Upper Extremeties

Which statement is true regarding a thumb radiograph?

It only has two phalanges

Which are parts of the scapula?

Lateral angle Costal surface Medial border

How much anatomy would a radiographer include for an acceptable AP image of the humerus?

2 inches superior to shoulder joint and 2 inches distal to elbow joint

Which are principle exposure factors for performing radiography of the upper limbs?

Small focal spot Low to medium kilovolt peak

What is the best action for the radiographer to take if the patient is unable to completely extend the finger for a PA projection of the finger?

Take separate images of small sections

How should a trauma radiologic technologist image the severely fractured limb of a patient who is not able to move the limb to any extent?

Take two projections 90 degrees apart

Which statements regarding the digits are correct?

The digits contain 14 phalanges Each phalanx consists of a head, body, and base.

What approach confirms that the humerus is in a true lateral position?

The epicondyles are superimposed

What would happen if the finger is not parallel to the image receptor for a finger exam?

The joint spaces would be closed

What description is correct regarding ulnar deviation of the wrist?

The lateral carpal bones are demonstrated Opens up spaces between the lateral carpal bones; scaphoid, trapezoid, trapezium

Which precaution does a trauma radiologic technologist take while lifting a fractured limb?

The limb should be held at both joints The limb should be moved with two hands The limb should be lifted to a limited height from the base

Which is true regarding positioning during radiography of the upper limbs?

The part should be parallel to the plane of the image receptor The central ray should be directed to the correct centering point The central ray should be 90 degrees or perpendicular to the part and IR unless specific central ray angle is indicated.

Which criterion is used to determine an acceptable PA radiograph of the third digit of the hand?

The proximal, middle, and distal phalanges are included.

What are the difference between an oblique elbow image and an AP elbow image?

The radial head is seen in the oblique image; the radial head is not seen in the AP image Oblique image shows the radius and ulna separated; AP image shows the radius and ulna superimposed

Which statements are true about lateral elbow projections?

The radial tuberosity is facing anteriorly The olecranon process can be seen in profile It is the only projection that can demonstrate all 3 fat pads The epicondyles are superimposed

Which statement is true about the humeroulnar and humeroradial joints?

They are included on an elbow exam

What radiograph is needed to rule out a Bennett fracture?

Thumb Bennett fracture is a fracture at the base of the first metacarpal

What is the main reason a lateral elbow projection is required for an elbow study?

To demonstrate fat pads.

Why are scaphoid series ordered?

To rule out wrist fractures not seen on wrist exam

How can the patient immobilize the digit for a lateral projection of the finger?

Use adhesive tape

What is one instance when an AP projection of the finger is desired over PA

When injury of joint is suspected

Which are ellipsoidal joints?

Wrist joint Metacarpophalangeal joint

What is the name of the lateral aspect of the clavicle?

acromial extremity

Which condition most likely shows fluid-filled joint space with possible calcification on a radiograph?

bursitis

Which bone serves as a fulcrum for the movement of the arm?

clavicle

Which projections are standard for a Radiographic examination of the thumb?

AP PA oblique Lateral

Which projection of the scapula demonstrates a slightly elongated inferosuperior view of the coracoid process?

AP axial

Which joints are included on a humerus radiograph?

humeroulnar humeroradial

Which articulation is also called the glenohumeral joint?

scapulohumeral

Which projection of the shoulder demonstrates the greater tuberosity in profile?

AP with external rotation

Which projection of the shoulder demonstrates the lesser tuberosity in profile medially?

AP with internal rotation

What approach demonstrates the humeral head and greater tubercle in profile for a humerus exam?

Abduct and supinate the entire arm AP

Which condition would show superior displacement of the distal clavicle on a radiograph?

Acromioclavicular dislocation

What is true regarding the bones of the forearm?

An ulnar deviation projection is known as a special scaphoid projection The forearm should be Radiographed in an AP position with the hand supinated

A patient with a fractured diaphysis of the humerus is positioned for a transthoracic projection and is not able to lift up his or her other arm. What can the radiologic technologist do in this case?

Angle the central ray 10 degrees cephalad

How do joint effusions appear on radiographs?

As fluid-filled joint cavities

Which indicators justify the use of the AP projection of the first carpometacarpal joint?

Bennett fracture Arthritic changes

How is a severely fractured thumb positioned for a PA projection during a Radiographic examination?

By placing the thumb on a radiolucent sponge

Where is pathology seen in patients with Ewing sarcoma?

Cancer is seen in medullary tissue

Which is the largest carpal bone?

Capitate

In which projection should the central ray be angled at 25 to 30 degrees to the long axis of the hand?

Carpal canal- tangential wrist projection

What is the name of the passage that is created between the carpal sulcus and the flexor retinaculum?

Carpal tunnel

How would the radiographer instruct the patient to position for a lateral finger?

Demonstrate the affected finger extended with unaffected digits free of superimposition

What can be viewed in a PA projection of the fingers

Distal phalanges Distal metacarpal Middle phalanges Proximal phalanges

Which joint should be imaged in the radiograph of a patient with Monteggia's fracture?

Elbow joint

What difference exists between osteogenic sarcoma and enchondromas?

Enchondromas are benign; Osteogenic sarcoma is malignant

What pathology causes the bone to have an "onion peel" look to it on the Radiograph?

Ewing sarcoma

Which bone tumors are malignant?

