RAD 210 Ch. 4 Upper Limb Flashcards
How many bones are in each hand and wrist?
The 27 bones in each hand and wrist
How many bones in the phalanges (fingers and thumb)?
14
How many bones are in the metacarpals?
5
How many bones are in the carpals (wrist)?
8
Interphalangeal (IP) Joint
The thumb has only two phalanges.
First Metacarpophalangeal (MCP) Joint
The joint between the first metacarpal and the proximal phalanx of the thumb
Distal Interphalangeal (DIP) Joint
Starting from the most distal portion of each digit
Proximal Interphalangeal (PIP) Joint
Followed after the distal portion of each digit
First Metacarpophalangeal (MCP) joints
The metacarpals articulate with the phalanges at their distal ends
carpometacarpal (CMC) joints
At the proximal end, the metacarpals articulate with the respective carpals
The five metacarpals articulate with specific carpals as follows:
- First metacarpal with trapezium
- Second metacarpal with trapezoid
- Third metacarpal with capitate
- Fourth and fifth metacarpal with hamate
Steve
Left
The
Party
To
Take
Carol
Home
Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
Trochlea
(meaning “pulley”) is shaped like a pulley or spool
Ulnar Deviation
Movement of the wrist “opens up” and best demonstrates the carpals on the opposite side (the radial or lateral side) of the wrist—the scaphoid, trapezium, and trapezoid.
Radial Deviation
Movement that opens and best demonstrates the carpals on the opposite, or ulnar, side of the wrist—the hamate, pisiform, triquetrum, and lunate.
AP, no rotation
Radius and ulna partially superimposed.
AP, medial rotation
Superimposed radius and ulna.
AP, lateral rotation
Separation of radius and ulna.
A common minimum source to image receptor distance (SID)
40 to 44 inches (100 to 110 cm)
The principal exposure factors for radiography of the upper limbs are:
- Lower to medium kVp (60 to 80—digital)
- Short exposure time
- Small focal spot
- Adequate mAs for sufficient density (brightness)
The following three positioning principles should be remembered for upper limb examinations:
- Part should be parallel to plane of IR.
- CR should be 90° or perpendicular to part and IR, unless a specific CR angle is indicated.
- CR should be directed to correct centering point.
Arthrography
Commonly used to image tendinous, ligamentous, and capsular pathology associated with diarthrodial joints, such as the wrist, elbow, shoulder, and ankle.
Barton fracture
Fracture and dislocation of the posterior lip of the distal radius involving the wrist joint.
Bennett fracture
Fracture of the base of the first metacarpal bone, extending into the carpometacarpal joint, complicated by subluxation with some posterior displacement.
Boxer fracture
Transverse fracture that extends through the metacarpal neck; most commonly seen in the fifth metacarpal.
Colles fracture
Transverse fracture of the distal radius in which the distal fragment is displaced posteriorly; an associated ulnar styloid fracture is seen in 50% to 60% of cases.
Smith fracture
Reverse of Colles fracture, or transverse fracture of the distal radius with the distal fragment displaced anteriorly.
Osteoarthritis
noninflammatory joint disease characterized by gradual deterioration of the articular cartilage with hypertrophic (enlarged or overgrown) bone formation.
Osteomyelitis
local or generalized infection of bone or bone marrow that may be caused by bacteria introduced by trauma or surgery.
Osteopetrosis
hereditary disease marked by abnormally dense bone.
Osteoporosis
reduction in the quantity of bone or atrophy of skeletal tissue.
Paget disease
a common chronic skeletal disease; it is characterized by bone destruction followed by a reparative process of overproduction of very dense yet soft bones that tend to fracture easily.
Rheumatoid
a chronic systemic disease with inflammatory changes throughout the connective tissues; the earliest change is soft tissue swelling that is most prevalent around the ulnar styloid of the wrist.
Skier’s thumb
a sprain or tear of the ulnar collateral ligament of the thumb near the MCP joint of the hyperextended thumb.
accurate lateral
90° flexion, along with possible associated visualization of fat pads, are essential for evaluation of joint pathology of the elbow.
five ligaments are commonly imaged with conventional arthrography or magnetic resonance imaging (MRI):
- Dorsal radiocarpal ligament
- Palmar radiocarpal ligament
- Triangular fibrocartilage complex (TFCC)
- Scapholunate ligament
- Lunotriquetral ligament
The bones of the upper limb can be divided into four main groups:
(1) hand and wrist
(2) forearm
(3) arm (humerus)
(4) shoulder girdle
phalanges
most distal bones of the hand which constitute the digits (fingers and thumb).
metacarpals
The second group of bones. these bones make up the palm of each hand.
carpals
The third group of bones. Consists of the bones of the wrist.
posterior fat pad
located deep within the olecranon fossa and normally is not visible on a negative elbow examination.
supinator fat stripe
a long, thin stripe just anterior to the proximal radius. It may indicate the diagnosis of radial head or neck fractures that are not obviously apparent.
Each phalanx consists of three parts:
a distal rounded head, a body (shaft), and an expanded base, similar to that of the metacarpals.
head
the rounded portion
body
(shaft) is the long-curved portion; the anterior part is concave in shape, and the posterior, or dorsal, portion is convex.
base
the expanded proximal end, which articulates with associated carpals.
ulnar notch
a small depression on the medial aspect of the distal radius.
head of the ulna
fits into the ulnar notch to form the distal radioulnar joint. located near the wrist at the distal end of the ulna.
head of the radius
located at the proximal end of the radius near the elbow joint. The long midportion of both the radius and the ulna is called the body(shaft).
fat pads, fat bands, or stripes
Radiographs of the upper and lower limbs are taken not only to evaluate for disease or trauma to bony structures but also to assess associated soft tissues
