Chapter 4: Upper Limb
Humeral Condyle: Capitulum
"Little Head" located on the lateral aspect and articulates with the head of the radius. memory aid: capitulum with the head of the radius
Scaphoid
"Thumb side" Boat like shaped bone Largest bone in the proximal row Articulates with the radius proximally Most frequent fractures carpel bone
Carpal Sulcus (Canal), or Tangential Projection tangential=passes through
-Demonstrates Carpal Sulcus formed by the concave anterior or palmer aspect of the carpals The anteriorly located pisiform and Hamulus process of the hamate are visualized best on this view This concave are, or groove is where major nervous and tendons pass
Lateromedial Projection: Forearm 40" SID on tabletop 14x17 IR portrait 60 kVp @ 4.0 mAs Gonadal Shielding + have patient look away Clinical Indications: -fractures & dislocations of radius or ulna -pathologic processes such as osteomyelitis or arthritis
-Elbow flexed 90° -rotate hand and wrist into true lateral -CR to midforearm
Lateromedial Projection: Elbow
-Elbow flexed 90° -rotate hand and wrist into true lateral position, thumb side up -Humerus and forearm parallel to IR -Three concentric arcs visible -Olecranon process in profile CR=directed to mid-elbow joint
Alternate AP-Partial Flexion: Elbow *when elbow can't fully extend
-Obtain TWO projections: one with forearm parallel to IR and one with humerus parallel to IR -CR perpendicular to mid-elbow joint, which is 2cm distal to midpoint of a line between epicondyles
PA Scaphoid-Hand Elevated and Ulnar Deviation: Wrist (Special) Modified Stecher Method 40" SID 10x12 IR portrait sit at end of table Clinical Indications: -possible fractures of scaphoid RULE OUT POSSIBLE WRIST TRAUMA FIRST
-Place hand and wrist palm down on IR with hand elevated on 20 degree angle sponge -ensure that wrist is in direct contact with IR - turn hand toward ulna/pinky unless contraindicated due to severe injury CR= perpendicular to IR; directed to scaphoid
PA Radial Deviation: Wrist (Special) 40" SID 10x12 IR portrait seated at table Clinical Indications: possible fractures of carpal bones on ulnar side, especially the lunate, triquetrum, pisiform, & hamate
-Position wrist as for PA projection-palm down with wrist and hand aligned with center of long axis of IR -without moving forearm, gently move the hand medially toward the thumb/radius side CR= perpendicular to IR; directed to midcarpal area
Special: PA Axial Scaphoid (CR Angle) with Ulnar Deviation Wrist 40" SID 10x12 IR portrait sit at end of table Clinical Indications: -possible fractures of scaphoid RULE OUT POSSIBLE WRIST TRAUMA FIRST
-Position wrist as for a PA projection-palm down and hand and wrist aligned with center of long axis of IR, with scaphoid centered to CR -without moving forearm, gently evert hand (move toward ulnar side) as far as patient can tolerate w/out lifting or rotating distal forearm CR: -Angle CR 10-15 degrees proximally, along long axis of forearm and toward elbow -center CR to scaphoid (thumb side)
Carpal Canal-Tangential: Wrist (Special) Gaynor-Hart Method used for carpal tunnel
-align hand and wrist parallel with long axis of IR -Ask patient to hyperextend (dorsiflex) as far as possible -use tape until long axis of metacarpals and fingers are near vertical (90 degrees to forearm) without lifting wrist and forearm from IR -rotate entire hand and wrist about 10 degrees internally (toward radial side) to prevent superimposition of pisiform and hamate CR= Angle CR 25-30 degree to long axis of the hand; direct CR to a point 2 to 3 cm distal to the base of the third metacarpal
AP Projection: Elbow (elbow fully extended)
-extend elbow, supinate hand, and align arm and forearm parallel with long axis of IR -have patient lean laterally if necessary for true AP projection -Epicondyles parallel to IR CR to mid-elbow joint= 2cm distal to midpoint of a line between epicondyles
AP Oblique-Medial (internal) Rotation: Elbow best visualizes coronoid process of ulna and trochlea in profile
-pronate hand into natural palm-down position and rotate arm internally/medially 45 degrees to the IR so that the distal humerus and the anterior surface of the elbow joint are rotated 45 degrees CR= perpendicular to IR; directed to mid-elbow joint, which is 2cm distal to midpoint of a line between epicondyles
Trauma Terminology: Fracture (fx)
-simple fracture (fx)=closed -compound fracture (fx)= open; breaks through skin -comminuted fracture (fx)= splintered or crushed -impacted fracture (fx)= fragments driven into each other
AP Oblique-Lateral (external) Rotation: Elbow best visualizes radial head and neck of the radius and capitulum and humerus
-supinate hand and rotate laterally/external the entire arm 45 degrees to IR so that the distal humerus and the anterior surface of the elbow joint are rotated 45 degrees CR= perpendicular to IR; directed to mid-elbow joint, which is 2cm distal to midpoint of a line between epicondyles
What do the five metacarpals (MCs) articulate with in terms of specific carpels
1) First MC with trapezium 2) Second MC with trapezoid 3) third MC with capitate 4) fourth MC with hamate 5) fifth MC with hamate
What are the 4 main groups of the upper limb?
