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Radiographic Procedures 1 > Scaphoid, Forearm and Elbow > Flashcards

Scaphoid, Forearm and Elbow Flashcards

1
Q

When working with angles what must you check?

A

The SID

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2
Q

What is the scaphoid?

A
  • the largest carpal in the proximal row
  • anterior and lateral tubercles
  • palpable near the base of the thumb
  • “anatomical snuffbox”
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3
Q

What is the carpal canal?

A
  • bony passageway for the median nerve and flexor tendons to pass through
  • goes through the carpals and the flexor retinaculum
  • compression of the median nerve causes carpal tunnel syndrome
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4
Q

What is the elbow?

A
  • articulation of the humerus with the radius and ulna
  • distal humerus has two condyles (trochlea and capitulum)
  • epicondyles are the medial and lateral protuberances above
  • distal humerus has 2 fossae (olecranon and coronoid)
  • 2 fat pads seen on the lateral projection
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5
Q

Scaphoid - PA Projection

A

position - hand prone in ulnar deviation
CR - perpendicular to IR
CP - scaphoid
collimation - base of 1st metacarpal to ulnar head

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6
Q

Scaphoid - PA Axial Projection

A

Position - hand prone in ulnar deviation
CR - 20 degrees proximally
CP - Scaphoid
collimation - base of 1st metacarpal to ulnar head

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7
Q

Scaphoid - Alternate PA Axial Projection

A

Position - hand prone in ulnar deviation - hand elevated on a 20 degree sponge
CR - perpendicular to IR
CP - Scaphoid
collimation - base of 1st metacarpal to ulnar head

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8
Q

Scaphoid - PA and PA Axial Evaluation Criteria

A
  • distal radius and ulna to proximal half of meta carpals
  • scaphoid and adjacent joint spaces open
  • axial method should show scaphoid freer from superimposition
  • no rotation
  • ulnar deviation
  • see boney trabeculae and soft tissue
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9
Q

What is the scaphoid series?

A

Rafert-Long method
4 images
PA and PA axial with angles of 10, 20 and 30

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10
Q

Tangential carpal canal projection

A
  • hyperextend wrist
  • slight radial rotation (flattens carpal canal)
    CR - 25-30 proximally
    CP - Palm of the hand, include all of the canal
  • styloids to centre of IR
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11
Q

Tangential carpal canal evaluation criteria

A
  • carpals are in an arch
  • pisiform separate and in profile
  • hook of hamate
  • common athletic injuries can be diagnosed with this projection: hook of hamate, pisiform and trapezium
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12
Q

Forearm - AP Projection

A

3 major joints must be on the same plane (wrist, elbow and shoulder)
- arm supinated, ensure elbow and wrist are true AP - epicondyles equidistant
CR - perpendicular
CP - middle of forearm
collimate 5cm or 2in past each joint

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13
Q

Forearm - AP Evaluation Criteria

A
  • entire forearm and both end joints
  • slight superimposition of proximal radius/ulna
  • no elongation/foreshadowing of humeral epicondyles
  • partially open wrist and elbow joints
  • open radioulnar space
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14
Q

Forearm - lateral projection

A

3 joints on same plane, arm bent 90, wrist and lateral in true lateral best you can
CR - perpendicular
CP - middle of forearm
Collimate 5cm or 2in past each joint

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15
Q

Forearm - lateral evaluation criteria

A
  • entire forearm and both end joints
  • superimposition of distal radius/ulna
  • superimposition of radial head and coronoid process
  • superimposed humeral epicondyles
  • radial tuberosity facing anteriorly
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16
Q

What projections do you start hanging in anatomical position?

A

elbow

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17
Q

Elbow - AP projection

A

3 joints on same plane
hand supinated, epicondyles equidistant to IR
CR - Perpendicular
CP - middle of elbow
collimate 8cm or 3in on either side of joint

18
Q

Elbow - AP Evaluation Criteria

A
  • radial head, neck and tuberosity slightly superimposed with proximal ulna
  • open humeroradial joint
  • no rotation
19
Q

Elbow - Lateral Projection

A

3 joints on same plane
elbow flexed 90, thumb up, superimpose epicondyles - may need sponge under wrist
CR - perpendicular to IR
CP - elbow
collimate 8cm or 3in on either side of the joint

20
Q

Elbow - Lateral Evaluation Criteria

A

true lateral position
- superimposed humeral epicondyles
- radial tuberosity facing anteriorly
- tip of coronoid process should cover 2/3 of radial head
- olecranon process in profile

21
Q

If the coronoid process is too high in relation to the radial head, then…..

