Upper Extremities Flashcards
Colles’ fracture
Fracture of the distal radius and ulnar styloid with posterior displacement
More frequent in older adults who fall on an outstretched hand
Smith’s Fracture
Fracture of the distal radius and ulnar styloid with anterior displacement
Also known as Reverse Colles’
Torus or Buckle fracture
Impacted fracture with a bulging periosteum
Most common fracture of the distal radius and ulnar in young children
Technique for a PA wrist and an Oblique wrist
54 @ 2
Technique for a Lateral wrist and an AP and lateral forearm
60 @ 2
60 @ 4
60 @ 4
Common wrist fractures
Colles’, smith’s, torus or buckle
Wrist projections
PA, PA Ob, Lateral, ulnar deviation
PA wrist
Flex elbow 90 degrees, fingers flexed under hand to make wrist and hand on same plane, CR perpendicular to IR and centered at the mid carpal area/ wrist, collimating to include metacarpals and about one inch of the distal radius and ulna
PA Oblique wrist
Flex elbow 90 degrees, straighten fingers, externally rotate hand so that it makes a 45 degree angle with the IR, CR perpendicular to IR and centered at the mid carpal area/ wrist, collimating to include metacarpals and about one inch of the distal radius and ulna
PA Oblique wrist evaluation criterial
Slight overlap of radius and ulna, trapezium and scaphoid demonstrated,
Lateral wrist
Flex elbow 90 degrees, fingers straight, medial side of arm down, thumb side up but thumb straight with other fingers, radial and ulnar styloid should inline with one another and superimposed, CR perpendicular to IR and centered at the mid carpal area/ wrist, collimating to include metacarpals and about one inch of the distal radius and ulna
Lateral wrist evaluation criteria
Proximal half of the metacarpals should be superimposed, radius and ulna should be superimposed, and carpals should be superimposed
PA ulnar deviation
Flex elbow 90 degrees, turn hand outward towards the CR perpendicular to IR and centered at the scaphoid, collimating to include metacarpals and about one inch of the distal radius and ulna
PA ulnar deviation evaluation criterial
Scaphoid demonstrated without foreshortening and adjacent articulations open, extreme ulnar deviation
Essential projections for the forearm
AP and Lateral
AP forearm
Hand is supinated, anterior side up, make sure arm and shoulder are the same plane, elbow needs to be extended, collimation needs to include elbow joint and wrist joint (wrist to distal humerus)
AP forearm criteria
Elbow joint partially open, wrist to distal humerus demonstrated, no elongation or foreshortening of the humeral epicondyles
Lateral forearm
Elbow flexed at 90 degrees, ulnar and radial styloid processes superimposed, entire upper limb in the same plane, collimated field includes wrist to distal humerus, CR enters at midpoint of the forearm
What does the shoulder girdle consists of?
Clavicle and scapula, which articulates with the head of the humerus, the manubrieum of sternum and each other
The function of the shoulder girdle is to…
connect the upper limb to the trunk of the body
Is the humerus considered to be apart of the shoulder girdle?
NO
What type of joint is the shoulder?
Diarthrodial classification by function, synovial classification by anatomy, ball and socket type capable of all motions
What bone lies just above the first rib and is classified as a long bone?
Clavicle
The clavicle has a lateral end and a medial end called what?
Lateral- acromial extremity
Medial - sternal extremity
What bone is triangular in shape, forms the posterior portion of the shoulder girdle, and is classified as a flat bone?
The scapula
The scapula has two surfaces called..
Costal - anterior
Dorsal - posterior
The scapula has 3 borders called…
Lateral, medial, and superior
The scapula has three angles which are..
Inferior angle, superior angle, and lateral angle
On the posterior side of the scapula there is the __________ of the spine that eventually forms the _________ process.
Crest; acromion
A fracture at the base of the first metacarpal
Bennet’s
A fracture of the body of the fifth metacarpal
Boxer’s fracture
Technique for digits
50/54 @ 2
All upper extremities are done at _____ inch SID
40
Technique for a PA hand
54 @ 2
Technique for an oblique hand
57 @ 2
Technique for a lateral hand
60 @ 2
Essential projections for digits 2-5?
PA, PA Oblique, Lateral
PA Positioning for digits 2-5?
Place hand prone flat on surface, center CR to the PIP, collimate to edges of the finger and 1.5 inch past knuckle
PA oblique positioning for digits 2-5?
