Module 5 Upper EXTREMITY Flashcards
8 CARPAL BONES
- Scaphiod
- Lunate
- Triquetrum
- Pisiform
- Trapezium
- Trapezoid
- Capitate
- Hamate
ELBOW
A joint between forearm and arm and has three articulations =
- Humeroradial joint
- Humeroulna joint
- Proximal radioulnar joint
HUMERUS
Proximal bone of the upper arm
PROXIMAL END OF THE HUMERUS ANATOMY
Head Anatomical neck Greater tubercle Lesser tubercle Bicipital groove Surgical neck
DISTAL END OF THE HUMERUS ANATOMY
Lateral epicondyles Medial epicondyles Troclea Capitulum Coronoid fossa Radial fossa Olecranon fossa
SCAPHOID ULNA DEVIATION VIEW PROJECTION STRUCTURES DEMONSTRATED
- Corrected foreshortening of the scaphoid
- Opens the spaces between the scaphoid and adjacent carpals
SCAPHOID (Stecher Method) VIEW PROJECTION STRUCTURES DEMONSTRATED ( 20deg cep)
Demonstrates the scaphoid without superimposition
RADIAL HEAD LATERALS PROJECTIONS
Their are four in total and they demonstrate the occult fractures of the radial head and neck
Done with the lateral elbow with 4 movements of the hand.
SUPERNATED
LATERAL
PRONATED
INTERNALLY ROTATED
ELBOW COYLE PROJECTION-METHOD
Elbow in lateral position with the hand pronated
CR 45 deg towards shoulder entering mid elbow
Demonstrates radial head free from superimposition
PA WRIST RADIOGRAPHIC CRITERIA
- Carpal bones at the centre of the IR
- Distal radial margined are almost superimposed
- 2nd to 5th carpometacarpal joints are open
- Carpalbones, distal radius and ulna and proximal metacarpals are included
- 3rd metacarpal and midforearm are aligned
RADIOGRAPHIC CRITERIA FOR PA OBLIQUE WRIST
- Demonstrate the carpals on the lateral side of the wrist ( trapezium and scaphoid)
- Separation between the trapezium and scaphoid
- 3rd metacarpal and the mid forearm are aligned
RADIOGRAPHIC CRITERIA FOR LATEROMEDIAL WRIST
- Anterior aspect of the distal scaphoid and pisiform are aligned
- Distal aspects of distal scaphoid and pisiform are aligned
- Distal radius and ulna are superimposed
- Carpal bones at the centre
RADIOGRAPHIC CRITERIA FOR ULNA DEVIATION SCAPHOID VIEW
- Scaphotrapezium and scaphotrazoidal, scaphocapitate and scaphoidlunate and radioscaphoid joint space are open
- 1st metacarpal and radius are aligned
- Scaphoid is at the centre
RADIOGRAPHIC CRITERIA FOR FOREARM
- Wrist and elbow joint included
- Radioscaphoid and radiolunate joint space are open
- Radial head, neck and tuberosity are superimposed over the proximal ulna
- Olecranon process is with in the Olecranon fossa
- Radius and ulna are parallel
RADIOGRAPHIC CRITERIA FOR LATEROMEDIAL FOREARM
- Distal radius and ulna are superimposed
- Elbow flexed 90degrees
- Radial head superimposed over the coronoidprocess
RADIOGRAPHIC CRITERIA FOR AP ELBOW
- Humeral epicondyles are in profile
- Radial head is superimposed over the proximal ulna
- Radial tuberosity is in profile medially
- Open radiocapitulum joint
- Olecranon process is within the Olecranon fossa
- Elbow joint at centre
RADIOGRAPHIC CRITERIA LATERAL ROTATION ELBOW
- Radiocapitulum joint is open
