TEST 4 Flashcards
how many phalanges in 2-5th digit
3
2 joints in 1st digit of toe
IP
MTP (metatarsophalangeal)
Where is the CR for metatarsals? What projection use this CR?
3rd TMT joint
AP & Oblique
Where is the CR for metatarsals?
3rd TMT joint
What is the joint located at the base of the metatarsal
Tarsometatarsal (TMT)
Which structure on the metatarsal provides for the attachment of a tendon
Tuberosity
What is the joint between the proximal and distal phalanges of first digit
IP joint
Where do sesamoid bones locate in the metatarsal?
the posterior or plantar surface at the head of the first metatarsal
When weight is placed on foot, fractures at ____ can cause pain & discomfort. Why?
sesamoid bones
because of their plantar location
Which projection is used to see the sesamoid bones of the foot
Tangential
THe most posterior-inferior part of calcaneus contains a process called ___
tuberosity
Achilles tendon attached to ____ of the _____
tuberosity - calcaneus
What structure is visualized laterally on axial projection of the calcaneus
peroneal trochlea
What is the trochlear process of the calcaneus called?
peroneal trochlea
Peroneal trochlea is located ____
Sustentaculum tali is located ___
laterally
medially
Between peroneal trochlea & sustentaculum tali, which one is more prominent
sustentaculum tali
What is the depression between the posterior & middle articular facet called?
calcaneal sulcus
Calcaneal sulcus located_____
between posterior & middle articulate surfaces
Sinus tarsi is formed by ___
calcaneus sulcus
Sinus tarsi is an opening for ___ to pass through
ligaments
Calcaneus articulates with ____
cuboid & talus
Calcaneus articulate ___ with cuboid and ____ with talus
anteriorly
superiorly (????)
Talus articulate:
superiorly with ___
anteriorly with ____
inferiorly with ___
tibia & fibula
navicular
calcaneus
Navicular articulates:
____ with talus
____ with cuboid
_____ with 3 cuneiforms
posteriorly
laterally
anteriorly
Medial cuneiform articulates:
___ with navicular
___ with 1st & 2nd metatarsal
____ with intermediate cuneiform
proximally
distally
laterally
Cuboid articulates:
proximally with ____
medially with ____
distally with ____
calcaneus
lateral cuneiform & navicular
4th & 5th metatarsal
Intermediate cuneiform articulate:
proximally with ___
distally with ____
_____ on each side
navicular
second metatarsal
medial & lateral cuneiforms
Lateral Cuneiform articulates:
distally with ____
medially with ____
laterally with ____
2,3,4th metatarsal
intermediate cuneiform
cuboid
Calcaneus articulates with talus to form ____ joint
subtalar
which articular facet of calcaneus provides medial support for subtalar joint
middle articular facet
Which tarsal bone is a part of the ankle joint
talus
TIbia is located ____
Fibula is located ____
medially
laterally
Medial malleolus associated with distal ____
tibia
Mortise is formed by _____
inferior portions of tibia & fibula
Ankle mortise is not seen on ____. Why?
true AP
talus overlap distal fibula & tibia
Ankle mortise can be seen on when legs are ___
15* internal rotated AP Oblique
Anterior tubercle is located on____
distal TIBIA
[ANKLE] 3 main parts of distal tibia
medial malleolus
anterior tubercle
fibular notch
What is the ceiling of ankle mortise joint called
tibial plafond
tibial plafond is formed by ___
distal tibial joint surface
The anterior tubercle is best seen on ___ view
lateral
Intermalleolar plane is drawn between two ____, approximately ___ to ____ degree from coronal plane
malleoli
15-20
__ arch located on the medial aspect of foot
longitudinal
Longitudinal arch is higher in the ____ side than ___ side
medial - lateral
___ arch located along plantar surface
transverse
which tarsal bone made up the transverse arch
cuneiforms
higher arch = ____ tube
higher
dorsiflexion will ___ angle of the joint
plantar flexion will ___ angle of the joint
decrease
increase
4 foot motions
dorsiflexion
plantar flexion
inversion
eversion
Routines for TOES & kVp
AP foot
Oblique
Lateral
50-60 kVp
position patient for AP Foot
knee is flexed and the plantar surface on IR
Where is the CR for AP FOOT? what is the tube angle, if there is one?
