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