges
27
Identify the number of bones in the total hand
PA oblique projection: Perform the medial oblique rather than lateral oblique to decrease OID. Lateral position: Perform a thumb-down lateral (mediolateral projection) to decrease OID.
Identify which positioning modification(s) should be used for study of the second digit to reduce distortion for each of the following
Parent or guardian
If physical immobilization is required, which individual should be asked to restrain a child for a shoulder series?
parent or guardian
If physical immobilization is required, which individual should be asked to restrain a child for a shoulder series?
humerus
Indicate whether the part is on the radius, ulna, or distal humerus: coronoid fossa
ulna
Indicate whether the part is on the radius, ulna, or distal humerus:coronoid process
ulna
Indicate whether the part is on the radius, ulna, or distal humerus:coronoid tubercle
humerus
Indicate whether the part is on the radius, ulna, or distal humerus:olecranon fossa
ulna
Indicate whether the part is on the radius, ulna, or distal humerus:olecranon process
ulna
Indicate whether the part is on the radius, ulna, or distal humerus:radial notch
humerus
Indicate whether the part is on the radius, ulna, or distal humerus:trochlea
tendonitis
Inflammatory condition of the tendon
Bankart lesion
Injury of the anteroinferior glenoid labrum
Steve Left The Party To Take Carol Home
List one of the mnemonics for remembering the eight carpal bones
Symmetric appearance of both sides of the shafts of phalanges and distal metacarpals.Equal amounts of tissue on each side of the phalanges
List the two radiographic criteria used to determine whether rotation is present on the PA projection of the digits.
Clavicle
Location: Acromial extremity
Not part of the shoulder girdle
Location: Condylar process
Scapula
Location: Coracoid process
Not part of the shoulder girdle
Location: Coronoid process
Scapula
Location: Crest of spine
Proximal humerus
Location: Greater tubercle
Proximal humerus
Location: Intertubercular groove
Proximal humerus
Location: Surgical neck
Plane
Movement type: Acromioclavicular
Spheroidal
Movement type: Scapulohumeral
Plane
Movement type: Sternoclavicular
Interphalangeal Joint (IP)
Name the joint between the proximal and distal phalanges of the first digit
distal phalanx, proximal phalanx, middle phalanx
Name the three portions of the second through fifth fingers
proximal phalanx, distal phalanx
Name the two portions of the thumb
ulnar deviation
Of the two positions listed in the previous question, which is most commonly performed to detect a fracture of the scaphoid bone?
1" inferior to coracoid process
Specifically, where is the CR placed for an AP projection of the shoulder?
acromioclavicular joint dislocation
Superior displacement of the distal clavicle
True
T/F: CT arthography of the shoulder joint often requires the use of iodinated contrast media injected into the joint space
False
T/F: MRI is an excellent modality for demonstrating bony injuries of the shoulder girdle
False
T/F: a central ray angle of 10-15 degrees caudad may be used for trans thoracic lateral shoulder projection if the patient is unable to elevate the uninjured arm and shoulder sufficiently
True
T/F: it is recommended to perform shoulder positions on obese patients in the erect position when possible
True
T/F: nuclear medicine bone scans can demonstrate signs of osteomyelitis and cellulitis
False
T/F: radiography is more sensitive than nuclear medicine demonstrating physiologic aspects of the shoulder girlde
False
T/F: rheumatoid arthritis is more prevalent in men than women
True
T/F: sonography can provide a functional (dynamic) evaluation of joint movement that MRI cannot
False
T/F: the affected arm must be placed into external rotation for trans thoracic lateral projection
False
T/F: the scapular Y lateral position requires the body to be rotates 25-30 degrees anteriorly toward the affected side
True
T/F: the shoulder is the most common joint to develop bursitis due to repetitive motion
Rheumatoid arthritis
The "ball-catcher's position" is commonly used to evaluate for early signs of:
Lateral angle, superior angle, inferior angle
The 3 angles of the scapula include the
Sternal extremity, body, acromial extremity
The 3 aspects of the clavicle are the
male
The ____ clavicle tends to be thicker and more curved in shape.
Anterior oblique/Grashey method
The _______ ______ projection of the shoulder produces an image of the glenoid process in profile. This projection is referred to as the ______ method.
Tangential projection/ Neer method
The __________ projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs, which create shoulder impingement symptoms
costal
The anterior surface of the scapula is referred to as the ______ surface.
90
The elbow generally should be flexed ___ degrees for the routine positions of the wrist.
Collimation borders should be visible on all four sides without cutting off essential anatomy.
