RAD 121 Test 2 Fingers, Hand, Wrist and Forearm
Forearm Routine
-AP -Lateral
Thumb Routine
-AP -Medial Oblique -Lateral
Elbow Routine
-AP -Medial or Lateral Oblique -90 degree Lateral
Thumb Special - AP Axial Projection (Modified Roberts Method)
-Base of first metacarpal is demonstrated for ruling out Bennett's Fracture -This special projection demonstrates fractures, dislocations, or pathology of the base of the first metacarpal
Metacarpals
-Bones that make up the hand -Numbered 1-5 with the thumb as 1 and the little finger as 5 -Has 3 parts -Head - Distal rounded part -Neck - Tapered just proximal the the head -Body - Shaft, long curved portion -Base - Proximal end, articulates with carpals
Fingers
-Digits which are composed of phalanges -Numbered 1-5 with the thumb as #1 and the little finger as #5
Elbow Special - Radial Head Laterals
-Done for occult fracture of the radial head and neck -4 separate lateral positions -Hand supinated -Hand Lateral -Hand pronated -Hand with maximum internal rotation
What are the 3 joints that make up the Elbow Joint?
-Humerus/Radius -Humerus/Ulna -Proximal radioulnar joint
Proximal Ulna
-Longer than radius -Primarily involved in formation of the elbow joint
Capitulum
-Means little head -Located laterally and articulates with the head of the radius. ("Cap" on the Head of the Radius)
What should be done if the patient cannot fully extend their elbow?
-Obtain 2 Projections -One with the humerus parallel to the IR -One with the forearm parallel to the IR
Special Elbow - Acute Flexion (Jones Method)
-Obtain 2 radiographs -One with Central ray perpendicular to the humerus -One with Central ray perpendicular to the forearm *****Done when patient cannot extend the elbow at all*****
Hand Routine
-PA -Lateral Oblique -Fan Lateral
Fingers (2nd-5th Digits) Routine
-PA -Lateral Oblique -Lateral
Forearm contains what bones?
-Radius on the lateral side or thumb side -Ulna of the medial side
List the Proximal Row of Carpals and what they articulate with.
-Scaphoid - Boat Shaped, Largest bone of proximal row, articulates with the radius -Lunate - moon-shaped, articulates with radius proximally and capitate distally -Triquetrum - Pyramidal shape, articulates with pisiform -Pisiform - Pea shaped, smallest carpal
Trochlea
-Shaped like a pulley or spool, with 2 rim like outer margins -Located medially on the humerus -Articulates with Ulna
Radial and Ulna Styloid Processes
-Small conical projections at the distal end of both the radius and ulna -Radial styloid process extends more distally and both are palpable
List the Distal Row of Carpals and what the articulate with.
-Trapezium - Irregularly shaped between the scaphoid medially and the 1st metacarpal distally - Trapezoid - Wedged-Shaped, smallest carpal in distal row -Capitate (os magnum) - Largest carpal bone, articulates with scaphoid and lunate proximally and 3rd metacarpal distally -Hamate - Hooklike process called hamulus projects from palmar surface
A good Lateral elbow demonstrates what 3 Concentric Arcs/Circles
1. Trochlear sulcus - Smallest 2. Outer Rims of the Capitulum and Trochlea 3. Trochlear or Samilunar Notch -If not in true lateral the arcs will not appear symmetrical and the joint space will not be optimally visualized.
How many phalanges does the thumb have?
2, The Proximal and Distal Phalanx
How many phalanges do digits 2-5 have?
3, The Proximal, Middle, and Distal
What is essential for finding Joint Pathology?
A True Lateral Position
Joint Effusion
Accumulated fluid, synovial or hemorrhagic, in the joint cavity.
The proximal and distal radioulnar joints allow for what to move?
Allows for rotational movement of the hand and wrist
Special Hand - AP Oblique Bilateral (Norgaard Method)
Also known as Ball Catcher's position -Done to evaluate Rheumatoid Arthritis
Carpals
Are the bones that make up the wrist
Anterior Depression - Coronoid Fossa
Area in which the coronoid process is located when the elbow is flexed
Anterior Depression - Radial Fossa
Area in which the radial head is located when the elbow is flexed
Posterior Depression - Olecranon Fossa
Area where the olecranon process is located when the arm is fully extended
Where does the radius and ulna articulate with each other?
At the proximal and distal Radioulnar Joints
Coronoid Process
Beak like process separated from the olecranon process by the trochlear (semilunar) notch
Olecranon Process
Beak like process that is easily palpated on the posterior aspect of the elbow (Funny Bone)
Distal Interphalangeal (DIP) Joint
Between the distal and middle phalanx of the 2nd and 5th digit.
Carpometacarpal (CM) Joint
Between the metacarpal and the appropriate carpal of the distal row of the wrist. -1st MC with trapezium -2nd MC with trapezoid -3rd MC with Capitate -4th and 5th MC with Hamate
Proximal Interphalangeal (PIP) Joint
Between the middle and proximal phalanx of the 2nd and 5th digit.
Interphalangeal (IP) Joint
Between the proximal and distal phalanx of the thumb
Metacarpophalangeal (MCP) Joint
Between the proximal phalanx and the metacarpals of each digit.
Neck
Constricted area located just distal to the head of the radius
Medial Oblique Elbow best demonstrates what?
