Exam 3 - Hand, Finger, Wrist, Forearm, Elbow, Humerus Flashcards
how many bones are in the hand?
27
how many phalange bones are there?
14
how many metacarpal bones are there?
5
how many carpal bones are there?
8
what type of joints are interphalangeal joints?
synovial ellipsoidal joints (flexion & extension)
what type of joints are metacarpophalangeal joints?
synovial ellipsoidal joints (Flexion, Extension, Abduction, Adduction, Circumduction)
what type of bone is a sesamoid bone?
floating bone
which metacarpal has 2 sesamoid bones?
1st metacarpal
what type of joints are carpometacarpal joints between 2nd-5th metacarpals & the trapezoid, capitate, and hamate, and intercarpal articulation?
synovial gliding joints
what type of joint is the carpometacarpal joint between the 1st metacarpal & trapezium?
synovial saddle joint (thumb oppose fingers)
what type of joints are part of the radiocarpal articulation?
synovial ellipsoidal joints
radioulnar articulations
synovial pivot joints
what carpal bones are in the proximal row?
scaphoid (navicular), lunate (semiulnar), triquetrum (cuneiform), pisiform
what carpal bones are in the distal row?
trapezium (greater multangular), trapezoid (lesser multangular), capitate (os magnum), hamate (unciform)
what order are the carpal bones in starting proximally under the thumb?
scaphoid
lunate
triquetrum
pisiform
hamate
capitate
trapezoid
trapezium
(so long to pinky, here comes the thumb)
what is the most commonly fractured carpal bone?
scaphoid
what is formed by tendons of 2 major muscles of the thumbs?
anatomic snuffbox
what is tenderness in the snuffbox area a clinical sign of?
suggests fracture of the scaphoid
passageway created between the carpal sulcus and flexor retinaculum
carpal tunnel
what runs through the carpal tunnel?
median nerve
eval criteria for PA of digits 2-5
entire digit from distal portion to the adjoining metacarpal
no soft tissue overlap from other digits
open IP and MCP spaces without bone overlap
what surface do you lay the hand on for a lateral projection of digits 2 & 3?
lateral
what surface do you lay the hand on for a lateral projection of digits 4 & 5?
medial
where do you put the central ray for a lateral projection of the digits?
proximal interphalangeal (PIP) joint
eval criteria for lateral projection of digits 2-5
no obstruction of prox phalanx or MCP joint
open IP joint spaces
how to take PA OBL projection for digits 2-5
45 degree external obl, central ray at PIP joint
eval criteria for PA oblique projection of digits 2-5
45 degree external obl, no superimposition, open IP and MCP joint spaces
how to take AP projection of 1st digit
flip hand so dorsal side of thumb is touching the IR
central ray at the MCP joint
distal tip to trapezium
how to take lateral projection of 1st digit
place hand palmar side down on IR, abduct thumb, curl digits 2-5 to move thumb into lateral position
central ray at MCP joint
how to take PA OBL projection of 1st digit
palmar side down to IR, thumb abducted, CR to MCP joint, all fingers and palm flat touching IR
what carpal bone needs to be included on all 1st digit x-rays?
trapezium
how to take PA projection of hand
hand flat to IR, spread fingers, CR at 3rd MCP joint, open MCP and IP joints, include all carpals & radius and ulna
how to take PA OBL projection of hand
rotate hand 45 degrees externally, good OBL hand shows space between metacarpals, space gets smaller as you go 1-5
how to take lateral projection of hand
hand on medial surface, thumb free of super imposition, digits 2-5 superimposed
what is a lateral projection of the hand used for?
finding forgein bodies and metacarpal fracture displacement
how to take fanned lateral projection of hand
hand on medial surface, fan out fingers to see each individually, CR to 2nd MCP, used to see phalangeal joints, superimposed metacarpals and radius & ulna
how to take AP OBL projection “ball-catchers” Norgaard method
hands dorsal surface to IR, rotated medially 45 degrees, hands relaxed in position like they are holding a ball
what is the “ball-catchers” Norgaard method used for?
to diagnose rheumatoid arthritis, demonstrates fractures at the base of the 5th metacarpal
how to take PA projection of wrist
CR perpendicular to midcarpals, flexed digits to decrease wrist OID, includes MCP joints and part of the radius & ulna
how to take lateral projection of wrist
hand on medial surface, elbow at 90 degrees, CR to carpals, metacarpals and radius & ulna are superimposed
what does a lateral projection of the wrist demonstrate?
anterior/posterior displacement fractures
what is a posterior displacement fracture of the wrist called?
colle’s fracture
what is an anterior displacement fracture of the wrist called?
smith’s fracture
how to take PA OBL projection of wrist
lateral (external) rotation 45 degrees, CR to carpals, slight space between metacarpals, slight overlap of radius and ulna
what does a PA OBL projection of the wrist demonstrate?
trapezium and scaphoid
what does a PA projection of the wrist with ulnar deviation show?
scaphoid (aka navicular view)
what does a PA projection of the wrist with radial deviation show?
open interspaces between carpals on medial side
how to take PA Axial projection - Scaphoid Stecher Method
20 degree angulation to project scaphoid free of superimposition
why is the PA Axial projection - Scaphoid Stecher Method used?
