UPPER EXTREMITY I.A. Flashcards
PA FINGER - GUIDELINES
- Soft tissue width & midshaft concavity are
equal on both sides of phalanges - Fingers separated, no tissue overlap from
adjacent digits - IP and MCP joints are demonstrated as open
spaces
ANALYZE PA FINGER
-Asymmetric midshaft concavity
- The finger in external rotation (LOOKS OBLIQUE)
ANALYZE PA FINGER
- The IP and MCP joints are closed
- Distal & middle phalanges are foreshortened.
- Finger was flexed
- CR NOT PARALLEL WITH JOINT SPACES
WHY IS INTERNAL ROTATION NOT POSSIBLE FOR DIGITS?
PHALANGES SGOULD BE SEEN ______ ON PA DIGIT, CR SHOULD BE _____
IF PATIENT UNABLE TO EXTEND FINGERS = ___________, WHY?
-THUMB PREVENTS
- WITHOUT FORESHORTENING / CR PARALLEL WITH OPEN JOINT
- AP PROJECTION - IP & MCP JOINTS WILL BE MORE OPEN / LESS PHALANGES SUPERIMP.
PA OBLQIE DIGIT - GUIDELINES
- More concavity seen on one aspect of phalangeal midshafts than other
- IP & MCP joints spaces should be open.
- No overlap/superimposition from adjacent fingers.
COMPARE THESE OBLQIUE DIGITS
IMAGE 1: LESS 45* OBLIQUE (looks PA)
IMAGE 2: MORE THAN 45* OBLIQUE (looks lateral)
IMAGE 3: OVERLAP OF ADJACENT DIGITS
LATERAL DIGIT - GUIDELINES
- Anterior surface of phalanges midshaft concavity
- IP and MCP joints spaces be open.
COMPARE THESE LATERAL DIGITS
IMAGE 1: INADEQUATE ROTATION (looks oblique)
IMAGE 2: OVERLAP OF ADJACENT DIGITS
AP THUMB - GUIDELINES
- Soft tissue width & midshaft concavity equal on both sides of phalanges
- Joint spaces open
COMPARE THESE AP THUMBS
IMAGE 1: HAND INTERNALLY ROTATED TOO FAR
IMAGE 2: PALAMR SURFACE NOT DRAWN BACK FROM THUMB
LATERAL THUMB - GUIDELINES
- Anterior proximal phalanx & MC midshaft concavity
- IP and MCP joint open
APA OBLIQUE THUMB - GUIDELINES
- More proximal phalangeal and MC midshaft concavity is present on the side of the thumb next to Fingers than on the other side.
- IP and MC joints open
PA HAND - GUIDELINES
- Soft tissue outlines of the 2nd through 5th phalanges are uniform.
- No soft tissue overlap from adjacent fingers.
- IP and MCP joints open.
COMPARE THESE PA HANDS
IMAGE 1: EXCESSIVE SEPERATION
IMAGE 2: EXTERNAL ROTATION
PA OBLIIQUE HAND - GUIDELINES
- First & second MC heads not superimp.
- 3rd through 5th are slightly superimposed.
- Small space is present btw the 3rd, 4th, and 5th MC midshaft.
- IP and MCP joints should be open.
ANALYZE OBLQIUE HAND:
- TOO MUCH MC HEAD SUPERIMP = _____
- TOO MUCH SEPARATION OF MC HEADS = ___
IMAGE 1: FINGERS/STRUCTURES TOO SUPERIMP.
IMAGE 2: MORE THAN 45* OBLIQUE
-TOO MUCH = OVER ROTATED
- TOO SEPARATED = UNDER ROTATED
FAN LATERAL HAND - GUIDELINES
- 2nd through 5th MCs are superimposed
- Thumb should be w/o superimp. of other digits.
COMPARE LATERAL FANS
- FOREIGN BODIES IN HAND BEST SEEN IN WHAT PROJECTION?
IMAGE 1: OVERLAP DIGITS
IMAGE 2: HAND EXTERNALLY ROTATED
IMAGE 3: HAND INTERNALLY ROTATED
-TRUE LATERAL
PA WRIST - GUIDELINES
- The intercarpal spaces not open b/c irregular shapes that result in overlapping.
- Superimposition of the MC bases is limited.
