WRST/ELBW/HUM PROC. Flashcards
Wrist has _____ bones
Proximal Row:
Distal Row:
Mnemonic:
8 carpal bones
- Prox (close to forearm) = Scaphoid, Lunate, Triquetrium & Pisiform
- Distal (close to finger) = Trapezium, Trapezoid, Capitate, Hamate
STEVE LEFT THE PARTY TO TAKE CAROL HOME
Smallest Carpal: _________
Largest Carpal: __________
Hamate contains: ___________
Largest Bone in prox row: __________
Most fx carpal: __________
-pisiform
-capitate
-hamulus (hook process)
- scaphoid
-scaphoid
What type of joint is wrist?
What is wrist joint called?
What bone(s) articulate directly with carpals?
Which carpal(s) does above articulate with?
-Condyloid / free moving
-Radiocarpal joint
- Radius only bone articulates
- Radius art w scaphoid & lunate
What is radial deviation? What does it visualize?
What is ulna deviation? What does it visualize?
Radial Dev = deviated to thumb
-demos carpal on opposite side
Ulna Dev = deviated to pinky
-demo scaphoid / opp. side carpals
Projections of Wrist
-ROUTINE
-ADVANCED
-TECHNIQUE
R: PA, Oblique & Lat
A: Ulna Dev, Axial Scaphoid, Stetcher, Radial dev & Tangential carpal (Gaynor hart)
Tech: 50-55 @ 2.5-3.2
PA WRIST
CR:
POSITION:
ANAT:
Alternative:
-CR: Perp. to Midcarpal
-Pos: shoulder, elbow & wrist same plane
-Anat: Carpals, distal ulna/radius & prox metacarpals.
-Not all intercarpal joints open due to shapes of carpals
Alternative = AP
PA OBLIQUE WRIST:
CR:
POSITION:
ANATOMY:
CR: Perp to midcarpal
POS: 45* oblique rotation
ANAT: Lateral carpals (trapezium&scaphoid)
- ulna & radius slight superimposed
- 3-5 distal metacarpal superimp
Lateral Wrist
CR:
POSITION:
ANATOMY:
CR: perp mid carpal
POSITION: elbow 90* flex,
ANATOMY: Ulna & Radius superimposed,
- Lateral view of carpals & metacarpals
- Ant or Post dislocations if present
PA AXIAL Scaphoid
WHY DONE?
CR?
POSITION?
ANATOMY?
- fxs o scaphoid
CR: 10-15* proximal (along forearm)
Perp to long axis of scaphoid
POS: same horizontal plane- deviate to pinky w/o moving FA
- Scaphoid centered to IR
ANAT: Scaphoid free of superimp & no foreshortening
Neutral Wrist, Location of Scaphoid:
Where is Carpal Sulcus located?
What passes through carpal canal?
What is Carpal Tunnel?
20* anterior tilt
-Palmar surface of wrist
- median nerve
-Compression of the median nerve
inside the carpal canal
PA Axial Wrist - Stetcher Method
WHY PREFORMED?
CR:
POSITION:
ANATOMY:
- Alternative?
- Suspected fx / unable to deviate
CR: Perp. to Scaphoid
POSITION: Hand PA, IR elevated 20* with sponge
ANATOMY: Scaphoid without superimposition- can angle tube 20* to elbow with horizontal IR
PA Wrist - Radial Deviation
Why preformed?
CR:
POSITION:
ANATOMY:
- Suspected fx of ulna side carpals
CR: perp. mid carpal
POSITION: PA Wrist, Deviation to thumb w/o moving forearm
ANATOMY: Open interspaces of carpals on medial wrist
Tangential Wrist
AKA:
Why Done?
CR:
POSITION:
ANATOMY:
GAYNOR-HART method
- R/o abnormal calcifications in carpal tunnel
- R/o fx of pisiform and hamate
CR: 1 inch distal to base 3rd metacarpal
- 25-30* to long axis of hand
POSITION: Extend fingers back vertically, rotate hand 10* internally
ANATOMY: Carpal canal, pisiform and hamulus hook w/o superimposition
What deviation is demonstrated?
radial deviation (to thumb)
Label the Image
A. Trapezoid
B. Trapezium
C. Capitate
D. Scaphoid
E. Radius (radial styloid)
F. Radius
G. Ulna
H. Ulnar styloid
I. Lunate
J. Triquetrum
K. Pisiform
L. Hamate
what type of joint is the elbow?
Movements of elbow joint?
What makes up elbow joint?
Diathoritic hinge joint
-flex and extension
Radius, ulna & distal humerus
Ulna is _____ side & Radius is ____ side
Ulna contains 2 projections: _____ & _______
- _______- large depression; articulates with distal humerus
-________- receives radial head forming the proximal radioulnar joint
medial & radius is lateral
- olecranon and coronoid process
- Trochlear notch
- Radial notch
Proximal Radius consists of ______ & _______.
Below neck of radius is the oval _________
Distal Radius has ________ on lateral surface
- head above the neck.
- oval radial tuberosity
- a styloid process on the lateral surface
Distal humerus is also called ________
Medial Side contains _____ & Lateral Side
Palpable parts of condyle are ______
Which is larger?