base of 3rd metatarsal
10 degree posterior tube angle
What happened if the plantar surface is not on the IR?
increased OID
base of metatarsal articulates with which tarsal bones
cuneiform & cuboid
for AP toe, the CR is ___ to metatarsal
perpendicular
1,2,3rd digits are positioned in ____
medial oblique
4 & 5th digits are positioned in _____
lateral oblique
How to position patient for oblique of 1-3rd toe
rotate leg internally for plantar surface to be 45 degree to IR
How to position patient for oblique of 4-5th toe
rotate leg externally for plantar surface to be 45 degree to IR
Where is the CR for oblique toe
MTP joint of the affected toe
For 1-3rd digit, which projection is used when taking lateral image of toe
lateromedial
For 4-5th digit, which projection is used when taking lateral image of toe
mediolateral
What is important when doing lateral toe
remove superimposition of unaffected toes
[LATERAL TOE] Where is the CR for:
1st
2-5th digit?
IP
PIP
Tangential projection of sesamoid bone will give the same image as ___
lateromedial of 1st digit
how to position for tangential projection of sesamoid
patient is in prone position
dorsiflex foot so plantar surface is 15-20 from vertical
dorsiflex digits
Where is the CR for tangential projection of sesamoid
posterior to 1st MTP
When do we see the sesamoid best on plantar surface
when digits are hyperflexed
kVp for foot
60-65
routines & alternatives for FOOT
AP
Internal Oblique
Lateral
external oblique
weight-bearing
how to position for internal oblique for FOOT
pt supine or sitting
knee flexed
rotate internally so the plantar surface is 30-40 degrees from IR
Why the tube angle is important for AP FOOT
elongate tarsals and remove superimposition of the transverse arch
[Internal Obl] Why is it important to rotate the foot internally 30-40 from IR?
see tarsal & proximal metatarsal without superimposition of the transverse arch
Where is the CR for Lateral foot
1st cuneiform
What is the projection for lateral FOOT
mediolateral
how to position for Lateral FOOT
externally rotate till lateral
plantar surface to 90 degrees to IR
How to position patient for AP Weight-bearing
pt erect with full weight evenly distributed
[FOOT] What is the tube angle for AP weight-bearing
15 degrees posterior
where is the CR for AP Weight-bearing
base of metatarsal
How to position the patient for Lateral Weight-bearing
pt erect with weight on the affected foot
Where is CR for Lateral Weight-bearing
3rd metatarsal
which arch is showed in lateral weight-bearing
longitudinal
Routines for Calcaneus
Plantodorsal
Lateral
kVp for calcaneus
65
Where is the CR for Calcaneus Plantodorsal, tube angle?
base of 3rd metatarsal
exit at lateral malleolus
40 degrees cephalad
How to position patient for Plantodorsal calcaneus
supine
dorsiflex foot 90
Where is the CR for lateral calcaneus
1” inferior to medial malleolus
How to position patient for lateral calcaneus
dorsiflex foot 90
rotate foot laterally
shoot mediolateral
3 anatomic structures on distal tibia
medial malleolus
anterior tubercle
fibular notch
Routines for ankle
AP or AP Mortise
Lateral
Internal/External Rotation
Where is the CR for AP Ankle
between malleoli
Where is the CR for Int/Ext rotation Ankle
between malleoli
How do you position patient for AP ankle
supine
extend leg
dorsiflex 90
How to position patient for Mortise AP
foot neutral
rotate leg 15-20 internally
how do you know if its a true Mortise
open lateral & medial mortise joint with malleoli in profile
what is the difference between AP and AP Mortise ankle
the superimposition of the fibula on talus + closed mortise ankle (AP)
How do you know if the ankle is internally or laterally rotate
distal tibiofibular joint open –> internal rotate
if it close –> external rotate
Where is the CR for lateral ankle? projection?
