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Wrist Flashcards

1
Q

PA projection of Wrist

Pt position

A

Conventional lateral seating/comfort position-edge RT

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2
Q

PA projection of Wrist

PART

A

Affected limb-top RT-flex elbow 90 degrees-hand pronated

Arch hand-MCPJ-place wrist-in contact-IR

RP: mid carpal area

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3
Q

PA projection of Wrist

IR & CRD

A

IR: 8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp-36-40”-SID-RP-MP-IR

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4
Q

(1) gives a slightly oblique rotation to the ulna - if ulna is under examination, (2) should be taken.

A
  1. PA projection
  2. AP projection
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5
Q

To demonstrate
▪ Distal radius and ulna, carpals, and proximal half of metacarpals
▪ No rotation in carpals, metacarpals, or radius
▪ Soft tissue and bony trabeculation
▪ No excessive flexion to overlap and obscure metacarpals with digits

A

PA projection of Wrist

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6
Q

PA projection of Wrist modification

A

Daffner, Emmerling, and Buterbaugh

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7
Q

Daffner, Emmerling, and Buterbaugh all the same with PA of Wrist-EXCEPT

A

CRD: 30 deg towards elbow
Obj: elongates the scaphoid and capitate

CRD: 30 deg towards fingertips
Obj: elongates only the capitate

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8
Q

Added: AP projection of Wrist

PART

A

Affected limb-top -hand and arm supinated

Elevate digits – support – wrist - IR

RP: mid carpal area

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9
Q

Added: AP projection of Wrist

IR & CRD

A

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp-36-40”-SID-RP-MP-IR

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10
Q

Carpal interspaces are better demonstrated

A

Added: AP projection of Wrist

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11
Q

To demonstrate
▪ Distal radius and ulna, carpals, and proximal half of the metacarpals
▪ No rotation of the carpals, metacarpals, radius, and ulna
▪ Well-demonstrated soft tissue and bony trabeculation
▪ No overlapping or obscuring of the metacarpals as a result of excessive flexion

A

Added: AP projection of Wrist

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12
Q

Lat projection (Lateromedial) of Wrist

PART

A

Affected limb-top RT-flex elbow 90 degrees-hand lateral and wrist in true lateral

RP: mid carpal area

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13
Q

Lat projection (Lateromedial) of Wrist

IR & CRD

A

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp-36-40”-SID-RP-MP-IR

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14
Q

This position can also be used to demonstrate anterior or posterior displacement in fractures.

A

Lat projection (Lateromedial) of Wrist

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15
Q

To demonstrate
▪ Distal radius and ulna, carpals, and proximal half of metacarpals
▪ Superimposed distal radius and ulna
▪ Superimposed metacarpals
▪ Radiographic density similar to PA or AP and oblique radiographs, which requires increased exposure factors to compensate for greater part thickness

A

Lat projection (Lateromedial) of Wrist

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16
Q

Lateral projection of Wrist

Radiographic density similar to PA or AP and oblique radiographs, which requires (1) to compensate for (2)

A
  1. increased exposure factors
  2. greater part thickness
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17
Q

Added: Lateral projection
(Mediolateral) of Wrist

A

Radial surgace against IR

Pt should lean forward to assume the position

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18
Q

Lateral projection of Wrist modification

A
  1. Burman et. al.
  2. Fiolle
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19
Q

If the lateral position of the scaphoid should be obtained, wrist should be in palmar flexion

A

Burman et. al.

(Lateral projection modification)

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20
Q

This action rotates the bone anteriorly into a dorso-volar position.

A

Wrist in palmar flexion

  • Burman et. al.
    (Lateral projection modification)
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21
Q

This is valuable only when sufficient flexion is permitted.

A

Burman et. al.

