Chapter 13
Fig. 13 - 94 Scapula postion for AP projection, patient upright
AP: Arm abducted so humerus is perpendicular to long axis of body. Elbow flexed 90º
Fig. 13 - 56 Elbow position for the AP projection
AP: Arm fully extended w/hand supinated and posterior surface in contact w/IR. Coronal plane of humeral epicondyle parallel to IR.
Fig. 13 - 52 Forearm position for AP projection
AP: Arm fully extended w/hand supinated and posterior w/coronal plane or arm parallel to IR. A small sandbag in palm of hand can aid in maintaining position
Fig. 13 - 68 Humerus position for AP projection patient upright
AP: Arm slightly abducted w/palm of hand supinated. Coronal plane of humeral epicondyles parallel or IR
Fig. 13 - 44 Wrist position AP oblique projection
AP: Posteomedial surface of wrist is in contact w/IR so that coronal plane forms a 45º w/IR CR: Perpendicular to midcarpal area Collimation: 2.5 in (6 cm) proximal and distal to the wrist joint and 1 in (2.5 cm) on the sides Structures seen: Distral radius and ulna, carpal bones, and proximal halves of metacarpals
Fig. 13 - 59 Elbow lateral (lateromedial) projection
Elbow lateral (lateromedial) projection
Fig. 13 - 78 Shoulder AP projection-external (arm) rotation
Shoulder AP projection-external(arm) rotation
Fig. 13 - 79 Shoulder AP projection-internal (arm) rotation
Shoulder AP projection-internal (arm) rotation
Bone infection may be caused by a number of different bacteria including:
Staphylococcus, Mycobacterium tuberculosis
Fig. 13 - 14 Hand position for PA oblique projection-lateral rotation, using stair-step sponge
PA oblique: Hand is rotated laterally to place the anteromedial aspect in contact w/IR. Coronal plane of hand forms 45º angle w/IR. Stair-step sponge to support and maintain position so IP joints are clearly visualized. Central ray: PA oblique: Perpendicular to 3rd MCP (metacarpophalangeal)joint.
The thumb has only ___ phalanges with ____ IP joint
2, 1
The proximal end of a metacarpal is called its:
Base
The greatest degree of movement of the wrist is:
Anterior (flexion), followed by (posterior) extension, ulnar deviation, and radial deviation.
As a whole the wrist is capable of all joint motions, except rotation. It moves in four directions:
Anterior, posterior, medial, and lateral
Common fractures are:
Boxer's fracture, Colles fracture, Monteggia fracture, Radial fracture, and Scaphoid fracture
The inferior lip of the semiulnar notch is called:
Coronoid process
Fig. 13 - 90 Clavicle PA projection
Clavicle PA projection
Glenohumeral joint
Dislocation of the shoulder and maybe displaced from the glenoid fossa either by anteriorly or posteriorly.
Fig. 13 - 30 Thumb position for AP projection
Dorsal surface of thumb is in contact w/IR. Coronal plane of thumb is parallel to IR. Plane of palm of hand is perpendicular to IR.
Fig. 13 - 57 Elbow AP projection
Elbow AP projection
Fig. 13 - 74 Shoulder position for AP projection-external (arm) rotation patient upright
External rotation: Arm slightly abducted w/palm supinated. Arm adjusted to place coronal plane of humeral epicondyles parallel to IR
Fig. 13 - 53 Forearm AP projection with healing fracture of the ulnar shaft (arrow)
Forearm AP projection with healing fracture of the ulnar shaft (arrow)
Fig. 13 - 55 Forearm lateral projection with healing fracture of the ulnar shaft (arrow)
Forearm lateral projection with healing fracture of the ulnar shaft (arrow)
The distal end of a metacarpal is called its:
Head
Clavicle Routine Examination includes the upright PA and PA axial projections, or recumbent AP and AP axial projections. Examination of the clavicle is routinely done in the PA and PA axial projections to keep the clavicle as close to the IR as possible. But is pt is recumbent a supine position is more comfortable when clavicle has been injured. Under these circumstances, AP and AP axial projections are performed.