medial malleoli
mediolateral
How do you position patient for Lateral ankle
lateral recumbent
dorsiflex 90
Anterior tubercle is best seen on ___
lateral view
How do you position patient to make the intermalleolar plane parallel to IR
rotate leg 15-20 degrees internally
where is the exit for CR of plantodorsal ankle
lateral malleolus
The ankle joint is the articulation of ____
distal tibia & fibular with talus
Which 2 projections/ positions will both include calcaneus
lateral ankle
plantodorsal calcaneus
Why we only see anterior tubercle in lateral?
because on an AP, anterior tubercle is on anterior aspect of distal tibia –> cant see that well
What is the weight-bearing bone of the leg
Tibia
The medial & lateral condyles of lower leg are located at _____
proximal tibia
where is intercondylar eminence located?
the superior surface of tibia head between 2 condyles
The intercondylar eminence is on the ___
tibial plateau
What are tibial plateau? what does it articulate with
articular facets of the condyles
femur
When an AP knee is positioned, why do we need to angle the CR?
CR parallel to the tibial plateau.
The tibial tuberosity is on ___
proximal end of tibia
The anterior crest is on ____
proximal tibia
Tibial tuberosity is a distal attachment of ____
patellar tendon
tibial plateau is on ___
proximal end of tibia
What is anterior crest? its location?
shin bone
on the anterior surface of tibial body
3 parts of proximal fibula
apex (styloid process)
head
neck
No weight-bearing bone, but has more muscle attachment of lower leg is ____
Fibula
Fibula articulates with ___ & ___ distally
tibia - talus
Head of the fibula articulates with the inferior aspect of lateral condyle of the proximal tibia to form ____
The proximal tibiofibular joint
The fibula articulates with the tibia at the fibular notch to form ____
distal tibiofibular joint
Routines for Tib/Fib
AP
Lateral
kVp for Tib/Fib
65
How to position pateitn for AP Tib/Fib
supine
extend leg
What is the projection for Lateral Tib/FIb
mediolateral
patellar surface can be seen on ___ of ___ femur
anterior
distal
Leg if flexed, patella moves __
Leg if extended, patella moves ___
downward & inward into the patella surface (intercondylar sulcus)
2 anatomic structures view on posterior aspect of distal femur
condyle
epicondyle
Intercondylar fossa is located on ___ aspect of the __femur, between ___
posterior
distal
the condyles
Adductor tubercle is located ___
medially with the medial epicondyle at distal femur
___ not seen on properly positioned lateral knee. Which position would we see it?
adductor tubercle
slightly rotated lateral view
What is the CR angle for lateral knee? why?
5-7 cephalad
for 2 condyles to be superimposed when femur is parallel to IR
In erect position, the femur is at angle of __
5-15
The femur angle is greater on __ than a ____
woman
man
What structure is the attachment for the tendon of adductor muscle
adductor tubercle of the distal femur
If we want to know whether there is rotation when critiquing a lateral knee, what do we look at
adductor tubercle - to determine if the knee is under-rotated or over-rotated
Over-rotation of the knee = ___ superimposition of ____
Under-rotation of the knee = ___ superimposition of ___
less superimposition of fibular head
more superimposition of fibular head
what are the attachment site for collateral ligaments
medial & lateral epicondyles of the distal femur
The ___ epicondyle along with the adductor muscle is more prominent
medial
routines for distal femur
AP
Lateral
kVp for femur
70-75
position patient for AP distal femur
supine
rotate leg 5 degree internal
Why rotate leg internally for AP distal femur?