Ewing's sarcoma Chondrosarcoma Multiple myeloma Osteogenic sarcoma

Two or more projections of which body part may be performed in an 8x10 ir

Finger

Which statements support an acceptable image of a lateral finger?

Fingernail in profile Concave surface of phalanx Soft tissue and bony trabeculation

What would happen if the tube was directed 10-15° cephalic during a PA projection of the first digit?

First metacarpal would be seen free of soft tissue

What are types of movements that an ellipsoidal joint allows for

Flexion Extension Abduction Adduction Circumduction

Which fracture is likely to be considered a Colles' fracture of the wrist?

Fracture of the distal radius

What anatomical part shows no superimposition in the AP apical oblique axial (Garth Method) projection of the shoulder?

Glenoid cavity Humeral head Head of scapula

Which method best shows the joint space between the humeral head and the glenoid cavity of the shoulder joint?

Grashey method

What would happen if a patient rotates the arm externally for a shoulder exam?

Greater tubercle is in profile

Which carpal articulated with the first metacarpal

Trapezium

What is the order from medial to lateral the distal row of carpal bones that would be visualized on a PA image of the wrist?

Hamate, capitate, trapezoid, trapezium

A radiograph of a patient shows a compression fracture of the articular surface of the posterolateral aspect of the humeral head. What pathological condition has the patient most likely developed?

Hill-Sachs defect

To which category of synovial joints are the interphalangeal joints classified?

Hinge Allow for movements in only a two directions, flexion and extension

What would happen if the humerus is rotated externally for a shoulder radiograph?

Humeral head is seen in profile Greater tubercle is seen in profile Scapulohumeral joint is visualized

Why is the transthoracic lateral shoulder image used?

If trauma is present If patient is unable to rotate arm If patient is unable to abduct the arm

What practice is always performed by the trauma radiologic technologist while imaging a fractured shoulder?

Image the injury as it is, without moving the limb

How does skiers thumb appear radiographically?

Increase in the degrees of the angle of the metacarpophalangeal line Widening of the inner metacarpophalangeal joint space of the thumb

What effect do compensating filters have on shoulder images?

Increased visualization of bone and tissue marking

Which projection would demonstrate a severe fracture of the fifth metacarpal?

Lane method

What are the best routine projections for the second to fifth digits of the hands?

Lateral PA PA oblique

What is best seen in the horizontal beam lateral projection of the humerus?

Lateral midhumerus

What is one problem that can occur if proper centering is not performed during an exam of the phalanx?

Obscuring of the joint spaces can occur

Which structures can be best demonstrated in the lateromedial elbow projection?

Olecranon process Fat pads of the elbow Soft tissues of the elbow

Which condition can best be demonstrated in an AP axial projection of the thumb?

Osteoarthritis Bennett's fracture Fracture or dislocation of the first carpometacarpal joint

Which pathological condition occurs due to increased density of atypically soft bone?

Osteopetrosis

Which projection of the shoulder will best show bursitis?

PA transaxillary

A patient has a dislocated glenohumeral joint. Which recumbent position is used to image this patients scapular Y?

Reverse PA oblique projection

Which condition is associated with closed joint spaces with subluxation of the metacarpophalangeal joints?

Rheumatoid arthritis

A radiograph of a patients hand shows dislocation of the largest carpal bone of the proximal row. Which bone has dislocated?

Scaphoid

What area is imaged to best visualize the "snuffbox"?

Scaphoid

From lateral to medial, how would the carpal bones be viewed on a PA image of the wrist?

Scaphoid, lunate, triquetrum, pisiform

Which part of the humerus is a site of frequent fractures that require surgery?

surgical neck

Which instruction applies to an injured patient undergoing a Radiographic examination of the dislocated scapula and humerus?

suspend breathing during exposure

What is true regarding an injured patient with a dislocated scapula and humerus who is positioned for a lateral scapular Y projection in the anterior oblique position?

- The patient obliquity must be 45 to 60 degrees - The central ray must be perpendicular to the image receptor - The line between the superior angle of the scapula and the acromioclavicular joint must be perpendicular to the image receptor.

Which carpals are located proximally?

Lunate Pisiform Scaphoid Triquetrum

Which articulations are found in the second to fifth digits?

Metacarpopjalangeal joint Distal interphalangeal joint Proximal interphalangeal joint

Garth Method (AP Axial Oblique Projection)

PP: Supine/seated/upright; RPO/LPO; body rotated 45 degrees toward the affected side; elbow flexed; arm placed across the chest. RP: Scapulohumeral joint CR: 45 degrees caudad SS: Glenoid cavity (scapulohumeral joint) Humeral head Coracoid process Scapular head & neck ER: For acute shoulder trauma For identifying posterior scapulohumeral dislocations Glenoid fxs Hill-Sachs lesions/defect Soft tissue calcification Posterior Dislocation: Humeral head projected superiorly from glenoid cavity. Anterior Dislocation: Humeral head projected inferiorly from glenoid cavity.

How can the radiographer demonstrate the lesser tubercle in profile on a humerus exam?

Position the patient's arm in the lateral position.

What is the criteria to review an acceptable radiograph of a PA projection of the thumb?

Proper collimation Open metacarpophalangeal joints

Which part of the scapula is sometimes called the head of the scapula?

lateral angle

Which special positioning method is used to demonstrate a Bennett fracture?

modified Robert method