1) Hand and Wrist 2) Forearm 3) Arm (Humerus) 4) Shoulder Girdle
Routine Hand Exam
1. PA 2. PA oblique 3. Lateral
Routine Fingers Exam
1. PA 2. PA Oblique 3. Lateral
How many bones are in each hand and what are the 3 main groups that divided the hands up?
27 total 1) Phalanges (fingers and thumb)=14 bones 2) Metacarpals (palm)=5 bones 3) Carpels (wrist)=8 bones
Carpal Tunnel Syndrome
A common painful disorder of the wrist and hand that results from compression of the median nerve as it passes through the center of the wrist Seen on PA & lateral wrist; Gaynor-Hart method
What hand position is used for rhematoid arthritis?
AP Oblique Bilateral Projection: Hand "Nogaard Method"
Distal Humerus anterior & posterior depressions
Anterior depressions: 1) Coronoid Fossa 2) Radial Fossa Posterior depression: 1. Olecranon fossa
True Lateral Elbow
Appearance should have 3 concentric arcs: 1. trochlear sulcus - first and smallest 2. capitulum and trochlea - 2nd - outer ridges/rounded edges 3. trochlear notch of the ulna. Arcs will appear symmetrically aligned when pure 90°
Olecranon fossa
Area of deep posterior depression of the distal humerus the olecranon process of the ulna fits into this depression
Carpometacarpal (CMC) joints
At the proximal end, the metacarpals articulate with the respective carpels
AP, Lateral Rotation
Causes separation of the ulnar and radius
Humeral Condyle
Connected to the body of the Humerus on the distal end Expanded distal end of the Humerus Articular portion of the Humeral Condyle is divided into the: 1. Trochlea (medial condyle) 2. Capitulum (lateral condyle)
Distal row (furthest from the wrist) of the carpal bones from lateral/radial to medial/ulnar side
Consists of 1) trapezium= under thumb 2) trapezoid= inside (surrounded by 4 other bones) 3) capitate=largest 4) hamate=hook like process
Phalanges
Consists of 14 bones Each finger and thumb is called a digit and consists of 2, or 3 bones. Digits are numbered 1-5 with the thumb being the first The four fingers consist of 3 bones (proximal, middle, and distal) The thumb consists of two bones (proximal, distal)
Metacarpals (palm)
Consists of 5 bones Numbered the same way the phalanges are Composed of 3 parts 1) head: rounded portion 2) shaft: body is the long curved portion 3) base: expanded proximal end
Carpals (wrist)
Consists of 8 bones Third group of bones of the hand and wrist Can be divided into 2 rows of 4 bones each
Proximal Ulna
Consists of: Olecranon & coronoid processes: which are the two beak like structures and can be easily palpated on the posteriori aspect of the elbow joint (A & C) Trochlear notch: Large concave depression, or notch that articulates with the distal Humerus (D) Radial notch: The small shallow depression located on the lateral aspect of the proximal ulna (B)
Proximal row (closest to wrist) of bones of the carpals from lateral/ radial to medial/ ulnar side
Consists of: 1) Scaphoid 2) Lunate 3) triquetrum 4) pisiform
Barton's fracture
Fracture and dislocation of the posterior lip of the distal radius involving the wrist joint
Bennett's fracture
Fracture of the base of the first metacarpal bone, extending into the carpometacarpal joint, complicated by subluxation with some posterior displacement
Capitate
Identified by its large rounded head that fits proximally into a concavity formed by the scaphoid and lunate bones