used when ulnar deviation is not possible
how to image the carpal canal
tangential projections
25-30 degree angle
an infection of bone and bone marrow, usually caused by pyogenic bacteria or mycobacteria, bone death appears as radiolucencies, if not treated affected area needs to be amputated
osteomyelitis
fracture that occurs when normal stress is placed on diseased areas of bone, the disease must be treated for the healing of the fracture to take place
pathologic fracture
when a small chip of bone breaks away when a joint is dislocated
avulsion fracture
occurs when the distal radius fractures with the fragment being displaced posteriorly
colles’ fracture
bone broken in 3 or more places, “shattered”
comminuted fracture
ends are driven into each other; commonly seen in arm fractures in children
buckled or impacted fracture
an incomplete fracture in which the bone is bent; occurs most often in children
greenstick fracture
the break has a curved or sloped pattern
oblique fracture
one part of the bone has been twisted at the break point
spiral fracture
a hairline crack
stress fracture
the broken piece of bone is at a right angle to the bone’s axis
transverse fracture
a fracture in which the bone breaks through the skin and can be seen outside the leg or there is a deep wound that exposes the bone through the skin
open or compound fracture
fracture where the bone doesn’t separate and does not break the skin
closed or simple fracture
distal clavicle is displaced superiorly
appearance: widening of AC space
AC dislocation
partial or complete tear of AC or CC ligaments
appearance: asymmetric
widening of AC compared to
opposite side (>3mm)
AC joint separation
fracture of anteroinferior genoid rim
appearance: disruption of glenoid rim
bankart lesion
fluid filled cyst within the wall of bone’s fibrous tissue
appearance: radiolucency
bone cyst
inflammation of the bursa
appearance: fluid filled joint space, possible calcification
bursitis
compression of the median nerve causing pain and paresthesia
appearance: possible calcification of the carpal sulcus
carpal tunnel syndrome
displacement of the bone from the joint space
appearance: bone displaced from the joint space
dislocation
fractures of the ribs causing irregular rise and fall of the chest during inspiration and expiration; underlying pulmonary injury
appearance: disruption of bony cortex of rib with linear lucency through the rib
flail chest
disruption of continuity of bone caused by a force (direct or indirect)
fracture
break and
dislocation of the
posterior lip of the
distal radius
barton’s fracture
break at the base
of the 1st
metacarpal
bennett fracture
transverse fracture of the 5th metacarpal neck
boxer’s fracture
fracture of distal radius with
posterior displacement of
the distal fragment. 50-60% have
associated ulnar styloid fracture
colles fracture
fracture of the
distal radius with
anterior
displacement of
distal fragment
smith fracture
impacted fracture
with bulging of the
periosteum
torus or buckle fracture
impacted
compression
fracture of
posterolateral
aspect of the
humeral head with
anterior dislocation
hills-sachs defect fracture
Hereditary form of arthritis in which uric acid is deposited in joints. Most common within the MTP joint of the foot
appearance: Uric acid
deposits in joint space. Destruction of the joint space
gout
Disability caused by chronic inflammation in and around the joint
appearance: possible calcification and/or other joint space anomalies
Idiopathic Chronic
Adhesive Capulitis
(frozen shoulder)
Impingement of the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch during arm abduction
appearance: Subacromial
spurs
impingement syndrome
Accumulated fluid (synovial or hemorrhagic) within the joint space
appearance: Fluid filled Cavity
joint effusion
Transfer of cancerous lesion from one area to another
appearance: Areas of
varying density
metastasis
Arthritis with gradual
degeneration of the articular cartilage with hypertrophic bone formation.
apperance: Narrowing of joint space(s) with periosteal growths on the
joint margins
Osteoarthritis/Degenerative Joint Disease
Inflammation of the bone as a result of pyogenic infection. Localized infection of bone or bone marrow.
appearance: Soft-tissue swelling and loss of the fat-pad detail visibility
Osteomyelitis
Hereditary disease. Abnormally dense bone.
appearance: “Marble Bone”, Opaque appearance with lack of distinction between bony cortex and trabeculae
Osteopetrosis
Loss of bone density appearance: Decreased density in distal extremities and joints. Long bones demonstrate thinned cortex
osteoporosis
chronic bone disease that causes destruction of the bone followed by a reparative process of overproduction of very dense yet soft bones that tend to fracture easily.
appearance: Mixed areas of sclerotic and cortical thickening accompanied by radiolucent lesions. “Cotton wool” appearance
paget’s disease
Congenital anomaly in which there is anterior protrusion of the lower sternum
appearance: Anterior protrusion of lower sternum
Pectus Carinatum
(Pigeon Chest)
Congenital anomaly demonstrating a depressed sternum
appearance: Depressed Sternum
Pectus Excavatum
(Funnel Chest)
Chronic, systemic, inflammatory collagen (connective tissue) disease
appearance: Closed joint
spaces with subluxation of the MCP joints
Rheumatoid Arthritis
Injury to one or more of these: teres minor, supraspinatous, infraspinatous, and/or subscapularis
appearance: Limited range of motion, fluid collections and soft tissue swelling
Rotator Cuff Tear
Transfer of lesions from one area to another
appearance: Osteolytic lesions are
destructive with irregular
margins
rib metastatic lesions
Removal of humeral head from the glenoid cavity (most anterior dislocations)
appearance: Separation
between the humeral head and glenoid cavity
Shoulder Dislocation
Sprain or tear of the ulnar
collateral ligament of the thumb caused by hyperextension of the MCP joint.