The general rule for collimation for upper limb radiography states
90 degrees
The hand and wrist form a ___ degree angle to the forearm with the carpal bridge (tangential) projection.
the metacarpophalangeal joints (MCP)
The joints between the metacarpals and the phalanges are
Proximal humerus, scapula, clavicle
The shoulder girdle consists of
15° - 20°
The supine version of the tangential projection for the intertubercular groove requires that the CR be angled __ to __ posteriorly from the horizontal plane.
head, body (shaft), base
The three parts of each phalanx starting distally are:
Scaphoid fat stripe and Pronator fat stripe.
The two important fat stripes or bands around the wrist joint are the
rotator cuff tear
Traumatic injury to one or more of the supportive muscles of the shoulder girdle
True/False: The use of a gird is not required for shoulder studies that measure less than 10 cm.
True
True
True/ False: A high-speed screen-IR system is recommended for analog shoulder studies when using a grid.
False
True/ False: Large focal spot setting should be selected for most adult shoulder studies.
False
True/ False: Low mA with short exposure times should beused for adult shoulder studies.
True
True/ False: The PA transaxillary projection (Hobbs modification) requires no CR angle.
False
True/ False: The kV range for adult shoulder projections is between 80 and 90 kV for analog and 100 to 110 kV for digital imaging systems.
True
True/ False: The use of a breathing technique can be performed for the transthoracic lateral humerus projection.
False
True/ False: a 72" source-image distance (SID) is recommended for most shoulder girdle studies.
True
True/False: Guardians of young pediatric patients who are undergoing upper limb studies can be asked to hold their child during the radiographic study.
false
True/False: If the posterior fat pad of the elbow is not visible radiographically, it suggests that a nonobvious radial head or neck fracture is present.
false
True/False: Lead (protective) shielding is only required for upper limb studies performed on patients who are of childbearing age or younger.
true
True/False: The entire metacarpal and trapezium must be demonstrated on all projections of the thumb.
True
True/False: The transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus.
True
True/False: The use of contact shields over the breast, lung, and thyroid regions is recommended for most shoulder projections.
false
True/False: Trauma or infection makes the anterior fat pad more difficult to see on a lateral elbow radiograph.
Infraspinous fossa, Supraspinous fossa
What are the names of the 2 fossae located on the posterior scapula?
Osteoporosis
What clinical indication requires a decrease in manual exposure factors?
Axilla
What is the anatomic name for armpit?
Capitate
What is the largest carpal bone?
Hamulus or hamular process
What is the name of the hooklike process extending anteriorly from the hamate?
Ulnar deviation and radial deviation
What is the name of the two special turning or bending positions of the hand and wrist that demonstrate medial and lateral aspects of the carpal regions?
PA, PA oblique, and lateral
What is the positioning routine for the second through fifth digits of the hand?
Norgaard method
What is the proper name for a position referred to as the "ball-catcher's position"?
80-90 kVp
What kV range (digital) should be used for a shoulder series on an average adult?
Fracture of clavicle
What must be ruled out before performing the weight-bearing study for acromioclavicular joints?
25°-30° medially
What type of CR angulation is required for the inferosuperior axial projection for the shoulder?
Proximal interphalangeal (PIP) joint
Where is the central ray centered for a PA oblique projection of the second digit?
Third MCP joint
Where is the central ray centered for a PA projection of the hand?
First metacarpophalangeal (MCP) joint
Where is the central ray centered for an AP projection of the thumb?
Superior angle of the scapula and the AC joint articulation
Which 2 landmarks are placed perpendicular to the IR for the scapular Y lateral projection?
AP external rotation, AP internal rotation
Which 2 routine shoulder projections are routinely taken for a shoulder (no trauma) and proximal humerus?
18 x 24 cm (8 x 10 inch)
Which IR size should be used for a thumb projection?
Anteroposterior (AP) projection (with the hand slightly arched)
Which alternative projection to the routine PA wrist best demonstrates the intercarpal joint spaces and wrist joint?
scaphoid
Which is the most commonly fractured carpal bone?
Transthoracic lateral projection for humerus
Which lateral projection can be performed to demonstrate the entire humerus for a patient with midhumeral fracture?
Lateral in extension
Which lateral projection of the hand best demonstrates a possible foreign body in the palm of the hand?
radial collateral ligament
Which ligament of the wrist extends from the styloid process of the radius to the lateral aspect of the scaphoid and trapezium bones?
pott's
Which of the following fractures is not demonstrated in a wrist routine?
PA transaxillary projection (Hobbs modification)
Which of the following non trauma projections can be performed erect to provide a lateral view of the proximal humerus in relationship to the scapulohumeral joint?
Excessive lateral rotation from PA
Which positioning error is involved if a majority of the carpal bones are superimposed in a PA oblique wrist projection?
Fan lateral
Which preferred lateral position of the hand best demonstrates the phalanges without excessive superimposition?
posterior oblique (Scapular Y) projection
Which projection best deomonstrates a possible dislocation of the proximal humerus?