Thumb Joints
Interphalangeal (IP) joint: joint between the only two phalanges First metacarpophalangeal (MCP) joint: joint between the first metacarpal and the proximal phalanx
Osteoarthritis (DJD)
Known as also degenerative joint disease (DJD) a non inflammatory joint disease characterized by gradual deterioration of the articular cartilage with hypertrophic (enlarged/overgrown) bone formation. most common type of arthritis
Hamate
Last carpal in the distal row Is easily distinguishable by the hook-like process called the Hamulus, or Hamular process, which projects from its palmar surfaces
Alternative to "fan" lateral: extension lateral and flexion lateral 40" SID on tabletop 10x12 IR portrait 60 kVp @ 3.0 mAs Gonadal Shielding + have patient look away
Lateral in extension: extend fingers and thumb, ensure all fingers and metacarpals are superimposed directly for true lateral position lateral in flexion: flex fingers into a natural flexed position, with thumb lightly touching CR: perpendicular to IR; directed to 2nd-5th MCP joints Exposure Factor: midphalanges & distal phalanges superimposed and extended Collimation: 4 sided collimation to outer margins of hand and wrist 1 inch of distal forearm included
Elbow rotational movements
Lateral rotation= separates radius and ulna medial rotation= superimposes radius and ulna
Styloid processes
Located at the extreme distal ends of the radius and ulna Radial styloid process can be palpated ln the thumb side of the wrist joint radial styloid process extends more distally than the ulnar styloid process
Head of the Radius
Located at the proximal end of the radius, near the elbow joint.
Lunate
Moon shaped, second carpal in the proximal row Articulates with the radius Distinguished by the deep cavity on its distal surface, where it articulates with the capitate of the distal row of carpals(best seen on anterior view)
Having your hand prone against the IR for finger x-rays does what to the joints?
Opens joints up
PA Oblique W/ Medial Rotation: Thumb 40" SID on tabletop 8x10 IR portrait 60 kVp @ 0.6 mAs Gonadal Shielding + have patient look away
Part Position: - Abduct thumb slightly with palmar surface of hand in contact with IR (naturally puts hand in 45 degree OB) -align thumb parallel with long axis of IR CR = Perpendicular to IR; centered at first MCP joint Collimation: 4 sided collimation to area of thumb including entire first metacarpal and trapezium
Lateral: Thumb (Routine) SID=40" on tabletop IR=8/10 kVp=60 mAs= 0.6 Gonadal Shielding + have patient look away
Part Position: - start with hand pronated and thumb abducted, with fingers and hand slightly arched; then rotate hand slightly medial until thumb is in true lateral position -align thumb parallel with long axis of IR CR = Perpendicular to IR; centered at first MCP joint Exposure Factor: SHARP BONY TRABECULAR MARKINGS Collimation: 4 sided collimation to area of thumb including entire first metacarpal and trapezium
AP Projection: Thumb 40" SID on tabletop 8x10 IR portrait 60 kVp @ 0.6 mAs Gonadal Shielding + have patient look away Clinical Indications: -Fractures & dislocations of the distal, middle, and proximal phalanges; distal metacarpal & associated joints. -Pathologic processes such as osteoporosis & osteoarthritis See special AP modified Robert's projection for Bennett's fracture at base of 1st metacarpal.
