Hand Flashcards
What is the standard protocol for a hand exam?
3 views, PA, oblique, lateral
How should your patient be prepped before starting the hand x-rays?
Have patient take off any jewelry, seat them at end of table with affected side closest to the table
For PA hand, how should the entire upper extremity be positioned?
Should have elbow bent at a 90 degree angle with elbow at shoulder level
For PA hand the hand should be _______________________ on the IR
Prone, parallel
What is the CR location for PA hand?
3rd MCPJ
When properly collimated & centered, how much of the distal radius and ulna should be visible?
1”
When evaluating your PA, what can be looked at to determine if there is any rotation? How should the metacarpal heads appear with no rotation?
Equal concavity on both sides of the metacarpal and phalangeal bodies
Equal amount of soft tissue on both sides of the phalanges
Fingernails, if visualized, in the center of each distal phalanx
Equal distance between the metacarpal heads
When evaluating your PA, you notice that the IPJ’s of the 4th and 5th digits are closed and there is some foreshortening of the phalanges. What error occurred?
Fingers were flexed
When evaluating your PA, you notice that there is soft tissue overlap of the 2nd and 3rd digits. What error occurred?
Fingers were not spread out enough
Which way is the hand rotated for PA oblique?
External/Lateral rotation
How much is the hand obliqued?
45 degrees
What is the CR location for PA oblique?
3rd MCPJ
How can you tell that you will not clip the soft tissue of the digits for PA oblique?
Look for the shadow of the fingers
When properly positioned, how should the metacarpal heads be demonstrated for PA oblique? Metacarpal bases? Metacarpal shafts?
Metacarpal heads and base should be slightly overlapped. Metacarpal shafts should have minimal overlap from 3-5 digits, more concavity toward anterior side
When evaluating your PA oblique, you notice that there is greater superimposition of the 3rd-5th metacarpal heads and there is overlap of the 4th metacarpal shaft over the 5th. What error occurred?
Hand is over rotated
When evaluating the PA oblique, you notice that there is no superimposition of the 3rd & 4th metacarpal bases. What error occurred?
Hand is under rotated
When evaluating your PA oblique, you notice that the interphalangeal joints are closed and there is foreshortening of the phalanges. What error occurred?
Fingers are flexed
What projection is performed for lateral hand?
Lateromedial
Why would you be performing an extension lateral of the hand? How would you position the part?
To localize foreign bodies. Hand would be placed in karate chop position with thumb extended out, 2-5 digits superimposed
What is the more common lateral performed? How would you position the part?
Fan lateral, have patient make okay sign without fingers touching, spread out digits 3-5
What is the CR location for lateral hand?
2nd MCPJ
In a properly positioned lateral hand, how should the metacarpals be seen?
They should be superimposed
When evaluating your lateral hand, you notice that the short metacarpal is demonstrated anterior to the other metacarpals. Which metacarpal are you seeing? What error occurred?
5th metacarpal, finger was not pulled back enough
When evaluating your lateral hand, you notice that the long metacarpal is demonstrated anterior to the other metacarpals. Which metacarpal are you seeing? What error occurred?
2nd metacarpal, flexed,
When evaluating your lateral hand, you notice that the radius is demonstrated anterior to the ulna. What error occured?
Hand is rotated anteriorly
When evaluating your image, you notice that the ulna is demonstrated anterior to the radius. What error occurred?
Hand is rotated posteriorly
For bone age bilateral hands, what is the method name?
Gruelich & ply method
For bone age bilateral, what is the projection?
PA
What can be determined from bone age bilateral image?
How much time a child will be growing, predicts puberty, and ultimate height
CR location for bone age bilateral?
Mid hands, level of 3rd MCPJ
