Procedures Chapter 4 quiz
hinge joint between the humerus and ulna hinge joint between humerus and radius proximal radioulnar joint
3 parts of the elbow joint
radius, ulna
During the act of pronation, the _____ crosses over the ______ near the upper third of the forearm
humeral condyle
Expanded distal end of the humerus
Centering for the thumb is an exception...where do center?
First MCP joint..get trapezium
Trochlear sulcus
First and smallest of the arcs:
hamular process
Hook like process extending anteriorly from the hamate
2
How many exposures (minimum) are required for the AP elbow acute flexion study?
2
How many phalanges in thumb
medial aspect of the distal radius
The ulnar notch is located at the: a) proximal end of the radius b) medial aspect of the distal radius c) proximal end of the ulna d) distal end of the ulna
osteopetrosis (additive disease)
abnormally dense bone
carpometacarpal joint
at the proximal end, the metacarpals articulate with the respective carpals and are called
ulnar collateral ligament
attaches to the styloid process of the ulna and fans out to attach the treiquetrum and the pisiform
carpals
bones of the wrist
metacarpals
bones that make up the palm of the hand
coronoid tubercle
medial margin of the coronoid process, opposite the radial notch
flexion, extension, abduction, adduction. Circumduction also happens at these joints....
metacarpophalangeal joints are ___ that allow movement in all ___ directions: ___, ___, ___, and ___.
phalanges
most distal bones of the hand
scaphoid
most frequently fractured carpal bone
coronoid and radial fossa
the distal humerus has specific depressions on both anterior and posterior surfaces. the 2 shallow anterior depressions are the ___ and ___
True
the distal radius will cross over the ulna when the hand is pronated T/F
diarthrodial, ginglymus
the elbow joint is classified as _____, and is considered ____
saddle, sellar
the first carpometacarpal joint of the thumb is classified as a ____ joint. Allows great ROM
metacarpophalangeal joint
the joint between the metacarpal and the proximal phalanx of the thumb
interphalangeal joint
the joint between the two phalanges of the thumb
trochlear notch
the large convcave depression, or notch, that articulate with the distal humerus
bone metastases
transfer of disease or cancerous lesions from one organ or part that may not be directly connected
45
Obliques of extremities are ___ degrees
proximal radius; elbow
Where is the neck and head of the radius located?
anterior fat pad posterior fat pad (NOT visible on a negative elbow exam) supinator fat stripe
3 fat pads of elbow
smaller-capitulum (lateral) larger- trochlea (medial)
Intermediate arc... Smaller- Larger-
Capitate
Largest carpal bone?
radial notch
Small, shallow depression located on the lateral aspect of the proximal ulna
fat pads
Soft tissue detail as depicted by ____ located within the deep olecranon fossa is important in trauma diagnosis of the elbow joint.
accurate lateral, 90 degree, fat pads
Specific positions, such as an ___ with___ flexion, along with possible associated visualization of ___, are essential for evaluation of joint pathology of the elbow.
plane, least
The 2nd-5th carpometacarpal joints are ___ which allow the ____ amount of movement of the synovial class joints
head
The ____ of the radius articulates with the ulna at the radial notch, forming the proximal radioulnar joint
radial, ulnar
The ____ styloid process extends more distally than the _____ styloid process
trochlea
The _____ is located more medially and articulates with the ulna
olecranon fossa
The deep posterior depression of the distal humerus is the _____. The olecranon process of the ulna fits into this depression when the arm is fully extended.
Trochlear notch
The large concave depression or notch that articulates with the distal humerus
medial epicondyle
The larger and more prominent than the lateral epicondyle and is located on the medial edge of the distal humerus
metacarpophalangeal joint
The metacarpals articulate with the phalanges at their distal ends are called
radial/lateral, scaphoid
Ulnar deviation best demonstrates the carpals on the ___ side... best demonstrates the ___ carpal
15 degrees proximal
What type of CR angle is required for the AP axial projection? (Modified Roberts method?)
25-30 degrees
What type of CR angle is required for the tangential gaynor-hart method?
Lunar collateral ligament injury
What type of injury is diagnosed most often with the PA stress (folio method) projection?