Part Position: awkward - internally rotate hand with fingers extended until posterior surface of thumb (finger nail) is in contact with IR -align thumb with long axis of IR so it is parallel CR = Perpendicular to IR; centered at first MCP joint Collimation: 4 sided collimation to area of thumb including entire first metacarpal and trapezium
PA Projection: Wrist 40" SID on tabletop 10x12 portrait 60 kVp @ 2.0 mAs Gonadal Shielding + have patient look away
Patient Position - Seat Patient at end of table with hand and forearm extended, drop shoulder so that shoulder elbow, and wrist are on same horizontal plane Part Position - Align and center along axis of hand and wrist to IR, with carpal area centered to CR - With hand pronated (AP projection) , arch hand slightly to place wrist and carpal area in close contact with IR CR = directed to midcarpal area
PA Projection: Fingers 40" SID on tabletop 8x10 IR portrait 60 kVp @ 0.6 mAs Gonadal Shielding + have patient look away Clinical Indications: Fractures & dislocations of the distal, middle, and proximal phalanges; distal metacarpal & associated joints. -Pathologic processes such as osteoporosis & osteoarthritis
Patient Position: - Patient is at the end of the table with elbow flex about 90 degrees with hand and forearm resting on the table Part Position: - Pronate hand with fingers extended - Center and along long axis of affected finger with long axis of IR - Separate adjoining fingers from affected finger CR: Perpendicular to IR; Centered at PIP joint Collimation: 4 sided collimation to area of affected finger & distal aspect of metacarpal
PA Oblique Projection: Fingers (Routine Position) *medial rotation=2nd digit *lateral rotation=digit 3-5 40" SID on tabletop 8x10 IR 60 kVp @ 0.6 mAs Gonadal Shielding + have patient look away Clinical Indications: -Fractures & dislocations of the distal, middle, and proximal phalanges; distal metacarpal & associated joints. -Pathologic processes such as osteoporosis & osteoarthritis
Patient Position: - Patient is at the end of the table with elbow flex about 90 degrees with hand and wrist resting on IR and fingers extended Part Position: -fingers extended against 45 degree wedge with thumb up -hand on IR so long axis of finger is aligned/parallel with long axis of IR 2nd digit=internally/medial rotate (towards midline/thumb) 3,4,5 digits= externally/lateral rotate (toward pinky) CR: perpendicular to IR; Centered at PIP joint Collimation: 4 sided collimation to area of affected finger & distal aspect of metacarpal
Lateral Projection: Finger 2nd digit= medial lateral projection 3rd-5th digit= lateromedial projection 40" SID on tabletop 8x10 IR portrait 60 kVp @ 0.6 mAs Gonadal Shielding + have patient look away Clinical Indications: -Fractures & dislocations of the distal, middle, and proximal phalanges; distal metacarpal & associated joints. -Pathologic processes such as osteoporosis & osteoarthritis
Patient Position: - Seat Patient at end of table with elbow flexed about 90 degrees with hand and wrist resting on IR and fingers extended Part Position: - Place hand in lateral position (thumb side up for digits 3-5) with finger to be examined fully extended and centered to portion of IR being exposed - Align & center finger to long axis of IR and to CR so parallel - Use sponge block or other radiolucent device to support finger and prevent motion. Flex unaffected fingers CR = Perpendicular to IR & centered directed to PIP joint Collimation: 4 sided collimation to area of affected finger & distal aspect of metacarpal
Lateral (Lateromedial Projection): Wrist 40" SID on tabletop 10x12 portrait 60 kVp @ 4.0 mAs Gonadal Shielding + have patient look away
Patient Position: - Seat Patient at end of table, with arm and forearm resting on the table. Place wrist and hand on IR in thumb-up lateral position. Shoulder, elbow, and wrist should be on same horizontal plane Part Position: - Align and center hand and wrist to long axis of IR - Adjust hand and wrist into a true lateral position, with fingers comfortably extended. CR= Perpendicular to IR; directed to midcarpal area
"Fan" Lateral - Lateromedial Projection: Hand 40" SID on tabletop 10x12 IR portrait 60 kVp @ 3.0 mAs Gonadal Shielding + have patient look away