- Ulna is demonstrated without radial head, neck, and tuberosity superimposition
- Elbow joint is at the centre
RADIOGRAPHIC CRITERIA FOR AP OBLIQUE MEDIAL ROTATION ELBOW PROJECTION
- Coronoid process, trochlea, trochlear notch, Olecranon are in profile
- Trochlear coronoid process is open
- Radial head and neck are superimposed over the ulna
- Elbow joint is at the centre
RADIOGRAPHIC CRITERIA FOR LATERAL ELBOW
- Elbow is flexed 90 degrees
- Elbow joint is open
- Radial head and Coronoid process are aligned
- Capitulum and trochlea are superimposed
- Elbow joint is at the centre
RADIOGRAPHIC CRITERIA OF AP HUMERUS
- Humeral condyles are in profile
- The greater tubercle is demonstrated in profile laterally
- Humeral head is demonstrated medially in profile
- Humeral midpoint is at the centre of exposure
RADIOGRAPHIC CRITERIA FOR LATERAL HUMERUS
- Lesser tuberosity is in profile medially
- Humeral head and greater tubercle are superimposed
- Radial head and Coronoid process are superimposed
- Capitulum is distal to the trochlea, due to superior central ray replacement
DELAYED BONE AGE
A developmental condition, skeletal development is determined by the presence of primary ossification centres and the development of the epiphysis
Carpal ossification and knee ossification epiphysis are looked at to determine skeletal maturation. Under 1 year
Only PA left hand over 1 year
COLLES FRACTURE
- Involves the distal radius with posterior displacement of distal fragment
- Posterior angulation
- New with no callus formation
SMITHS FRACTURE
- Involves the distal radius
- Anterior and lateral displacement of distal fragment with Volar angulation
- New fracture with no callus formation
GREENSTICK FRACTURE
- Break of bone with no break in cortex
- A childhood fracture
- Often seen in the forearm
- Bone bend appearance
- Fracture on one side of the bone and bent on the other
MONTEGGIA FRACTURE
Fracture of the shaft of the ulna with dislocation of the radial head caused by blow to the ulna or fallen outstretched hand
GALEAZZI FRACTURE
Fracture of the shaft of the radius with dislocation of the ulnar head. May be caused by an outstretched arm.
RADIAL HEAD FRACTURE
- Intra- articulate radial head fracture
- Vertical
- Lateral displacement
- New soft tissue swelling with no callus formation
RHEUMATOID ARTHRITIS
- Inflammation if the small joints of the hands and feet. Women average age of 40 years are 3x more likely than men
Results into a crippling deformity of the affected joints
RADIOGRAPHIC APPEARANCE OF RHEUMATOID ARTHRITIS
- 1st sign synovitis
- then Pannus Formation
- Fibrous scarring
- Ankylosis
SYNOVITIS
The inflammation of synovial membrane that lines the joint
PANNUS
Thickened tissue eroding of the articular cartilage and bony cortex
ANKYLOSIS
Boney fusion across a joint
OSTEOMYELITIS
A bone disease that results from an Inflammation of bone resulting from progenitor infection
SHOULDER JOINT
Ball and socket synovial joint with The articulation between the glenoid of the scapula and the Humeral head. Often referred to as the scapulohumeral or glenohumeral joint.
