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Diagnostic Imaging EDITABLE > 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? (5)

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

what can be observed well in a lateral radiographic view of the elbow? (category with 2 subcategories, another category with 4 subcategories)

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? (2)

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? (4)

what angle is it taken at?

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

elbow is flexed and supinated 45 deg

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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

T/F: Digits are superimposed in this view

A

45 degree rotation from PA position

False, 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
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
18
Q

describe the projection for the wrist oblique view

A

45 degree rotation from PA position

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

General Indications for CT of elbow

A
  1. Severe trauma
  2. Assessing fracture alignment/ displacement
  3. Identifying loose bodies in elbow joints
  4. If MRI contraindicated, identifying osteochondral lesions and other health conditions for which MRI is typically indicated (including contrast studies)
24
Q

general indications CT of wrist and hand

A

–Severe Trauma

–Suspected fracture with normal radiographs (scaphoid, hook of the hamate, etc.)

•Suspect distal radioulnar subluxation, metacarpal fracture or subluxation, etc.

–Surgical Planning

  • Displacement of Fractures
  • Fractures involving articular surfaces

–Osteochondral lesions (without MR availability)

–CT Arthrography

•TFCC/ interosseous ligament sprain

25
Q

CT wrist -saggital

what is metacarpal neck to shaft angle supposed to be?

A
  • Long axis alignment of radius, lunate, capitate, 3rd metacarpal
  • Metacarpal neck to shaft angle ~15 degrees
  • Lunate position
  • Fracture fragment displacement

15 deg

26
Q

CT Wrist - coronal

A

radial styloid fracture

27
Q

MRI general indications wrist

A

–TFCC/ Ligamentous damage

•Gamekeeper’s Thumb

–Occult Scaphoid Fractures & scaphoid fracture complications

–Osteochondral/ articular cartilage abnormalities

–Chronic pain with normal radiographs

–Distal radius fracture suspicion with normal x-rays

–AVN

28
Q

MR Arthrography general indications (2)

A
  • Peripheral TFCC tear
  • Scapholunate tear
29
Q

axial MRI general indications/best viewed

A
  • Neuro-vascular structures
  • Distal radioulnar joint
  • Tendons
  • Carpal tunnel & flexor retinaculum
30
Q

sagittal MRI best viewed

A
  • Bony alignment
  • Ligaments
  • Long axis of tendons
31
Q

coronal MRI best viewed

A
  • Ligaments
  • TFCC
  • Alignment
  • Scapholunate articulation

Diagnostic Imaging EDITABLE (16 decks)

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