Patient Position: - Seat patient at end of table with hand and forearm extended Part Position: - Align long axis of hand parallel with long axis of IR - Rotate hand and wrist into lateral position with thumb side up - Spread fingers and thumb into a "fan", or "okay" position, and support each digit on radiolucent block as shown. Ensure that all digits including the thumb, are separate and parallel to IR and that metacarpals are not rotate, but remain in a true lateral position .CR = Perpendicular to IR, directed at SECOND MCP joint Exposure Factor: midphalanges & distal phalanges should appear sharp, but may be slightly overexposed Collimation: 4 sided collimation to outer margins of hand and wrist 1 inch of distal forearm included
PA Projection: Hand 40" SID on tabletop 10x12 IR portrait 60 kVp @ 1.8 mAs Gonadal Shielding + have patient look away
Patient Position: - Seat patient at end of table with hand and forearm extended Part Position: - Pronate hand with palmar surface in contact with IR; spread fingers slightly - Align long axis of hand and forearm parallel with long axis of IR - Center hand & wrist to IR CR = Perpendicular to IR; directed to THIRD MCP joint Collimation: 4 sided collimation to outer margins of hand and wrist 1 inch of distal forearm included
PA Oblique Projection: Hand 40" SID on tabletop 10x12 IR portrait 60 kVp @ 1.8 mAs Gonadal Shielding + have patient look away
Patient Position: -Seat patient at end of table with hand and forearm extended Part Position: - Pronate hand on IR; center and align long axis of hand with long axis of IR - Rotate entire hand and wrist laterally 45 degrees and support with radiolucent wedge or step block, as shown, so that all digits are separated and parallel to IR CR = Perpendicular to IR, directed to THIRD MCP joint Collimation: 4 sided collimation to outer margins of hand and wrist 1 inch of distal forearm included
AP Projection: Forearm 40" SID on tabletop 14x17 IR 60 kVp @ 1.8 mAs Gonadal Shielding + have patient look away Clinical Indications: -fractures & dislocations of radius or ulna -pathologic processes such as osteomyelitis or arthritis
Patient Position: -seat patient at end of table, with hand and arm fully extended and palm up/supinated Part Position: -Drop shoulder to place entire upper limb on same horizontal plane -align and center forearm to long axis of IR, ensuring that both wrist and elbow joints are included -instruct patient to lean laterally as necessary to place entire wrist, forearm and elbow in a near true frontal -palpate the medial and lateral epicondyles to ensure they are the same distance from IR CR= perpendicular to IR; directed to mid-forearm
PA Oblique With 45 Degree Lateral Rotation: Wrist 40" SID on tabletop 10x12 IR portrait 60 kVp @ 2.0 mAs Gonadal Shielding + have patient look away
Patient position: - Seat Patient at end of table with hand and forearm extended, drop shoulder so that shoulder, elbow, and wrist are on the same horizontal plane Part Position: - Align center of hand and wrist to IR - From pronated position rotate wrist and hand 45 degrees - For stability, place a 45 degree support under thumb side of hand to support hand and wrist in a 45 degree oblique position OR partially flex fingers to arch hand so that fingertips rest lightly on IR w/out support CR= Perpendicular to IR; direct to midcarpal area Exposure Factor: SHARP BONY TRABECULAR MARKINGS
How to name joints of the body
Proximal bone is named first. Followed by the distal bone
trauma axial lateromedial and mediolateral: elbow coyle method
Radial Head-Axial Lateromedial CR 45° to shoulder Elbow 90° flexion For radial head Coronoid Process-Axial Mediolateral CR 45° away shoulder Elbow 80° flexion For coronoid process
What two bones consist of the Forearm?
Radius & Ulna They form to make the: -Proximal Radioulnar joint -Distal Radioulnar joint -allow for the rotational movement of the wrist and hand
AP, no rotation
Radius and ulna partially superimposed
Which of the two bones radius or ulna is directly involved in the wrist joint?
Radius is directly involved with wrist joint. During pronation the radius rotates around the ulna
Which of the two bones in the forearm is the shortest?
