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Image Analysis (mine) > Chapter 4: Wrist > Flashcards

Chapter 4: Wrist Flashcards

1
Q

is the thumb on the lateral or medial aspect

A

Lateral (radius side)

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2
Q

what is at the extreme lateral and medial edges of the radius and ulna

A

Radial and ulnar styloids are at the extreme lateral and medial edges keep it in the same plane

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2
Q

what articulation should be open in a pa wrist

A

Radioulnar articulation is open

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3
Q

what is rotation controlled by for a pa wrist

A

hand, elbow, and humerus keep in the same plane

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4
Q

for a pa wrist where is limited superimposition

A

Superimposition of the MCP bases is limited

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5
Q

what better demonstrates the ulna styloid process in a pa wrist

A

when the humerus, elbow, and forearm are in the same plane 90 degrees

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6
Q

what type of fracture is the ulnar styloid process likely to get

A

an avulsion fracture

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7
Q

what type of fracture happens when there is hyperextension or hyperflexion of a joint

A

avulsion

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8
Q

What do you do to bring the carpal bones closer for PA wrist

A

curl fingers up to bring carpal bones in contact with IR

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9
Q

What’s the CR for PA wrist

A

CR Perpendicular to midcaarpal area or carpal bones

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10
Q

What should you make sure you get for PA wrist

A

make sure you get up to McP bases up to radius / ulna

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11
Q

What should be visible on all PA wrist images

A

Scaphoid fat stripe

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12
Q

what is adequate to demonstrate the schaphoid fat stripe

A

contrast and density

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13
Q

It is convex and located lateral to the scaphoid in an uninjured wrist

A

scaphoid fat stripe

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13
Q

A change in the covexity may indicate the presence of a…

A

joint effusion
radial side fracture of the scaphoid radial styloid process
or proximal first metacarpal

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14
Q

how should the scaphoid fat pad be?

A

Convexed

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15
Q

How much should you get for carpal bones, radius/ ulna, and proximal MCP for PA wrist

A

carpal bones in center 1/4 of distal ulna and radius plus 1/2 of the proximal MCP are included in the field

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16
Q

what projection shows better carpal interspaces

A

AP wrist

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17
Q

fluid can buldge out

A

joint effusion

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18
Q

can die off when there is a fracture

A

scaphoid

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18
Q

how are the hand and wrist rotated in this oblique position?:
the MC bases and carpal bones on the medial aspect of the wrist are superimposed( whereas laterally they are not)

A

Hand and wrist rotated externally into an oblique position

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18
Q

what wrist rotation best demonstrates the trapezium and trapzoid.

decreased space between 4th and 5th MCP

  • Radioulnar articulation closes
A

external rotation of wrist

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19
Q

causes the laterally located carpal bones and MC bases to be superimposed and increases visibility of the pisiform and hamate hook

  • radioulnar atriculation close
A

Internal rotation of the hand and wrist

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20
Q

What should you look for to see if there’s a rotation of the wrist

A

Look at the 3rd MCP to see if is straight or not

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21
Q

away from the body

A

abduction

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21
Q

towards the midline of the body

A

adduction

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22
Q

what determines the positioning of the placement of the ulnar styloid

A

humerus and elbow

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22
Q

what happens if the humerus remains in a vertical position

A

If humerus remain in a vertical position the ulna and radius cross over and the ulnar styloid is no longer in profile

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22
Q

when elbow is bent at 90 degrees what is in profile

A

the ulna styloid process

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23
Q

Abduction the humerus to position the elbow in the lateral position and humeral epicondyles aligned perpendicular to IR

A

brings the ulna styloid process in profile

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23
Q

what are parallel with each other

A

radius and ulna

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23
Q

what type of rotation is it when the pisiform is out by itself

A

internal rotation

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24
Q

what MC should you be looking at if you are concerned if there is rotation

A

the third MC- it should be straight

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25
Q

what is concave and slants 11 degrees from posterior to anterior

A

Distal radial carpal articular surface

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26
Q

how many degrees does the distal radial carpal surface concave and slant from posterior to anterior

A

11 degrees

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27
Q

CR perpendicular Forearm is positioned parallel with IR for PA wrist, the slant of the distal radius causes the

regular x-ray

A

the posterior radial margin to project slightly distal to the anterior radial margin obscuring the radiocarpal joints​

