Upper Limb
where is the central ray centered for an AP projection of the thumb??
First metacarpophalangeal (MCP) joint
should exposure factors increase, decrease or remain the same? bursitis
remain the same
true/false: guardians of young pediatric patients who're undergoing upper limb studies can be asked to hold their child during the radiographic study
true
fluid filled joint space with possible calcification
bursitis
for upper limb fiberglass cast increase kV how much?
3-4kV
upper limb later of small focal spot?
small
True/false- In the addition to the ulnar and radial collateral ligaments, the following five additional ligaments are also important in stabilizing the wrist joint.
True: dorsal radiocarpal palmar radiocarpal triangular fibrocartilage complex (TFCC) scapulolunate lunotriquetral
true/false- the entire metacarpal and trapezium must be demonstrated on all projections of the thumb?
false
true/false: for a forearm study, the technologist needs to include only the joint closest to the site of the injury
false
true/false: lead (protective) shielding is only required for upper limb studies performed on patients who are of child bearing age or younger
false
true/false: trauma or infection makes the anterior fat pad more difficult to see on a lateral elbow radiograph.
false
which lateral projection of the hand best demonstrates a possible foreign body in the palm of the hand?
lateral in extension
which routine projection best demonstrates the pronator fat stripe?
lateral wrist
best position to evaluate the posterior fat pads of the elbow joint
lateral, flexed 90 degree
which joint permits the forearm to rotate during pronation?
proximal radioulnar joint
which ligament of the wrist extends from the styloid process of the radius to the lateral aspect of the scaphoid and trapezium bones?
radial collateral ligament
in the anatomic position, which of the bones of the forearm is located on the lateral (thumb) side?
radius
should exposure factors increase, decrease or remain the same? joint effusion
remain the same
the ball catcher position is commonly used to evaluate for early signs of?
rheumatoid arthritis
upper limb long or short exposure time?
short exposure time
sprain or tear of the ulnar collateral ligament
skier's thumb
correctly exposed radiography of the upper limb show?
soft tissue margins and trabecular markings of all bones
total # of bones in hand and wrist
27
# of carpals in wrist
8
a minimum of ____ inches of the forearm should be included radiographically for a PA projection of the hand
1 in
the pertinent factors that help reduce image distortion during upper limb radiography?
1. 40-44 in SID 2. minimal object image receptor distance (OID) 3. correct central ray placement and angulation 4. use of small focal spot
Three portions of the finger
1. proximal phalanx 2. middle phalanx 3. distal phalanx
two important fat stripes or bands around the wrist joint are:
1. scaphoid of the fat stripe 2. pronator fat stripe
two radiographic criteria used to determine whether rotation is present on the PA projection of the digits
1. symmetric appearance of both sides of the shafts of phalanges and distal metacarpals 2. equal amounts of tissue on each side of phalanges
why is it important to keep the affected digit parallel to the image receptor (IR) for the PA oblique and lateral projects?
1. to prevent distortion of the phalanx 2. to prevent distortion of the joints 3. to demonstrate small, nondisplaced fractures near the joint
criteria for evaluating a true lateral position of the elbow are the appearance of three concentric arcs
1. trochlear sulcus (groove) 2. intermediate double arc, consisting of the outer ridges of: capitulum (smaller) trochlea (larger) 3. trochlear arch (part of the ulna)
what is the name of the two special turning or bending positions of the hand and wrist that demonstrate medial and lateral aspects of the carpal region?
1. ulnar deviation 2. radial deviation
are grids used if upper limb body part measures greater than?
10cm
# of phalanges
14
which IR size should be used for a thumb projection?
18 x 24
upper limb most common SID?
40 in
how much rotation is required for an oblique projection of the wrist?
45 degree
# of metacarpals
5 in each hand
for upper limb small to medium plaster casts increase kV how much?
5-7kV
upper limb kV range
60-70 kVp
for upper limb large plaster cast increase kV how much?
8-10 kV
the elbow generally should be flexed _____ degrees for the routine positions of the wrist
90
the fat pads around the elbow joint are valuable diagnostic indicators if they following three technical/positioning requirement are met with the lateral positions.
A. elbow flexed at 90 degrees B. optical exposure factors used C. in a true lateral position
which routine projections are required for a study of the forearm
AP and Lateral
which routine projection of the elbow best demonstrates the radial head, neck, and tuberosity with slight (if any) superimposition of the ulna?
