Radiologic Eval Elbow, Wrist and Hand Flashcards
what imaging study is typically ordered first with suspected bone and soft tissue injuries to the elbow?
radiographs
what radiographic views are available at the elbow?
- AP views
- lateral views
what can be observed well in a radiographic AP view of the elbow?
- carrying angle
- humeroulnar joint spaces
- humeroradial joint spaces
- distal humerus
- radial head, neck, tuberosity
- proximal ulna
what can be observed well in a lateral radiographic view of the elbow?
- Spatial relationships
- olecranon and olecranon fossa
- superimposed epicondyles, circular trochlear sulcus directly below
- Continuity/structures
- olecranon
- corinoid process
- radial head
- fat pads anterior and posterior to distal humerus
what is the sail sign? what radiographic view is it best observed?
sail sign → when effusion pushes fat pads upward/outward
best seen in the lateral view
T/F: the forearm should be included during routine radiographic exam of the elbow?
TRUE
list radiographic views of the forearm
- AP views
- lateral views
what is best observed in the radiographic AP view of the forearm?
- entire length of radius and ulna
- proximal and distal articulations
what is best observed in the radiographic lateral view of the forearm?
- normal bowing of radius and ulna
- elbow structures (as with lateral view of elbow)
- radial head superimposed over coronoid process
- proximal and distal articulation
what type of imaging study is typically performed first with suspected bone and soft tissue injuries to the wrist and hand?
Radiographs
what are the common projections for radiographs of the wrist, hand, and digits?
- PA
- Lateral
- Oblique
- Other projections available → carpal tunnel view
x-ray beam coned down for close up and fingers point upward on images
what is best observed in the hand PA view?
- Spatial relationships
- long axis of 3rd metacarpal and long axis of radius
- oblique line along met heads 3-5
- overlapping met bases 2-5
- overlap trapezium and trapezoid, pisiform and triquetrum
- Symmetry
- lateral metacarpal shafts
- Continuity
- Other → tuft distal fingers
what is best observed in the hand oblique view?
- spatial relationships of IP and MCP joint spaces
- symmetry
- continuity
describe the projection for the hand oblique view
45 degree rotation from PA position
digits do not superimpose
describe the projection for the hand lateral view
thumb magnified (farthest from receptor)
overlap: phalanges, metacarpals, distal radius and ulna
what is best observed in the lateral view of the hand?
- spatial relationships
- displacement of fracture fragments (dorsal/volar)
- long axes of radius, lunate, and capitate
- continuity
what is best observed in the wrist PA view?
- spatial relationships
- arch distortions: carpal subluxation/dislocations
- overlap trapezium and trapezoid; pisiform and triquetrum
- symmetry
- continuity
- hook of the hammate
describe the projection for the wrist oblique view
45 degree rotation from PA position
what is best observed in the oblique wrist view?
- spatial relationships
- trapezium’s articulations
- hamate
- triquetrum
- symmetry
what is magnified in a lateral wrist view?
the 1st metacarpal
what is best observed in the lateral wrist view?
- spatial relationships
- volar tilt of the articular surface of the radius
- scapholunate angle
- capitolunate angle
- Continuity
what does the carpal tunnel view offer?
visualization of hook of hamate
arched arrangement of carpals
List general indications for CT of the elbow
- severe trauma
- assessing fracture alignment/displacement
- ID loose bodies in elbow joints
- If MRI contraindicated, ID osteochondral lesions and other health conditions for which MRI is typically indicated
List general indications for MRI of the elbow
- soft tissue type injuries
- bony abnormalities
- fluid
- cancer
- congenital/developmental conditions
list clinical scenarios in which an MRI of the elbow may be required
- chronic/unexplained elbow pain
- acute trauma
- instability
- mechanical symptoms
- limited/painful ROM
- swelling/mass/atrophy
- planned arthroscopy
- residual symptoms following surgery
what initial imaging is most appropriate for a pt presenting with chronic elbow pain?
X-ray elbow
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
MRI, MR arthrography best
CT, CT-arthrography good as an alternative
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
MRI elbow
what follow-up test/image is most appropriate for chronic elbow pain along with a palpable soft-tissue mass and radiographs were nondiagnostic?
MRI elbow
US elbow as alternative
what follow-up test/image is most appropriate for a pt with suspect chronic epicondylitis, refractory to empirical treatment and radiographs were nondiagnostic
MRI elbow
US elbow as alternative
what follow-up test/image is most appropriate for a pt with chronic elbow pain and suspected collateral ligament tear but radiographs were nondiagnostic
MRI elbow, MR arthrography
what follow-up test/image is most appropriate for a pt with suspected biceps tendon tear but radiographs were nondiagnostic?
MRI elbow
US elbow as alternative
what follow-up test/image is most appropriate for a pt with chronic elbow pain and a suspected nerve abnormality but radiographs were nondiagnostic?
MRI elbow
US elbow as alternative
what follow-up test/image is most appropriate for a pt with elbow stiffness; and suspected HO/osteophytosis by radiography?
CT elbow
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?
MRI elbow
US elbow as an alternative
once x-rays have been ordered, if there is need for further imaging at the elbow what image/test is most appropriate?
MRI elbow for essentially all other conditions except HO
what initial imaging is most appropriate for a pt with chronic wrist pain, with or without prior injury?
X-ray of the wrist
once x-rays have been ordered for a patient with wrist pain what is generally the most appropriate follow-up image/test?
MRI wrist
what wrist conditions/ACR variants do not call for an MRI as the second/follow-up imaging study?
- Variant 4 → chronic wrist pain, normal radiographs or show nonspecific arthritis, exclude infection = aspiration wrist 2nd study
- Variant 8 → chronic wrist pain. Kienbock’s disease on radiography = CT wrist
- Variant 10 → chronic wrist pain. suspect occult fracture or stress fracture with nondiagnostic radiographs = MRI wrist or CT wrist
- Variant 12 → chronic wrist pain, normal/nondiagnostic radiographs with suspected carpal tunnel syndrome = US wrist or MRI may be appropriate
what initial imaging is most appropriate for a pt with acute blunt or penetrating trauma to the hand or wrist?
Radiography of interest
what follow-up imaging study is most appropriate for a pt with suspected acute hand or wrist trauma. Initial radiographs negative or equivocal.
MRI area of interest, repeat radiography, CT
what follow-up imaging study is most appropriate for a pt with acute wrist fracture on radiographs and suspected wrist tendon or ligament trauma?
MR arthrography, MRI wrist, CT arthrography, or US wrist
what follow-up imaging study is most appropriate following initial radiographs showing distal radioulnar joint or carpal malalignment in the absence of fracture?
CT wrist, MRI wrist, MR arthrography
what follow-up imaging study is most appropriate for acute hand fracture on radiographs with suspected hand tendon or ligament trauma?
MRI hand, US hand
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?
MRI hand or US hand
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.
US area of interest, CT area of interest