Coronoid Process
Special Wrist - Carpal Canal (Tunnel), Tangential, Gaynor-Hart Method
Demonstrates carpals in an arched arrangement -Possible fractures of the hamulus process of the hamate, pisiform, and trapezium
Wrist Special - PA Radial Deviation
Demonstrates fractures of the Lunate, Triquetrum, Pisiform, and Hamate
Thumb Special - PA Stress
Demonstrates metacarpophalangeal angles and joint spaces at MCP joints
Wrist Special - PA Modified Stretcher Method
Demonstrates possible fractures of the scaphoid -This is an alternative to the ulnar deviation
Special Wrist - Ulnar Deviation (Ulnar flexion)
Demonstrates the Scaphoid
What joint movement is involved with Metacarpophalangeal (MCP) Joints?
Ellipsoidal or Condyloid type -Allows flexion, extension, abduction, adduction
What joint movement is involved with the Radiocarpal (also known as the wrist joint) Joints?
Ellipsoidal or condyloid type
Humeral Condyle of the Distal Humerus
Expanded distal end
Ginglymus or Hinge Joints
Flexion and extension movements -Elbow -Interphalangeal
Ellipsoid or Condyloid Joints
Flexion, Extension, Adduction, Abduction and Circumduction -Wrist
Spheroid or Ball and socket Joints
Flexion, Extension, abduction, adduction, circumduction, and medial and lateral rotation -Shoulder -Hip
Coronoid Tubercle
Found of the medial margin of the coronoid process
Barton's Fracture
Fracture and dislocation of the posterior lip of the distal radius
Bennett's Facture
Fracture of the base of the first metacarpal with subluxation and posterior displacement
Joint Effusion indicates what?
Fracture, dislocation, soft-tissue damage or inflammation
Diarthrosis
Freely movable-most synovial joints with a joint capsule containing synovial fluid, joints of the limbs
What joint movement is involved with the Elbow Joint?
Ginglymus hinge type
What joint movement is involved with Interphalangeal (IP) Joints?
Ginglymus or Hinge type -Allows flexion and extension movement
Trochlear Sulcus
Groove, depressed center portion between the rim like outer margins of the trochlea, appears circular on lateral view
3 parts of the phalanx are what?
Head - Distal rounded part Body - Middle section or shaft Base - Flattened proximal portion
Small chip fractures frequently occur near what?
Joint Spaces
Trochlear Notch
Large concave depression articulating with the distal humerus
Medial epicondyle
Larger than the lateral epicondyle, located of the medial edge of the distal humerus
Head of ulna
Located at the distal end of the ulna, proximal to the styloid process
Body or Shaft
Long midportion of both the radius and ulna
Osteoarthritis
May see DJD (Degenerative Joint Disease) -Gradual deterioration of articular cartilage -Considered a normal part of the aging process
What is another term for scaphoid?
Navicular
Where are the posterior fat pads on a elbow located?
Normally located deep within the olecranon fossa and is not visible on a negative elbow exam
Ulnar Notch
On medial aspect of distal radius where head of ulna sits
What joint movement is involved with the Intercarpal Joints?
Plane or gliding type
What joint movement is involved with the 2nd-5th Carpometacarpal (CM) Joints?
Plane or gliding type -Least amount of movement of the synovial class of joints
Lateral Oblique Elbow best demonstrates what?
Radial head and Neck
What bone articulates directly with the wrist joint?
Radius
Smith's Fracture
Reverse of Colle's fx, transverse fracture of distal radius displaced anteriorly
Trochoid or Pivot Joints
Rotational movements -Proximal and Distal Radioulnar Joints of the forearm
Radial Tuberosity
Rough oval process on the medial and anterior side of the radius just distal to the neck
Head of radius
Round and flat, located at the proximal end of the radius
Sellar or Saddle Joints
Same movements as ellipsoid -First carpometacarpal joint of the thumb, ankle
What carpal is the most fractured?
Scaphoid
What joint movement is involved with the thumb 1st Carpometacarpal (CM) Joints?
Sellar or Saddle type -Allows flexion, extension, abduction, adduction, circumduction, opposition and some rotation
What is another name for the Trochlear notch?
Semilunar notch
Visualization of the posterior fat pad on a lateral elbow image indicates what?
Significant injury, fracture or pathologic process
Plane or Gliding Joints
Sliding or gliding motion -Carpometacarpal -Atlantoaxial
Radial Notch
Small Shallow depression on the lateral side of the proximal ulna that articulates with the head of the radius to form the proximal Radiounlar Joint
Lateral epicondyle
Small projection on lateral aspect of the distal humerus above the capitulum
Correctly exposed images should demonstrate what?
Soft-tissue margins for fat pad visualization and fine trabecular markings of all bones
The upper limb is classified as what type of Joint
Synovial, diarthrodial and freely movable joints
What anatomy must be included on a thumb radiograph as opposed to other fingers?
The phalanges and entire 1st Metacarpal must be included.
What anatomy must be included on 2-5 digit radiograph?
The phalanges and the distal portion of the metacarpal are required
What happens when the hand is pronated?
The radius rotates around the more stationary ulna
What is the forearm performed AP?
To prevent the Ulna and Radius from superimposing
Colle's Fracture
Transverse Fracture of the distal radius, displaced posteriorly, often a second fx at the ulnar styloid also occurs
Boxer's Fracture
Transverse Fracture through the metacarpal neck, most commonly the 5th metacarpal
What indicated elbow trauma?
Visualization of displaced posterior fat pads
Trauma Axial Lateral Elbow (Coyle Method)
-2 projections -One to demonstrate Radial Head -One to demonstrate coronoid process