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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
Q

Half life of technetium

A

6 hours

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26
Q

What is an angiogram?

A

Invasive radiological procedure where you gain access to the arterial vascular system via an artery puncture using catheters and wires

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27
Q

Which artery enters the top of the upper arm?

A

Subclavian artery

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28
Q

Where does the right subclavian artery come from?

A

The brachiocephalic artery

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29
Q

What is the brachiocephalic artery?

A

First branch of the aortic arch

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30
Q

Where does the left subclavian artery come from?

A

The third branch of the aortic arch

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31
Q

When does the subclavian artery become the axillary artery?

A

The lateral border of the first rib

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32
Q

When does the axillary artery become the brachial artery?

A

Just below the axilla, as it crosses the inferior border of the teres major

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33
Q

When does the brachial artery divide into the radial and ulnar arteries?

A

Distal to the elbow

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34
Q

Flow chart of blood vessels in arm

A

Subclavian - axillary - brachial - radial - ulnar

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35
Q

What is a CT angiogram?

A

Much less invasive
Standard venous cannula and the machinery and radiographers time the scan acquisition according to the vessel they want to study

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36
Q

Which bone does the radial artery follow?

A

The radius

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37
Q

When it reaches wrist, what does the distal ulnar artery continue as?

A

Superficial palmar arch

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38
Q

When it reaches wrist, what does the radial artery continue as?

A

Deep palmar arch

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39
Q

In what direction does blood flow in the hand?

A

Distal to proximal

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40
Q

Where does the scaphoid receive its blood supply from?

A

Lateral and distal branches of radial artery

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41
Q

What is the anterior fat pad?

A

Curvilinear lucency in front of humerus heading towards radial head

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42
Q

What does elevation of the anterior fat pad indicate?

A

Effusion within the joint because it is normally concealed within the coronoid fossa
Indicates intra-articular fracture

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43
Q

Where is the posterior fat pad?

A

From humerus to olecranon - it is a Lucent crescent of fat in the olecranon fossa

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44
Q

How many interphalangeal joints are there?

A

2 - distal and proximal

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45
Q

How many types of phalanges are there?

A

3 - proximal, middle and distal

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46
Q

Where is the carpometacarpal joint?

A

Between carpals and metacarpals

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47
Q

What are the 8 carpal bones?

A 
Scaphoid
Lunate
Triquetrum 
Hamate
Capitate
Trapezoid
Trapezium
Pisiform
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48
Q

What is the physis?

A

A radiolucent line in a skeletally immature patient which is located between the epiphysis and metaphysis
As the metaphysis and epiphysis mature, it disappears

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49
Q

What happens to the physes as a child grows?

A

Undergo endochondral ossification

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50
Q

How do the carpal bones ossify?

A

Starts in capitate and goes round clockwise, ending at pisiform
At birth, no calcification

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51
Q

When does the capitate ossify?

A

1-3 months

52
Q

When does the pisiform ossify?

A

8-12 years

53
Q

Sequence of ossification of carpal bones

A

Capitate, hamate, triquetrum, lunate, scaphoid, trapezium, trapezoid, pisiform

54
Q

Which radioactive isotope is used in nuclear medicine in children?

A

Technetium 99

55
Q

What can nuclear medicine show in children?

A

Bone structures/malignancy/fractures

56
Q

Characteristics of brachial plexus

A

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
Q

What do the anterior rami do?

A

Form roots

58
Q

What do posterior divisions of brachial plexus do?

A

Innervate skin and muscles of intrinsic back musculature

59
Q

What are the three trunks of the brachial plexus?

A

Superior/middle/inferior

60
Q

Which nerves innervate the superior trunk?

A

C5 and C6

61
Q

Which nerves innervate the middle trunk?

A

C7

62
Q

Which nerves innervate the inferior trunk?

A

C8 and T1

63
Q

How many branches does each trunk split into and where?

A

2 and posterior triangle of neck

64
Q

What happens to the two divisions of a trunk of the brachial plexus?

A

One moves anteriorly and the other posteriorly - they pass into the axilla and recombine into the cords of the B.P

65
Q

Place roots cords and trunks in order

A

Roots - trunks - cords

66
Q

What are the three cords of the BP?

A

Lateral/posterior/medial cords

67
Q

What is the lateral cord formed by?

A

Anterior divisions of superior and middle trunk

68
Q

What is the posterior cord formed by?

A

Posterior divisions of superior/middle/inferior trunk

69
Q

What is the medial cord formed by?

A

Anterior division of inferior trunk

70
Q

Which nerves to the three cords give rise to?

A

Musculocutaneous, axillary, medial, radial and ulna

71
Q

List the 10 bones/joints of the shoulder

A 
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
Q

What is the function of the rotator cuff?

A

Stabilises glenohumeral/shoulder joint

73
Q

4 muscle in rotator cuff

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

74
Q

What does the supraspinatus do?

A

Abduction

75
Q

What does the infraspinatus do?

A

External rotation

76
Q

What does the trees minor do?

A

External rotation

77
Q

What does the subscapularis do?

A

Internal rotation

78
Q

What ligaments are found in the rotator cuff?

