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UPPER EXTREMITY I.A. Flashcards

1
Q

PA FINGER - GUIDELINES

A
  1. Soft tissue width & midshaft concavity are
    equal on both sides of phalanges
  2. Fingers separated, no tissue overlap from
    adjacent digits
  3. IP and MCP joints are demonstrated as open
    spaces
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2
Q

ANALYZE PA FINGER

A

-Asymmetric midshaft concavity
- The finger in external rotation (LOOKS OBLIQUE)

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3
Q

ANALYZE PA FINGER

A
  • The IP and MCP joints are closed
    • Distal & middle phalanges are foreshortened.
    • Finger was flexed
    • CR NOT PARALLEL WITH JOINT SPACES
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4
Q

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?

A

-THUMB PREVENTS

  • WITHOUT FORESHORTENING / CR PARALLEL WITH OPEN JOINT
  • AP PROJECTION - IP & MCP JOINTS WILL BE MORE OPEN / LESS PHALANGES SUPERIMP.
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5
Q

PA OBLQIE DIGIT - GUIDELINES

A
  1. More concavity seen on one aspect of phalangeal midshafts than other
  2. IP & MCP joints spaces should be open.
  3. No overlap/superimposition from adjacent fingers.
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6
Q

COMPARE THESE OBLQIUE DIGITS

A

IMAGE 1: LESS 45* OBLIQUE (looks PA)
IMAGE 2: MORE THAN 45* OBLIQUE (looks lateral)
IMAGE 3: OVERLAP OF ADJACENT DIGITS

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7
Q

LATERAL DIGIT - GUIDELINES

A
  1. Anterior surface of phalanges midshaft concavity
  2. IP and MCP joints spaces be open.
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8
Q

COMPARE THESE LATERAL DIGITS

A

IMAGE 1: INADEQUATE ROTATION (looks oblique)
IMAGE 2: OVERLAP OF ADJACENT DIGITS

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9
Q

AP THUMB - GUIDELINES

A
  1. Soft tissue width & midshaft concavity equal on both sides of phalanges
  2. Joint spaces open
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10
Q

COMPARE THESE AP THUMBS

A

IMAGE 1: HAND INTERNALLY ROTATED TOO FAR
IMAGE 2: PALAMR SURFACE NOT DRAWN BACK FROM THUMB

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11
Q

LATERAL THUMB - GUIDELINES

A
  1. Anterior proximal phalanx & MC midshaft concavity
  2. IP and MCP joint open
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12
Q

APA OBLIQUE THUMB - GUIDELINES

A
  1. More proximal phalangeal and MC midshaft concavity is present on the side of the thumb next to Fingers than on the other side.
  2. IP and MC joints open
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13
Q

PA HAND - GUIDELINES

A
  1. Soft tissue outlines of the 2nd through 5th phalanges are uniform.
  2. No soft tissue overlap from adjacent fingers.
  3. IP and MCP joints open.
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14
Q

COMPARE THESE PA HANDS

A

IMAGE 1: EXCESSIVE SEPERATION
IMAGE 2: EXTERNAL ROTATION

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15
Q

PA OBLIIQUE HAND - GUIDELINES

A
  1. First & second MC heads not superimp.
    • 3rd through 5th are slightly superimposed.
  2. Small space is present btw the 3rd, 4th, and 5th MC midshaft.
  3. IP and MCP joints should be open.
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16
Q

ANALYZE OBLQIUE HAND:

  • TOO MUCH MC HEAD SUPERIMP = _____
  • TOO MUCH SEPARATION OF MC HEADS = ___
A

IMAGE 1: FINGERS/STRUCTURES TOO SUPERIMP.
IMAGE 2: MORE THAN 45* OBLIQUE

-TOO MUCH = OVER ROTATED
- TOO SEPARATED = UNDER ROTATED

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17
Q

FAN LATERAL HAND - GUIDELINES

A
  1. 2nd through 5th MCs are superimposed
  2. Thumb should be w/o superimp. of other digits.
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18
Q

COMPARE LATERAL FANS

  • FOREIGN BODIES IN HAND BEST SEEN IN WHAT PROJECTION?
A

IMAGE 1: OVERLAP DIGITS
IMAGE 2: HAND EXTERNALLY ROTATED
IMAGE 3: HAND INTERNALLY ROTATED

-TRUE LATERAL

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19
Q

PA WRIST - GUIDELINES

A
  1. The intercarpal spaces not open b/c irregular shapes that result in overlapping.
  2. Superimposition of the MC bases is limited.
  3. Separation of distal radius and ulna, except
    for possible minimal superimposition at the
    distal radioulnar joint.
20
Q

ANALYZE THE PA WRISTS

A

IMAGE 1: EXTERNAL ROTATION
- RADIOULNAR TOO CLOSE
- MEDIAL CARPALS SUPERIMPOSED
IMAGE 2: INTERNAL ROTATION
- LATERAL CARPALS SUPERIMPOSED

21
Q

PA OBLIQUE WRIST - GUIDELINES

A
  1. Trapezium & trapezoid W/O superimposition.
  2. Ulnar head partially superimp. by distal radius.
  3. Proximal 3rd - 5th MC bases mostly superimp.
22
Q

