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Musculoskeletal system > Imaging of the upper limb > Flashcards

Imaging of the upper limb Flashcards

1
Q

Characteristics of x-rays

A

Ionising radiation
High voltage used to accelerate electrons produced by cathode in X-ray tubes, where electrons interact with eachother to produce x-rays

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2
Q

What is ionising radiation?

A

Enough energy to displace orbiting electrons from an atom in the absorbing medium, producing positive ions

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3
Q

What colour is photographic film until exposed to x-rays?

A

White

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4
Q

ALARA principle

A

Keeping radiation as low as possible

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5
Q

Why does bone appear white on an x-ray?

A

Blocks most of the beam

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6
Q

Why does soft tissue appear grey on an x-ray?

A

Partially blocks beam

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7
Q

Why does fat appear dark grey on an x-ray?

A

Less dense

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8
Q

Why do air containing tissues appear black on an x-ray?

A

Block very little of the beam

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9
Q

Characteristics of CT scan

A

Produced by x-rays
Emitter and detector of x-rays move around patent but are always opposite each other
Images organs/bones/muscle/soft tissue
Can diagnose trauma/cancer/disease

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10
Q

Benefits of CT scans

A

Non-invasive, accurate, fast, can image multiple tissue simultaneously

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11
Q

Disadvantages of CT scans

A

Ionising radiation leads to malignancy, anaphylactic reaction with contrast dye

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12
Q

Characteristics of MRI scans

A

Uses strong magnetic fields and field gradients and radio waves
Utilises how body is mainly H2O

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13
Q

How do MRI scans work?

A

At the centre of each hydrogen is a proton
Protons act like a magnet - they all line up in the same orientation under the scanner
Radio waves knock protons out of alignment but they realign when scanner switched off
Sends out radio signals that are detected by receivers
Can distinguish between tissues because protons return at different speeds
Computer combines signals to produce image for radiologists

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14
Q

Benefits of MRI scans

A

Defines soft tissue, bones, joints and cartilage, can detect tumours/blood vessels/organs

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15
Q

Limitations of MRI scans

A

Time consuming, expensive, claustrophobic, contrast reaction

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16
Q

What is a sagittal plane?

A

Cuts along midline

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17
Q

What is a transverse plane?

A

Cuts in half along hips

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18
Q

What is a coronal plane?

A

Creates forward and backward sides

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19
Q

Characteristics of ultrasound scans

A

Uses high-frequency sound to define tissues
Transducer sends pulses to tissues and receives echo back which contains spatial and contrast information
Computer created 2D greyscale image

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20
Q

Benefits of ultrasound scans

A

No radiation, readily available, cheap, portable, can examine physiology/heart/blood vessels/fetus

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21
Q

Limitations of ultrasound scans

A

Trained operator required, can’t penetrate bone/thermal heating

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22
Q

Characteristics of nuclear medicine

A

Radioactive tracer injected to diagnose/monitor/treat disease
Commonly use technetium
Uses ionising radiation
Functional not anatomical imaging

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23
Q

What can nuclear medicine scan for?

A

Fractures/metastases/cancers/brain disorders

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24
Q

Which chemical is used in nuclear medicine?