A

humerus is too elevated
- shoulder too high
- elbow too low

22
Q

If coronoid process is between radial head and condyles, then…..

A

hand is too low

23
Q

If radial head is between coronoid process and condyles, then…..

A

hand is too high

24
Q

When is the posterior elbow fat pad visible in a lateral projection?

A

usually only if there is an injury or the elbow is too extended, injury can also cause raised anterior fat pad

25
Q

Elbow - Medial AP Oblique Projection

A

Arm extended, hand pronated, epicondyles at 45 angle
CR - perpendicular to IR
CP - middle of elbow
collimate to 8cm or 3” on either side of joint

26
Q

Elbow - Medial AP Oblique Evaluation Criteria

A
  • coronoid process in profile
  • trochlea
  • elongated medial epicondyle
  • ulna superimposed by the radial head and neck
  • olecranon within the olecranon fossa
27
Q

Elbow - Lateral AP Oblique Projection

A

Arm extended, hand supinated, rotate externally until epicondyles at 45 angle
CR - perpendicular
CP - middle of elbow
collimate to 8cm or 3” on either side of joint

28
Q

Elbow - Lateral AP Oblique Evaluation Criteria

A
  • radial head, neck and tuberosity free of ulna
  • elongated lateral epicondyle
  • capitulum
29
Q

What do you do if the patient is unable to full extend their arm?

A

no issues with the lateral projection
Requires 2 different AP projections
- humerus parallel o IR
- forearm paralle to IR

30
Q

Elbow - Partial Flexion Distal Humerus and Proximal Forearm Projection

A

supinate hand if possible
CR - perpendicular to IR
CP - middle of elbow
Distal humerus: seat patient so entire humerus is on same plane
Proximal forearm: patient may need to stand to get forearm parallel to IR

31
Q

Elbow - Partial Flexion Distal Humerus and Proximal Forearm Evaluation Criteria

A
  • area of interest should be free of distortion (area parallel to IR)
  • are not of interest will be foreshortened
32
Q

What is acute flexion?

A

when patient presents elbow fully flexed and unable to straighten it at all
- can do lateral
2 projections to make AP
- Distal humerus parallel to IR
- proximal forearm - distal humerus still parallel to IR - CR at proximal angle

33
Q

Elbow - Acute Flexion Distal Humerus Projection

A

humerus parallel to IR
CR - perpendicular to IR
CP - 5cm or 2” superior to olecranon

34
Q

Elbow - Acute Flexion Distal Humerus Evaluation Criteria

A
  • no rotation
  • humerus and forearm superimposed
  • olecranon process and distal humerus without distortion
35
Q

Elbow - Acute Flexion Proximal Forearm Projection

A

humerus parallel to IR
CR - perpendicular to forearm
CP - 5cm or 2” superior to olecranon
REMEMBER SID

36
Q

Elbow - Acute Flexion Proximal Forearm Evaluation Criteria

A
  • no rotation
  • proximal radius and ulna with minimal distortion
  • joint space is more open than on distal humerus image
37
Q

Elbow - Radial Head Series Projection

A

4 views
- shows the entire circumference of the radial head free of superimposition
- positioning set up same as for the lateral elbow
1. hand supinated as much as possible
2. hand in lateral position
3. hand pronated
4. hand internally rotated

38
Q

Elbow - Radial Head Series Evaluation Criteria

A
  • radial head partially superimposed by coronoid, but seen in all 4 images
  • elbow flexed 90
  • radial tuberosity anterior for first 2, posterior for latter 2
39
Q

What is the Coyle Method?

A

Axiolateral elbow
Same position as lateral elbow but hand pronated
CR - 45 towards shoulder
CP - mid elbow
collimate 8cm or 3” on either side of joint

40
Q

What are the advantages of the Coyle Method?

A
  • radial head, neck and tuberosity mostly free of superimposition
  • open joint between radius and capitulum
  • elongated epicondyles

Radiographic Procedures 1 (10 decks)

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