When joints are of interest
When do we do obliques of extremities?
c) anterior to the distal radius
Where is the pronator fat stripe located? (wrist) a) anterior to the elbow joint b) posterior to the elbow joint c) anterior to the distal radius d) anterior to the radial head
Lateral
Which of the following projections demonstrated a possible elevated fat pad near the elbow joint?
barton's fracture
fracture and dislocation of the posterior lip of the distal radius
27
how many bones on each hand
8
how many carpals
5
how many metacarpals
14
how many phalanges
osteomylelitis
infection of bone or bone marrow
bursitis
inflammation of the bursae or fluid-filled sacs that enclose the joints; the process generally involves the formation of calcification in associated tendons, which causes pain and limited movement
plane (gliding)
intercarpal joints have only a ___ movement
ginglymus, hinge-type, 2 directions, flexion, extension
interphalangeal joints are ___, or ___-type. Movement happens in ___ directions, ___ and ___ only.
head of radius
located and the proximal end of radius, near the elbow
ulnar; lunate, treiquetrum, pisiform, hamate
radial deviation movement that opens and best demonstrates the carpals on the ___ side, best demonstrates the ___ carpals
fat pads, fat bands, or stripes
radiographs of the upper and lower limbs are taken not only to evaluate for disease or trauma to bony structures, but also to assess associated soft tissues, such as certain accumulations of fat called: ___
osteoperosis
reduction in the quantity of bone or atrophy
ulnar notch
small depression of medial aspect of distal radius
ulnar notch
small depression on the medial aspect of the distal radius (head of ulna fits into the ulnar notch)
radial notch
small shallow depression located on the lateral asepct of the ulna
colles fracture
transverse fracture of the distal radius in which the distal fragment is displaced POSTERIORLY
boxer's fracture
transverse fracture that extends through the metcarpal neck, 5th metacarpal
carpal
tunnel syndrome is a common painful disorder of the wrist and hand that results from compression oft he median nerve as it passes through the center of the wrist
anteriorly located pisiform and the hamular process of the hamte
what is visible on the tangential projection of the wrist
capitulum
which is located on the distal humerus? a) styloid process b) olecranon process c) capitulum d) coronoid process
synovial, diarthrodial
All joints in this chapter are classified as ___, or _____. Only the movement types differ
trochlea & capitulum
Articular portion of the humeral condyle is divided into two parts:
Capitulum
Articular portion of the lateral portion of the distal humerus
Trochlea
Articular portion of the medial aspect of the distal humerus
Trapezium
Carpal that articulated with the thumb
scaphoid fat stripe- visualized on PA it is elongated and slightly convex in shape and is located between the radial collateral ligament and adjoining muscle tendons *absence of fat stripe indicates fracture on radial aspect of wrist pronator fat stripe- visualized on the lateral view of the wrist *displacement of fat stripe can indicate subtle fractures
2 fat stripes on wrist
first and smallest arc- trochlear sulcus the second intermediate arc appears double-lined as the outer ridges or rounded edges of the capitulum and trochlea (smaller of the double-lined is the capitulum; the larger is the trochlea third arc- trochlear notch of the ulna
3 concentric arcs
distal interphalangeal joint proximal interalphalangeal joint metacarpophalangeal joint
3 joints of digits 2-5
lateral
3 significant fat pads or stripes of the elbow are visualized only on the ___ projection
Dorsal radiocarpal Palmar radiocarpal Triangular fibrocartilage complex Scapulolunate Lunotriquetral
5 ligaments that stabilize the wrist
3 concentric arcs.. if the elbow is not in a true lateral, the 3 arcs will not show
A good criterion by which to evaluate a true lateral position of the elbow when it is flexed 90-degrees is the appearance of the _____
Lateral epicondyle
A small projection on the lateral aspect of the distal humerus above the capitulum
Trochlear sulcus
Depression of trochlea, which begins anteriorly and continues inferiorly and posteriorly , appears circular on a lateral end-on view; on a lateral elbow radiograph...it appears as a less dense (more radiolucent)
1. lower to medium kV (55-70-analog, 60-80 digital 2. short exposure time 3. small focal spot 4. adequate mAs for sufficient density
Exposure factors for upper limbs (4)
Styloid process
Extreme distal ends of both the radius and ulna (can be palpated on the thumb side of the wrist)
fluid, effusion
Fat pads...Most often, such changes result from ___ accumulation aka, ____ within the joint, which indicates the presence of an injury involving the joitn.
from the distal phalanx to the base of the first metacarpal
For radiographic procedures, the first metacarpal is considered part of the thumb and must be included in its entirety in a radiograph of the thumb..from ____ to ____
80
How much is the elbow flexed for a trauma axial lateral projection (Coyle method) to demonstrate the coronoid process?
1st view- as patient presents 2nd view- 90-degrees from first view
How to x Ray a trauma patient
head of radius
Located at proximal end of the radius near the elbow joint
head of ulna
Located near the wrist at the distal end of the ulna (pinky side-can be felt when hand is pronated)
head of ulna
Located near the wrist at the distal end of the ulna. Can be seen when hand is pronated.
Ulna
Longer of the forearm bones, primarily involved in the elbow joint
Capitulum
Means "little Head" and is located on the lateral aspect and articulates with the head of the radius
Send Letter To Peter To Tell 'em (to) Come Home
Mnemonic for carpals
Scaphoid
Most commonly fractured carpal bone?
radius, scaphoid, lunate, radiocarpal joint
Of the two bones in the forearm, only the ____ articulates directly with the two carpal bones...the ____ and the ____. the wrist joint is called the ___ joint.
