week 8: upper extremity Flashcards
display these as if the patient were hanging from the fingertips
finger, wrist, and forearm
display these as if they were hanging from the shoulder
elbow, humerus
what determines whether you use table top versus bucky?
grids not used when anatomic part is less than 10cm (4 inches) and less than 60 kVp is needed = tabletop
over 10cm and greater than 60 kVp = bucky
non-bucky table top exams
fingers
hand
wrist
forearm
elbow
gray scale for extremity work = ____________
high contrast, sharp definition
no gown for these exams
fingers, hands, wrist
maybe a gown for these exams
forearm, humerus, shoulder girdle
what is to note about seating the patient for a table top exam?
“Oblique” their body so primary beam is not directed at their lap
for upper extremity work, patients need __________
to have gonadal shielding
what does PIP joint stand for?
proximal interphalangeal joint
what type of rotation do you have the patient preform for oblique finger digits 3-5?
lateral rotation
why is medial rotation preferred for 2nd digit oblique finger XR?
keeping the anatomy of interest closer to the IR
what type of rotation do you have the patient preform for oblique finger digit 2?
medial rotation
Finger: Lateral projections for which digits?
2nd digit = mediolateral projection
3-5th = lateromedial projection
how to determine a true lateral on lateral finger XR?
one side (posterior) straight, one side (palmar) on concave
routine projections for finger
PA, oblique, lateral
routine projections for thumb
AP, PA oblique, lateral
what type of joint is the thumb
saddle
where is the CR centered for thumb exams?
first MCP joint
where is the CR centered for PA oblique projection of hand?
third MCP joint
where is the CR centered for PA projection of hand?
third MCP joint
where is the CR centered for fan lateral/lateral in extension of hand?
second MCP joint
where is the CR centered for PA and AP projection of the wrist?
midcarpal area
where is the CR centered for a PA oblique projection of wrist?
midcarpal area
where is the CR centered for a lateromedial projection of the wrist?
midcarpal area
where is the CR centered for a PA projection with ulnar deviation of the wrist?
scaphoid, angled 10-15 degrees proximally
where is the CR centered for a PA projection with radial deviation of the wrist?
midcarpal aera
what does MCP joint stand for?
metacarpophalangeal joint
what is another name for scaphoid bone?
navicular bone
what does ulnar deviation “move”?
scaphoid
what does radial deviation “move”?
lunate, triquetrum, pisiform, and hamate
what are the proximal row carpal bones, moving from radius to ulna (lateral to medial in anatomical position)
scaphoid, lunate, triquetrum, pisiform
what are the distal row carpal bones, moving from radius to ulna (lateral to medial in anatomical position)
trapezium, trapezoid, capitate, hamate
for wrist x-rays, the elbow and the wrist need to be ______________
on the same plane (not necessarily same position)
Ulna “out” anteriorly for a lateral wrist x-ray means you have ________ the hand
supinated
Radius “out” anteriorly for a lateral wrist x-ray means you have ________ the hand
pronated
for forearm and elbow x-rays, ________________ are all in same plane
shoulder, elbow, wrist
does the radius cross over the ulna, or does the ulna cross over the radius?
radius crosses over the ulna
AP forearm with hand pronated is _______ because _____________
incorrect, radius crosses over the ulna
where is the CR center for AP forearm and lateromedial forearms? any CR angulation?
mid-forearm area, 0 angulation
how much of carpal bones/humerus are needed to be shown in forearm x-rays?
⅓ distal humerus
⅓ proximal carpal bones
Olecranon process is on the ______
proximal end of the ulna
where does the CR enter for an AP elbow?
mid-elbow joint (a point approx. 3/4 inch distal to midpoint of a line between epicondyles), 0 angulation
where does the CR enter for a lateral elbow?
mid-elbow joint (a point approx. 1 1/2 inches medial to easily palpated posterior surface of olecranon process)
what are the “three concentric arcs” of the lateral elbow?
trochlear sulcus
outer ridges of capitulum and trochlea
trochlear notch of ulna
how many fat pads are of note in a lateral elbow? what are they?
3
anterior fat pad
supinator fat pad
posterior fat pad within olecranon process
this view of the elbow best visualizes radial head and neck of the radius and capitulum of humerus
AP oblique projection lateral (external) rotation
this view of the elbow that best visualizes coronoid process of ulna and trochlea in profile
AP oblique projection medial (internal) rotation
the AP oblique projection of elbow with medial (internal) rotation best demonstrates _________________
coronoid process of ulna, trochlea in profile
the AP oblique projection of elbow with lateral (external) rotation best demonstrates _________________
radial head and neck of the radius and capitulum of humerus
for thumbs and fingers, raise ___________________
IR so forearm and hand are on same plane
what is another name for wrist ulnar deviation?
“scaphoid view”
which lateral hand projection is preferred for the hand if phalanges are the area of interest?
fan lateral
Which lateral hand projection is preferred if localization of a metallic foreign body in the palm of the hand is of interest (best demonstrates the metacarpals)?
lateral in extension
Hand x-rays
_________ is best for demonstrating metacarpals; _________ is best for demonstrating phalanges
lateral in extension = metacarpals
fan lateral = phalanges
the 2nd through 5th CMC joints are _______ joints, which allow the ___________
plane (gliding)-type joints, least amount of movement of the synovial joints
in a PA oblique wrist x-ray, ___________ should be well visualized with _____________ on their _____ aspects
trapezium and scaphoid, only slight superimposition of other carpals, medial
in a PA wrist x-ray, all intercarpal spaces (do/do not) appear open. what is the reasoning behind this?
do not, irregular shapes that result in overlapping
External finger rotation = if anterior surface is rotated towards ______________________
thumb
Internal finger rotation = ______________
thumb prevents this movement
For a PA finger, if patient cannot extend fingers, _________________ can help visualize phalanxes and joint spaces
switching to an AP projection
