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Diagnostic Imaging > Radiologic Eval Elbow, Wrist and Hand > Flashcards

Radiologic Eval Elbow, Wrist and Hand Flashcards

1
Q

what imaging study is typically ordered first with suspected bone and soft tissue injuries to the elbow?

A

radiographs

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2
Q

what radiographic views are available at the elbow?

A
  1. AP views
  2. lateral views
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3
Q

what can be observed well in a radiographic AP view of the elbow?

A
  1. carrying angle
  2. humeroulnar joint spaces
  3. humeroradial joint spaces
  4. distal humerus
  5. radial head, neck, tuberosity
  6. proximal ulna
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4
Q

what can be observed well in a lateral radiographic view of the elbow?

A
  1. Spatial relationships
    1. olecranon and olecranon fossa
    2. superimposed epicondyles, circular trochlear sulcus directly below
  2. Continuity/structures
    1. olecranon
    2. corinoid process
    3. radial head
    4. fat pads anterior and posterior to distal humerus
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5
Q

what is the sail sign? what radiographic view is it best observed?

A

sail sign → when effusion pushes fat pads upward/outward

best seen in the lateral view

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6
Q

T/F: the forearm should be included during routine radiographic exam of the elbow?

A

TRUE

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7
Q

list radiographic views of the forearm

A
  1. AP views
  2. lateral views
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8
Q

what is best observed in the radiographic AP view of the forearm?

A
  1. entire length of radius and ulna
  2. proximal and distal articulations
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9
Q

what is best observed in the radiographic lateral view of the forearm?

A
  1. normal bowing of radius and ulna
  2. elbow structures (as with lateral view of elbow)
  3. radial head superimposed over coronoid process
  4. proximal and distal articulation
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10
Q

what type of imaging study is typically performed first with suspected bone and soft tissue injuries to the wrist and hand?

A

Radiographs

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11
Q

what are the common projections for radiographs of the wrist, hand, and digits?

A
  1. PA
  2. Lateral
  3. Oblique
  4. Other projections available → carpal tunnel view

x-ray beam coned down for close up and fingers point upward on images

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12
Q

what is best observed in the hand PA view?

A
  1. Spatial relationships
    1. long axis of 3rd metacarpal and long axis of radius
    2. oblique line along met heads 3-5
    3. overlapping met bases 2-5
    4. overlap trapezium and trapezoid, pisiform and triquetrum
  2. Symmetry
    1. lateral metacarpal shafts
  3. Continuity
  4. Other → tuft distal fingers
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13
Q

what is best observed in the hand oblique view?

A
  1. spatial relationships of IP and MCP joint spaces
  2. symmetry
  3. continuity
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14
Q

describe the projection for the hand oblique view

A

45 degree rotation from PA position

digits do not superimpose

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15
Q

describe the projection for the hand lateral view

A

thumb magnified (farthest from receptor)

overlap: phalanges, metacarpals, distal radius and ulna

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16
Q

what is best observed in the lateral view of the hand?

A
  1. spatial relationships
    1. displacement of fracture fragments (dorsal/volar)
    2. long axes of radius, lunate, and capitate
  2. continuity
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17
Q

what is best observed in the wrist PA view?

A
  1. spatial relationships
    1. arch distortions: carpal subluxation/dislocations
    2. overlap trapezium and trapezoid; pisiform and triquetrum
  2. symmetry
  3. continuity
    1. hook of the hammate
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18
Q

describe the projection for the wrist oblique view

A

45 degree rotation from PA position

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19
Q

what is best observed in the oblique wrist view?

A
  1. spatial relationships
    1. trapezium’s articulations
    2. hamate
    3. triquetrum
  2. symmetry
20
Q

what is magnified in a lateral wrist view?

A

the 1st metacarpal

21
Q

what is best observed in the lateral wrist view?

A
  1. spatial relationships
    1. volar tilt of the articular surface of the radius
    2. scapholunate angle
    3. capitolunate angle
  2. Continuity
22
Q

what does the carpal tunnel view offer?

A

visualization of hook of hamate

arched arrangement of carpals

23
Q

List general indications for CT of the elbow

A
  1. severe trauma
  2. assessing fracture alignment/displacement
  3. ID loose bodies in elbow joints
  4. If MRI contraindicated, ID osteochondral lesions and other health conditions for which MRI is typically indicated
24
Q

List general indications for MRI of the elbow

A
  1. soft tissue type injuries
  2. bony abnormalities
  3. fluid
  4. cancer
  5. congenital/developmental conditions
25
Q

list clinical scenarios in which an MRI of the elbow may be required

A
  1. chronic/unexplained elbow pain
  2. acute trauma
  3. instability
  4. mechanical symptoms
  5. limited/painful ROM
  6. swelling/mass/atrophy
  7. planned arthroscopy
  8. residual symptoms following surgery
26
Q

what initial imaging is most appropriate for a pt presenting with chronic elbow pain?

