Chapter 4: Upper Limb Flashcards
The proximal row of carpal , which is nearest to the forearm, contains
the scaphoid, lunate, tri quetrum, and pisiform
The distal row of the carpals includes
the trapezium, trapezoid, capi tate, and hamate.
Articulates with the 3rd metatarsal and is the largest and most centrally located carpal
Capitate
Wedge shape and exhibit a prominent of hook located on the anterior surface.
Hamate
A triangular depression is located on the posterior surface of the wrist and is visible when the thumb is abducted and extended. This depression, known as the _____________,is formed by the tendons of the two major muscles of the thumb.
Anatomic snuffbox
* Tenderness in the snuffbox area is a clinical sign suggesting fracture of the scaphoid-the most commonly fractured carpal bone.
a strong fibrous band, attached medially to the pisiform and hook of hamate and laterally to the tubercles of the scaphoid and trapezium.
Flexor Retinaculum
Results from compression of the median nerve inside the carpal tunnel.
Carpal tunnel syndrome
Interphalangeal articulations
synovial hinge type and allow only flexion and extension
Metacarpophalangeal
Synovial, Ellipsoidal type
Carpometacarpal, first digit
Synovial, Saddle
Carpometacarpal, 2nd to 5th digit
Synovial, gliding
Intercapal
Synovial, gliding
Radiocarpal
Synovial, Ellipsoidal
Radioulnar, Proximal and Distal
Synovial, Pivot
Humeroulnar
Humeroradial
Synovial, hinge
The fat pads become significant radiographically when an elbow injury causes effusion and displaces the fat pads or alters their shape. Visualization of the _____________ is a reliable indicator of elbow pathology.
Posterior fat pads
Fluid filled cyst with a wall of fibrous tissue
Bone Cyst
Displacement of a bone from the joint space
Dislocation
Disruption in the continuity of bone
Fracture
Fracture at the base of the first metacarpal
Bennet’s Fracture
Fracture at the base of the fifth metacarpal
Boxer’s
Fracture of the distal radius and ulnar styloid with posterior displacement
Colle’s
Fracture of the distal radius and ulnar styloid with anterior displacement
Smith’s
Impacted fracture with bulging of the periosteum
Torus/Buckle
Accumulation of fluid in the joint associated with an underlying condition
Joint effusion
Form of arthritis marked by progressive cartilage deterioration in synovial joints and vertebrae
Osteoarthritis or Degenerative Joint Disease
Inflammation of bone due to a pyogenic infection
Osteomyelitis
Increased density of atypically soft bone
Osteopetrosis
Loss of bone density
Osteoporosis
Chronic, systemic, inflammatory collagen disease
Rheumatoid Arthritis
New tissue growth where cell proliferation is uncontrolled
Tumor
Malignant tumor arising from cartilage cells
Chondrosarcoma
Benign tumor consisting of cartilage
Enchondroma
Malignant tumor of bone arising in medullary tissue
Ewing’s Sarcoma
Malignant, primary tumor of bone with bone or cartilage formation
Osteosarcoma
When joint injury is suspected, an AP projection is recommended instead of a PA projection.
True or False?
True
Lewis’ suggested directing the central ray ___________ degrees along the long axis of the thumb toward the wrist to demonstrate the first metacarpal free of the soft tissue of the palm.
10-15 degrees
This projection is commonly performed to demonstrate arthritic changes, fractures, di placement of the first CMC joint, and the Bennett’s fracture.
Robert Method
- 0 degrees to carpometacarpal joint.
Long-Rotert modification.
15 degrees cephalad to carpometacarpal joint.
Lewis modification.
10 to 15 degrees cephalad to the metacarpophalangeal joi
When hyperextension of the wrist is not contraindicated, this projection provides a clearer image of the first CMC joint than the standard AP projection.
Burman Method
* Hyperextended hand and abducted thumb position for AP of the first carpometacarpal joint * CR - 45 degree to 1st CMC toward the elbow
This projection is useful for the diagnosis of ulnar collateral ligament (UCL) rupture in the Mcp joint of the thumb, also known a “skier’s thumb.”
Folio Method
When the MCP joints are under examination, what will you do if the patient cannot extend the hand enough to place its palmar surface in contact with the IR?
the position of the hand can be reversed for an AP projection.
describe a special exposure technique for imaging early rheumatoid arthritis
Clements and Nakayama
Lane, Kennedy, and Kuschner’ recommend the inclusion of a reverse oblique projection to better demonstrate ________________. This projection is accomplished by having the patient rotate the hand 45 degree medially (internally) from the palm-down position.
severe metacarpal deformities or fractures.
What projection superimpose the metacarpals but demonstrates almost all of the individual phalanges. The most proximal portions of the proximal pha langes remain superimposed
Fan Lateral
Sometimes referred to as the ball-catcher’s position, assists in detecting early radiologic changes needed to diagnose rheumatoid arthritis.
Norgaard method
* Stapczynski recommended this projection for the demon tration of fracture of the ba e of the fifth metacarpal.