so inter epicondylar line parallel to IR
What structure must be included for AP distal femur
knee
projection for Lateral distal femur
either mediolateral or lateromedial
What is the difference when using mediolateral projection for Lateral Distal Femur compared to lateromedial projection
M-L: flex knee 45 + remove superimposition of unaffected leg
L-M: no rotation & use horizontal beam
For Lateral Distal Femur, what do you look for to make sure the patient is in true Lateral
epicondyles perpendicular to IR
Patella articulates with the ____ surface of ____
anterior of distal femur
Patella doesnt articulate with ______
tibia
Patellar surface is located on _____
distal femur
Where is the location of patella when knee is extended
lies superior on the anterior aspect of patellar surface on distal femur
which knee ligament extends from lateral epicondyle of femur to lateral proximal fibula
LCL (lateral collateral ligament)
The head of fibula articulates with _____
lateral condyle of tibia
The knee joint depends on which major ligaments for stability
PCL & ACL AND MCL & LCL
which ligaments located within knee joint capsule
ACL & PCL
LCL & MCL prevents what movement of the knee
adduction & abduction
what 2 ligaments are on the side of the knee
LCL & MCL
What 2 ligaments attach to anterior & posterior aspect of intercondylar eminence of the tibia
ACL & PCL
Where do patellar ligament located
anteriorly & inferiorly to the patella
Patellar ligaments extends from ____, over _____, then to ____
quadriceps femoris muscle over to the patella to the tibial tuberosity
Sprain to ____ will cause instability in knee
LCL & MCL
which ligament articulate anteriorly to the intercondylar eminence
ACL
ACL extends from _____
PCL extends from ____
lateral condyle
medial condyle
which ligament articulate posteriorly to the intercondylar eminence
PCL
What is the important attachment point for patellar ligament as it comes down and attached to proximal tibia
tibial tuberosity
which position will best show the tibial tuberosity in profile?
lateral knee
Why tibial tuberosity is not best seen on AP knee
tibial tuberosity superimposed the proximal end of tibia
The knee joint is enclosed in ____
articular capsule
3 types of bursa
suprapatellar
prepatellar
infrapatellar
Which bursa extends upward under & superior to patella
suprapatellar
Which bursa extends anterior to patella
prepatellar
which bursa extends inferior to patella
infrapatellar
Which part of the knee is made of cartilage? location?
Menisci (articular disk)
between femur and tibia
what is the function of menisci?
allows femoral condyle to lie on tibial plateau without having bone lie on bone
Breakdown of menisci can cause ____
arthritis
Is medial or lateral menisci more likely to tear? why?
medial menisci because medial aspect of knee is lower than the lateral.
Routines for knee
AP
Lateral
External oblique
Internal oblique
Alternative routine for knee
Tunnel
kVp for knee
65
[AP Knee] Why rotate leg 5 degree medial?
so femoral epicondyle align to IR
Do we need a tube angle for AP Knee
MAYBE
Why do we angle the tube for AP KNEE
CR parallel to the tibial plateau
CR for AP knee
1/2” distal to patella apex
Why do we flex knee for Lateral knee? how much flexion?
flex knee 20-30degree
epicondyle perpendicular to IR
Is there a tube angle for lateral knee? how much?
5-7 cephalad
Why is there a tube angle for Lateral Knee
elevate inferior medial epicondyle to superimpose lateral epicondyle
In true Lateral knee, what do femoral condyles look like
superimposed
In the normal position, ___ condyle is more inferior
medial
CR for lateral knee
1” distal to medial epicondyle
How do you know if the knee is in true medial oblique
lateral epicondyle in profile
opening of proximal tibiofibular joint
CR for knee medial oblique
1/2” distal to patella apex
How do you tell if the knee is in true external oblique
medial condyle in profile
superimpose of fibular head/neck
What are the 3ways to do tunnel view of knee
Camp Coventry
Beclere
Holmblad
what is the CR for knee tunnel view
perpendicular to Tib/Fib
1/2” distal to patella apex
Routines for patella
PA
Lateral
Axial (Sunrise)
kVP for Patella
60
how to position patient for PA patella
Prone
leg extended & rotate 5 medial
CR for PA patella ?
mid patella
Wy Patella is taken in PA instead of AP?
decreased OID
Where is the CR for lateral patella
mid-femoropatellar joint
how do you know if the patella is in true lateral
the patellofemoral joint is open
Sunrise of patella should not be attempted until ___
patella fracture is ruled out
Pelvis consists of how maby bones? what are they?