Angle hand 45 degrees to IR, CR enters at the PIP, collimate to the edges of finger and 1.5 inches past knuckle
Evaluation of PA digit positioning
No rotation, concave phalanx bones, open IP and MCP joints (finger flat)
PA Oblique digits 2-5 evaluation
Hand at 45 degrees, open IP and MCP joints, proximal phalanx and MCP demonstrated without superimposition of adjacent digits
Lateral digits 2-5 positioning
Reduce magnification by placing the digit in a way where it is closest to the IR, flat, straight, lateral, injured finger is the only one extended the rest are flexed toward the hand, CR entering at the PIP joint
Lateral evaluation of digits 2-5
True lateral, look for outline of soft tissue, look for a straight line on one side of the phalanx and a curved line on the other (anterior surface of the phalanges should be concave), open IP joint spaces,
Essential projections for the thumb
AP, PA oblique, lateral
AP positioning for the thumb
Hand in extreme internal rotation, flat on surface, posterior surface of thumb in contact with the IR, CR centered at MCP, collimation includes the entire thumb down to the trapezium carpal bone and surrounding soft tissue
AP thumb evaluation
No rotation, shafts of metacarpal and phalanges should be concave on both sides, open IP and MCP joints, anatomy for distal tip of thumb to trapezium demonstrated, equal amounts of soft tissue demonstrated
PA oblique positioning
Anterior part of hand flat on the IR, thumb in neutral position gives an natural 45 degree angle, CR enters at the MCP, thumb to trapezium in collimation field
PA oblique evaluation
Proper rotation of 45 degrees, anatomy from distal tip of thumb to trapezium demonstrated, open IP and MCP joint spaces
Lateral thumb positioning
Flex fingers under hand, turn thumb so lateral side is resting on the IR (mediolateral projection), CR enters at the MCP, collimate thumb to trapezium,
Lateral thumb evaluation
True lateral, straight on one side, anterior side concave, anatomy from distal tip of thumb to trapezium demonstrated, open IP and MCP joint spaces
Essentials projections of the hand
PA, PA oblique, Lateral (fan or extension)
Why use the extension lateral position of the hand?
To look for foreign bodies or use if patient can not fan fingers
PA positioning of the hand
Hand flat on palmar surface, fingers straight and spaced out, CR entering at the MCP of the 3rd metacarpal, collimation includes the entire hand fingers and wrist to one inch of the distal radius and ulna, hand and arm in the same plane
PA evaluation of the hand
Hand and arm in same plane, metacarpal and phalange shafts concave, IP and MCP joint spaces open, anatomy from the tips of the fingers to one inch of the distal radius and ulna
PA oblique positioning of the hand
Forearm resting on table, hand and arm in the same plane, palmar surface on IR, form a 45 degree angle with the MCP and IR, use sponge if have one, CR enters at 3rd metacarpal, collimation includes all hand fingers wrist and one inch of the distal radius and ulna
PA oblique evaluation of the hand
Proper 45 degree rotation, open IP and MCP joint spaces, no soft tissue over lap of the digits, anatomy from the distal phalanges to one inch of the distal radius and ulna
Lateral (fan) positioning of the hand
Place the medial side (pinky side) of the hand on the IR, elbow flexed 90 degrees, forearm and hand in same plane, make an okay sign with hand and then straighten and space out (fan out) each digit to make them free of super imposition, ulna and radial styloid process superimposed, CR entering at the 2nd MCP, collimation should be of the distal phalanges to one inch of the distal radius and ulna
Lateral extension position of the hand
Place the medial side (pinky side) of the hand on the IR, elbow flexed 90 degrees, forearm and hand in same plane,ulna and radial styloid process superimposed, phalanges superimposed, first digit abducted from Palm to form right angle, CR entering at the 2nd MCP, collimation should be of the distal phalanges to one inch of the distal radius and ulna
Lateral evaluation of the hand
Fan - phalanges free of superimposition
Extension - phalanges superimposed
Both - metacarpals and distal radius and ulna superimposed, extended digits
Lateral forearm evaluation criteria
Wrist to distal humerus demonstrated, superimposition humeral epicondyles, superimposition of the distal ends of the radius and ulna, elbow flexed at 90 degrees, radial head superimposed over coronoid process, radial tuberosity pointing anteriorly
Projections for an elbow
AP, AP oblique, lateral
AP elbow positioning
60 @ 2, supinate hand, extend arm and elbow flat on IR, hand and upper limb in same plane, CR centered at mid elbow, humeral epicondyles parallel with IR, collimation includes distal humerus radioulnar articulation and proximal radius and ulna