IR: 10 x 12 in ( 24 x 30 cm) crosswise Grid: Yes SID: 40 in Body position: Standing or seated facing Bucky with coronal plane parallel to IR. Head turned away from side of interest. Arm at side CR: PA or AP perpendicular to midclavicle PA axial: 15º to 30 º caudad to midclavicle Collimation: Adjust to 8 x 12 in (18 x 30 cm) on collimator Pt. instructions: Stop breathing, don't move Structures Seen: Entire clavicle and articulations
Shoulder Routine Examination includes AP projections w/both internal and external humerus rotation. Examination of the shoulder requires rotation of the humerus and is possible for mild or chronic complaints and it is desirable to examine the shoulder girdle, and the routine study should include the: scapula, clavicle, and proximal humerus. Structures Seen: Entire clavicle and scapula and proximal third humerus.
IR: 10 x 12 in ( 24 x 30 cm) diagonal 14 x 17 in (35 x 43 cm) crosswise Grid: Yes SID: 40 in Body position: Standing or seated w/back to upright Bucky or grid cabinet or supine on table; coronal plane of body parallel to IR CR: Perpendicular to a point 1 in inferior to coracoid process Collimation: Adjust to 10 x 12 in (24 x 30 cm) on the collimator
Forearm Routine Examination includes the AP and lateral projections and is usually ordered when the area of clinical interest is in the shaft of the radius and or the ulna.
IR: 10 x 12 in ( 24 x 30 cm) diagonal 14 x 17 in (35 x 43 cm) lengthwise Grid: none SID: 40 in Body position: Seated at end of table w/axilla (armpit) at table level.
Scapula Routine Examination includes the AP and lateral projections
IR: 10 x 12 in ( 24 x 30 cm) lengthwise Grid: Yes SID: 40 in Body position: Standing or seating at Bucky or grid cabinet, or recumbent on table. CR: Perpendicular to midscapula Collimation: Adjust 10 x 12 in (24 x 30 cm) on collimator Pt. instructions: Stop breathing, don't move Structures Seen: Entire scapula and articulations w/clavicle and humerus. AP demonstrates portions of scapula not obscured by ribs and clavicle.
Acromioclavicular Joints Routine Examination includes bilateral AP projections both w/and w/o weights. The purpose is to determine ligament integrity by demonstrating change in relative positions of the acromion and clavicle when under stress.
IR: 14 x 17 in ( 35 x 43 cm) crosswise or two 10 x 12 in (24 x 30) cm lengthwise-one for each shoulder Grid: none SID: 40 in Body position: Standing w/back to IR(s)
Hand Routine Examination includes the PA, PA oblique-lateral rotation and lateral projections. Structures seen: entire hand (including fingertips), carpus and most distal aspects of radius and ulna.
IR: 8 x 10 (18 x 24 cm) or 10 x 12 in (24 x 30 cm) Grid: none SID: 40 in Body position: Seated @ end @ table w/elbow flexed @ 90º and arm fully extended. Part position: PA: hand open, fingers extended, w/palmar surface in contact w/IR, fingers moderately separatedCollimation: 1 in (2.5 cm) on all sides of hand, including 1 in (2.5 cm) proximal to the ulnar styloid Pt. Instructions: Don't move
Elbow Routine Examination positions are at the same for the forearm. B/c its often impossible for pets w/an injured elbow to fully extend the elbow joint, alternatives are presented for the AP projection w/the elbow partially flexed. The routine examination of the elbow includes the AP and lateral projections. Structures Seen: elbow joint w/portions of distal humerus and proximal forearm
IR: 8 x 10 (18 x 24 cm) or 10 x 12 in (24 x 30 cm) lengthwise Grid: none SID: 40 in Body position: Seated @ end @ table w/axilla at level of table w/arm fully extended w/hand supinated and posterior w/coronal plane or arm parallel to IR. Collimation: 3 in (8cm) proximal and distal to the elbow joint and 1 in (2.5 cm) on the sides
Finger Routine Examination includes the PA, PA oblique-lateral rotation, lateral projections and although the fingers are included in the examination of the hand, separate finger studies are often performed when the area of clinical interest is limited specific finger
IR: 8 x 10 in (18 x 24 cm) lengthwise Grid: none SID: 40 in min Body position: Seated @ end of table w/elbow flexed & arm resting on table CR: Perpendicular to proximal IP joint Collimation: 1 in (2.5 cm) on all sides of the digit, including 1 in (2.5 cm) proximal to the MCP joint. Structures seen: Entire digit & distal position of metacarpal w/IR and MCP joint spaces open and clearly visualized.