- Separation of distal radius and ulna, except
for possible minimal superimposition at the
distal radioulnar joint.
ANALYZE THE PA WRISTS
IMAGE 1: EXTERNAL ROTATION
- RADIOULNAR TOO CLOSE
- MEDIAL CARPALS SUPERIMPOSED
IMAGE 2: INTERNAL ROTATION
- LATERAL CARPALS SUPERIMPOSED
PA OBLIQUE WRIST - GUIDELINES
- Trapezium & trapezoid W/O superimposition.
- Ulnar head partially superimp. by distal radius.
- Proximal 3rd - 5th MC bases mostly superimp.
COMPARE THESE OBLIQUE WRISTS
IMAGE 1: MORE THAN 45* OBLIQUE
- TRAPEZIUM, TRAPEZOID & CAPITATE SUPERIMP.
IMAGE 2: LESS THAN 45* OBLIQUE
- FOREARM ELEVATED
- RADIUS SUPERIMP. LUNATE & SCAPHOID
LATERAL WRIST - GUIDELINES
- Ulnar head superip. over distal radius
- Distal aspect of the scaphoid & pisiform aligned
- Proximal 2nd - 5th MCs aligned & near superimp.
COMPARE THE LATERAL WRISTS
IMAGE 1: WRIST EXTERNAL ROTATION
- PISIFORM ANTERIOR TO SCAPHOID
- ULNA ANTERIOR TO RADIUS
IMAGE 2: THUMB NOT DEPRESSED
- THUMB FORESHORTENED & SUPERIMP. TRAPEZIUM
ULNAR DEVIATION, PA AXIAL WRIST - GUIDELINES
-SCAPHOID POISTION IN NUETRAL?
-CR / POSITION FOR PROJECTION?
- Scaphoid without foreshortening & superimp.
- Radioscaphoid joint space open.
- NUETRAL PA - SCAPHOID TILTS ANTERIORLY, 20* ANGLE TO IR
-ULNAR DEVIATION WITH 10-15* ANGULATION TO LONG AXIS OF SCAPHOID
COMPARE ULNA DEVIATIONS
IMAGE 1 & 2: SCAPHOID FX
- IMAGE 1 MORE DEVIATED THAN IMAGE 2
IMAGE 3: PALM NOT FLAT / INSUFF. DEVIATION
-TRAPEZIUM & TRAPEZOID SUPERIMP. 2ND MC
AP FOREARM - GUIDELINES
- Humeral epicondyles in profile
- Radial head, neck, & tuberosity slightly superimp. by ulna
- Radial tuberosity in profile
- Wrist and elbow joints partially open
(because of divergent beam)
COMPARE AP FOREARMS
IMAGE 1: ELBOW INTERNAL ROTATION
- HUMERAL EPICONDYLE POOR POSITION
- RADIAL HEAD TOO SUPERIMP OVER ULNA
IMAGE 2: ELBOW EXTERNALLY ROTATED
- RADIAL HEAD NOT SUPERIMP BY ULNA
LATERAL FOREARM - GUIDELINES
- Distal radius and ulna are superimposed
- Humeral epicondyles superimposed
- Radial head superimpose coronoid process
- Radial tuberosity not in profile
- Elbow flexed 90*
COMPARE LATERAL FOREARMS
IMAGE 1: WRIST INTERNALLY ROTATED
- ELBOW FLEX LESS THAN 90*
- DISTAL RADIUS ANTERIOR TO ULNA
IMAGE 2: DISTAL RADIUS FRACTURE
- POSITION JOINT CLOSEST TO FX IN LATERAL POSITION
ANALYZE LATERAL FOREARM
- WHAT POSITION IS PATIENT IN?
-PROXIMAL HUMERUS ELEVATED
- EPICONDYLES NOT SUPERIMPOSED
- CORONOID PROCESS & RADIAL HEAD TOO SUPERIMP.
AP ELBOW - GUIDELINES
- No rotation is evidenced by:
- Medial and lateral epicondyles in profile.
- Radial head, neck, & tuberosity slightly superimp. by ulna.- Radial tuberosity in profile medially.