Capitulum, epicondyles
This structure becomes significant in the evaluation for a true lateral position of the elbow, as does the direct superimposition of the ____
supinated for an AP projection
To prevent superimposition of the radius and ulna that may result from these pivot-type rotational movements, the forearm is radiographed with the hand ___
PIP
Where is the CR centered fro a PA projection of the second digit
small to medium: increase 5kv to 7kv large plaster cast: increase 8kv to 10kv fiberglass: increase 3kv to 4kv
cast conversion chart: small to medium plaster cast: larger plaster cast: fiberglass cast:
carpal sulcus
concave area or groove of carpals
osteoarthritis
degenerative joint disease, noninflammatory joint disease characterized by gradual deterioration of the articular cartilage
bennetts fracture
fracture of the base of the first metacarpal bone
fracture
is a break in the structure of the bone caused by a force
rheumatoid arthritis
is a chronic systemic disease with inflammatory changes throughout the connective tiessues; the earliest change is soft tissue swelling that is most prevalent around ulnar styloid and wrist
capitate
large of all carpal bones, identified by its large rounded head that fits proximally into a concavity formed by the scaphoid and lunate bones
scaphoid
largest carpal in the proximal row and articulates with the radius proximally
which 2 bony landmarks are palpated to assist with positioning of the upper limb?
lateral and medial epicondyles
head, neck, radial tuberosity, trochlear notch
on a lateral view of the elobw, the ___ and ___ of the radius are well demonstrated, as are the ___ and the large concave ____
joint effusion
refers to accumulated fluid in the joiny cavity
smith's fracture
reverse of colles fracture, or fracture of the distal radius (ANTERIOR)
lunate
second carpal in the proximal row, it articulates with the radius. it is distinguished by the deep concavity on its distal surface, where it articulates with the capitate on the distal row of the carpals
first mc with trapezium second mc with trapezoid third mc with capitate fourth and fifth mc with hamte
the 5 metacarpals articulate with the specific carpals:
ellipsoidal
the MCP joints are classified as:
triquetral, articular, distal radioulnar joint.
the ___ bone is also part of the wrist joint in that it is opposite the ____ disk. the articular disk is part of the total wrist articulation, including a joint between the distal radius and ulna of the forearm...the ___ joint
trochlea, trochlear sulcus
the ___ is shaped like a pulley or spool; it has two rimlike outer margins and a smooth depressed center portion called the _____, or groove.
olecranon process
the ____ can be easily palpated on the posterior aspect of the elbow
radius
the ____ is the only one of the two bones that is directly involved in the wrist joint
radius, wrist joint
the ____ is the shorter of the 2 bones and is directly involved in the ____
ulna
the ____, is the longer of the 2 bones and is primarily involved in the elbow joint
PA, because there is a cross-over when hand is pronated, results from unique pivot-type rotational movements of the forearm that involve both the proximal and distal radioulnar joint
the forearm should not be radiographed in a ___ position because___
ginglymus/hinge
the interphalangeal joints are classified as:
hamate, hamulus
the last carpal in the distal row on the medial aspect is the ___, easily distinguished by the hook-like process called the ___ which projects from its palmar surface.
radius and ulna
the lateral view of the elbow clearly shows specific parts of the proximal ____ and _____
elbow, pivot/trochoid
the proximal radioulnar joint is considered part of the ___ joint, and is a ____ type of joint.
lateral, medial
the radius and ulna can be separated through ___ rotation of the elbow, where as ___ position completely superimposes them
radial tuberosity
the rough oval process on the medial and anterior side of the radius, distal to the neck is the ____
trapezium
the second, more distal row of four carpals articulates with the 5 metacarpal bones...starting on the lateral, or thumb, is the ___ a 4-sided, irregularly shaped bone that is located medial and distal to the scaphoid and proximal to the first metacarpal
pisiform
the smallest of the carpal bones, is located anterior to the triquetrum and is most evident in the carpal canal or tangential projection
carpal sulcus, concave anterior (or palmer) aspect of the carpals
the tangential projection down the wrist and arm from the palm of a hyperextended wrist. this view demonstrates the ___ ___ formed by the ____
thumb, first MCP joint
the thumb is classified as _____ although it has a very limited abduction and adduction movement because of the wider and less rounded head of the first metacarpal.
ellipsoidal, freely, diarthroidal
the wrist joint is _____ -type joint and is the most ___ movable, or ______ of the synovial classification
triquetrum
third carpal bone on the proximal row?
triquetrum
third carpal is the ______, which has 3 articular surfaces and is distinguished by its pyramidal shape and anterior articulation with the small pisiform
olecranon and coronoid process
two beak-like processes on the proximal ulna are called the ___ & ____
trapezoid
wedge-shaped, 4-sided, smallest bone in distal row
Olecranon fossa
Deep depression located on posterior aspect of the distal humerus is the
