Bontrager's

Epicondyle (lateral)

Small projection on lateral aspect of distal humerus

radial notch of ulna

Small shallow depression on lateral aspect. Radial head articulates with ulna at radial notch. .

PA- Oblique Medial/Lateral

(SID) 40-in (102 cm) Non grid 55-60 kV 45* foam wedge or step wedge (pt) position 90* with hands testing on (IR) Finger extended 45* w/foam block hands in 45* Oblique lateral (thumb side up) Affected part 45* Oblique & parallel to IR. CR perpendicular to IR directed to PIP joint.

Wrist joint fat stripe

1. Scaphoid- visualized with a PA & Oblique projections. Elongated & convex between radial collateral ligament & adjoining muscle tendons. Lateral to scaphoid- 2. Pronator 1cm (1/4in) from anterior surface of the radius. Obliteration of this fat indicates fracture.

Radius & Ulna parts

1. Styloid processes 2. Ulnar notch 3. Head of ulna 4. Head of the radius 5. Radial tuberosity

MPJ & CMP JOINTS

1.Articulate with phalanges at distsl end. (MCP) JOINTS. 2. Carpometacarpal (CMC) joint.

upper limb bones

1.Hand & wrist- 2. Forearm- 3. Arm- 4. Shoulder girdle

Thumb

1st. Digit Has two phalanges Joint between called interphalangeal joint Joint between first metacarpal & proximal phalanx is the metacarpophalangeal

Distance/(SID)

40-44 In. (192-112cm) When radiographs are taken with the (IR) directly on table top tube height must increase.

Thumb

A radiograph of the thumb must include the distal phalanx to the base of the first metacarpal.

General positioning rule

Always place long axis of party being imaged parallel to long axis of (IR) being exposed.

Elbow rotational movements

Appearance changes as elbow and distal humerus rotate obliquely, medially or laterally. Lateral- separates Medial- superimposes

Coronoid process (medial margin)

Coronoid tubercle

Elbow joint (synovial)

Diarthrodial -ginglymus(hinge) joint Between ulna- humerus- radius. 3 joints enclosed w/n one capsule. Proximal radioulnar joint (pivot-trichodial)

Fat pads, Bands, Stripes

Displacement of is an indicators of disease or serious injury.. Most important are near upper & lower limbs. They are extrasynovial -outside of synovial wall but w/n the joint capsule. Difficult to see add the are similar in density to surrounding shift tissue.

Interphalangeal joints

Distally- all (IP) Joints are Ginglymus (hinge type) & move only in flexion or extension directions. Thumb- 1st digit Fingers-2nd-5th Joints.

Forearm rotational movements

Do not radiograph in pronated PA projection. DO radiograph in anteroposterior AP projection with the hand supinated. Prevents superimposition of radius & ulna.

Wrist joint (parts & articulations)

Ellipsoidal (condyloid) most freely moveable joint. Diarthrodial-synovial Articulates via scaphoid & lunate (radio carpal joint) *Triquetra (opposite articular disk) *Makes up the distal radioulnar joint.

Metacarpal joints

Ellipsoidal- allow movement in-4 directions 1. Flexion 2. Extension 3. Adduction 4. Abduction Also circumduction in cone-like movement. Thumb classified as ellipsoid joint w/limited movement.

Shielding

Gonadal shield placed across (PT) lap top protect gonads.

Hand & Wrist specs

Has 27 bones 1. Phalanges (fingers and thumb) 2. Metacarpals (palm) 3. Carpals (wrist)

Intercarpal joints

Have plane (gliding) joints only.

Fingers (2nd-5th digits)

Have three phalanges with the joints each. 1. Distal interphalangeal (DIP) joint 2. Proximal interphalangeal (PIP) joint 3. Metacarpophalangeal (MCP) joint

trochlear notch of ulna

Large concave depression articulates with distal humerus.

Capitulum of humerus

Little head* Articulates with radial head.

Proximal ulna

Longer of the two bones of the forearm. Two processes of ulna are 1.Olecranon 2. Coronoid processes

Exposure factors (upper limb)

Low-med kvp (55-70 analog, 60-80 digital) Short time Sm (FSS)

2nd group of bones on hand.

Metacarpals (palm)

medial epicondyle of humerus

More prominent than lateral. On medial edge of distal humerus.

Lateral thumb

SID 40 (102cm) Pronated hand Thumb abducted fingers arched Hand rotated medially thumb in true lateral Align long axis thumb to long axis of IR CR perpendicular to IR directed to 1st MCP joint Collimation must include trapezium

PA Oblique Hand

SID 40(102cm) Hand pronate Long axis hand with long axis of IR Hand rotated laterally 45* CR perpendicular to IR directed to 3rd MCP joint.

