Upper Extremity Anatomy and Positioning Review Sheet
how are the epicondyles of the humerus when positioning for the AP projection of the forearm? lateral position of the forearm?
-AP projection --> parallel -lateral projection --> perpindicular
where does the CR enter and the angle for the Coyle Method to demonstrate the coronoid process? what is the degree of flexion for the elbow? is the hand supinated or pronated?
-CR enter mid-elbow jt -CR angled 45 degrees from the shoulder
where does the CR enter and the angle for the Coyle Method to demonstrate the radial head and neck? is the hand supinated or pronated?
-CR enter mid-elbow jt. (radial head) -CR angled 45 degrees towards the shoulder
what is best demonstrated on an AP oblique projection - medial rotation of the elbow?
-coronoid process -distal humerus
describe the part positioning for the Gaynor - Hart Method? (include the rotation also and why it is rotated)
-hyperextend wrist -grasp the fingers with other hand and hyperextend hand -->metacarpals and forearm should be at 90 degrees -->keep wrist and forearm on IR -rotate entire hand and wrist 10 degrees internally --> this is will prevent superimposition of pisiform and hamate
on the PA oblique on the hand is there an overlap of the 2nd and 3rd head of the metacarpals; what positioning error has been made?
-no -overlap of 3rd, 4th and 5th metacarpals
what is best demonstrated on the lateral position of the elbow?
-olecranon process -coronoid process -trochlear notch
what is best demonstrated on an AP oblique projection - lateral rotation of the elbow?
-radial head, neck and tuberosity will be free from superimposition by ulna -distal humerus
what is done positioning to make sure the wrist / hand is in a true lateral for the fan lateral of the hand and of the lateral wrist? looking on a radiograph, how can you make sure it has been done?
-tilt back 3-5 degrees -radius, ulna and metacarpals are superimposed
what two factors determine if the technique is good on all extremities?
-trabecular markings (dark markings) -soft tissue
what two carpals are best demonstrated on a lateral position of the wrist?
-trapezium -scaphoid
where does the CR enter for the Gaynor - Hart Method?
1 inch distal to base of 3rd metacarpal
what is the degree of angle and direction of the CR when positioning for a PA axial scaphoid - ulnar deviation?
10-15 degrees proximal
what is the IR size for all elbow projections?
10x12
where does the CR enter for an AP projection, PA oblique projection, and lateral position of the thumb?
1st MCP Joint
describe how the angle is placed on the part for the PA Scaphoid - Modified Stretcher Method
20 degree angle sponge
what is the CR angle and what direction is used for the Gaynor - Hart Method?
25-30 degrees towards long axis of hand
what is the degree of rotation for a PA oblique projection of the wrist?
45 degrees
which deviation best demonstrates the carpals and carpal inter-spaces on the medial side of the wrist? is the wrist inverted or everted?
PA Projection - Radial Deviation: Wrist
which method demonstrates the scaphoid with no angle on the tube?
PA Scaphoid - Modified Stretcher Method
when positioning for all elbow projections how should the entire arm be?
arm should be same plane as the shoulder
how much of the humerus and ulna/radius should be included in the AP projection and both obliques of the elbow?
at least two inches of the radius/ulna and humerus
why is the wrist and elbow joint only partially open on an AP projection of the forearm?
divergent beam
what is the degree of oblique for a lateral or medial rotation of the elbow?
epicondyles should be 45 degrees to IR
is the hand inverted or everted when positioning for the PA axial scaphoid - ulnar deviation?
everted
what is the degree of oblique on a PA oblique projection of the hand?
hand and wrist rotated 45 degrees
fiberglass cast
increase 3 kV to 4 kV
small to medium plaster cast
increase 5 kV to 7 kV
large plaster cast
increase 8 kV to 10 kV
when positioning for a PA oblique of digits 3-5, which oblique medial or lateral is done? why?
lateral oblique is done to decrease OID
what is the projection for a lateral position of the elbow?
lateromedial projection
what type of projection is done for lateral wrist?
lateromedial projection
why does the patient make a fist for a PA projection of the wrist?
makes a loose fist to decrease OID
where is the marker placed for a fan lateral of the hand?
marker placed in front (anterior)
what nerve may be impinged on causing carpal tunnel syndrome?
medial nerve
when positioning for a PA oblique of the 2nd digit which oblique medial or lateral is done? why?
medial oblique is done to decrease OID
where does the CR enter for the AP, both obliques, and lateral position of the elbow?
mid elbow joint
where does the CR enter for a PA, PA oblique oblique projection, and a lateral position of the wrist?
midcarpal area
where does the CR enter for the AP projection and lateral projection of the forearm?
midforearm
should the phalanges be visible on a radiograph of the wrist?
no - collimate off phalanges
what position is the thumb in on a PA projection of the hand?
oblique
how much forearm needs to be included on the PA, PA oblique projection, and lateral of the hand?
one inch of distal forearm (ulna and radius)
is the hand pronated or supinated on a PA projection of the hand?
pronated
is the hand supinated or pronated for the medial rotation of the elbow?
pronated
is the hand supinated or pronated for the lateral rotation of the elbow?
supinated
is the hand supinated or pronated for the AP projection of the forearm? explain why
supinated to prevent crossing over of radius and ulna
where is the marker placed on a PA and PA oblique projection of the hand?
thumb side (lateral side)
why is it important to make sure the fingers are parallel on the PA oblique and fan lateral of the hand?
to open joint spaces
how much of the ulna and radius must be included on PA, PA oblique and lateral position of the wrist?
two inches of distal ulna and radius
which deviation of the wrist best demonstrates the scaphoid?
ulnar deviation
what is done to ensure the ulna and radius will be superimposed on the lateral position of the forearm?
wrist is rolled back 3-5 degrees
what SID is used on all upper extremities?
40 inches
how much should the elbow be flexed for the lateral position of the forearm?
90 degrees
where does the CR enter for a PA, PA oblique projection, and a lateral of digits (fingers) 2-5?
PIP Joint
where does the CR enter for the PA projection, and PA oblique projection of the hand?
CR enters at 3rd MCP Jt.
how should the entire upper limb be when positioning for the AP projection or lateral position of the forearm?
same plane as the shoulder
what size focal spot is used on all upper extremities?
small focal size
what type of lateral hand is done?
fan lateral
how much of the humerus and metacarpals should be included on an AP projection of the forearm?
-1 inch of humerus -1/3 of metacarpals
when positioning for an AP thumb, oblique or lateral position of the thumb what must be included?
-1st digit -1st metacarpal -trapezium -joints
on all extremities at least 2 views are done. what is the number of degrees between them? what do these two views demonstrate?
-90 degrees -best demonstrates location of foreign objects and dislocations
how are the humeral epicondyles in respect to the IR for an AP projection of the elbow? lateral position of the elbow?
-AP --> humeral condyles are parallel to IR -lateral --> humeral condyles are perpendicular to IR
what does a lateral extension position of the hand best demonstrate?
-localization of foreign body -anterior/posterior displacement of metacarpals
which method best shows the carpal canal?
Gaynor-Hart Method