Thumb Routine Examination includes the AP, PA oblique, and lateral projections and the examination of the thumb must include the 1st metacarpal rather than only a portion of it:
IR: 8 x 10 in (18 x 24 cm) lengthwise Grid: none SID: 40 in min CR: AP: Body position: Seated @ end of table leaning forward, arm abducted 90º w/forearm rotated internally into exaggerated degree of pronation PA oblique & lateral: Seated @ end of table w/elbow flexed 90º, arm fully support and palm resting on the IR
Wrist Routine Examination includes the PA, PA oblique-lateral rotation and lateral projections. The wrist is a complex structure w/many bones and joints. Structures seen: Distal portion of radius and ulna, carpal bones, and proximal halves of metacarpals
IR: 8 x 10 in (18 x 24 cm) lengthwise Grid: none SID: 40 in min CR: Perpendicular to the mid carpal area Body position: Seated @ end of w/elbow flexed 90º and forearm resting on table. Collimation: 2.5 in (6 cm) proximal and distal to the wrist joint and 1 in (2.5 cm) on the sides
Humerus Routine Examination w/pt upright includes AP and lateral projections. The humerus may be radiographed w/pt either upright or supine, depending on pt condition. The thickness of the shoulder joint usually indicates that this study be done using a Bucky or grid. For relatively small pts, however, a grid is not necessarily required.
IR:14 x 17 in (35 x 43 cm) lengthwise Grid: Yes SID: 40 in Body position: Seated or standing w/back to upright Bucky or grid cabinet. Body position, whether oblique or facing toward or away from the IR is not critical as long as the epicondyles are oriented appropriately for the projection CR: Perpendicular to midhumerus Collimation: 2 in (5 cm) distal to the elbow joint and superior to the shoulder and 1 in (2.5 cm) on the sides
Fig. 13 - 75 Shoulder position AP projection-internal (arm) rotation, patient upright
Internal rotation: Humerus and arm rotated internally until back of hand is against thigh. Arm adjusted to place coronal plane of humeral epicondyles perpendicular to IR
The hinge joints that connect the phalanges are called the____ ____ and are distinguished as proximal and distal:
Interphalangeal (IP) joints
Joint effusion
It is the increased fluid in the joint capsule that occurs due to a fracture at the elbow
Fig. 13 -34 Thumb position for lateral projection
Lateral: Beginning w/hand positioned for PA oblique thumb, pt. flexes MCP joints 2 - 5 w/the fingers extended, "tenting" hand until thumb is in lateral position
Fig. 13 - 58 Elbow position for lateral (lateromedial) projection
Lateral: Elbow flexed 90º w/medial surface in contact w/IR. Coronal plane of humeral epicondyles perpendicular to IR. Wrist is in lateral position to degree pt can achieve
Fig. 13 - 69 Humerus position for lateral projection patient upright
Lateral: Elbow flexed ~ 45º and palm of hand against hip so that fingertips point down and elbow is lateral w/coronal plane of humeral epicondyles perpendicular to IR
Fig. 13 - 54 Forearm position for lateral projection
Lateral: Elbow is flexed 90º w/medial surface in contact w/IR. Wrist is in lateral position
Fig. 13 - 42 Wrist position for lateral projection
Lateral: Medial surface of wrist is in contact w/IR. Coronal plane wrist is perpendicular to IR.
Fig. 13 - 18 A. Hand ulnar lateral position finger in extenstin Fig. 13 - 18 B. Hand ulnar lateral position fingers fanned
Medial aspect hand is in contact w/IR w/coronal plane of hand perpendicular to IR. Thumb is positioned as for PA projection and is supported on a radiolucent sponge. Wrist will be slightly pronated. Finger may be separated (fanned out) so as not to be superimposed, if desired. Lateral: Perpendicular to 2nd MCP joint
The hinge joints b/w the metacarpals and the proximal phalanges are called the:
Metacarpophalangeal (MCP) joints
Fig. 13. 23 Finger position for PA oblique projection-lateral rotation
PA oblique: Hand rotated lateral to place the anteromedial (palmar/ulnar) surface in contact w/IR. Coronal plane of fingers @ 45º angle to IR. Fingers supported by stair-step sponge.
Fig. 13 - 32 Thumb position for PA oblique projection
PA oblique: Palmar surface of hand is in contact w/IR as for PA projection of hand. Coronal plane of thumb will be 45º to plane of IR.
Fig. 13 - 40 Wrist Position for PA oblique projection lateral
PA oblique: anteromedial surface of wrist is in contact w/IR so that coronal plane of wrist forms a 45º angle w/IR. Position may be supported by wedge sponge, or pt's thumb.