4
2 hip bones
sacrum
coccyx
The sacrum articulates with ___
fifth lumbar vertebra
Iliac bone articulate with__
sacrum posteriorly
what 3 bones fused to form the acetabulum
ilium
pubis
ischium
Which anatomy part articulates with the acetabulum
femoral head
which hip bone is located superior to the acetabulum
illium
which hip bone is located inferior and posterior to acetabulum
ischium
which hip bone is located inferior and anterior to acetabulum
pubis
What form the pelvic girdle
2 hip bones
acetabulum
3 important part of Ilium
Ala
Body
Iliac Crest
The body of ilium includes ___ of acetabulum
superior part of acetabulum
The ala is ___ part of the ilium
superior
The iliac crest extends from ___ to ___
ASIS
PSIS
below the ASIS & PSIS, there are ___
AIIS
PIIS
what are the 2 important landmarks for ilium
iliac crest & ASIS
The body of ischium includes ____ of acetabulum
posterioinferior acetabulum
Ramus is the __ aspect of the ischium
lower
___ project anteriorly from ischial tuberosity
ramus
Which landmark is more commonly used? ischial tuberosity or iliac crest
iliac crest
Posterior to the acetabulum is the bony projection called ____
ischial spine
superior to the ischial spine is _____
inferior to ischial spine is ___
Greater sciatic notch
Lesser sciatic notch
What goes through the greater sciatic notch
sciatic nerve
THe body of pubis includes __ of acetabulum
anterioinferior
____ extend anteriorly & medially from the body of each pubis
superior ramus
The two superior & inferior rami of pubis join to form ___
pubic symphysis
Obturator foramen is formed by ____
ramus & body of each ischium & pubis
The true pelvis forms ____
birth canal
True pelvis has an inlet & outlet which are also called___
superior aperture
inferior aperture
The inferior aperture is made up of ___ (2)
tip of 2 ischial tuberosities
tip of coccyx
The superior aperture is made up of ___ (3)
sacrum
ilium
pubis
4 types of pelvis joints
SI (sacroiliac joint)
Symphysis pubis
Acetabulum
Hip joint
Sacroiliac joints joins ____ & ____
sacrum & ilium
Hip joint is made up of ___
head of femur & acetabulum of pelvis
Classification of Pelvis joints:
-SI joint is ___
-Hip joint is __
-Acetabulum is ___
-Symphysis pubis is ___
synovial
synovial
cartilaginous
cartilaginous
Characteristics of Male pelvis
narrow inlet
ala less flared
acute pubic arch
oval obturator foramen
Characteristics of Female pelvis
wider inlet
flared ala
obtuse pubic arch
narrow obturator foramen
To determine if the pelvis belongs to a male or a female, which structure do we look at (4)
inlet
ala
pubic arch
obturator foramen
position patient for AP Pelvis
supine
rotate leg internally 15 degree
CR for AP pelvis?
bw ASIS & symphysis pubis
Which structure do you look at to indicate if there are rotation for AP pelvis
obturator foramen (narrow foramen indicate rotation in that direction)
Fovea Capitis is located in ____ What go through fovea capitis
head of the femur
ligaments
Greater trochanter is located ____ & _____
Smaller trochanter is located ___ & ____
superiorly and laterally to the femoral shaft
posteriorly and medially from femoral neck & shaft
G & L trochanters are joined ___ by ____
posterioly
intertrochanteric crest
in normal position, The head & neck of the femur is at angle of ____
15-20 anterior
Routines for Hip
AP Pelvis
Lateral (frog leg)
position patient for AP unilateral hip
supine + leg extended & rotate 15 internally.
where is cr for AP unilateral hip
2” distal to femoral neck
- 2” medial 4” distal to ASIS
[AP PELVIS] changes in what structure would indicate rotation?
