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Image Analysis (mine) > Chapter 4: Finger and Hand > Flashcards

Chapter 4: Finger and Hand Flashcards

1
Q

Where do you center for a PA finger?

A
  • perpendicular to IR
  • enters patient at PIP joint
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2
Q

What joint should be included for PA finger?

A

include joint between carpal and metacarpal

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2
Q

What should you make sure regarding the elbow for PA finger

A

make sure everything is in the same plane elbow bent at 90 degrees. Hand nice and flat

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3
Q

What should you do with the fingers for PA finger

A

make sure to separate fingers and make sure joint space is open

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3
Q

What should you include in collimation for PA finger

A

entire digit from fingertip to distal portion of the adjoining metacarpal

  • no soft tissue overlap from adjacent digits
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4
Q

How do you know if there’s no rotation on PA finger

A

no rotation of the digit demonstrated by concavity, of the phalangeal bodies and an equal amount of soft tissue on both sides of phalanges

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5
Q

What joint space should be open for PA finger

A

open IP and MCP joint spaces without overlap of bones

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5
Q

How is the fingernail for PA finger

A

fingernail if visualized and normal centered over distal phalanx

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6
Q

To open up joint space how should the CR be centered to IR and how should the CR be centered to joint

A

CR perpendicular to IR
CR parallel to the joint

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7
Q

pulling the bone away

A

avulsion

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8
Q

What should you make sure for the palmar surface for PA finger

A

extended with palmar surface in center of unmasked portion of IR

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8
Q

If patient can’t extend their fingers for PA finger what do you do

A

you do an AP to open joint spaces

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9
Q

How should the palmar surface be for an oblique PA finger

A

extended with palmar surface resting on 45- degrees wedge sponge

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10
Q

How should the digit be for oblique PA finger

A

digit of interest separated to prevent soft tissue overlap

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11
Q

What is the CR for oblique PA finger?

A

perpendicular to PIP joint of affected digit

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12
Q

What is the proper collimation for oblqiue PA finger

A

entire digit, including the distal portion of the adjoining metacarpal

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13
Q

How do you know if the digit is rotated 45 degrees for the oblique positioning for PA finger

A

digit rotated at 45 degrees demonstrated by concavity of the elevated side of the phalangeal bodies

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14
Q

What joint spaces should be open for oblique of PA finger

A

open IP and MCP joint spaces

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15
Q

Is there superimposition for oblique PA finger

A

no superimposition of the adjacent digit over the proximal phalanx or MCP joint

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16
Q

What should you see for oblique PA finger

A

should see twice as much soft tissue on one side than the other

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17
Q

To maintain open joint space what should you do for the finger

A

place finger parallel to maintain open joint space

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18
Q

What is the proper positioning for lateral finger in regards to the 2nd and 3rd digit

A

2nd/ 3rd digit with lateral surface in contact with IR (mediolateral projection)

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19
Q

What is the proper positioning for lateral finger in regards to the 4th and 5th digit

A

4th/ 5th digit digit extended with medial surface in contact with iR (lateromedial projection)

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20
Q

How is the CR for a lateral finger

A
  • directed perpendicular to the IR
  • enters patient at PIP joint
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21
Q

What is in profile for the lateral finger

A

fingernail in profile if visualized and normal

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22
Q

Evidence of proper collimation for lateral finger

A

entire digit in a true lateral position

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23
Q

How is the anterior surface for the lateral finger

  • how about rotation
A

concave anterior surfaces of the phalanges
- no rotation of phalanges

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24
Q

What should you make sure relating to obstruction of the phalanges for lateral finger

A

no obstruction of the proximal phalanx or MCP joint by adjacent digits

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24
Q

what joint should be open for lateral finger

A

open IP joint spaces

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25
Q

What’s in profile for the lateral finger

A

fingernail is in profile for the lateral

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26
Q

What should you make sure to get for lateral finger

A

get head of metacarpals up to carpal joint

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27
Q

What should be superimposed for the lateral finger

A

head of phalanges should be superimposed ( round balls)

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28
Q

How should the hand be for AP thumb and what should touch the IR

A
  • hand in extreme internal rotation
  • posterior surface of thumb on IR
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29
Q