Humeral Condyle
- M-Troclea. / L- Capitulum
- medial and lateral epicondyles
-Medial epicondyle is larger
________ - Superior to Trochlea, receives Coronoid process
________-Superior to Capitulum, Receives Radial head
________-Posterior depression behind coronoid fossa and accommodates the olecranon process
Coronoid fossa
Radial fossa
Olecranon fossa
Proximal Humerus consist of:
_______ - lies in oblique plane
_______- Below above structure
_______- Anterior surface below neck
_______- Lateral surface of humerus
_______- Between tubercles
________ - Site of many fractures
Head
- Anatomic neck
- Lesser tubercle
-Greater tubercle
-Intertubercular groove (or bicipital)
- Surgical neck
What View of elbow?
Posterior
- can tell by Olecranon Process
What view of elbow?
ANTERIOR
What view of elbow?
ANTERIOR
Projections of Elbow
ROUTINE
ADVANCED
TECHNIQUE
R: AP, Lateral & Oblique (medial / lateral rotations)
A: AP Partial Flexion, Coyle Method - Trauma (lateromedial & mediolateral)
Tech: 60-65 @ 4-6
Label the image
A. Medial epicondyle
B. Trochlea
C. Coronoid tubercle
D. Radial head
E. Capitulum
F. Lateral epicondyle
H. Olecranon process
AP ELBOW
CR:
POSITION:
ANATOMY:
EPICONDYLES:
CR: Perp to elbow joint
POSITION: Humerus, Elbow & FA same plane, hand supine
ANATOMY: Medial & Lateral epicondyles in profile
- Rad head, neck & tuberosity slight superimposed by ulna
EPICONDYLES: Parallel to IR
AP OBLIQUE ELBOW
CR:
POSITION:
ANATOMY:
CR: Perp to mid elbow
- Lateral Oblique: 45* rotation to thumb side, hand supinated
Anat: Rad head, neck & tuberosity in profile w/o superimposition - Medial Oblique: 45* rotation medically, hand pronated
Anat: Coronoid process in profile, Rad head & neck superimposed
Lateral Elbow
CR:
POSITION:
ANATOMY:
EPICONDYLES:
CR: Perp elbow joint
POSITION: Elbow 90*
ANATOMY: Olecranon in profile
- superimposed epicondyles
- 3 concentric arcs & fat pads visual
EPICONDYLES: Perp. to IR
What are the 3 concentric arcs & where are they located?
What projection demonstrates fat pads?
Name 3 fat pads:
Where is posterior fat pad located & why is it important?
- Trochlea Sulcus, Ridges of trochlea & capitulum and Trochlear notch = all in lateral elbow
- lateral elbow
-Anterior, Posterior & Supinator Fat Pads
- Posterior located in olecranon fossa and only visible if injury present
AP ELBOW - PARTIAL FLEXION
How preformed?
Why preformed?
Position?
CR?
Anatomy?
2 partially flexed AP projections
-when arm can’t be fully extended
-Image 1. humerus parallel to IR, image 2. forearm parallel to IR
-CR: Perp to elbow joint
-ANAT: Distal humerus seen on humerus parallel image & prox rad/ulna seen on forearm parallel image
ELBOW AXIAL- LATEROMEDIAL & MEDIOLATERAL
Why Preformed?
Lateromedial (CR, Position, Anat)
Mediolateral (CR, Position, Anat)
- Done when patient can’t extend elbow / trauma view
Lateromedial:
- Flex 90, hand pronated
- CR 45 to shoulder
- Radial Head
Mediolateral:
- Flex 80, hand pronated
- CR 45 away shoulder
- Coronoid process
Projections of Humerus
Routine:
Advanced:
Technique:
R: AP & Lateral
A: Transthroacic Lateral
Tech: 70-75 @ 8-10
AP HUMERUS
CR:
EPICONDYLES:
ANAT:
CR: Perp mid humerus
EPI: Parallel IR,
ANAT: Greater tub in profile laterally, Epicondyles in profile
Lateral Humerus
CR:
Epicondyles:
Positions:
Anatomy:
CR: Perp mid humerus
Epi: perp to IR
POS: Lateromedial or Mediolateral
ANAT: Lesser Tubercle in profile medically, Epicondyles superimposed
Transthoracic Humerus
AKA:
WHY DONE:
CR:
POSITION:
RESPIRATION:
ANATOMY:
AKA: Lawrence Method
WHY DONE: Trauma /Arm can’t abduct
CR: Perp entering MCP @ Surgical Neck
POSITION: Affect side to IR in neutral,
- unaffected arm raised above
- Unaffected side slightly anterior
RESPIRATION: Orthostatic
ANATOMY: Lateral view of proximal humerus
- glenohumeral joint w/o superimp. of the uninjured humerus.
In Transthoracic Humerus, why orthostatic breathing?
What is done with the transthoracic projection?
What is done for possible distal humerus fractures?
Breathing instructions / why?
Blur ribs and lung markings
- Ap humerus, neutral rotation
-Projection for distal humerus, elbow in lateral position against IR
- Suspend respiration to not move IR
How many exposures (minimum) are required for the AP elbow acute flexion study?
How much is the elbow flexed for a trauma axial lateral projection (Coyle method) to demonstrate the coronoid process?
2
80*