A

X-ray elbow

27
Q

what follow-up test is most appropriate for a pt with mechanical symptoms such as locking, clicking, and limited motion at the elbow and there is a suspected intra-articular osseocartilaginous body or synovial abnormality? Radiographs were taken and nondiagnostic

A

MRI, MR arthrography best

CT, CT-arthrography good as an alternative

28
Q

what follow-up test/image is most appropriate for a pt with chronic elbow pain and a suspected occult fracture or other bone abnormality? Radiographs were nondiagnostic

A

MRI elbow

29
Q

what follow-up test/image is most appropriate for chronic elbow pain along with a palpable soft-tissue mass and radiographs were nondiagnostic?

A

MRI elbow

US elbow as alternative

30
Q

what follow-up test/image is most appropriate for a pt with suspect chronic epicondylitis, refractory to empirical treatment and radiographs were nondiagnostic

A

MRI elbow

US elbow as alternative

31
Q

what follow-up test/image is most appropriate for a pt with chronic elbow pain and suspected collateral ligament tear but radiographs were nondiagnostic

A

MRI elbow, MR arthrography

32
Q

what follow-up test/image is most appropriate for a pt with suspected biceps tendon tear but radiographs were nondiagnostic?

A

MRI elbow

US elbow as alternative

33
Q

what follow-up test/image is most appropriate for a pt with chronic elbow pain and a suspected nerve abnormality but radiographs were nondiagnostic?

A

MRI elbow

US elbow as alternative

34
Q

what follow-up test/image is most appropriate for a pt with elbow stiffness; and suspected HO/osteophytosis by radiography?

A

CT elbow

35
Q

what follow-up test/image is most appropriate for a pt with chronic elbow pain and suspected inflammatory arthritis or bursitis and radiographs were obtained?

A

MRI elbow

US elbow as an alternative

36
Q

once x-rays have been ordered, if there is need for further imaging at the elbow what image/test is most appropriate?

A

MRI elbow for essentially all other conditions except HO

37
Q

what initial imaging is most appropriate for a pt with chronic wrist pain, with or without prior injury?

A

X-ray of the wrist

38
Q

once x-rays have been ordered for a patient with wrist pain what is generally the most appropriate follow-up image/test?

A

MRI wrist

39
Q

what wrist conditions/ACR variants do not call for an MRI as the second/follow-up imaging study?

A
  1. Variant 4 → chronic wrist pain, normal radiographs or show nonspecific arthritis, exclude infection = aspiration wrist 2nd study
  2. Variant 8 → chronic wrist pain. Kienbock’s disease on radiography = CT wrist
  3. Variant 10 → chronic wrist pain. suspect occult fracture or stress fracture with nondiagnostic radiographs = MRI wrist or CT wrist
  4. Variant 12 → chronic wrist pain, normal/nondiagnostic radiographs with suspected carpal tunnel syndrome = US wrist or MRI may be appropriate
40
Q

what initial imaging is most appropriate for a pt with acute blunt or penetrating trauma to the hand or wrist?

A

Radiography of interest

41
Q

what follow-up imaging study is most appropriate for a pt with suspected acute hand or wrist trauma. Initial radiographs negative or equivocal.

A

MRI area of interest, repeat radiography, CT

42
Q

what follow-up imaging study is most appropriate for a pt with acute wrist fracture on radiographs and suspected wrist tendon or ligament trauma?

A

MR arthrography, MRI wrist, CT arthrography, or US wrist

43
Q

what follow-up imaging study is most appropriate following initial radiographs showing distal radioulnar joint or carpal malalignment in the absence of fracture?

A

CT wrist, MRI wrist, MR arthrography

44
Q

what follow-up imaging study is most appropriate for acute hand fracture on radiographs with suspected hand tendon or ligament trauma?

A

MRI hand, US hand

45
Q

what follow-up imaging study is most appropriate after an initial radiographs show MCP, proximal IP, or distal IP joint malalignment in the absence of fracture?

A

MRI hand or US hand

46
Q

what follow-up imaging study is most appropriate for a pt with suspected penetrating trauma with a foreign body in the soft tissues in the hand or wrist. Initial radiographs are negative.

A

US area of interest, CT area of interest

Diagnostic Imaging (15 decks)

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