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27
Q

when the radius is straight out

A

the posterior and anterior aspect do not superimposed each other

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28
Q

if posterior radial margin is extremely distal to the anterior margin , how was the proximal forearm

A

the proximal forearm was elevated higher than the distal forearm ( elbow was raised)

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29
Q

if anterior radial margin is extremely distal to the posterior margin how was the proximal forearm positioned

A

the proximal forearm was positioned lower than distal forearm (elbow lowered)

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30
Q

what would you do to superimpose the distal radial margins and demonstrate the radioscaphoid and radiolunate joints as open spaces

  • posterior aspect towards proximal
  • anterior aspect more distal
A

the proximal aspect of the forearm should be positioned slightly lower than the distal forearm(5 to 6 degrees)
(so half of the 11 degrees)

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31
Q

what should you do when you have a thick or muscular forearm

A

proximal forearm it may be necessary to extend the arm off the IR or table in order to position it parallel with the IR

  • lower proximal forearm parallel with IR
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32
Q

how to put the wrist in a neutral position

A

To put the wrist in a neutral position, flex the patient’s fingers (curl fingers), flexing the until the MC are angled to 10-15 degrees with the IR

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32
Q

results in obscured 3rd -5thCM joint spaces and severely foreshortened scaphoid (signet ring configuration) and triangular lunate
distal portion goes anterior

A

Flexion
-fingers are straight out

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33
Q

when there is foreshortening of the schaphoid what is visible

A

visible signet ring (white circle)

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33
Q

results in foreshortened MC and closed 2nd-3rd CM joint spaces , decreased scaphoid foreshortening, and triangular lunate

scaphoid elongating

A

Extension (hand extended up)
-pullinh distal part of scaphoid up elongating it

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34
Q

Excessive foreshortening and signet ring configuration of scaphoid
- Lunate is triangular
- 3rd -5th CM places are obscured​

A

wrist flexion

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35
Q

what can you do to fix the wrist flexion

A

The hand needs to be extended*Curl the patient’s finger

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35
Q

Foreshortened MCP Closed 2nd-3rd CMC joint spaces
- Decreased scaphoid foreshortening​
- brought fifngers up
- elongated scaphoid
- triangular lunate
- bases of the metacarpals are obscuring distal row of carpal bones

A

wrist extension

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36
Q

distal scaphoid to shift anteriorly (towards palmar surface) and increase foreshortening as if forms the signet ring configuration
- hand towards thumb
- lunate will shift medially towards ulna
- ring (flexion)

A

radial deviation

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37
Q

how will the lunate shift in a radial deviation

A

Lunate will shift medially toward the ulna

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38
Q

distal scaphoid tilts posteriorly (dorsally) and demonstrate decrease foreshortening
- elongate scaphoid
- lunate will shift laterally towards the radius

A

ulnar deviation

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39
Q

why is ulnar deviation or radial deviation typically done

A

for wrist joint mobility

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40
Q

what is ulnar deviation used for

A

to demonstrate the scaphoid better - elongates it

41
Q

Note the long axis of the 3rd MCP, use to judge

A

if foreshortening is due to flexion or extension of carpal bones or radial and/or ulnar deviation​

42
Q

make sure make sure you have contrast and density

A

to demonstrate scaphoid fat stripe

43
Q

PA oblique projection is how many degrres

A

45 degrees oblique

44
Q

What is best demonstrated in a PA 0blique wrist

A

trapezoid and trapezium are demonstrated without superimposition

45
Q

what joint space is open for a PA oblique wrist

A

Trapeziotrapezoidal joint

46
Q

What is demonstrated in profile for a PA oblique wrist

A

Scaphoid tuberosity and waist

47
Q

Small degree of trapezoid and capitate superposition is present​
- slight space between 4th and 5th MCP joint
- lateral aspect is best demonstrated
- lower thumb to not foreshroten it and not obscure trapezium

A

PA oblique wrist

48
Q

if under-rotated for an oblique wrist how is the trapezoid and trapezium

A

If under rotated the trapezoid and trapezium are superimposed

49
Q

how is trapeziotrapezoidal joint space when the wrist is under rotated for an oblique

A

The trapeziotrapezoidal joint space is obscured

50
Q

The trapezoid demonstrates minimal capitate superimposition

A

under rotated pa oblique wrist

51
Q

The long axis of the 3rdmetacarpal and midforearm are aligned long axis of the collimation field, what position is the wrist in

A

the wrist is in a neutral position.

