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Rad Pro 3 > Lecture 2: Image Critique Upper Extremity > Flashcards

Lecture 2: Image Critique Upper Extremity Flashcards

1
Q

T/F

There is more soft tissue and concavity on anterior surface of the finger

A

True

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2
Q

What should be seen on an image of a PA finger?

A

-Equal soft tissue
-Midpoint concavity the same on both sides of phalanges
-Open joint spaces

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3
Q

What errors have been made in this image of the PA finger?

A

Lateral side of the digit is obliqued with the thumb away from the IR

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4
Q

What digit is this?

A

Right index

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5
Q

What errors have been made in this image of the PA finger?

A

No joint space visible, right index finger is flexed

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6
Q

T/F

There is better joint space visibility when doing an AP projection for unextendable digits

A

True

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7
Q

What should be seen on an image of a lateral finger?

A

-Open interphalangeal joints
-Superimposed heads of proximal and middle phalanges
-Fingernail in profile
-No overlap of adjacent digits

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8
Q

What errors have been made in this image of the lateral finger?

A

-Finger is not parallel to the IR (tip down too low)
-Marker overtop of the finger

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9
Q

What error(s) have been made in this image of the lateral finger? How can this be corrected?

A

-Fingers are not out of the way
-External rotation needed to align the 2nd metacarpal over the 4th

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10
Q

Is this image repeatable?

A

No; because fracture is visualized

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11
Q

T/F

The second metacarpal is the longest

A

True

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12
Q

What corrections should be made to this image of the lateral finger?

A

More internal rotation needed

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13
Q

What should be seen on an image of the PA thumb?

A

-Equal soft tissue
-Midpoint concavity the same on both sides of phalanges
-Open joint spaces
-Long axis of thumb in line with central ray
-Include trapezium

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14
Q

What error(s) have been made? What could be done to correct this?

A

Slightly obliqued; externally rotate the wrist to fix

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15
Q

What error(s) have been made? How could this be corrected?

A

-Distal joint space is not open
-Flatten thumb against IR to fix

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16
Q

How can you visualize all four joints spaces of the trapezium?

A

By raising the elbow

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17
Q

What projection is this?

A

AP thumb

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18
Q

What should been seen in an image of the lateral thumb?

A

-Open interphalangeal joints
-Superimposed heads of proximal phalanx
-Fingernail in profile
-Include trapezium
-Abduct thumb

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19
Q

What correction(s) if any, need to be made to this image of the lateal thumb?

A

-Internal rotation of the thumb needed

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20
Q

What correction(s) if any, need to be made?

A

Thumb needs to be abducted slightly because the soft tissue is superimposed

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21
Q

What should be seen on an image of the PA hand?

A

-No rotation
-Equal distance between MCP heads
-Thumb is in a PA oblique position
-5th phalanges lined up with metacarpal
-Open MCP and IP joint spaces

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22
Q

What error(s) have been made to this image of the PA hand?

A

-Hand externally rotated

-Looks like oblique due to the metacarpal spaces getting closer together and concavity of the phalanges seen

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23
Q

What error(s) have been made in this image of the PA hand?

A

-Hand is not flat (fingers flexed)
-Hand slightly obliqued

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24
Q

What error(s) have been made in this image of the PA hand?

A

-5th phalange not in line with the 5th metacarpal (over abducted)
-Joint space closed on digits due to beam divergence from over abducted digits

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25
Q

What should be seen in an image of the PA Oblique hand?

A

-Open MCP and IP joint spaces
-Overlap of MC heads 3-5
-No overlap between 2nd and 3rd MC heads
-Slight space between 4th and 5th metacarpal at the midshaft

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26
Q

What error(s) have been made in this image of the PA oblique hand?

A

-Poor centering; too much on wrist and cutting off middle tip of finger

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27
Q

What will be visualized if the hand is underobliqued in a PA oblique?

A

Space bigger between the metacarpal heads, and larger spaces between the metacarpal shaft

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28
Q

What could have been done to better visualize the joint spaces?

A

Fingers need to be more extended to visualize the joint spaces

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29
Q

What error(s) have been made in this PA oblique?

A

-Fingers need to be more extended to visualize joint space

(good oblique)

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30
Q

What error(s) have been made in this image of the PA oblique?

A

Over obliqued (too externally rotated)

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31
Q

What should be seen in an image of the fan lateral?