COMPARE THESE OBLIQUE WRISTS

A

IMAGE 1: MORE THAN 45* OBLIQUE
- TRAPEZIUM, TRAPEZOID & CAPITATE SUPERIMP.
IMAGE 2: LESS THAN 45* OBLIQUE
- FOREARM ELEVATED
- RADIUS SUPERIMP. LUNATE & SCAPHOID

23
Q

LATERAL WRIST - GUIDELINES

A
  1. Ulnar head superip. over distal radius
  2. Distal aspect of the scaphoid & pisiform aligned
  3. Proximal 2nd - 5th MCs aligned & near superimp.
24
Q

COMPARE THE LATERAL WRISTS

A

IMAGE 1: WRIST EXTERNAL ROTATION
- PISIFORM ANTERIOR TO SCAPHOID
- ULNA ANTERIOR TO RADIUS
IMAGE 2: THUMB NOT DEPRESSED
- THUMB FORESHORTENED & SUPERIMP. TRAPEZIUM

25
ULNAR DEVIATION, PA AXIAL WRIST - GUIDELINES -SCAPHOID POISTION IN NUETRAL? -CR / POSITION FOR PROJECTION?
1. Scaphoid without foreshortening & superimp. 2. Radioscaphoid joint space open. - NUETRAL PA - SCAPHOID TILTS ANTERIORLY, 20* ANGLE TO IR -ULNAR DEVIATION WITH 10-15* ANGULATION TO LONG AXIS OF SCAPHOID
26
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
27
AP FOREARM - GUIDELINES
1. Humeral epicondyles in profile 2. Radial head, neck, & tuberosity slightly superimp. by ulna 3. Radial tuberosity in profile 4. Wrist and elbow joints partially open (because of divergent beam)
28
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
29
LATERAL FOREARM - GUIDELINES
1. Distal radius and ulna are superimposed 2. Humeral epicondyles superimposed 3. Radial head superimpose coronoid process 4. Radial tuberosity not in profile 5. Elbow flexed 90*
30
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
31
ANALYZE LATERAL FOREARM - WHAT POSITION IS PATIENT IN?
-PROXIMAL HUMERUS ELEVATED - EPICONDYLES NOT SUPERIMPOSED - CORONOID PROCESS & RADIAL HEAD TOO SUPERIMP.
32
AP ELBOW - GUIDELINES
1. No rotation is evidenced by: - Medial and lateral epicondyles in profile. - Radial head, neck, & tuberosity slightly superimp. by ulna. - Radial tuberosity in profile medially.
33
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
34
ANALYZE AP ELBOW
- HAND & WRIST INTERNALLY ROTATED IN PA OBLIQUE - INCREASED SUPERIMP. OF RADIUS - RADIAL TUBEROSITY NOT IN PROFILE / ROTATED POSTERIORLY
35
ELBOW MEDIAL OBLQIUE - GUIDELINE
1. Coronoid process of the ulna in profile. 2. Medial epicondyle & trochlea elongated / in partial profile. 3. Radial head and neck superimposes the ulna
36
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
37
ELBOW LATERAL OBLIQUE - GUIDELINES
1. Ulna w/o radial head, neck and tuberosity superimposition. 2. Lateral epicondyle and capitulum aelongated and in profile. 3. Radioulnar joint is open.
38
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
39
LATERAL ELBOW -GUIDELINES
1. One-half of radial head superimposed by coronoid process. 2. Olecranon process is in profile. 3. Superimposition of epicondyles. 4. Humerus three concentric arcs
40
COMPARE LATERAL ELBOWS
IMAGE 1: PROXIMAL HUMERUS ELEVATED IMAGE 2: PROXIMAL HUMERUS DEPRESSED - RADIAL HEAD TOO ANTERIOR TO CORACOID
41
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
42
AP HUMERUS - GUIDELINES
1. Greater tubercle visualized in profile laterally. 2. Humeral head in profile medially - minimal superimposition of the glenoid cavity. 3. Margin of lesser tubercle halfway btw greater tubercle and humeral head. 4. Medial & lateral humeral epicondyles in profile.
43
COMPARE AP HUMERUS
IMAGE 1: HUMERUS EXTERNALLY ROTATED - RADIAL HEAD DOESNT SUPERIMP. ULNA IMAGE 2: ARM INTERNALLY ROTATED - RAD HEAD & ULNA TOO SUPERIMP.
44
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
45
LATERAL HUMERUS - GUIDELINES
1. Epicondyles are directly superimposed 2. Lesser tubercle in profile medially, partially superimposed by glenoid cavity.
46
ANALYZE LATERAL HUMERUS
INSUFFICIENT INTERNAL ROTATION - EPICONDYLES NOT PERP TO IR - DISTORTED FOREARM - LESSER TUB. IN PROFILE
47
THIS IMAGE IS AN EXAMPLE OF: A. FORESHORTENING B. MAGNIFICATION C. ELONGATION
A. FORESHORTENING

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