52
Q

does radial or unlar deviation increase the foreshortening of the scaphoid

A

radial deviation

52
Q

Preventing visualization of the scaphoid tuberosity and waist
radial deviation

A

positions the scaphoid directly next to the radius

53
Q

decreases scaphoid foreshortening, the scaphoid will be elongated

A

ulnar deviation

54
Q

the MCP is not aligned with the midforearm

A

ulnar deviation

54
Q

in a oblique wrist *If the image demonstrates the posterior radial margin too far distal to the anterior margin , how was the proximal forearm

A

the proximal forearm was elevated higher than the distal forearm

55
Q

in an oblique wrist , If the anterior radial margin is demonstrated distal to the posterior margin, how is the proximal forearm

A

the proximal forearm was positioned lower than the distal forearm

55
Q

Parallel to the anteriorsurface of the distal radiusNormally convexBowing or obliteration mayIndicate subtle radial fracture

A

pronator fat stripe

56
Q

scaphoid and lunate articulate with

A

radius

57
Q

anterior margain is more than the posterior for radius

11 degrees difference in the radius

A

more whiter

58
Q

an open radiolunate and radioscaphoid joint spaces

A

the proximal forearm was positioned slightly lower 5 to 6 degrees

59
Q

In a lateral wrist there should be contrast and density to adequately demonstrate the

A

pronator fat stripe and posterior soft tissue should look convex

60
Q

if pronator fat stripe is not convex

A

there is a subtle radial fracture

61
Q

for lateral wrist elbow should be flexed 90 degrees and abduct humerus until

A

it is parallel with ir

62
Q

in a lateral wrist what should be aligned

A

distal scaphoid and pisiform

63
Q

what is aligned parallel with the forearm for lateral wrist

thumb has to be down don’t want to obscure the trapezium

A

long axis of the 1st McP

64
Q

what do you want to make sure you get for lateral wrist in relation to radius and ulna and MCp

A

1/4 distal of ulna and radius and 1/2 of proximal MCP

64
Q

parallel to the anterior surface of the distal radius

A

pronator fat stripe

65
Q

how to check for rotation of a lateral wrist

A

To detect rotation check the relationship between the distal aspect of the scaphoid and the pisiform

66
Q

how should the the distal aspect of the scaphoid and the pisiform be in a lateral wrist

A

They should superimpose and demonstrate anterior to the capitate and lunate

67
Q

criteria for lateral wrist to make sure that is no rotation

A

-all mc should all be superimposed
-radius and ulna superimposed
-distal scaphoid and pisiform anterior to capatate and lunate

67
Q

what should be align on top of one another in a lateral wrist

A

pisiform and scaphoid

68
Q

how is the pisiform when the wrist is externally rotated

a

A

bringing pisiform forward

69
Q

how should the pisiform in a true lateral wrist be

A

scaphoid and pisiform should be superimposed

-scaphoid can be slightly anterior but pisiform superimposed over it

70
Q

how is the scaphoid when the wrist is rotated externally for a lateral wrist

A

*If wrist is rotated externally (supinated) the distal scaphoid is visible posterior to the pisiform

71
Q

5th MCP, pisiform, ulna more anterior in

A

external rotation of lateralwrist

72
Q

pisiform will go more anterior, radius will go posterior and ulna will go anterior

A

external rotation of lateral hand

73
Q

If the distal scaphoid and pisiform are not superimposed and the ulna is positioned anterior to the radius

A

it is externally rotated lateral wrist

74
Q

If wrist is rotated internally( hand pronated)

A

the distal scaphoid is visible anterior to the pisiform​

75
Q

in an internal rotation of the lateral wrisyt

A

pisiform will go posterior the scaphoid more anterior radius will go anterior and ulna posterior

75
Q

If distal scaphoid and pisiform are not superimposed and the ulna is positioned posterior to the radius,

A

the wrist was internally rotated​

75
Q

scaphoid, radius, 2nd MCP more anterior

A

internal rotation of lateral wrist

76
Q

if the radial side is placed on the IR

A

the ulna and pisiform are anterior to the radius and scaphoid

77
Q

align the long axis of the 3rd MC with the midforearm parallel with the IR

A

neutral lateral wrist

77
Q

when the proximal forearm is higher in a lateral wrist is this radial flexion or extension