ROTATOR CUFF MUSCLES
- Subscapular
- Supraspinatus
- Infraspinatus
- Teres minor
CLAVICLE
Coller bone, made up of three portions =
- Medial or sternal end- articulates with manubrium forming sternoclavicular joint
- Lateral or acromial extremity- articulates with the acromion forming acromioclavicular joint
- Body - anterior bone of the shoulder girdle
SCAPULA
Flat bone posterior to the shoulder, consists of:
Two surfaces- Anterior/ costal and posterior/ dorsal
Three borders- Superior, - Medial, - Lateral
Three angles- Superior, -Inferior- , Lateral
SHOULDER AP PROJECTION EXTERNAL ROTATION
- Patient erect or supine
- Arm and hand supernated
- epicondyles parallel with the IR plane
- CR perpendicular and 2:5cm inferior to the coracoidprocess
AP SHOULDER EXTERNAL ROTATION STRUCTURES DEMONSTRATED
Humeral head and greater tuberosity in profile on the lateral aspect of the humerus
SHOULDER AP PROJECTION ARM INTERNAL ROTATION
- Patient erect or supine
- Internally rotate arm until epicondyles of the distal humerus are perpendicular to IR
- CR perpendicular 2,5 cm inferior to the coracoid process
SHOULDER AP PROJECTION ARM INTERNAL ROTATION STRUCTURES DEMONSTRATED
- Lesser tuberosity in profile medially
- Greater tuberosity superimposes the Humeral head
SHOULDER AP PROJECTION ARM NEUTRAL ROTATION
- Patient erect or supine
- Patients arm rested on thigh
- Epicondyles at an angle of about 45deg to the IR
- CR perpendicular 2,5cm inferior to the coracoid process
SHOULDER AP PROJECTION ARM NEUTRAL ROTATION STRUCTURES DEMONSTRATED
Greater tuberosity partially superimposing the Humeral head
AP OBLIQUE GLENOID. AVITY ( GRASHEY METHOD )
- Rotate patient 35-45deg towards the affected side
- if supine patient may be rotated more than 45deg to place scapular parallel to the IR
- CR perpendicular 5cm medial and 5 cm distal to the supralateral border of the shoulder
GRASHEY METHOD STRUCTURES DEMONSTRATED ( glenoid cavity)
The joint space between the Humeral head and the glenoid cavity
PA OBLIQUE PROJECTION SCAPULAR Y
- Patient erect or supine 45- 60 deg anterior oblique position
- Patients are on the abdomen
- CR perpendicular to IR directed to the scapulohumeral joint, 5-6cm below the top of the shoulder
-
PA OBLIQUE PROJECTION SCAPULAR Y STRUCTURES DEMONSTRATED
- Thin scapula without rib superimposition
- Acromion and coracoid process
- Humeral head should superimpose over the base of Ymir the humerus is not dislocated
AP OBLIQUE PROJECTION SCAPULAR Y
- Patient erect or supine 45- 60 deg anterior oblique position
- Patients are on the abdomen
- CR perpendicular to IR directed to the scapulohumeral joint, 5-6cm below the top of the shoulder
AP OBLIQUE PROJECTION SCAPULAR Y STRUCTURES DEMONSTRATED
– Thin scapula without rib superimposition
- Acromion and coracoid process
- Humeral head should superimpose over the base of Ymir the humerus is not dislocated
- Humerus magnified due to OID (FFD)
DEMONSTRATION OF THE INFEROSUPERIOR AXIAL PROJECTION
LAWRENCE METHOD
- Performed to demonstrate fractures and dislocations of the proximal humerus
- May also demonstrate osteoporosis and osteoarthritis
INFEROSUPERIOR AXIAL PROJECTION
LAWRENCE METHOD
- Position patient with shoulder raised from table with a sponge
- Abduct the affected arm 90 deg if possible and externally rotated
- Rotate patients head away from affected side
- Place IR perpendicular to table above the shoulder
- CR angled cephalade medially 25-30 deg horizontally to the axilla
NB- ( if arm is abducted less than 90 deg, the CR medial angle should be decreased to 15-20 deg
INFEROSUPERIOR AXIAL PROJECTION
( LAWRENCE METHOD ) STRUCTURES DEMONSTRATED
- Proximal humerus projected laterally in relation to the glenohumeral joint
- coracoid process pointing anteriorly and lesser tuberosity in profile so directed anteriorly
INFEROSUPERIOR AXIAL PROJECTION ( RAFERT MODIFICATION )
Similar to the Lawrence Method but with an exaggerated external rotation of the arm and thumb point down