A

Coracohumeral and glenohumeral

79
Q

What are the 3 muscles of the anterior arm compartment?

A

Biceps brachii
Brachialis
Coracobrachialis

80
Q

What nerve innervates the anterior arm compartment?

A

Musculocutanous nerve

81
Q

Which artery supplies the anterior arm compartment?

A

Brachial

82
Q

What are the 3 muscles of the posterior arm compartment?

A

Triceps Brachi
Anconeus
Articularis cubiti

83
Q

What are the anterior and posterior compartments of the arm divided by?

A

Fascia

84
Q

When does compartment syndrome occur?

A

Increased inter compartmental pressure

85
Q

When does myonecrois occur?

A

Interstitial pressure exceeds pressure in capillary bed

86
Q

Symptoms of compartment syndrome

A

Pain, paraesthesia, pallor, paralysis, pulseness

87
Q

9 components of the elbow

A 
Shaft of humerus
Olecranon process
Trochlea
Coronoid process
Radial head
Ulna shaft
Lateral/medial epicondyle 
Capitulum
Trochlear notch
88
Q

What is the trochlearnotch?

A

Olecranon and coronoid processes articulate with trochlea

89
Q

5 components of wrist

A 
Radius
Ulna
Ulnar/radial styloid
Lunate
Radiocarpal joint
90
Q

Where are the flexors in the forearm?

A

Mainly on palm

91
Q

Where are the extensors in the forearm?

A

Backside of arm

92
Q

What are the three subgroups of the anterior compartment?

A

Superficial/intermediate/deep

93
Q

What do muscles in the anterior compartment do?

A

Flexion at wrist and fingers and pronation

94
Q

What do muscle din the posterior compartment do?

A

Extend wrists and fingers

95
Q

What are muscle in the posterior compartment innervated by?

A

Radial nerve

96
Q

What are the superficial and deep layers of the posterior compartment divided by?

A

Fascia

97
Q

How many extensors are there?

A

12

98
Q

When does compartment syndrome occur?

A

Increased inter compartmental pressure

99
Q

When does myonecrois occur?

A

Interstitial pressure exceeds pressure in capillary bed

100
Q

Symptoms of compartment syndrome

A

Pain, paraesthesia, pallor, paralysis, pulseness

101
Q

9 components of the elbow

A 
Shaft of humerus
Olecranon process
Trochlea
Coronoid process
Radial head
Ulna shaft
Lateral/medial epicondyle 
Capitulum
Trochlear notch
102
Q

What is the trochlearnotch?

A

Olecranon and coronoid processes articulate with trochlea

103
Q

5 components of wrist

A 
Radius
Ulna
Ulnar/radial styloid
Lunate
Radiocarpal joint
104
Q

Where are the flexors in the forearm?

A

Mainly on palm

105
Q

Where are the extensors in the forearm?

A

Backside of arm

106
Q

What are the three subgroups of the anterior compartment?

A

Superficial/intermediate/deep

107
Q

What do muscles in the anterior compartment do?

A

Flexion at wrist and fingers and pronation

108
Q

What do muscle din the posterior compartment do?

A

Extend wrists and fingers

109
Q

What are muscle in the posterior compartment innervated by?

A

Radial nerve

110
Q

What are the superficial and deep layers of the posterior compartment divided by?

A

Fascia

111
Q

How many extensors are there?

A

12

112
Q

What are the two types of movement occurring at the elbow joint?

A

Flexion-extension

Pronation-supination

113
Q

What are the three muscles in the flexion (anterior compartment) muscle group?

A

Biceps brachii
Brachialis
Coracobrachialis

114
Q

What does the biceps brachii do?

A

Attaches scapula to radial tuberosity and fascia of forearm

115
Q

What does the brachialis do?

A

Attaches anterior humerus to coronoid process and ulnar tuberosity

116
Q

What does the coracobrchialis do?

A

Attaches coracoid process to medial surface of humerus

117
Q

Which muscle is in the extension-posterior compartment?

A

Triceps brachii

118
Q

What does the triceps brachii do?

A

Attaches scapula and humerus to olecranon and fascia of forearm

119
Q

What are the three muscles in the anterior compartment of the forearm?

A

Pronator teres
Flexor carpi radialis
Palmaris longus

120
Q

What does the pronator teres do?

A

Attaches humeral head to body of radius

121
Q

What does the flexor carpi radialis do?

A

Attaches metacarpals 2 and 3 to humerus medial epicondyle

122
Q

What does the palmaris longus do?

A

Attaches medial epicondyle to palmar aponeurosis

123
Q

Which nerve supplies anterior compartment of arm?

A

Musulocutaneous nerve

124
Q

Which nerve supplies posterior compartment of arm?

A

Radial

125
Q

Why is the radial nerve liable to injury?

A

Sits in radial groove - very exposed

126
Q

Which muscles are paralysed when the humeral shaft is damaged?

A

Triceps brachii, Brachioradialis, supinator and extensor muscles of wrist

127
Q

Damage to which nerve causes the characteristic wrist drop?

A

Radial

Musculoskeletal system (24 decks)

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