A

-2nd – 5th metacarpals superimposed
-IP joints are open
-2nd – 5th digits are separated

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32
Q

Wht error(s) have been made in this image of the fan lateral?

A

None

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33
Q

What error(s) have been made in this image of the fan lateral? What could be done to correct this?

A

-Not in a good lateral
-Metacarpals are not superimposed; needs more external rotation

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34
Q

Where should the styloid processes be in a PA wrist image?

A

Styloid processes are at the extreme edges

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35
Q

What joint spaces need to be open in a PA wrist?

A

-Scapholunate joint
-Radioulnar joint
-CMC joints

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36
Q

Where should the pisiform be in relation to the triquetrum on in a PA wrist

A

Pisiform is positioned outside of ulnar border of the triquetrum

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37
Q

How can you visualize the radiocarpal joint space?

A

11 degree angle cephalad

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38
Q

What border is the red and yellow line on the radius?

A

Red: Anterior margin
Yellow: Posterior margin

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39
Q

What oblique of the wrist best demonstrates the pisiform?

A

AP Oblique

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40
Q

What oblique is the best to to demonstrate the scaphoid?

A

PA oblique

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41
Q

What error(s) have been made in this image of the PA wrist?

A

-Wrist is obliqued (thumb is off the IR)

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42
Q

How could CMC joint space be better visualized?

A

Flatten the wrist

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43
Q

What carpal bone is visualized?

A

Trapezium

44
Q

What radiographic sign is visable with radial deviation in the wrist?

A

Signet ring sign

45
Q

What is present?

Radial deviation OR Ulnar deviation?

A

Radial deviation

46
Q

T/F

In a PA wrist, having the proximal forearm higher than distal forearm will cause excessive foreshortening of the scaphoid

A

True

47
Q

T/F

Ulnar deviation will cause excessive forshortening of the scaphoid.

A

False; radial deviation will cause excesive forshortening of the scaphoid

48
Q

What happens with wrist extension to the scaphoid and CMC joints in a PA wrist?

A

-Less foreshortening of the scaphoid
-CMC joint spaces closed

49
Q

How should the pisiform and scaphoid be aligned in a lateral wrist?

A

Anterior part of distal scaphoid is nearly aligned with anterior part of pisiform

50
Q

T/F

In a lateral wrist, the radius and ulnar should be superimposed.

A

True

51
Q

Label the blue, purple and red lines

A

Red: Trapezium
Purple: Scaphoid
Blue: Pisiform

52
Q

If you are doing lateral wrist, what do hit first; scaphoid or pisiform?

A

Scaphoid

53
Q

How much of the ulna on the radius at the radial tuberosity should be overlaped in an AP elbow?

A

50% of the radial tuberosity should be overlapping on the ulna

54
Q

How much should the radial head be overlapped over the ulna in an AP elbow?

A

0.25” (0.6 cm) overlap of radial head on ulna

55
Q

What joint space should be open in an AP elbow?

A

Capitulum-radial joint space is open

56
Q

T/F

In an AP elbow the radius and ulna should be parallel

A

True

57
Q

What error(s) have been made in this image of the AP elbow?

A

Too much overlap (thumb has come off the IR)

58
Q

What error(s) have been made in this image of the AP elbow?

A

Elbow too externally rotated

59
Q

What projection is this?

A

Partial flexion elbow with forearm off IR

60
Q

How should you image a child for a partial flexion elbow view?

A

Humorous parallel to the IR

61
Q

How should you image an adult for a partial flexion elbow view?

A

Forearm parellel to the IR

62
Q

What is the best way to demonstrate the radial head fracture?

A

AP External Oblique

63
Q

What joint spaces need to be open for a AP External Oblique?

A

-Capitulum-radial joint space
-Radio-ulnar joint space

64
Q

T/F

The radial head, neck, and radial tuberosity should be superimposed on the ulna in an AP External Oblique.

A

False; No overlap of radial head, neck, or radial tuberosity on ulna

65
Q

What error(s) have been made in this image of the AP External oblique elbow? How could this be corrected?

A

-Radial head joint space not open
-Place forearm flat on the IR

66
Q

What error(s) have been made in this image of the AP external oblique elbow?

A

Too externally rotated

67
Q

What error(s) have been made in this image of the AP external oblique elbow?

A

-Not rotated enough
-Radioulnar joint space is not open

68
Q

How much of the radial head should be superimposed on the ulna in an AP internal oblique?