COMPARE AP ELBOWS
IMAGE 1: ELBOW INTERNAL ROTATION
- RADIAL TUBEROSITY TOO SUPERIMP. OVER ULNA
- HUMERAL EPICONDYLES NOT IN PROFILE
IMAGE 2: ELBOW IN EXTERNAL ROTATION
- TOO LITTLE SIPERIMP OF RADIAL HEAD & TUBEROSITY
- HUMERAL EPICONDYLES NOT IN PROFILE
ANALYZE AP ELBOW
- HAND & WRIST INTERNALLY ROTATED IN PA OBLIQUE
- INCREASED SUPERIMP. OF RADIUS
- RADIAL TUBEROSITY NOT IN PROFILE / ROTATED POSTERIORLY
ELBOW MEDIAL OBLQIUE - GUIDELINE
- Coronoid process of the ulna in profile.
- Medial epicondyle & trochlea elongated / in partial profile.
- Radial head and neck superimposes the ulna
COMPARE MEDIAL OBLIQUE ELBOW
IMAGE 1: LESS 45* ELBOW OBLIQUE
- CORONOID PROCESS NOT IN PROFILE
IMAGE 2/3: MORE THAN 45* ELBOW OBLIQUE
- TOO MUCH RADIUS SUPERIMP. OF ULNA
ELBOW LATERAL OBLIQUE - GUIDELINES
- Ulna w/o radial head, neck and tuberosity superimposition.
- Lateral epicondyle and capitulum aelongated and in profile.
- Radioulnar joint is open.
COMPARE LATERAL OBLIQUE ELBOW
-IMAGE 1: GOOD IMAGE
IMAGE 2: CAPITULUM-RADIAL JOINT SPACE CLOSE
- FOREARM NOT PARALLEL TO IR (FLEXED)
IMAGE 3: LESS 45* OBLIQYE
- RADIAL HEAD & TUBER. PARTIALLY SUPERIMP. BY ULNA
LATERAL ELBOW -GUIDELINES
- One-half of radial head superimposed by coronoid process.
- Olecranon process is in profile.
- Superimposition of epicondyles.
- Humerus three concentric arcs
COMPARE LATERAL ELBOWS
IMAGE 1: PROXIMAL HUMERUS ELEVATED
IMAGE 2: PROXIMAL HUMERUS DEPRESSED
- RADIAL HEAD TOO ANTERIOR TO CORACOID
EVALUATE WRIST POSITION IN LATERAL ELBOWS
IMAGE 1: WRIST EXTERNAL ROTATED
- TUBEROSITY IN PROFILE ANTERIORLY
IMAGE 2: WRIST IN LATERAL POSITION (CORRECT)
- RADIAL TUB. SUPERIMP. BY RADIUS
IMAGE 3: WRIST INTERNALLY ROTATED
- RAD TUBER. PARTIAL PROFILE POSTERIOR
AP HUMERUS - GUIDELINES
- Greater tubercle visualized in profile laterally.
- Humeral head in profile medially
- minimal superimposition of the glenoid cavity.
- Margin of lesser tubercle halfway btw greater tubercle and humeral head.
- Medial & lateral humeral epicondyles in profile.
COMPARE AP HUMERUS
IMAGE 1: HUMERUS EXTERNALLY ROTATED
- RADIAL HEAD DOESNT SUPERIMP. ULNA
IMAGE 2: ARM INTERNALLY ROTATED
- RAD HEAD & ULNA TOO SUPERIMP.
IF HUMERUS FX CLOSE TO SHOULDER = ____________ B/C __________
IF FX CLOSE TO ELBOW = ________________
ROTATE PT 40* TO AFFECTED HUMERUS
- BRINGS GREATER TUB. IN PROFILE
EXTEND ARM & ROTATE TORSO UNTIL EPICONDYLES ARE PARALLEL TO IR
LATERAL HUMERUS - GUIDELINES
- Epicondyles are directly superimposed
- Lesser tubercle in profile medially, partially
superimposed by glenoid cavity.
ANALYZE LATERAL HUMERUS
INSUFFICIENT INTERNAL ROTATION
- EPICONDYLES NOT PERP TO IR
- DISTORTED FOREARM
- LESSER TUB. IN PROFILE
THIS IMAGE IS AN EXAMPLE OF:
A. FORESHORTENING
B. MAGNIFICATION
C. ELONGATION
A. FORESHORTENING