PA Hand

SID 40(102cm) Pronate hand with Palmar in contact with IR Fingers spread Long axisb of hands & forearm with long axis of IR CR perpendicular to IR directed to 3rd MCP joint

AP Axial (Robert's)

SID 40-(102cm) Arm rotated internally thumb on IR Thumb centered parallel to IR border Extend fingers CR 15* proximally (toward wrist) 1st CMC joint Lewis-CR 10-15* angle proximal to MCP

AP Thumb

SID 40In. (102cm) Supinate thumb Posterior thumb contact with IR Align with long axis of IR Center 1st MCP joint to CR CR perpendicular to 1st MCP joint

PA Oblique Medial Rotation

SID- 40In (102cm) Non grid Abduct thumb w/Palmar in contact with IR-45* Oblique position Align long axis of thumb with long axis of IR Center 1st MCP to CR & center of IR CR perpendicular to MCP joint.

PA - Projection of fingers

SID-40-(102cm) Non grid Detail screen Kv-50-60 Pronate hand with fingers extended Center & align finger with long axis of IR Separate aftereffects affected finger CR- perpendicular to (IR) directed to (PIP) joint. Collimate all sides to distal aspect of metacarpal.

Lateromedial or Mediolateral projection fingers

SID-40In. (102cm) Non grid Kv-55-60+ Part position Lateral (thumb up) Align to long axis of IR & to CR Long axis parallel to IR CR perpendicular to IR directed to PIP joint.

Carpometacarpal joints

Saddle joint Movement- Flexion Extension Abduction Abduction Circumduction Opposition Some rotation 2nd-5th CMC are plane gliding joints Limited movement-synovial fluid

Elbow -lateral view

Shows- head-neck of radius & radial tuberosity & trochlear notch (semilunar)

Distal humerus depressions

1. Anterior depressions- A. coronoid fossa B radial fossa 2. Posterior depressions- A. Olecranon fossa

Elbow Joint fat pad

1. Anterior fat pad -seen on lateral projections. Formed by superimposed coronoid and radial pads. Teardrop shaped. 2. Posterior fat pad -deep within olecranon fossa not visible on negative exam. Seen with 90* flexed lat elbow 3. Supinator fast stripe -a long thin stripe anterior to proximal radius. (Indicates fracture of radial head or neck fractures)

Distal humerus (parts)

1. Body 2. Humeral condyle 3. Trochlea 4. Capitulum

Phalanges parts

1. Distal (rounded head) 2. Middle (shaft) 3. Proximal (base)

Phalanges (Finger and Thumb digits)

1. Finger- has three phalanges Thumb has two. Finger phalanges have 3 bones. Thumb have 2 bones.

Metacarpal articulate with specific carpals

1. First MC with trapezium 2. Second MC with trapezium 3. Third MC with capitate 4. Fourth & 5th MC with hamate

PA Stress Thumb

SID 40 Hands side by +_ 45* oblique position Wrap bands around distal thumbs Before exposure ask PT to pull thumbs apart CR perpendicular to IR to midway between MCP joints.

True lateral elbow

Evaluated at 90* which shows 3 concentric arcs-1. Trochlear sulcus 2. Capitulum (am 2x lined) 3. Trochlear notch of ulna These are ONLY seen with TRUE lateral.

Second group upper limb bones

Forearm-Radius & Ulna

Radial deviation

PA projection demonstrates carpals on ulnar side- the Hamate.. Pisiform.. Triquetrum & Lunate

Centering

Part parallel to (IR) plane. CR 90* or perpendicular to part & (IR) CR directed to centering point

Distal bones of hand

Phalanges (fingers & thumb)

Trochela (articulates with ulna)

Pulley/spool. Rimlike outer margins smooth depressed center. (trochlear sulcus)

Seven wrist ligaments

Ulnar collateral Radial collateral Dorsal radiocarpal Palmer radiocarpal Triangular fibrocartilage complex (TFCC) Scapholunate Lunotriquetral

Wrist ligaments

Ulnar collateral ligament *Attached to styloid process of ulna Radial collateral ligament *Attached to trapezium extends from styloid process

Wrist movement

Ulnar deviation scaphoid projection. Wrist OPENS up demonstrating carpals on opposite side radial-lateral side. Known as (special scaphoid projection)

Anterior/Posterior fast pads

Useful in diagnosing work there lateral elbow Must be in 90* flex position In true lateral position Optimum exposure techniques for study tissue detail.