Spring 2020 Procedures Upper Extremity WRIST
the Gaynor Hart method (original) requires a CR direction of ______ degrees
25 inferosuperior
the proper SID for a magnification wrist series should be ________
40"
when the arm is in flexion the _______ fits into the ______ on the _______ surface
coronoid process coronoid fossa anterior
radial deviation aka ____ aka ulnar ____
flexion extension
ulnar deviation aka ulnar ______ aka radial ____
flexion extension
list distal carpal bones (both names)
greater multangular (trapezium) lesser multangular (trapezoid) capitate (osmagnum) hamate (unciform)
The ______ is considered a medial carpal bone
hamate
what are the 3 carpals that have processes?
hamate scaphoid trapezium
which carpal bone contains a "hook"?
hamate (unciform)
gaynor hart VARIATION: CR is angled toward the ______ approx ___-____ degrees from the LONG AXIS of the FOREARM
hand 20-35
_____ rotation oblique better demonstrates lateral carpal bones
lateral
_____ wrist shows distal radius and ulna w/ superimposition
lateral
the _______ will demonstrate the thumb in the oblique position
PA hand
how many degrees should the arm be flexed for the lateral forearm exam?
90
original gaynor heart method is: a. inferosuperior b. superoinferior
A (anterior surface of the wrist)
what projection/ position shows LATERAL carpal bones best (esp trapezium and scaphoid)
PA oblique lateral rotation
the AP oblique medial rotation of the wrist is the same as the _______ position
PA oblique with ulna up
____ position corrects foreshortening of scaphoid/ navicular
PA ulnar deviation
____ rotation oblique better demonstrates medial carpal bones
medial
variation gaynor heart method is: a. inferosuperior b. superinferior
B
the depression on the lateral side of the wrist, just in front of the radial styloid is termed the _____
snuff box
T/F flex the elbow 90 degrees to rotate the ulna into the lateral position
true
T/F must have at least 90 degree difference in images for upper extremity
true
T/F use the Lateral view to look for anterior/ posterior displacement
true
navicular view is ALWAYS done with _____ deviation
ulnar
which surface of the wrist is placed on the IR for a lateral wrist?
ulnar (pinky)
all navicular positions require the ______ of the wrist
ulnar deviation
______ ______ is the distal radio-ulnar joint space/ shape which recognizes different types of slopes of the distal radius and post trauma alterations of the radius and ulna
ulnar variance
the "ulnar variance" study must be performed _______
with the elbow flexed 90 degrees and in the same plane as the wrist and shoulder
PA lateral ulnar deviation of scaphoid shows slight _____ of scaphoid
elevation
lateral aka
external (rotation)
T/F a voucher will say whether it is a trauma
false
you know it is a MEDIAL oblique if you see the ___ sticking out by itself
pisiform
the PA oblique medial rotation will demonstrate what carpal bone without any superimposition and what is the degree of rotation?
pisiform 45
the PA oblique wrist with medial rotation (ulna rotated up) will demonstrate ______
pisiform without superimposition
what are the typical positions performed for a magnification or 6 view study of wrist?
1) neutral PA 2) neutral lateral 3) PA w/ ulnar deviation 4) PA w/ radial deviation 5) lateral w/ flexion 6) lateral w/ extension
where is the CR directed for carpal bridge and what is the angulation?