(Lateral projection modification)

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22
Q

First to describe a small bony growth occurring on the dorsal surface of the 3rd CMCJ ‘carpe bossu’ (carpal boss) and found that it is demonstrated best in a lateral position with the wrist in palmar flexion

A

Fiolle

(Lateral projection modification)

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23
Q

Added: PA Oblique projection: Lateral rotation (Wrist)

PART

A

Affected limb-top RT-flex elbow 90 degrees-axilla in contact – RT –place wrist-in contact-IR

Prone – rotate laterally – 45 deg with IR plane

Note: use foam wedge – If ff-up will be done

RP: scaphoid

If POI is scaphoid, with ulnar deviation

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24
Q

Added: PA Oblique projection: Lateral rotation (Wrist)

IR & CRD

A

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp midcarpal-36-40”-SID-just distal to radius

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25
Q

Demonstrates the carpals on the lateral side of the wrist, particularly the trapezium and the scaphoid.

A

Added: PA Oblique projection: Lateral rotation (Wrist)

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26
Q

To demonstrate
▪ A well demonstrated scaphoid and trapezium
▪ Distal radius and ulna, carpal and proximal half of metacarpals
▪ Usually, adequate amount of obliquity in the following circumstances:
✓ Slight interosseus space between the 3rd-4th and 4th-5th metacarpal shafts
✓ Slight overlap of the distal radius and ulna
▪ Soft tissue and bony trabeculation

A

Added: PA Oblique projection: Lateral rotation (Wrist)

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27
Q

Added: AP Oblique projection: Medial
rotation (Wrist)

PART

A

Affected limb-top RT- FA rest on RT - place wrist-in contact-IR

Supine – rotate medially –semi-supinated - 450 with IR plane

Note: use foam wedge – If ff-up will be done

RP: midway medial and lateral borders – midcarpal area

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28
Q

Added: AP Oblique projection: Medial
rotation (Wrist)

IR & CRD

A

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp midcarpal-36-40”-SID-RP

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29
Q

Separates the pisiform from the adjacent carpal bones.

A

Added: AP Oblique projection: Medial
rotation (Wrist)

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30
Q

Gives a more distinct radiograph of the triquetrum and hamate

A

Added: AP Oblique projection: Medial
rotation (Wrist)

31
Q

To demonstrate
▪ Carpals on medial side of wrist
▪ Triquetrum, hamate, and pisiform free of superimposition and in profile
▪ Distal radius and ulna, carpals and proximal half of metacarpals
▪ Radiographic quality soft tissue and bony trabeculation

A

Added: AP Oblique projection: Medial
rotation (Wrist)

32
Q

Added: PA PROJECTION: Ulnar deviation (Wrist)

PART

A

Affected limb-top RT- FA rest on RT - place wrist-in contact-IR

PA proj pos’n – wrist in extreme ulnar deviation

RP: scaphoid

33
Q

Added: PA PROJECTION: Ulnar deviation (Wrist)

IR & CRD

A

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp – scaphoid - 36-40”-SID-RP

Note: Clear delineation sometimes requires a CR angulation of 10 to 15 degrees proximally or distally

34
Q

Corrects foreshortening of the scaphoid, which occurs with a perpendicular central ray.

A

Added: PA PROJECTION: Ulnar deviation (Wrist)

35
Q

It also opens the spaces between the adjacent carpals

A

Added: PA PROJECTION: Ulnar deviation (Wrist)

36
Q

To demonstrate
▪ Scaphoid with adjacent articulation open
▪ No rotation of wrist
▪ Extreme ulnar deviation, as revealed by the angle formed between longitudinal axes of the forearm compared with the longitudinal axes of the metacarpals
▪ Soft tissue and bony trabeculation

A

Added: PA PROJECTION: Ulnar deviation (Wrist)

37
Q

Added: PA PROJECTION: Radial deviation (Wrist)

PART

A

Affected limb-top RT- FA rest on RT - place wrist-in contact-IR

PA proj pos’n – wrist in extreme radial deviation

RP: midcarpal

38
Q

Added: PA PROJECTION: Radial deviation (Wrist)

IR & CRD

A

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp – midcarpal - 36-40”-SID-RP

39
Q

Opens the interspaces between the carpals on the medial side of the wrist

A

Added: PA PROJECTION: Radial deviation (Wrist)