A

Technetium

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25
Half life of technetium
6 hours
26
What is an angiogram?
Invasive radiological procedure where you gain access to the arterial vascular system via an artery puncture using catheters and wires
27
Which artery enters the top of the upper arm?
Subclavian artery
28
Where does the right subclavian artery come from?
The brachiocephalic artery
29
What is the brachiocephalic artery?
First branch of the aortic arch
30
Where does the left subclavian artery come from?
The third branch of the aortic arch
31
When does the subclavian artery become the axillary artery?
The lateral border of the first rib
32
When does the axillary artery become the brachial artery?
Just below the axilla, as it crosses the inferior border of the teres major
33
When does the brachial artery divide into the radial and ulnar arteries?
Distal to the elbow
34
Flow chart of blood vessels in arm
Subclavian - axillary - brachial - radial - ulnar
35
What is a CT angiogram?
Much less invasive Standard venous cannula and the machinery and radiographers time the scan acquisition according to the vessel they want to study
36
Which bone does the radial artery follow?
The radius
37
When it reaches wrist, what does the distal ulnar artery continue as?
Superficial palmar arch
38
When it reaches wrist, what does the radial artery continue as?
Deep palmar arch
39
In what direction does blood flow in the hand?
Distal to proximal
40
Where does the scaphoid receive its blood supply from?
Lateral and distal branches of radial artery
41
What is the anterior fat pad?
Curvilinear lucency in front of humerus heading towards radial head
42
What does elevation of the anterior fat pad indicate?
Effusion within the joint because it is normally concealed within the coronoid fossa Indicates intra-articular fracture
43
Where is the posterior fat pad?
From humerus to olecranon - it is a Lucent crescent of fat in the olecranon fossa
44
How many interphalangeal joints are there?
2 - distal and proximal
45
How many types of phalanges are there?
3 - proximal, middle and distal
46
Where is the carpometacarpal joint?
Between carpals and metacarpals
47
What are the 8 carpal bones?
``` Scaphoid Lunate Triquetrum Hamate Capitate Trapezoid Trapezium Pisiform ```
48
What is the physis?
A radiolucent line in a skeletally immature patient which is located between the epiphysis and metaphysis As the metaphysis and epiphysis mature, it disappears
49
What happens to the physes as a child grows?
Undergo endochondral ossification
50
How do the carpal bones ossify?
Starts in capitate and goes round clockwise, ending at pisiform At birth, no calcification
51
When does the capitate ossify?
1-3 months
52
When does the pisiform ossify?
8-12 years
53
Sequence of ossification of carpal bones
Capitate, hamate, triquetrum, lunate, scaphoid, trapezium, trapezoid, pisiform
54
Which radioactive isotope is used in nuclear medicine in children?
Technetium 99
55
What can nuclear medicine show in children?
Bone structures/malignancy/fractures
56
Characteristics of brachial plexus
Network of nerves supplying skin and upper limb C5 to T1 At each vertebral level, the paired spinal nerves leave the spinal cord by neural foramen where they divide into anterior and posterior rami
57
What do the anterior rami do?
Form roots
58
What do posterior divisions of brachial plexus do?
Innervate skin and muscles of intrinsic back musculature
59
What are the three trunks of the brachial plexus?
Superior/middle/inferior
60
Which nerves innervate the superior trunk?
C5 and C6
61
Which nerves innervate the middle trunk?
C7
62
Which nerves innervate the inferior trunk?
C8 and T1
63
How many branches does each trunk split into and where?
2 and posterior triangle of neck
64
What happens to the two divisions of a trunk of the brachial plexus?
One moves anteriorly and the other posteriorly - they pass into the axilla and recombine into the cords of the B.P
65
Place roots cords and trunks in order
Roots - trunks - cords
66
What are the three cords of the BP?
Lateral/posterior/medial cords
67
What is the lateral cord formed by?
Anterior divisions of superior and middle trunk
68
What is the posterior cord formed by?
Posterior divisions of superior/middle/inferior trunk
69
What is the medial cord formed by?
Anterior division of inferior trunk
70
Which nerves to the three cords give rise to?
Musculocutaneous, axillary, medial, radial and ulna
71
List the 10 bones/joints of the shoulder
``` ACJ (acromion process articulates with distal end of clavicle) Subacromion space (below acromion) Glenohumeral joint (humerus and glenoid fossa) Clavicle Acromion process Glenoid fossa Coracoid process Humeral head Greater/lesser tuberosity Scapula ```
72
What is the function of the rotator cuff?