appearance: Widening of
the inner MCP
joint space of
thumb
“Skier’s Thumb”
inflammation of the tendon and tendon muscle attachment
appearance: Calcification
Tendinitis
New tissue growth where cell proliferation is uncontrolled
tumor malignant
Arises from cartilage cells
appearance: Contains
calcifications
with cartilaginous mass
Chondrosarcoma
Arises from
medullary tissue. Common in children and young adults
appearance: Has an “onion peel” appearance
Ewing’s Sarcoma
Most common malignant. Arises from bone marrow or marrow plasma cells
appearance: appear as
“punched out” osteolytic lesions
Multiple Myeloma
Primary tumor of the bone with bone and cartilage formation
appearance: Dependent on stage of tumor
Osteosarcoma Benign
Slow growing
tumor consisting of
cartilage
appearance: radiolucent with thin cortex, often
associated with pathologic
fractures
Enchondroma
Most common benign. Arise from outer cortex and grow parallel
to the bone
appearance: Growth of tumor is parallel and pointing away from the adjacent joint
Osteochondroma
Where does the CR go for a single digit?
PIP joint
All of the following are projections of the thumb except?
PA
Which is true concerning fat pads of elbow?
can only see in lateral positions
Which joint CR for OBL thumb?
MCP
How to reduce motion in picture?
immobilization, decrease exposure time
Which bones articulate with lunate and scaphoid of wrist?
distal radius
When doing wrist what angle for OBL?
45 degree
Ulnar deviation, which bone?
scaphoid
Anatomical position what side is 1st metacarpal on?
lateral
Which carpal bone is most fractured?
scaphoid (navicular)
Lateral hand with digits super imposed what are you looking for?
foreign bodies or displacement of broken bone
What carpal bone has hook?
hamate
Trochlear notch =
semilunar notch
what is between the greater and lesser tuberosity of humerus?
bicipital groove
Capitulum is on the
lateral anterior side
Trochlea is on the
posterior side and medial anterior side
where do the radial head and coronoid process rest?
anterior of humerus
What is the shallow depression on the anterior distal humerus?
coronoid fossa
What is the distal portion of the humerus that articulates with the ulna called?
trochlea
What are the bony prominences on proximal humerus?
greater and lesser tubercles
What kind of joint is your elbow?
synovial, hinge, diarthrotic
can only see fat pads in a
lateral position
If you can see posterior fat pad on x-ray that indicates a
radial head fracture
Why is the hand supinated for AP projection of forearm?
so the radius & ulna don’t cross
AP forearm should include _______ to _______
elbow joint to carpals
Be sure the shoulder is in the _____ _____ as the elbow for AP projection of elbow so there’s ___ ______
same plane, no flexion
For lateral elbow the wrist and hand should be ______ because it makes the epicondyles _______
lateral, superimposed
Why would you pronate hand for AP oblique medial elbow?
To see the coronoid process free of superimposition
For AP oblique lateral rotation elbow you rotate the elbow _______ to see the ______ _____ free of superimposition
laterally, radial head
What happens when a patient cannot fully extend the elbow due to injury?
You use partial flexion with 2 AP projections of the distal humerus and proximal forearm. Humerus on table for one, forearm on table for other
Distal Humerus Acute flexion (Jones Orthopedic Method) demonstrates
the olecranon process
Why should you take humerus images upright when possible?
it’s easier for the pt, less painful
AP Humerus joint should include ______ ______ to ______ ______, with ______ ________ in profile
shoulder joint to elbow joint, greater tubercle
Lateral humerus should show ______ ______ superimposed and _____ _______ in profile
greater tubercle, lesser tubercle
What do you do for technique for transthoracic lateral projection proximal humerus?
increase time, decrease mA
What definition refers to an epiphysis?
ossification center
Which definition refers to periosteum?
membranous sheath
Distal ulna articulates
with _____ Notch of
_____
ulnar, radius
Proximal head of radius
articulates with _____
notch of _____
radial, ulna
what type of joint allows supination and pronation of the forearm and hand?
synovial pivot joint
Humeroulnar and humeroradial articulations
Synovial Hinge Joints
Flexion / Extension
What are the 3 areas of fat pads?
posterior, anterior, supinator
What view are the fat pads visible in?
lateral
How do you do the trauma patient view to see the radial head?
angle tube 45 degrees cephalic to the radial head
How do you do the trauma patient view to see the coronoid process?
angle tube 45 degrees caudal to the coronoid process
What is the PA Axial Projection Distal Humerus used for?
to image radiohumeral bursitis (tennis elbow); detects otherwise obscured calcifications located in the ulnar sulcus
CR: is perpendicular
