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