Radius is the shortest
Smith's Fracture
Reverse Colles Fracture, or transverse fracture of the distal radius with the distal fragment displaced anteriorly
Routine Thumb Exam
Routine 1. AP 2. PA Oblique 3. Lateral
Routine Elbow Exam & Specials
Routine: 1. AP fully extended or AP partial flexion 2. AP Oblique lateral (external) rotation 3. AP Oblique medial (internal) rotation 4.lateral (lateromedial) Special: 1. Trauma axial laterals "Coyle Method" 2. Radial head laterals
Routine Wrist Exam & Specials
Routine: 1. PA 2. PA oblique 3. Lateral Special: 1. Scaphoid Projections: CR angle w/ ulnar deviation 2. Scaphoid Projections: hand elevated & ulnar deviation "Modified Stecher Method" 3. Radial Deviation 4. Carpal Canal Tangential "Gaynor-Hart Method"
Some Lovers Try Positions That They Cannot Handle
Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate
Humeral Condyle: Trochlea
Shaped like a pulley or a spool; has two rimlike outer margins & a smooth depressed center portion called the trochlear sulcus, or groove. Located more medially & articulates with the ulna
Cast Conversions
Small to medium dry plaster cast: +5-7 kV Large or wet plaster cast: +8-10 kV Fiberglass cast: +3-4 kV
Pisiform
Smallest of the carpal bones Located anterior to the triquetrum Pea shaped Most evident in the carpal canal of tangential projection
Finger joints
Starting from the most distal portion: 1) distal interphalangeal (DIP) joint 2) proximal interphalangeal (PIP) joint 3) metacarpophalangeal (MCP) joint
Which of the two bones radius or ulna is primarily involved in the formation of the elbow joint?
The Ulna is primarily involved with the formation of the elbow joint
metacarpophalangeal (MCP) joints
The metacarpals articulate with the phalanges at their distal ends
Triquetrum
Third carpal of the proximal (closest to wrist) row Has three articular surfaces and is distinguished by its pyramidal shape and anterior articulation with the small pisiform
Wrist Radial Deviation
Towards the radius (thumb) less common PA wrist projection used to best demonstrate the medial carpals closest to the ulnar side (pinky)
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 metacarpal neck most often seen in the fifth metacarpal
epicondyles of humerus
Two Epicondyles: 1. lateral epicondyle= the small projection on the lateral aspect of the distal humerus above the capitulum 2. medial epicondyle=larger and more prominent than the lateral epicondyle and is located on the medial edge of the distal humerus In a true lateral position, the directly superimposed epicondlyes are seen as proximal to the circular appearance of the trochlear sulcus.
Trapezoid
Wedge shaped Four sided Smallest bone in the distal row trapezoid=inside (surrounded by 4 other bones)
General positioning rule for upper limb
always place the long axis of the part being imaged parallel to the long axis of the portion of the IR being exposed. All body parts should be oriented in the same direction
Trauma Terminology: Dislocation
displacement from joint
Importance of visualizing fat pads, fat bands, or stripes
displacement of an adjoining fat pad or band may be the only indication of disease or significant injury or fracture within joint region
Alternative to PA Wrist: AP
hand slightly arched to place wrist and carpals in close contacts with IR, to demonstrate intercarpal spaces and wrist joint better and to place the intercarpal spaces more parallel to the divergent rays.
Bursitis
inflammation of a bursae, or fluid-filled sacs that enclose the joints; the process generally involves the formation of calcification in associated tendons Seen on AP & Lateral joint
Skier's Thumb
is a sprain or tear of the ulnar collateral ligament of the thumb near the MCP joint of the hyperextended thumb Seen on PA bilateral stress thumbs "Folio Method"
radius is located on what side of the body in anatomical position
lateral/thumb side
ulna is located on what side of the body in anatomical position
medial/pinky
Evaluation Criteria: AP Thumb
no rotation evident by symmetric appearance of both sides or concavities of the phalanges IP joint open, indicating thumb was fully extended & correct CR location used clear sharp bony trabecular markings
Evaluation Criteria: PA Finger
no rotation evident by symmetric appearance of both sides or concavities of the shaft of the phalanges & distal metacarpals. clear sharp bony trabecular markings
Evaluation Criteria: PA Oblique Hand
oblique projection of entire hand and wrist with about 1" of distal forearm visible clear sharp bony trabecular markings
Trauma Terminology: Subluxation
partial dislocation
Why should the forearm should be done AP with the hand supinated
prevent superimposition caused by crossover of radius and ulna when the hand is pronated
Osteoporosis
reduction in the quantity of bone or atrophy of skeletal tissue. It occurs in postmenopausal women and elderly men, resulting in bone trabeculae that are scanty and thin.