PA oblique
Which projection of the thumb is achieved naturally by placing the palmar surface of the hand in contact with the cassette?
Fisk modification
Which projection produces a tangential projection of the intertubercular sulcus (groove)?
lateral wrist
Which routine projection best demonstrates the pronator fat stripe?
Posteroanterior (PA) and oblique wrist
Which routine projections best demonstrate the scaphoid fat pad?
Modified Robert's method. 15 degrees proximal
Which special positioning method can be performed to demonstrate a Bennett's fracture?What degree of central ray angulation is required for this projection?
AP Apical Oblique Axial (Garth Method)
Which special projection of the shoulder requires that the affected side be rotated 45 degrees toward the cassette and uses a 45 degree caudad central ray angle?
PA projection with radial deviation
Which special projection of the wrist best demonstrates the interspaces on the ulnar side of the wrist between the lunate, triquetrum, pisiform, and hamate bones?
Tangential inferosuperior or Gaynor-Hart projection
Which special projection of the wrist helps rule out abnormal calcifications in the carpal sulcus?
To prevent distortion of the phalanx and joints and to demonstrate small, nondisplaced fractures near the joint.
Why is it important to keep the affected digit parallel to the image receptor (IR) for the PA oblique and lateral projects?
The AP position produces a decrease in OID and increased resolution.
Why is the anteroposterior (AP) projection of the thumb recommended instead of the PA?
Arthrography
___ is a radiographic procedure that uses contrast media injected into the joint capsule to visualize soft tissue pathology of the wrist, elbow, and shoulder joints.
Boomerang compensating filter
device permits good visualization of soft-tissue and bony anatomy for adult shoulder radiography
diarthroidal, 4
ellipsoidal joints are classified as freely moveable, or _, and allow movement in _ directions
5-15 degrees
how much is the CR angled for the inferosuperior axial projection (clements) if the patient cannot fully abduct the arm 90 degrees
radius
in the anatomic position, which of the bones of the forearm is located on the lateral (thumb) side?
ulna
in the anatomic position, which of the bones of the forearm is located on the medial (pinky) side?
ulna
indicate whether the part is on the radius, ulna, or distal humerus:trochlear notch
saddle
match the following articulations with the correct joint movement types: carpometacarpal of first digit
ginglymus
match the following articulations with the correct joint movement types: elbow joint
plane
match the following articulations with the correct joint movement types: intercarpal
ginglymus
match the following articulations with the correct joint movement types: interphalangeal
ellipsoidal
match the following articulations with the correct joint movement types: metacarpophalangeal of second to fifth digits
pivot
match the following articulations with the correct joint movement types: proximal radioulnar joint
ellipsoidal
match the following articulations with the correct joint movement types: radoiocarpal
Acromioclavicular joint seperation
match the following radiographic appearances to the correct pathology: abnormal widening of acromioclavicular joint space
Bankart lesion
match the following radiographic appearances to the correct pathology: avulsion fracture of the glenoid rim
tendonitis
match the following radiographic appearances to the correct pathology: clacified tendons
rheumatoid arthritis
match the following radiographic appearances to the correct pathology: closed joint space
Hill-Sachs defect
match the following radiographic appearances to the correct pathology: compression fracture of humeral head
Bursitis
match the following radiographic appearances to the correct pathology: fluid filled joint space
osteoarthritis
match the following radiographic appearances to the correct pathology: narrowing of joint space
impingement syndrome
match the following radiographic appearances to the correct pathology: subacromial spurs
osteoporosis
match the following radiographic appearances to the correct pathology: thin bony cortex
capitulum
the articular portion found on the lateral aspect of the distal humerus is called
trochlea
the articular portion of the medial aspect of the distal humerus is called
olecranon fossa
the deep depression located on the posterior aspect of the distal humerus is the
Elbow flexed 90 degrees, optimal exposure factors used, and in a true lateral position
the fat pads around the elbow joint are valuable diagnostic indicators if the following three technical/positioning requirements are met with the lateral position.
supraspinatus
the most common injury in the rotator cuff is to the _ tendon
Base, body, head
the three parts of each metacarpal, starting proximally:
Rotate affected arm externally approximately 45 degrees
to best demonstrate a possible Hill-Sacks defect, which additional positioning technique can be added to the inferosuperior axial projection?
true
true/False: Excessive kV (analog imaging) may obscure the visibility of a fat pad.
true
true/False: Slight superimposition of the distal third, fourth, and fifth metacarpals may occur with a well-positioned PA oblique projection of the hand.
15 degrees cephalad
what CR angle is required for the AP axial projection (alexander) for AC joints
30° caudad
what type of CR angle is required for the Apical AP axial shoulder projection?
proximal radioulnar joints
which two joints of the forearm allow it to rotate during pronation