What should be flat on the IR for AP thumb

A

fingernail is flat on the IR

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30
Q

What joint should we get all way down for AP thumb

A

get all the way down to the MCP joint

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31
Q

What articulation should you get down for the AP thumb

A

Make sure to get articulation between thumb and trapezium

  • area from the distal tip of the thumb to the trapezium
  • no rotation
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32
Q

How is the concavity for AP thumb

A

there should be equal concavity of the phalangeal and metacarpal bodies

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33
Q

What do you do if you have fatty fingers

A

angle 10 degrees

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34
Q

What view will magnified the thumb

A

PA thumb

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35
Q

What should you do with the fingers for a lateral thumb

A

drag fingers up to make thumb true lateral

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36
Q

what digit is in a true lateral projection for lateral thumb

A

first digit

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37
Q

What is in profile for a lateral thumb

A

thumbnail

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38
Q

what should be superimposed for lateral thumb

A

heads of phalanges superimposed

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39
Q

What area should you get for lateral thumb

A

area from the distal tip of the thumb to the trapezium

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40
Q

What should you look in the 2nd to 5th digit regarding the PA hand?

  • how about the concavity
A

2nd/ 5th digit should look like PA fingers

  • equal concavity on shaft
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41
Q

Which digit will be oblique for the PA hand

A

thumb will be oblique

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41
Q

how is the tissue for the PA hand for 2nd and 5th digit

A

soft tissue outline should be uniform in 2nd through 5th digit

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42
Q

how is the distance in the MCP and heads for PA hand

A

distance between the MCP and heads is equal

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42
Q

how is the concavity throughout the digits for PA hand

A

midshaft concavity is equal throughout the 2nd to 5th digit

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43
Q

what should you make sure you do for PA hand in regards to the fingers

A

make sure to separate fingers to have no soft tissue overlap

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43
Q

what joints should be open for PA hand when hand is flat

A

IP, MCP, and CMC joints are open

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44
Q

How is the thumb in PA hand

A

thumb 45 degrees oblique

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45
Q

what should be on the table for PA hand

A

forearm on table

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46
Q

What should you make sure you get on for PA hand

A

should show 1 inch of radius and ulna

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47
Q

Where is the CR for PA hand

A

perpendicular to 3rd MCP joint

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48
Q

What is the proper collimation for PA hand

A
  • anatomy from fingertips to distal radius and ulna
  • equal distance between the metacarpal heads
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49
Q

How many degrees is the hand rotated for Oblique hand

A

45 degrees rotation

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50
Q

How should the fingers be for oblique hand

A

fingers should be parallel with IR and extended

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51
Q

How do you know you have a good obliquity for PA oblique hand in relationship to the 2nd and 5th MCP

A

2nd and 5th MCP show more concavity on one side than the other side turn up best

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52
Q

Where should there be a space in PA oblique hand

A

There should be a slight space between the 4th and 5th MCP shafts

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52
Q

When there’s no space in PA oblique hand what does that mean

A

no space means over rotated

52
Q

What happens the more you close up space in PA oblique Hand

A

The more you close up space externally rotated you went gone to lateral

52
Q

What varies from lateral to oblique

A

the thumb

53
Q

What are not superimposed in a PA oblique hand

A

2nd and 3rd MCP heads are not superimposed

53
Q

What are slightly superimposed for PA oblique hand

A

3rd to 5th MCP heads are slightly superimposed

54
Q

What should you make sure you get for PA oblique hand

A

one inch of radius and ulna

54
Q

What anatomy should you include for PA oblique hand

A

anatomy from fingertips to distal radius and ulna

55
Q

How should the digits be for PA oblique hand

A

digits separated slightly

55
Q

What’s the CR for PA oblique hand

A

perpendicular to 3rd mcP joint

56
Q

If you see skin folds on PA oblique hand

A

hand was turn in

57
Q

What x-ray do we typically do for a lateral hand

A

we do a fan lateral

58
Q

Why do we do a fan lateral

A

looking for foreign body

58
Q

What should you make sure you do when doing a fan lateral

A

strengthen our fingers when doing ok sign to not close up joint space

59
Q

What should be superimposed for a fan lateral

A

metacarpals
- radius / ulna

59
Q

Where is there no superimposition for fan lateral

A

no superimposition of thumb (vary from oblique to PA)