40
Q

To demonstrate
▪ Carpal and their articulations on the medial side of the wrist
▪ No rotation of wrist
▪ Extreme radial deviation, as revealed by the angle formed between longitudinal axes of forearm compared to the longitudinal axes of the metacarpals
▪ Soft tissue and bony trabeculation

A

Added: PA PROJECTION: Radial deviation (Wrist)

41
Q

Projection for Scaphoid

A

PA AXIAL PROJECTION:
STECHER METHOD

42
Q

PA AXIAL PROJECTION:
STECHER METHOD

PART

A

Affected limb-top RT- FA rest on RT – axilla on RT - wrist-centered and in contact-IR

PA proj pos’n – one end of IR – support – 20 deg elevated (phalangeal end)

RP: scaphoid

43
Q

PA AXIAL PROJECTION:
STECHER METHOD

IR & CRD

A

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp – RT - scaphoid - 36-40”-SID-RP

44
Q

Places the scaphoid at right angles to the CR so that it is projected without self-superimposition

A

PA AXIAL PROJECTION:
STECHER METHOD

45
Q

To demonstrate
▪ Scaphoid
▪ No rotation of carpals, metacarpals, radius, or ulna
▪ Distal radius and ulna, carpals, and proximal half of the metacarpals
▪ Soft tissue and bony trabeculation

A

PA AXIAL PROJECTION:
STECHER METHOD

46
Q

PA AXIAL PROJECTION: BRIDGMAN METHOD

All the same as Stecher method EXCEPT:

A

With ulnar deviation

47
Q

PA AXIAL PROJECTION:
STECHER METHOD Variations

A

▪ IR and wrist - horizontal – CR 20 deg toward elbow
▪ SUPEROINFERIOR fx line demo: wrist angled inferiorly or CR angled towards the digits
▪ Clench fist: elevates distal end of scaphoid (parallel with IR) & widens fracture line – (PA wrist; no CR angulation)

48
Q

The series is performed after routine wrist radiographs do not identify a fracture

A

Scaphoid series

49
Q

PA and PA AXIAL PROJECTION: Ulnar deviation

RAFERT-LONG METHOD

PART

A

Affected limb-top RT- FA rest on RT –- wrist-centered and in contact-IR

PA proj pos’n of wrist – extreme ulnar deviation

RP: scaphoid

50
Q

PA and PA AXIAL PROJECTION: Ulnar deviation

RAFERT-LONG METHOD

IR & CRD

A

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: SERIES: Perp (0°), 10°, 20°, and 30° cephalad

51
Q

Scaphoid is demonstrated with minimal superimposition

A

PA and PA AXIAL PROJECTION: Ulnar deviation

RAFERT-LONG METHOD

52
Q

To demonstrate
* No rotation of the wrist
* Scaphoid with adjacent articular areas open
* Extreme ulnar deviation

A

PA and PA AXIAL PROJECTION: Ulnar deviation

RAFERT-LONG METHOD

53
Q

Projection for Trapezium

A

PA AXIAL OBLIQUE PROJECTION
CLEMENTS-NAKAYAMA METHOD

54
Q

PA AXIAL OBLIQUE PROJECTION
CLEMENTS-NAKAYAMA METHOD

PART

A

Affected limb-top RT- FA rest on RT –- hand in contact- IR – lateral – 45° sponge wedge on palmar surf

Wrist – lat – resting on ulnar – center of IR – ulnar deviation

***LA of IR and FA & wrist align with CR and rotate 20° away from CR (if ulnar deviation not possible)

RP: scaphoid

55
Q

PA AXIAL OBLIQUE PROJECTION
CLEMENTS-NAKAYAMA METHOD

IR & CRD

A

8x10/10x12-top-RT-longitudinal-MP-RP

CRD: 45° distal to anatomic snuffbox of wrist

56
Q

Demonstrates the trapezium and its articulations with the adjacent carpal bones.