A

¾ of the radial head is superimposed on ulna (min 75% of superimposition)

69
Q

What position best demonstrates the coronoid process?

A

AP internal oblique

70
Q

T/F

The trochlear notch is visible in an AP internal oblique of the elbow.

A

True

71
Q

What error(s) have been made in this image of the AP internal oblique elbow?

A

-Not enough internal rotation

72
Q

What error(s) have been made in this image of the AP internal oblique elbow?

A

None :)

73
Q

What structures should be aligned/superimposed in a lateral elbow?

A

-Capitulum and trochlea superimposed
-Articulating surfaces of radial head and coronoid process are aligned

74
Q

What occurs to the fat pads if there is excessive flexion in a lateral elbow projection?

A

The SAIL sign/anterior fat pad is pushed back

75
Q

What structure is seen first in a lateral elbow?

A

The radius

76
Q

What corrective measures should be made to correct the mistakes made in this image?

A

Raise the hand, slight more flexion

77
Q

How can you tell the difference between the medial and the lateral condyles of the elbow?

A

Medial side: Smooth continuous bump
Lateral side: Jutts in to form an abrupt angle

78
Q

What corrective measure should be made in this image?

A

-Raise the elbow up/shoulder down

79
Q

Label the red and the yellow lines:

A

Yellow: Medial
Red: Lateral

80
Q

What corrective measure should be made for the lateral elbow?

A

-Raise the hand and raise the elbow up

81
Q

What corrective measures should be made for this image?

A

-Hand down
-Elbow up
-Flex elbow more
-Center on the condyles

82
Q

What is the corrective measure for this image?

A

Raise the hand, lower the elbow

Note the posterior fat pad, sail sign

83
Q

What position should be done first in a shoulder series?

A

External rotation

(includes all of scapula and clavicle)

84
Q

Where is the greater tuberosity and the humeral epicondyles in an external rotation shoulder?

A

-GT in profile on the lateral side
-Humeral epicondyles are parallel to IR

85
Q

Where is the lesser tuberosity and the humeral epicondyles located in an internal rotation shoulder?

A

-Lesser tuberosity in profile medially
-Humeral epicondyles are perpendicular to IR

86
Q

Where is the Greater tuberosities located in a neutral shoulder projection? Where are the humeral epicondyles?

A

-Anterior on the humeral head
-Humeral epicondyles at a 45 degree oblique

87
Q

How can you image the subacromial space in the shoulder?

A

By using a caudad angle

88
Q

What projection of the shoulder is this?

A

-External rotation

-Grade 3 AC separation, broken ribs, scapula

89
Q

What projection is this?

A

Internal rotation shoulder

90
Q

What projection is this?

A

Neutral rotation

91
Q

In a glenoid projection, what should be superimposing the humeral head and by how much?

A

Coracoid process superimposes humeral head by 0.25” or 0.6 cm

92
Q

What corrections need to be made to this image of the glenoid?

A

-Need to be obliqued more (ribs need to be closer to the joint space)

93
Q

What correction needs to be made to this image of the glenoid?

A

Patient needs to be obliqued more

94
Q

What space needs to be open in a lateral Y scap?

A

Subacromial space

95
Q

Where should the humeral head be in a lateral Y scap?

A

In the middle of the Y

96
Q

What error(s) have been made to this image of the Y scap?

A

Patient was obliqued too far

97
Q

If an angle was need for a Y scap, and the patient was PA, what angle would you use, caudad or cephalad?

A

Caudad

98
Q

What correction needs to be made for this image?

A

Patient needs to be obliqued more

99
Q

Where should the lesser tuberosity be seen in axillary projection of the shoulder?

A

Lesser tuberosity in profile anteriorly

100
Q

What is the best projection to confirm shoulder dislocations?

A

Axillary projection of the shoulder

101
Q

Where should the coracoid process and the glenoid cavity be in relation to one another in an axillary projection?

A

Glenoid cavity lines up with lateral border of coracoid process

102
Q

What should the angle between central ray and the side of the body be for an infrosuperior axial shoulder?

A

Angle between central ray and the side of the body: 30-35 degrees

103
Q

In an infrosuperior axial view, what structure do we hit first?

A

The glenoid

104
Q

What error(s) have been made in this image?

A

Angle between the body and central ray is too small

105
Q

What corrections need to be made to this image of the AP glenoid?

A

-Patient needs to be more obliqued
-Axillary view needed

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