59
Q

What is the part position for fan lateral

A
  • forearm on table with elbow flexed 90 degrees
  • hand restingon medial surface
  • palmar surface perpendicular to IR
60
Q

What is the CR for fan lateral

A

perpendicular to 2nd MCP joint
- digits positioned out of superimposition

61
Q

proper positioning for true lateral hand full extension

A

check for foreign bodies of the palm, completely extend the fingers
- first digit abducted to right angle to palm
- elbow flexed 90 degrees hand on medial surface

62
Q

What is the CR for true lateral hand full extension

A

perpendicular to 2nd MCP joint

63
Q

what’s free of motion and superimposition in a true lateral hand full extension

A

thumb

63
Q

done for foreign bodies of the metacarpals

A

true lateral hand full extenson

64
Q

What should be superimposed for lateral hand

A

superimpose the 2nd through the 5th MCP placing the knuckles one on top of the other

64
Q

digits and long axis of hand aligned parallel

A

true lateralfull extension

64
Q

in a lateral what may you not always be able to get

A

in a lateral you may not always be able to get a true lateral wrist ( radius and ulna to directly superimpose

65
Q

How should the ulna be in regards to the radius in a lateral hand

A

the ulna is demonstrated slightly posterior to the radius

66
Q

How should you judge your lateral hand

A

judge your lateral by the superimposition of the 2nd to 5th MCP

67
Q

What MCP is the shortest

A

5th MCP

68
Q

In an external rotation of the lateral hand

A

this will show the 5th metacarpal anterior to the 2nd and 4th MCP posterior. Thumb going back. Radius goes externally and ulna going anteriorly

68
Q

What MCP is the longest

A

2nd MCP

69
Q

radius will go externally (posteriorly) and ulna will go anteriorly in what

A

external rotation of the lateral hand

70
Q

Internal rotation of the lateral hand

A

This will show the 2nd MCP anterior to the 3rd-5th MCP posterior. Thumb coming closer in. Ulna coming externally and radius coming anteriorly

71
Q

Ulna coming externally (posterior) and radius coming anteriorly

A

internal rotation of lateral hand

71
Q

thumb coming closer in to the IR

A

internal rotation of lateral hand

71
Q

fully extend the fingers and use same analysis as for the lateral fan hand

A

lateral hand in extension

72
Q

done to demonstrate foreign bodies of the palm

A

lateral hand in extension

72
Q

it makes for better localization of foreign body in

A

extension

73
Q

flexion and extension of the lateral hand are done for what

A

for mobility

74
Q

flex the 2nd to 5th fingers until they meet the first finger but do not superimposed it

A

lateral hand in flexion

75
Q

distinguish the degree of anterior or posterior displacement of a fracture MCP

A

lateral hand in flexion

76
Q

PA or AP hand done for

A

medial / lateral displacement

77
Q

lateral hand done for

A

anterior or posterior fractures

77
Q

obtained to assess the skeletal versus the chronological age of the child
- must be assess from infancy through adolescence

A

pediatric bone age

78
Q

there’s a difference between males and females in

A

a pediatric bone age

79
Q

What hand do we usually do for pediatric bone age

A

none dominant hand

79
Q

If the pediatric is not dominant in one hand then what hand do we x-ray

A

Left PA hand and wrist are normally taken

79
Q

What is the reason for pediatric bone age

A

illness, metabolic or endocrine dysfunction, certain meds and therapies

79
Q

posteroanterior (PA) projection of finger, concavity of the phalanges is

A

equal on both sides

79
Q

in the lateral projection of the finger what happens to the surfaces

A

the anterior surface is concave and the posterior surface is slightly convex

80
Q

As the finger is rotated medially for a PA oblique projection

A

the amount of concavity increases on the side that the anterior surface is rotated toward and decreases on the side that the posterior surface is rotated toward.

81
Q

Position finger in PA projection with the palmar surface placed flat against and centered on the IR.

A

Soft tissue width and midshaft concavity are equal on both sides of phalanges

82
Q

Separate fingers slightly for PA finger

A

There is no soft tissue overlap from adjacent digits

83
Q

Fully extend finger aligning it parallel with the IR. for PA finger

A

IP and MCP joints are demonstrated as open spaces.
* Phalanges are seen without foreshortening

84
Q

Center the CR to the PIP joint.