obturator foramen
What does it mean if we see lesser trochanter for AP pevis
patient didnt rotate leg 15 internally
What structure would u see AND not see on AP Pelvis
see: greater trochanter
not see: lesser trochanter
[AP Pelvis] rotate leg 15 degree internally will place _____ in true AP
femoral neck
Alternative routines for lateral pelvis
cross table hip
clement-nakayama
How to position patient for Frog Leg Lateral
supine
flex knee & abduct 45 degree
[FROG LATERAL] can we abduct leg more than 45 degree? if not why?
more than 45 will cause superimposition over femoral neck
Where is the CR for FROG LATERAL
femoral neck (4” distal to asis)
What is the location for femoral neck?
4” distal to ASIS
How to position patient for CROSS TABLE
supine
elevate unaffected leg without moving affected hip
What is the alternative position when patient cant do FROG LAteral
CROSS TABLE HIP
[PELVIS] Where is the CR for CROSS TABLE
perpendicular to IR & femoral neck
[CROSS TABLE] IR/grid placement?
in the crease above iliac rest
–> // to femoral neck AND perpendicular to IR
how to position patient for CLements- Naka
supine
leg fully extended
place affected side near the edge of the table
Where is CR for Clem-Naka?
below level of table top
What is the tube angle for Clem-Naka
15 degree mediolaterally perpendicular to femoral neck *& IR
[Clem-Naka] IR placement?
tilted approx 15 degree and // with femoral neck
What is the projection for Clem-Naka
axiolateral
What is the position/projection for Pelvis Inlet & Outlet
AP AXIAL
[PELVIS] Where is the CR for AP Axial Outlet? tube angle?
angled cephalad
1-2” inferior to symphysis pubis or greater trochanter
[AP Axial Outlet] CR angle:
Male: ___
Female:
20-30
30-40
What 2 hip bones would be visible when taking AP Axial Outlet
Pubis & Ischium
What part of pubis will be visible on AP Axial Outlet
superior & inferior ramus
What part of ischium will be visible on AP Axial Outlet
body & ramus
How do you position patient for AP Axial Outlet
supine
leg fully extended
Where is the CR for AP Axial Inlet? tube angle?
angled 40 caudad
midline to ASIS
What structure would be visible on AP Axial inlet
entire superior aperture
Superior Aperture is ____
pelvis inlet
[AP AXIAL] tube angle:
Inlet:
Outlet:
40 degree caudad
cephalad (20-30 for M) ( 30-40 for F)
To make CR perpendicular to inlet, what is the tube angle
CR 40 degree caudad
What structure would be visible on AP Axial Inlet
ischial spine
you would clearly see obturator foramen on AP Axial ____
outlet
The routine for this structure required 2 images done for comparisons
Posterior oblique of Acetabulum
how to position patient for Post Obl Acetabulum
rotate pelvis & thorax to 45 degree posterior oblique
Anterior column is ____
Posterior column is _____
pubis
ischium
Judet view of acetabulum is AP or PA
AP
Where is the CR for downside acetabulum
2” distal & medial to downside ASIS
where is the CR for upside acetabulum
2” distal to upside ASIS
if the CR is for right downside acetabulum, which position is the pt in
RPO
if the CR is for right upside acetabulum, which position is the pt in
LPO
Downside acetabulum will show ___ wall & ___ column
anterior
ilioischial
Upside acetabulum will show ____ wall & _____ column
posterior
iliopubic
Pt in LPO
iilioischial column & Anterior wall visible
what is the CR
2” distal & medial to left downside ASIS
Obturator foramen is open for ___ acetabulum
upside
on downside acetabulum, the iliac wing is ____
on upside, acetabulum, the iliac wing is ____
elongated
foreshortened
Where is the CR for Sacroiliac joint
1” medial to upside ASIS
How to position patient for SI joint imaging
25-30 posterior oblique
joint of interested is elevated
Place pt in
RPO for _____ SI joint
LPO for _____ SI joint
LT
RT