To better demonstrate the scaphoid and capitate, Daffner, Emmerling, and Buterbaugh’ recommended angling the central ray when the patient is positioned for a PA radiograph. A central ray angle of 30 degree toward the _____ elongates the scaphoid and capitate, whereas an angle of 30 degree toward the ______ only elongates the capitate.
Elbow
Fingertips
Why is it that the carpal interspaces are better demonstrated in the AP image than the PA image.
Because of the oblique direction of the interspaces, they are more closely parallel with the divergence of the x-ray
beam
Fiollez was the first to describe a small bony growth occurring on the dorsal surface of the third CMC joint. He termed the condition _____________ and found that it is demonstrated best in a lateral position with the wrist in palmar flexion
carpe bossu (carpal boss)
This projection demonstrates the carpals on the lateral side of the wrist, particularly the trapezium and the scaphoid. The scaphoid is superimposed on itself in the direct PA projection.
PA Oblique Projection, Lateral Rotation
* When the scaphoid is under examination, adjust the wrist in ulnar deviation.
This position separates the pisiform from the adjacent carpal bones. It also gives a more distinct radiograph of the triquetrum and hamate.
AP Oblique Wrist, Medial Rotation
This position corrects foreshortening of the scaphoid, which occurs with a perpendicular central ray. It also opens the spaces between the adjacent carpals.
PA Projection, Ulnar Deviation
opens the interspaces between the carpals on the medial side of the wrist
PA Wrist, Ulnar Deviation
PA AXIAL PROJECTION
Stetcher Method
The 20-degree angulation of the wrist places the scaphoid at right angles to the central ray so that it is projected without self-superimposition
Variations
☑️ by placing the IR and wrist horizontally and directing the central ray 20 degrees toward the elbow
☑️ the wrist may be angled inferiorly, or from the horizontal position the central ray may be angled toward the digits
☑️ is to have the patient clench the fist. This elevates the distal end of the
caphoid 0 that it lies parallel with the IR; it also widens the fracture line. The wrist is positioned as for the PA projection, and no central ray angulation is used
PA wrist with ulnar deviation, With the hand and wrist in
the same position for each projection, four separate exposure are made at 0, 10, 20, and 30 degrees cephalad.
Rafert-Long Method
* minimal superimposition of scaphoid, technique for diagnosis of scaphoid fracture
clearly demontrates the trapezium and its articulations with the adjacent carpal bones
Position:
Place a 45-degree sponge wedge against the anterior surface, and rotate the hand to come in contact with the sponge, with ulnar deviation if patient can handle.
PA Axial Oblique wrist for trapezium: Clements-Nakayama method
Angulation for tangential carpal bridge
Directed to a point about 1 and half inches (3.8 cm) proximal to the wrist joint at a caudal angle of 45 degrees
___________ of the hand crosses the radius over the ulna at its proximal third and rotates the humerus medially, resulting in an oblique projection of the forearm
Pronation
Griswold’ gave two reasons for the importance of flexing the elbow 90 degrees:
( l ) the olecranon process can be seen in profile,
(2) the elbow fat pads are the least compressed.
When injury to the soft tissue around the elbow is suspected, the joint should be flexed only _______________
for lateral elbow. This partial flexion does not compress or stretch the soft tructures as does the full 90-degree lateral flexion.
30-35 degrees
an oblique projection of the elbow with the coronoid process projected free of superimposition
AP Oblique, Medial Rotation (Elbow)
oblique projection of the elbow with the radial head and neck projected free of superimposition of the ulna
AP Oblique, Lateral Rotation (Elbow)
For demonstration of the entire circumference of the radial head free of superimposition, what four projections with varying positions of the hand are performed.
☑️lateral elbow, radius with hand supinated as much as possible
☑️Lateral elbow,radius with hand lateral
☑️Lateral elbow, radius with hand pronated
☑️Lateral elbow radius with hand internally rotated
Greenspan and Norman’ reported that the radial head can be projected more clearly with reduced superimposition by directing the central ray ___________ medially (toward the shoulder)
45 degrees
This projection demonstrates the epi condyles, trochlea, ulnar sulcus (groove between the medial epicondyle and the trochlea), and olecranon fossa. This projection is used in radiohumeral bursitis (tennis elbow) to detect otherwise obscured calcifications located in the ulnar sulcus.
PA Axial Projection of the Elbow
The projection demonstrates the olecranon process and the articular margin of the olecranon and humerus .
☑️Arm at an angle 40-45 degrees angle from vertical
☑️CR - perpedicular to olecranon process to demonstrate dorsum of the olecranon process
*20 degrees toward wrist - to demonstrate the curved extremity and articular margin of the olecranon process
PA Axial Projection (Olecranon Process)
The lateral projection demonstrates the entire length of the humerus. A true lateral image is confirmed by _______________.
Superimpose epicondyles
Place the upper margin of the IR
approximately above the humeral head for humerus position
1 and 1/2 inches (3.8cm)
Recumbent position for AP humerus, note that the hand is _________.
Supinated
Recumbent position for lateral humerus. Note the posterior aspect of patient’s hand against ______.
The thigh