A

PA AXIAL OBLIQUE PROJECTION
CLEMENTS-NAKAYAMA METHOD

57
Q

Eval criteria:
Trapezium projected free of the other carpal bones with the exception of the articulation with the scaphoid

A

PA AXIAL OBLIQUE PROJECTION
CLEMENTS-NAKAYAMA METHOD

58
Q

Projection for Carpal Bridge

A

TANGENTIAL PROJECTION

59
Q

TANGENTIAL PROJECTION (Carpal Bridge)

Pt position

A

Conventional lateral seating/stand -edge RT – allow manipulation of arm / XRT

60
Q

TANGENTIAL PROJECTION (Carpal Bridge)

PART

A

Affected limb-top RT- hand – palm upward on IR – hand at right angle to FA or elevate FA on sandbags – wrist flexed at right angle - IR in vertical position

RP: anatomic snuffbox – pass through trapezium

61
Q

TANGENTIAL PROJECTION (Carpal Bridge)

IR & CRD

A

8x10-top-RT-longitudinal-MP-RP

CRD: 1 1⁄2 inch prox to wrist - 450 caudal

62
Q

For demonstration of fractures of the scaphoid, lunate dislocations, calcifications and foreign bodies in the dorsum of the wrist, and chip fractures of the dorsal aspect of the carpal bones.

A

TANGENTIAL PROJECTION (Carpal Bridge)

63
Q

Eval criteria:
* Dorsal aspect of the wrist
* Carpals
* Dorsal surface of the carpals free of superimposition by the metacarpal bases

A

TANGENTIAL PROJECTION (Carpal Bridge)

64
Q

Projection for Carpal Canal

A

TANGENTIAL PROJECTION
GAYNOR-HART METHOD: inferosuperior

65
Q

TANGENTIAL PROJECTION
GAYNOR-HART METHOD: inferosuperior

Pt position

A

Conventional lateral seating-edge RT – FA parallel with LA of RT

66
Q

TANGENTIAL PROJECTION
GAYNOR-HART METHOD: inferosuperior

PART

A

Affected limb-top RT- hand – hyperextend wrist – level of radial styloid process

Radiolucent pad – 3⁄4 inch – under lower FA – rotate hand slightly toward radial side (prevent superimpo of shadows of hamate and pisiform)

Pt – grasp digits w/ opp hand or use a suitable device to hold wrist in extended pos’n

RP: 1 in distal to bass of 3rd MC

67
Q

TANGENTIAL PROJECTION
GAYNOR-HART METHOD: inferosuperior

IR & CRD

A

8x10-top-RT- LW -MP-RP

CRD: 25 to 30 degrees - towards palm of hand – LA of hand -RP

68
Q

Shows the palmar aspect of the trapezium, the tubercle of the trapezium, and the scaphoid, capitate, hook of hamate, triquetrum, and entire pisiform

A

TANGENTIAL PROJECTION
GAYNOR-HART METHOD: inferosuperior

69
Q

TANGENTIAL PROJECTION
GAYNOR-HART METHOD: superoinferior (modification)

Pt pos’n

A

Stand -edge RT – allow manipulation of arm

70
Q

TANGENTIAL PROJECTION
GAYNOR-HART METHOD: superoinferior (modification)

PART

A

Affected limb-top RT- hand – dorsiflex wrist as much as tolerable – lean forward level – carpal canal tangent to IR

RP: midpoint of wrist

71
Q

TANGENTIAL PROJECTION
GAYNOR-HART METHOD: superoinferior (modification)

IR & CRD

A

8x10-top-RT- LW -MP-RP

CRD: tangential to carpal canal – midpoint of wrist or angled toward the hand 20 – 35 degree from LA of FA

72
Q

Shows the palmar aspect of the trapezium, the tubercle of the trapezium, and the scaphoid, capitate, hook of hamate, triquetrum, and entire pisiform

A

TANGENTIAL PROJECTION
GAYNOR-HART METHOD: superoinferior (modification)

73
Q

TANGENTIAL PROJECTION
GAYNOR-HART METHOD: superoinferior (modification)

When dorsiflexion of the wrist is limited, (1) suggested placing a 45-degree angle sponge under the (2) of the hand. This slightly elevates the wrist to place the (3). A slight degree of magnification exists because of the (4)

A
  1. Marshall I
  2. palmar surface
  3. carpal canal tangent to the central ray
  4. increased OID

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