1.5 " proximal to wrist jt 45
Gaynor hart (carpal canal): when the wrist cannot be extended to within ____ degrees of VERTICAL it is suggested that the CR be aligned PARALLEL to the PALMAR surface and then angled an additional ___ degrees toward the PALM
15
the stetcher method variation requires a CR angulation toward the elbow of _____ degrees
20
stetcher method- the ___ degree angulation of the wrist will place the _____ at right angles to the IR therefore the _____ will be projected without _____
20 Scaphoid (navicular) Scaphoid self superimposition
CARPE BOSSA: small bony growth on the dorsal surface of the ___ CMCJ. Best shown in _____ position with ____
3rd lateral flexion
the radiograph for a carpal bridge requires an angle of _____ degrees ________
45 superoinferior
scaphoid fractures account for ____% of all carpal injuries
60
the ______ position of the wrist will best demonstrate all carpal interspaces
AP
The _____ projection demonstrates the carpal interspaces than does ____ projection due to oblique direction off they interspaces, they are more closely parallel with the divergence off the X-ray beam
AP PA
STETCHER VARIATION: if 20 degree angle sponge in unavailable the use of _____ angle is acceptable but not preferred
CR
What projection is the lateral wrist
Lateromedial
What is the routine protocol for wrist (on voucher)
PA Lateral PA oblique (lat rotation) PA oblique (med rotation or AP med rot obl)
Where do you center the CR for PA wrist
Perpendicular to the midcarpal area (don't make first)
Why do you slightly arch/cup the hands at the MCPJs by flexing the digits
Places wrist in close contact with the IR (closes the gap)
What 3 joints have to be in the same plane to permit right angle rotation of the ulna and radius in the lateral position
Shoulder Elbow Wrist
the carpal canal will demonstrate which surface of the carpal bones the best?
anterior
which carpal bone is the largest of all carpal bones?
capitate
PA medial ulnar deviation of scaphoid shows slight _____ of scaphoid
depression
the lateral wrist position will demonstrate what anatomic structures superimposed on each other?
distal radius and ulna
name 2 specific structures that should be superimposed for the lateral forearm?
distal radius and ulna (radial head over coronoid process)
very important to use ULNAR DEVIATION for all views of the SCAPHOID bc it will demonstrated the navicular without ______
foreshortening
medial aka
internal (rotation)
what shows superimposed distal radius and ulna and superimposition of the metacarpals
lateral wrist
rotate wrist 45 degrees ___/ _____ for PA oblique wrist
laterally externally
the typical routine lateral wrist is the ______ projection
lateromedial
name any specific bony structure within the elbow joint
medial epicondyle
lest all proximal carpal bones (both names)
navicular (scaphoid) lunate (semilunar) triquetrum (triangular) pisiform (ospisiform)
stetcher method is done to view the ______
navicular (schaphoid)
what anatomy must be included when performing a routine forearm (from what to what)?
olecranon of ulna to radial styloid
Gaynor hart (carpal canal) method: where is the CR directed? what is the CR angle? what is it angled to?
palm of hand at about 1" distal to base of metacarpal 25-30 long axis of hand
for oblique wrist rest _____ surface on the IR and place ______ in the center of IR after rotation
palmar scaphoid
when the wrist is placed in a PA or AP position, an imaginary line drawn through the styloid processes should be what to the IR
parallel
when the wrist is placed in a lateral position, an imaginary line drawn through the styloid processes should be what to the IR
perpendicular
where is the CR directed for PA oblique wrist?
perpendicular to midcarpal area (just distal to the radius)
for both the AP and lateral forearm, where should the CR be directed?
perpendicular to the midpoint of forearm
where is the CR directed for lateral wrist
perpendicular to wrist joint
the carpal bridge will demonstrate which surface of the carpal bones best?
posterior
the CR should enter ______ for a PA projection of the wrist
posterior wrist at midcarpal region
3 ways to perform trauma wrist 1) _____ when they can't turn wrist on medial surface 2) _______ for oblique medial and lateral (will cause some distortion) 3) AP instead of ____
shoot through lateral CR angulation 45 (degrees) PA
when performing the Gaynor-Hart method (alternative) for carpal canal, the projection is
superioinferior
the true stetcher method will incorporate _______________
the pts wrist placed on the IR which is on a 20 degree angle sponge
what carpal articulates with the first metacarpal
trapezium (greater multangular)
name 2 articulating structures of the navicular
trapezium and radial styloid
______: A serious injury or shock to the body; modifications may include variations in positioning, minimal movement of the body part, etc.
trauma
how does the stetcher method demonstrate the navicular?
w/o self superimposition