A

PA finger

85
Q

If the anterior surface is rotated toward the longest second metacarpal (MC) or thumb

A

the finger was externally rotated

86
Q

what prevents the hand or finger from doing an internal rotation?

A

the thumb

87
Q

If the finger is flexed or tilted toward the IR,

A

the CR will be poorly aligned with the joint spaces and phalanges, causing the phalanges to foreshorten and be superimposed on the joint spaces, closing them

88
Q

If the patient is unable to extend the finger,

A

it may be best to use an anteroposterior (AP) projection to demonstrate open IP and MCP joint spaces and to visualize the phalanges of greatest interest without foreshortening

89
Q

Analysis
The side of the digit facing the thumb demonstrates greater phalangeal midshaft concavity and soft tissue width. The finger was externally rotated for the projection.
What is the correction:

A

Internally rotate the finger, placing it flat against the IR.

90
Q

Analysis
The IP and MP joints are closed, and the phalanges are foreshortened. The finger was flexed.
what is the correction

A

Extend the finger, and place the palm flat against the IR. If the patient is unable to extend the finger, position it in an AP projection, aligning the phalanx of interest parallel with the IR or affected joint space perpendicular to the IR.

91
Q

for a PA oblique projection finger, If the phalangeal midshaft concavity and soft tissue width on both sides of the digit are more nearly equal, the finger

A

was rotated less than the required 45 degrees

92
Q

for a pa oblique projection If the soft tissue width on one side of the digit is more than twice as much as that on the other side, and when one aspect of the phalangeal midshaft is concave but the other aspect is slightly convex

A

the finger was rotated more than the required 45 degrees

93
Q

When the hand and fingers are rotated to obtain the PA oblique

A

all but the fifth finger are positioned away from the IR at varying object

94
Q

Begin with finger in PA projection with the palmar surface placed flat against and centered on the IR.
* Externally rotate the hand until the affected finger is at a 45-degree angle with IR.
PA oblique of PA fingers

A

Twice as much soft tissue width is demonstrated on one side of the phalanges as on the other side.
* More concavity is seen on one aspect of the phalangeal midshafts than the others

95
Q

Fully extend finger, aligning it parallel with the IR.
* Use radiolucent support under fingertip as needed to keep finger parallel with IR and prevent motion.

PA oblique finger

A

IP and MCP joints are demonstrated as open spaces.
* Phalanges are not foreshortened

96
Q

Analysis
The soft tissue width and midshaft concave are nearly equal on both sides of the phalanx. The finger was positioned at less than 45 degrees of obliquity for the projection. The IP and MP joints are closed. The finger was not aligned parallel with the IR.
what is the correction

A

correction:
Increase the finger obliquity to 45 degrees. Keep finger parallel with the IR.

97
Q

If the hand is not drawn into a tight fist for a lateral finger

A

the unaffected fingers will superimpose the proximal phalanx of the affected finger, preventing adequate visualization

98
Q

Form the hand into a tight fist, with affected finger extended.
* Use device as needed to extend finger only if the device can be placed proximal to the injured area

lateral finger

A

There is no overlap from adjacent fingers

99
Q

Center finger on the IR, with the lateral surface resting on the IR if imaging the second or third finger and medial surface for fourth or fifth finger.
* Adjust hand rotation to obtain a lateral projection with fingernail in profile.

A

Anterior surface of the middle and proximal phalanges demonstrate midshaft concavity and the posterior surfaces show slight convexity.
* More than twice as much soft tissue width is demonstrated on the anterior surface than the posterior surface

100
Q

Align finger parallel with the IR.

A

IP joints are demonstrated as open spaces.
* Phalanges are not foreshortened.

101
Q

Analysis
The proximal aspect of the affected finger is obscured. The fifth finger was fanned posteriorly and the third finger was fanned anteriorly.
what is the correction

A

Draw all of the unaffected fingers into a fist

102
Q

Extend and internally rotate arm until the thumb is in an AP projection, with the thumbnail not visible on either side.
* Center thumb on IR.