Joint Effusion
refers to accumulated fluid in the joint cavity. it is a sign pf am underlying condition such as a fracture, dislocation, soft tissue damage, or inflammation Seen on AP and lateral joint
Trauma Terminology: Sprain
rupture or tearing of connective tissues
AP, Medial Rotation
superimposed radius and ulnar
Wrist Ulnar Deviation
towards the ulna (pinky) opens up and best demonstrates the medial carpals on the radial side (thumb) Ulnar deviation projection is commonly known as a special scaphoid projection because the scaphoid is the most commonly broken carpal
Evaluation Criteria: PA Oblique W/ Medial Rotation Thumb
IP and MCP joints open if phalanges are parallel to IR and CR location is correct
Evaluation Criteria: PA Oblique Finger
IP and MCP joints open indicating correct CR location & phalanges are parallel to IR clear sharp bony trabecular markings
Evaluation Criteria: Lateral Fingers
finger in true lateral indicated by the concave appearance of the anterior surface of the shaft of the phalanges. IP and MCP joints open indicating correct CR location & phalanges are parallel to IR clear sharp bony trabecular markings
Head of the Ulna
Located near the wrist at the distal end of the ulna When the hand is pronated, the ulnar head and styloid process are easily felt
Evaluation Criteria: PA Hand
PA projection of entire hand and wrist with about 1" of distal forearm visible clear sharp bony trabecular markings
Alternate to Routine AP Thumb: PA Why is the PA thumb not advisable?
PA thumb results in loss of definition due to increased OID Part Position: -place hand in near lateral position and rest thumb on sponge support so thumb is not rotated but is in true lateral position. CR= perpendicular to IR; to first MCP joint Collimation: 4 sided collimation to area of thumb including entire first metacarpal and trapezium
Evaluation Criteria: AP Forearm
minimum of 1-1.5" (3-4 cm) distal to wrist and elbow joints included
Evaluation Criteria: Lateromedial Forearm
minimum of 1-1.5" (3-4 cm) distal to wrist and elbow joints included
What are all the joints in the upper limb classified as?
Synovial, or diarthrodial joints
Evaluation Criteria: Lateral Wrist
True lateral position is evidenced by: ulnar head should be superimposed over distal radius; proximal 2nd-5th metacarpals all appear aligned and superimposed
Ulnar notch
small depression on the medial aspect of the distal radius. Head of the ulna fits into the ulnar notch forms the distal radioulnar joint
Trapezium
A four sided irregularly shaped bone that is located medial and distal to the scaphoid and proximal to the first metacarpal trapezium=under the thumb
Osteopetrosis (marble bone)
A hereditary disease characterized by abnormally dense bone, likely as a result of faulty bone resorption
radial tuberosity
The rough oval process on the medial and anterior side of the radius, just distal to the neck.
Routine Forearm Exam
1. AP 2. Lateral
Fracture
A Break in the structure of the bone caused by a force (direct or indirect)
rheumatoid arthritis (RA)
A chronic disease with inflammatory changes throughout the connective tissues *Use AP Oblique Bilateral Projection "Norgaard method"
Label the image with the metacarpal bones
A. Scaphoid B. Lunate C. Triquetrum D. Pisiform E. Trapezium F. Trapezoid G. Capitate H. Hamate
Label the metacarpel bones and joints
A. first carpometacarpal joint (CMC) of right hand B. first metacarpal of right hand C. first metcarpophalangeal (MCP) joint D. proximal phalanx of 1st digit(or thumb) E. interphalangeal joint of 1st digit (or thumb) F. distal phalanx of 1st digit (thumb) G. 2nd metacarpophalangeal (MCP) joint H. proximal phalanx of 2nd digit I. proximal interphalangeal joint (PIP) of 2nd digit J. Middle phalanx of 2nd digit K. distal interphalangeal joint of 2nd digit L. distal phalanx of 2nd digit M. middle phalanx of 4th digit N. distal interphalangeal (DIP) joint of 5th digit O. proximal phalanx of 3rd digit P. 5th metacarpophalangeal (MCP) Q. 4th metacarpal of right hand R. 5th carpometacarpal (CMC) joint
Trauma Terminology: Contusion
bruise without fracture (fx)