Stabilises glenohumeral/shoulder joint
73
4 muscle in rotator cuff
Supraspinatus Infraspinatus Teres minor Subscapularis
74
What does the supraspinatus do?
Abduction
75
What does the infraspinatus do?
External rotation
76
What does the trees minor do?
External rotation
77
What does the subscapularis do?
Internal rotation
78
What ligaments are found in the rotator cuff?
Coracohumeral and glenohumeral
79
What are the 3 muscles of the anterior arm compartment?
Biceps brachii Brachialis Coracobrachialis
80
What nerve innervates the anterior arm compartment?
Musculocutanous nerve
81
Which artery supplies the anterior arm compartment?
Brachial
82
What are the 3 muscles of the posterior arm compartment?
Triceps Brachi Anconeus Articularis cubiti
83
What are the anterior and posterior compartments of the arm divided by?
Fascia
84
When does compartment syndrome occur?
Increased inter compartmental pressure
85
When does myonecrois occur?
Interstitial pressure exceeds pressure in capillary bed
86
Symptoms of compartment syndrome
Pain, paraesthesia, pallor, paralysis, pulseness
87
9 components of the elbow
``` Shaft of humerus Olecranon process Trochlea Coronoid process Radial head Ulna shaft Lateral/medial epicondyle Capitulum Trochlear notch ```
88
What is the trochlearnotch?
Olecranon and coronoid processes articulate with trochlea
89
5 components of wrist
``` Radius Ulna Ulnar/radial styloid Lunate Radiocarpal joint ```
90
Where are the flexors in the forearm?
Mainly on palm
91
Where are the extensors in the forearm?
Backside of arm
92
What are the three subgroups of the anterior compartment?
Superficial/intermediate/deep
93
What do muscles in the anterior compartment do?
Flexion at wrist and fingers and pronation
94
What do muscle din the posterior compartment do?
Extend wrists and fingers
95
What are muscle in the posterior compartment innervated by?
Radial nerve
96
What are the superficial and deep layers of the posterior compartment divided by?
Fascia
97
How many extensors are there?
12
98
When does compartment syndrome occur?
Increased inter compartmental pressure
99
When does myonecrois occur?
Interstitial pressure exceeds pressure in capillary bed
100
Symptoms of compartment syndrome
Pain, paraesthesia, pallor, paralysis, pulseness
101
9 components of the elbow
``` Shaft of humerus Olecranon process Trochlea Coronoid process Radial head Ulna shaft Lateral/medial epicondyle Capitulum Trochlear notch ```
102
What is the trochlearnotch?
Olecranon and coronoid processes articulate with trochlea
103
5 components of wrist
``` Radius Ulna Ulnar/radial styloid Lunate Radiocarpal joint ```
104
Where are the flexors in the forearm?
Mainly on palm
105
Where are the extensors in the forearm?
Backside of arm
106
What are the three subgroups of the anterior compartment?
Superficial/intermediate/deep
107
What do muscles in the anterior compartment do?
Flexion at wrist and fingers and pronation
108
What do muscle din the posterior compartment do?
Extend wrists and fingers
109
What are muscle in the posterior compartment innervated by?
Radial nerve
110
What are the superficial and deep layers of the posterior compartment divided by?
Fascia
111
How many extensors are there?
12
112
What are the two types of movement occurring at the elbow joint?
Flexion-extension | Pronation-supination
113
What are the three muscles in the flexion (anterior compartment) muscle group?
Biceps brachii Brachialis Coracobrachialis
114
What does the biceps brachii do?
Attaches scapula to radial tuberosity and fascia of forearm
115
What does the brachialis do?
Attaches anterior humerus to coronoid process and ulnar tuberosity
116
What does the coracobrchialis do?
Attaches coracoid process to medial surface of humerus
117
Which muscle is in the extension-posterior compartment?
Triceps brachii
118
What does the triceps brachii do?
Attaches scapula and humerus to olecranon and fascia of forearm
119
What are the three muscles in the anterior compartment of the forearm?
Pronator teres Flexor carpi radialis Palmaris longus
120
What does the pronator teres do?
Attaches humeral head to body of radius
121
What does the flexor carpi radialis do?
Attaches metacarpals 2 and 3 to humerus medial epicondyle
122
What does the palmaris longus do?
Attaches medial epicondyle to palmar aponeurosis
123
Which nerve supplies anterior compartment of arm?
Musulocutaneous nerve
124
Which nerve supplies posterior compartment of arm?
Radial
125
Why is the radial nerve liable to injury?
Sits in radial groove - very exposed
126
Which muscles are paralysed when the humeral shaft is damaged?
Triceps brachii, Brachioradialis, supinator and extensor muscles of wrist
127
Damage to which nerve causes the characteristic wrist drop?
Radial

Musculoskeletal system (24 decks)

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