WRST/ELBW/HUM PROC. Flashcards by Jolene Lavelle

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

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Smallest Carpal: _________
Largest Carpal: __________
Hamate contains: ___________
Largest Bone in prox row: __________
Most fx carpal: __________

-pisiform
-capitate
-hamulus (hook process)
- scaphoid
-scaphoid

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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What deviation is demonstrated?

radial deviation (to thumb)

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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

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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?

What view of elbow?

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*