Fig. 13 - 38 Wrist position for PA projection
PA: Anterior surface of wrist is in contact w/IR. Fingers are flexed to form a loose fist, placing wrist in firmer contact w/IR and opening intercarpal joints.
Fig. 13-21 Finger position for PA projection
PA: Hand open w/palmar surface in contact w/IR. Finger moderately separated
Fig. 13 -12 Hand position for PA projection
PA: Hand open, fingers extended w/palmar surface in contact w/IR, fingers moderately separated Central ray: Perpendicular to 3rd MCP (metacarpophalangeal)joint.
Fig. 13 - 50 Wrist position for tangential projection of carpal canal (Gaynor-Hart method)
Part position: Arm extended and parallel to long axis of table for correct alignment w/angled x-ray beam. Wrist extended as much as possible w/palm of hand paced perpendicular to IR
Fig. 13 - 48 Wrist position for PA axial projection
Part position: Arm is extended and parallel to long axis of table for correct alignment w/angled x-ray beam. 1 end of the IR is elevated so the plane of the IR is 20º w/respect to tabletop. Wrist positioned w/anterior aspect on IR as for PA wrist, w/finger oriented to the elevated end of the IR
Fig. 13 - 46 PA projection-ulnar deviation
Part position: Same as for PA wrist w/fingers extended. Hand in then deviated outward in the direction of ulna to the extent that pt. can tolerate
Located toward the proximal end on the shaft of the radius; small prominence that is a point of attachment for tendons of the bicep muscle.
Radial tuberosity
Forearm consist of two long bones:
Radius and ulna
The proximal end of the radius is referred to as:
Radius head
Tangential projection (Gaynor-Hart Method) is used to demonstrate the carpal canal usually in pts w/symptoms of carpal tunnel syndrome of suspected fracture.
Structures Seen: Carpal canal-anterior arch of carpal bones, including portions of the scaphoid, trapezium, pisiform, and hood hamate
Large distal projection on lateral side of radius:
Styloid
Fig. 13-19 A. Hand lateral (lateromedial) projection
Superimposition of 2nd - 5th metacarpals. Superimposition of 2nd - 5th phalanges (extension) or phalanges individually demonstrated
Supplemental projection AP oblique projection-medial rotation:
The AP oblique projection w/medial rotation is useful for demonstration of the medial aspect of the carpus, particularly the lunate and the pisiform.
Fig. 13 - 31 Thumb AP projection
Thumb AP projection
Fig. 13 - 33 Thumb PA oblique projection
Thumb PA oblique projection
Fig. 13 - 19 B. Hand lateral (lateromedial) projection fingers fanned
Thumb is seen in PA projection
Fig. 13 - 35 Thumb lateral projection
Thumb lateral projection
Fig. 13 - 95 Scapula position for lateral projection (anterior oblique position) forearm behind back, patient upright
Upright lateral: Anterior oblique body position w/affected side nearest IR. Adjust rotation of body (45 to 60º) so that blade (body) scapula is perpendicular to IR.
Fig. 13- 88 Clavicle position for PA projection, patient upright
Upright: Standing or seated facing Bucky with coronal plane parallel to IR. Head turned away from side of interest. Arm at side
Fig. 13 - 45 Wrist AP oblique projection
Wrist AP oblique projection
Fig. 13 - 49 Wrist PA axial projection
Wrist PA axial projection (Stretcher method)
Fig. 13 -39 Wrist PA projection
Wrist PA projection
Fig. 13 - 47 Wrist PA projection ulnar deviation
Wrist PA projection-ulnar deviation
Fig. 13 - 43 Wrist lateral projection
Wrist lateral (lateromedial) projection
Fig. 13 - 51 Wrist tangential (inferosuperior) projection
Wrist tangential (inferosuperior) projection
Scaphoid fracture
carpal bone injury often caused by a fall on an outstretched arm and when they are new these fractures may be occult (very subtle) of completely invisible on a radiograph
The upper limb, also called the upper extremity includes the:
fingers, thumb, hand, wrist, forearm, elbow, humerus, and shoulder girdle
Boxer's fracture:
fracture of the 5th metacarpal usually caused when the pt strikes a solid object w/a closed fist
Colles fracture:
fracture of the distal radius, accompanied by posterior or medial displacement
Radial fracture
fracture of the elbow that is a result of a fall on an outstretched arm
Monteggia fracture
fracture of the ulna and dislocation of the radial head