INFEROSUPERIOR AXIAL PROJECTION ( RAFERT MODIFICATION ) STRUCTURES DEMONSTRATED
A Hills Sachs defect would be demonstrated if present. This is a wedge shaped depression on the posterior aspect of the Humeral head
SUPEROINFERIOR AXIAL PROJECTION
- Patient Is seated at the end of the RADIOGRAPHIC table with affected shoulder adjacent to table
- Head tilted away from IR
- Abduct affected arm and have patient lean laterally and centred on IR
- Rest shoulder on table for support
- CR ANGLED vertically 5-15 deg in the direction of elbow
Note= Larger angle is needed for less shoulder abduction
SUPEROINFERIOR AXIAL PROJECTION STRUCTURES DEMONSTRATED
- Scapulohumeral joint
- Coracoid process projected above the clavicle
- Lesser tubercle in profile
- AC joint through the Humeral head
SHOULDER GIRGLE TRANSTHORACIC LATERAL PROJECTION REASON
Performed during trauma,when the arm cannot be rotated or abducted because of injury
SHOULDER GIRGLE TRANSTHORACIC LATERAL PROJECTION
- The patient sits or stands with the injured arm nearer the erect Bucky
- Have the patient raise the uninsured arm over the head elevating the shoulder as much as possible
- The epicondyles of the elbow should be perpendicular to the IR
- Perform supine if patient cannot stand
- CR at the level of the surgical neck
- shallow breathing technique with a long exposure to blur out pulmonary vasculature
SHOULDER GIRGLE TRANSTHORACIC LATERAL PROJECTION STRUCTURES DEMONSTRATED
- Proximal portion of the humerus is projected through the lung fields
- The lesser tuberosity is in profile on the anterior surface of the Humeral head
CLAVICLE AP OR PA PROJECTION
- Patient supine or prone (better detail with prone)
- Centre Clavicle to the midline of table or erect Bucky
- Place the arms of the patient along the sides of the body
- Centre IR midway between the midline of body and outer border of shoulder
- CR perpendicular to the mid shaft of the clavicle
CLAVICLE AP OR PA PROJECTION STRUCTURES DEMONSTRATED
- Medial half of the clavicle demonstrated through the thorax
- Lateral half of the clavicle above the scapula
CLAVICLE AP AXIAL PROJECTION
- Patient supine or proneor erect
- Place arms along the sides of the body
- CR directed 15-30 deg cephalad to mid shaft of the clavicle
CLAVICLE AP AXIAL PROJECTION STRUCTURES DEMONSTRATED
- Axial image of the clavicle projected above the ribs
- The medial end of the clavicle overlaps the first and second ribs
- Lateral ends of the clavicle seen above the ribs and scapula
- Clavicle see more horizontal
SCAPULA AP PROJECTION
- May be done supine or erect
- Centre the affected scapula to the mid line of the grid
- Abduct the arm at right angles to the body to draw the scapula laterally
- No body rotation needed
- CR perpendicular 5 cm inferior to the coracoid process
- Breathing must be slow to obliterate the lung detail
SCAPULA AP PROJECTION STRUCTURES DEMONSTRATED
Lateral portion of the scapula free of superimposition from the ribs
SCAPULA LATERAL PROJECTION ( RAOOR LAO )
- Patient erect or prone
- Rotate patient 30deg anteriorly from lateral position
- Mid coronal plane must form an angle of 45-60 deg from the IR
- CR perpendicular to the medial border of the protruding scapula
SCAPULA LATERAL PROJECTION ( RAOOR LAO ) Arm position
- Elbow flexed and arm placed on anterior or posterior chest
DEMONSTRATES = acromion and coracoid process - Extend arm upwards and rest forearm on head.
DEMONSTRATES = Scapula body
AC JOINT AP PROJECTION
- Shoulder and clavicle imaging done first to rule out fractures
- Done bilaterally and always erect
- 1st image with weights and the second without weights
- Patient erect on erect Bucky with arms beside the body with shoulders on the transverse plane
- CR perpendicular to the mid line of the body at the level of AC joints
Or directly at each respective AC joint if two separate exposures are necessary
AC JOINT AP PROJECTION STRUCTURES DEMONSTRATED
Dislocation is demonstrated,along side with separation and function of the Joints