A

Concavity on both sides of the phalanges and MC midshafts is equal.
* There is equal soft tissue width on each side of the phalanges

103
Q

Fully extend the thumb, aligning it parallel with the IR.

A

IP, MCP, and CM joints are demonstrated as open spaces.
* Phalanges are not foreshortened

104
Q

The fifth MC and the medial palm soft tissue are superimposing the proximal first MC and CM joint. There is slightly more phalangeal concavity on the side of the thumb that is closest to the hand. The MCs and palmar surface have not been drawn away from the thumb and the thumb was internally rotated slightly more than needed.

A

Correction
Using the opposite hand, draw the medial side of the affected hand and palmar surface away from the thumb. Make sure that the thumb does not rotate from an AP projection with this movement.

105
Q

Analysis
The midshafts of the proximal phalanx and the MC demonstrate some degree of concavity on both sides, indicating a PA oblique projection. The hand was not flexed enough.
what is the correction

A

correction:
Flex the hand until the thumb rolls to a lateral projection with the thumbnail in profile.

106
Q

Center a perpendicular CR to the MCP joint.

A

AP thumb

106
Q

Using the unaffected hand, draw the medial palmar surface away from the thumb without rotating thumb from the AP projection.

A

Superimposition of the medial palm soft tissue over the proximal first MC and the CM joint is minimal

106
Q

Abduct the thumb drawing it away from the second finger.

A

First proximal MC is only slightly superimposed by the second proximal MC

107
Q

If the hand is not flexed enough to place the thumb in a lateral projection,

A

the midshafts of the proximal phalanx and the MC will show some degree of concavity on both sides, indicating a PA oblique versus a lateral projection

108
Q

Place the palmar surface flat against the IR.
* Center the thumb on the IR.
* Flex the hand and fingers only until the thumb naturally rolls into a lateral projection and thumbnail is in profile

A

Anterior proximal phalanx and MC demonstrate midshaft concavity, and the posterior proximal phalanx and MC demonstrate slight convexity.
* When visualized the thumbnail is demonstrated in profile

109
Q

Analysis
in a pa oblique thumb
The IP and MCP joints are closed, and the phalanges are foreshortened. The palm surface was not positioned flat against the IR, and the thumb was tilting down toward the IR.
what is the correction

A

Correction
Place the palmar surface and thumb flat against the IR.

110
Q

Pronate and extend the hand and fingers, and place the palmar surface flat against the IR in a PA projection.
* Center hand on IR.

PA hand

A

Soft tissue outlines of the second through fifth phalanges are uniform.
* Distance between the MC heads is equal.
* Equal midshaft concavity is seen on both sides of the phalanges and MCs of the second through fifth fingers.
* Thumb demonstrates a 45-degree PA oblique projection

111
Q

in a pa hand
Analysis
The IP and CM joints are closed, and the phalanges and MCs are foreshortened. The thumb demonstrates a lateral projection. The hand and fingers were flexed for this projection.
what is the correction

A

Fully extend the hand and fingers, and place them flat against the IR. If the patient is unable to extend the hand and fingers, position the hand in an AP projection with the MC aligned parallel with the IR. If the phalanges are of interest, tilt the hand until the bony structure of greatest interest is parallel with the IR

111
Q

The thumb was abducted and the CR was centered to the second MCP joint.

A

Position the thumb closer to the hand and center the CR to the third MCP joint.

111
Q

The midshaft of the fourth and fifth MCs are superimposed. The hand was placed at more than 45 degrees of obliquity. The phalanges are foreshortened, and the IP joint spaces are closed. The fingers were flexed toward the IR.

A

Internally rotate the hand until the MCs and IR form a 45-degree angle and extend the fingers, placing them parallel with the IR.

111
Q

in a pa hand
Analysis
There is unequal midshaft concavity on either side of the phalanges and MCs, and uneven spacing of the MC heads. The hand was in slight external rotation. Less than 1 inch (2.5cm) of the distal forearm is included on the projection.
what is the correction

A

Correction
Internally rotate the hand and place the palm and fingers flat against the IR. Open the longitudinal collimation 0.5 inch (1.25cm).

112
Q
A
112
Q
A
113
Q
A
113
Q
A
114
Q
A

Image Analysis (mine) (5 decks)

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