A

radial flexion

78
Q

what view forces the distal scaphoid anteriorly and the pisiform is distal to the scaphoid

A

Radial deviation of wrist

79
Q

what deviation shifts the distal scaphoid posteriorly

A

ulnar deviation

79
Q

when the proximal forearm is higher it create radial flexion or radial deviation which

A

forces the distal scaphoid anterior and tghe pisiform more distal to the scaphoid which foreshrotens the scaphoid

80
Q

The pisiform is proximal to the scaphoid

The proximal forearm may not be level ,but lower
what does this cause

A

ulnar deviation

81
Q

is this wrist flexion or extension? the lunate and distal scaphoid tilt anteriorly
- foreshortens scaphod (ring)

A

wrist flexion

82
Q

wrist extension or flexion? the lunate and distal scaphoid tilt posteriorly
- elongates the scaphoid

A

wrist extension

83
Q

is the elbow is higher, is it radial or ulnar deviation

A

radial deviation

84
Q

if the elbow is lower, is it radial or ulnar deviation

A

ulnar deviation

85
Q

if the first MC is not lowered it will be foreshortened and its proximal aspect is superimposed over what carpal bone?

A

trapezium

85
Q

1st and 2nd MCP should be what

A

at the same level

86
Q

is this radial deviation or ulnar?
foreshortened scaphoid will go down anterior pushing pisiform distally

A

radial deviation

87
Q

down from suspected fracture of scaphoid

A

pa axial ulnar deviation

87
Q

Demonstrate scaphoid fat stripe
*Scaphotrapezium and scaphotrapezoidal joint spaces are open
*These joints are aligned at a 15° angle to the IR when the hand is fully extended
*Ulnar deviation approx. 25°
*Align 1st MC with the radius

A

Ulnar Deviation PA Axial Projection

88
Q

the distal scaphoid tilts anteriorly approx. 20° and results in foreshortening of the scaphoid
Why does this happen

A

wrist is non flexed

89
Q

if patient is unable to achieve max ulnar deviation what angle should you use

A

20 degrees

90
Q

what is the most. common fractured carpal bone?

A

the waist of the scaphoid

90
Q

what angle best demonstrates the proximal scaphoid

A

5 to 10 degress

91
Q

what degree best demonstrates the distal scaphoid

A

25 degrees

91
Q

where is most of the stress on when the hand is hyperexteneded

A

waist of the scaphoid

91
Q

what degree best demonstrates the waist of the scaphoid

A

15 degrees

92
Q

what degree do you need when the fracture is more distal on the scaphoid

A

more angle

93
Q

If the scaphocapitate joint space is closed and the capitate and hamate are demonstrated without superimposition
how was the degree of obliquity

A

insufficient

94
Q

If the scapholunate joint space is closed and the capitate and hamate demonstrate some degree of superimposition
how was the degree of obliquity

A

rotated more than needed

94
Q

-tube angled inferior to superior
-tangential view skimming base of 3rd MC
-want to see arch
-good view of hamate
- hyperextend wrist til long axia of MC are close to vertical
-25-30 degree angulation
-rotate hand so 5th MC is perp to IR

A

Gaynor Hart

94
Q

Pisiform is demonstrated without superimposition
*Hamulus of the hamate and carpal canal is clearly demonstrated
*Carpal canal is center of collimated field
*Trapezium ,distal scaphoid, pisiform and hamulus of the hamate are all included within the field
*Hyperextending (dorsiflex) of wrist until long axis of MC are close to vertical
*Central ray 25 to 30 degrees, rotate hand to the radial side approx. 10 degrees, 5th MC vertical

A

criteria for gaynor hart

95
Q

why does this happen in a gaynor hart:
the carpal canal will not be fully demonstrated and the carpal bones will be foreshortened

A

angle between the CR and MC is too great

95
Q
A
95
Q

why does this happen in a gaynor hart :
the bases of the hamulus process, pisiform and scaphoid are obscured by the MC bases

A

angle is too small

96
Q
A
97
Q
A
97
Q
A
97
Q
A
97
Q
A
98
Q
A

Image Analysis (mine) (5 decks)

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