AP oblique w 45 degree lateral rotation
which projection of the elbow best demonstrates the coronoid process in profile
AP oblique w 45 degree medial rotation
which alternative projection to the routine PA wrist best demonstrates the inter carpal joint spaces and wrist joints?
AP projection
joints between the metacarpals and the phalanges are the..
Metacarpophalangeal (MCP) joint
which routine projections best demonstrate the scaphoid fat pad?
PA and oblique wrist
which projection of the thumb is achieved naturally by placing the palmar surface of the hand in contact with the cassette?
PA oblique
what is the positioning routine for the second through fifth digits of the hand?
PA, PA oblique, and Lateral
where is the central ray centered for a PA oblique projection of the second digit?
PIP joint
what is the most commonly fractured carpal bone?
Scaphoid
an abnormality of the cartilage affecting long bones
achondroplasia
__________ is a radiographic procedure that uses contrast media injected into the joint capsule to visualize soft tissue pathology of the wrist, elbow, and shoulder joints.
arthography
fracture and dislocation of the posterior lip of the distal radius
barton's fracture
a Bennett's fracture involves:
base of first metacarpal
transverse fracture extending through the distal aspect of the metacarpal neck, most often the fifth metacarpal
boxer's fracture
what is the largest carpal bone
capitate
the similar structure found on the lateral aspect of the distal humerus is called
capitulum
possible calcification in the carpal sulcus
carpal tunnel syndrome
transverse fracture of the distal radius with posterior displacement of the distal fragment
colle's fracture
should exposure factors increase, decrease or remain the same? advanced rheumatoid arthritis
decreased
should exposure factors increase, decrease or remain the same? osteoporosis
decreased
why is the AP projection of the thumb recommended instead of a PA?
decreases OID and increases resolution
upper limb: type of intensification screens most commonly used for analog imaging
detail screen
ellipsoidal joints are classified as freely movable, or ________, and allow movement in _______ directions.
diarthrodial, 4
how much of the metacarpals should be included for PA projection of the digits?
distal aspect of the metacarpals
True/false: if the posterior fat pad of the elbow is not visible radiographically, it suggests that a nonobvious radial head or neck fracture is present.
false: nonvisable fat pad suggest negative exam
true/false: lead (gonadal) shielding is not required for upper limb radiographs if the patient can sit upright for these exams
false; bc scatter, divergent rays, or both reaching the gonads
which preferred lateral position of the hand best demonstrates the phalanges without excessive superimpostion?
fan lateral
what is the name of the hooklike process extending anteriorly from the hamate?
humulus or hauler process
should exposure factors increase, decrease or remain the same? advanced paget's disease
increased
should exposure factors increase, decrease or remain the same? osteopetrosis
increased
name of the joint between the proximal and distal phalanges of the first digit
interphalangeal joint
a sesamoid is frequently found adjacent to the _______ joint of the thumb?
metacarpopharengeal
what special positioning method can be performed to demonstrate a Bennett's fracture?
modified Roberts method
most common type of primary malignant tumor occurring in bone
multiple myeloma
what is the proper name for the position referred to as the "ball-catcher's position"?
norgaard method
the deep depression located on the posterior aspect of the distal humerus is
olecranon fossa
narrowing of joint space with periosteal growth on the joint margins
osteoarthritis
soft tissue swelling and loss of fat pa detail visibility
osteomyelitis
hereditary condition marked by abnormally dense bone
osteopetrosis
mixed areas of sclerotic and cortical thickening along with radiolucent lesions
osteopetrosis
reduction in the quantity of bone or atrophy of skeletal tissue
osteoporosis
to position the patient properly for an AP projection of the elbow, the epicondyles must be _______ tp the IR.
parallel
how does the forearm appear radiographically if pronated for a psoteroanterior (PA) projection?
the proximal radius crosses over the ulna
where is the central ray for a PA projection of the hand?
third MCP joint
the articular portion of the medial aspect of the distal humerus is called
trochlea
True/false: excessive kV (analog imaging) may obscure the visibility of a fat pad.
true
true/ false: slight superimposition of the distal third, fourth, and fifth metacarpals may occur with a well positioned PA oblique projection of the hand.
true
anatomic position which bones of the forearm is located on the medial side?
ulna
what is most commonly performed to detect a fracture of the scaphoid bone?
ulnar deviation