Upper Extremity (non-shoulder) Flashcards
what are the 8 carpal bones?
*in order from lateral to medial, bottom row first
bottom: scaphoid, lunate, triquetrum, pisiform
Top: trapezium, trapezoid, capitate, hamate
what are the 8 carpal bones?
*in order from lateral to medial, bottom row first
bottom: scaphoid, lunate, triquetrum, pisiform
Top: trapezium, trapezoid, capitate, hamate
PA, Lateral, and PA Oblique 2nd-5th digits centering point
Proximal Interphalangeal Joint of digit of interest
AP and PA Oblique 1st digit centering point
1st Metacarpophalangeal joint
PA Digit (2nd-5th) Image Eval
- distal metacarpal included
- biconcavity of phalangeal bodies
- open IP and MCP joints
PA Oblique Digit (2nd-5th)
Image Eval
- distal metacarpal included
- anterior concavity of phalanx
- open IP and MCP joints
PA Lateral Digit (2nd-5th)
Image Eval
- distal metacarpal included
- anterior concavity of phalanx
- superimposed condyles
- open IP and MCP joints
What anatomy should be included in a projection of the 1st digit?
both phalanges and all of the adjacent metacarpal
PA and PA Oblique Hand
Positioning
- anterior surface of hand flat on IR (laterally rotated 45 degrees for Oblique)
- collimate to include the fingers, carpals, metacarpals, and distal radius and ulna
- center at 3rd MCP joint
PA hand
Image Eval
- all of hand to distal radius and ulna included
- biconcavity of phalanges
- metacarpals equidistant
PA Oblique Hand
- all of hand to distal radius and ulna included
- anterior concavity of phalanges
- minimal overlap of 3-5 metacarpals
- 2nd-3rd metacarpals separated
Lateral Hand
Positioning
Image Eval
- center at 2nd MCP joint
- position for either fingers on top of each other (karate chop) or “okay” symbol (fan)
- collimate to include distal radius and ulna
- metacarpals should be superimposed
AP Oblique Hand(s)
- ball-catcher’s position
- 45 degrees rotated medially from supinated position
- separate digits best as possible
- similar image eval as PA oblique
Why do AP Wrist instead of PA?
- done as part of carpal series
- shows carpal interspaces better
PA Wrist
Positioning and Image Eval
- place elbow, shoulder, and wrist in same plane; flex elbow 90 degrees
- abduct fingers into palm (pushes wrist into IR)
- collimate to 2.5” above and below wrist joint
- image should show open radioulnar joint space
Lateral Wrist
Positioning and Image Eval
- place elbow, shoulder, and wrist in same plane; flex elbow 90 degrees
- rotate forearm and hand into true lateral position
- image should show superimposed: radius and ulna; and metacarpals
PA Oblique Wrist (lateral rotation)
Positioning and Image Eval
- rotate laterally until wrist is 45 degrees from IR
- center at midcarpals
- image should show lateral carpals
- trapezium and lateral half of scaphoid free of superimposition
Why do AP Oblique Wrist?
- shows medial carpal bones
- triquetrum, hook of hamate, and pisiform free of superimposition
- especially pisiform*
Why do PA Wrist with Ulnar deviation?
done to image scaphoid free of superimposition
Why is PA Axial Wrist done and how is it different than normal PA?
- done to better view the scaphoid; often done with ulnar deviation
- IR or part is elevated 20 degrees (or CR is angled 20 degrees toward the wrist
AP Forearm
Positioning and Image Eval
- supinate forearm until humeral epicondyles are parallel to IR
- Pt may have to lean laterally to get true supination
- collimate to include 2” above elbow and 2” below wrist
- image should show elbow, wrist, and open radioulnar space
Lateral Forearm
Positioning and Image Eval
- position shoulder, elbow, and wrist in same plane
- flex elbow to 90 degrees and point thumb side up
- image should include 2” above elbow and 2” below wrist
- image should show superimposition of distal radius and ulnar
- and superimposed humeral epicondyles
AP Elbow
Positioning and Image Eval
- positioning is nearly identical to AP Forearm; however centering point is at the joint
- most important: humeral epicondyles must be parallel to IR
- Radial head, neck and tuberosity are slightly superimposed over ulna
- olecranon and coranoid fossae nearly equidistant from epicondyles
Lateral Elbow
Positioing and Image Eval
- positioning nearly the same as Lateral Forearm; however centering point is at the joint
- most important: humeral epicondyles must be perpendicular to IR
- olecranon process seen in profile
- elbow joint is open
What is the difference between the AP Obliques of the Elbow? Lateral and Medial rotations
- both rotate 45 degrees medial or lateral
- MEDIAL rotation shows open olecranon fossa, trochlea, and superimposed radius and ulna
- LATERAL rotation shows open radioulnar space and capitulum
What is the tube angle used for a “Trauma Elbow”? What is the method and anatomy of interest?
- 45 degrees cephalad for radial head and capitulum (similar to AP Oblique lateral rotation)
- 45 degrees caudad for coronoid process and trochlea (similar to AP Oblique medial rotation)
- Coyle Method
AP Humerus (Upright) Positioning and Image Eval
- position so that humerus is free of superimposition of torso
- supinate hand (unless contraindicated) and abduct arm
- humeral epicondyles should be parallel with IR
- greater tubercle should be in profile
- should have 2” inches above and below humerus on image
Lateral Humerus (Upright) Positioning and Image Eval
- internally rotate arm until epicondyles are perpendicular to IR
- adduct arm, flex elbow 90 degrees, and place hand on hip
- can be PA if pt cannot adduct arm
