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Upper Extremity Unit
Upper Extremity
| Question | Answer |
|---|---|
| Where is the CR directed on all finger radiographs? | PIP |
| Which projection (not routine) will show the joint interfaces better? | AP |
| What is the main difference in CR placement between the thumb vs the finger? | MCPJ |
| Why is there a difference in cr placement between finger and thumb? | No middle phalanx |
| WHAT ADVANTAGES OR DISADVANTAGES TO DOING A PA OR AP PROJECTION OF THE THUMB? | PA HAS MORE OID BUT IS MORE COMFORTABLE TO PT. AP HAS LESS OID BUT IS HARDER FOR PT TO ACHIEVE |
| where is the cr directed for a pa projection of a hand> | 3rd mcp |
| where is the cr directed for an oblique projection of the hand? | 3rd mcp |
| where is the cr projection for a lateral projection of the hand? | 2nd mcp |
| how many degrees is the hand obliqued? | 45 |
| what projection does the lateral position of the hand have? | lateral to medial |
| what are the variations of positioning a lateral hand? Why are they done? | fan lateral, and lateral-medial finger involvement, fx location mc |
| how is the pt positioned? | seated @ the end of the table |
| What SID do you use on hand? | 40 in sid |
| what is a bone age film done for adn how do you do it? | bone ossification, lt PA hand |
| what projection will demonstrate rheudoid arthritis? How do you do it? | Norgaard/Ballcatchers Midpoint between both hands, Cr 2 3rd MCP |
| Name all the bones in the wrist | scaphoid, lunate, triquetrium, pisiform, trapezium, trapazoid, capitate, hamate |
| How do you tell the difference between a PA projection adn a PA oblique of a wrist? | PA oblique- 3-5th MC heads overlap Well diminstrated trapezoid and distal scaphoid |
| On a lateral wirst, how is the hand, thumb, forearm and elbow positioned? | Perpendicular to IR, elbow @ 90 degrees |
| If the radiologist wanted to see the pisiform in prodile, what projection would show that? | AP oblique |
| Where does the CR go for all wrist radiographs? | midcarpal |
| to decrease the distance between the carpal bones and the film on the PA projection, what can be done? | Arch hand @ MCPJ |
| Why does the navicular/scaphoid bone have a separate routine? | Common fx site |
| What is the routine discussed in class for scaphoid? | Ulnar diviation and stetcher (axial) |
| What will happen to the scaphoid by diviating the wrist 45 degrees toward the ulna? | Corrects foreshortening, elongates the scaphoid |
| Where is the Cr directed on the PA projection of the scaphoid? | perpendicular to scaphoid |
| What does the term axial mean? How does it relate to the scaphoid routine? | more than 10 degree angle |
| Why would we angle the CR on the PA axial projection? How much and which direction? | Clear deliniation of scaphoid, 20 degree caudad (toward elbow) |
| What do you do with your SID when you angle the CR? Why? | decrease your distance 1 in for every 5 degree, keep oid |
| radiolgraphically, describe how to tell the difference betweem the PA projection with 45 degree ulnar diviation and the PA axial? | Axial- scaphoid projected without self superimposition |
| What does the term tangential mean? How does it relate to the Carpal Tunnel routine? | Skimming, you want to just skim the carpals |
| Describe how to do the inferosuperior projection of the carpals tunnel? | Hyperextend, CR at the radiostyloid process |
| Where it the Cr directed on a carpal tunnel view? which way it it angeled, how much? | radiolstyloid, 25-30 degrees, reduce tube 5-6 inches |
| Describe how to do the superoinferior projection on a carpal tunnel view? | dorsoflex and lean forward |
| What is the only bone to be see free from superimposition on carpal tunnel views? | pisiform |
| What is the routine for forearm | Ap and Lateral |
| Where is the Cr directed for a forearm? | midpoint to elbow |
| radiologically, what anatomy must be included on both forearm projections? | ulna and radium, both elbow and wrist joint |
| How is the hand positioned for an AP projection of the wrist? What happens if the hand is not positioned correctly? | Supinate, radius nad ulna will cross |
| How is the lateral wrist positioning done? | elbow @ 90 degrees, thumb up, epicondyles perp to IR |
| When an imaginary line is drawn between the humeral epicondyles and it is parallel to the film, what projection of the elbow will you have? | AP |
| Whar is the line that is perp to the film, and what projection will you have in an elbow? | Lat |
| where does the cr go on an ap projection of the elbow> | Midpoint of the elbow |
| How many degrees do you rotate for a lat/med oblique of the elbow? | 45 |
| How is acute flexion of the elbow done? | Elbow fleced, humerus on IR |
| Why is the angled lateral (axiolateral) projection of the elbow done? How is it done? How is the CR angled? Which direction? | Trama view, 45 degree angle toward/away from |
| how many exposures must be done to see the entire circumference of the radial head? | 4, PA, Ap, oblique (lat and med) |
| what are the Fat pads of the arm? | Supinator, anterior and posterior |
| What is the humerus routine? | Ap and Lateral |
| what breathing instructions do you give the patient? Why? | Shallow or suspended breathing, blurr motion lines, or decrease motion |
| To get and AP projestion, what must you do with the humeral epicondyles? Lateral? | Ap: parallel to IR, Lat:Perp to IR |
| Where is the CR directed on a humerus? | midhumerus |
| What anatomic structure will be seen clearly on the humeral head on the AP projection? Lateral? | Ap: greater trochanter, Lat: lesser trochanter |
| When would you need to perform a tranthoracic lateral projection of the humerus? | trama |
| How it a transthoracic donr? film size? Affected arm? Unaffected arm? Cr? Breathing insturctions? | Affected arm against IR, Cr through surgical neck, midcoronal plane. Unaffected are up out of the way. Affected arm against the buckie. 14x17 IR |
| Lateral Forearm evalutaion | wrist and distal humerus, superimposed radius and ulna, elbow flexed 90 degrees |
| Pa wrist eval | carpals, distal rad and ulna, prox. mc. no rotation, Radial and ulnar joint spaces open. No excessive flexion to obscure mc or digits. |
| Pa hand eval: | no rotation of hand. = concavity of mc and phalanges. = amount of soft tissue. =distance between mc heads. open mcp and ipj. Slight separation w/ soft tissue overlap. All anatomy distal to radius and ulna |
| Lat Wrist eval | lat projection of mc,c,distal radius and ulna. Ant/post. displacement of fractures. superimposed distal radius, ulna and mc |
| Oblique Hand eval | min. overlap of 3rd-4th, 4th-5th mc shafts. Slight overlap of mc heads and bases. Separation of 2nd and 3rd mc. Open mcp and ipj. Digits separated w/ no overlap of soft tissue. All anatomy distal to ulna and radius. Soft tissue and bony trabiculae |
| Lat hand eval | true lat. Superimposition of phalanges, mc nad distal rad and ulna adn extended digits. Thumb frr of superimposition. Each bone outlined through superimposed shadows of other mc |
| Norgaard eval | both hands from carpal area to tip of digits. Mc free of superimposition. Useful level of density over heads of mc |
| AP elbow eval | Rad head, neck and tuberosity slightly superimposed over prox ulna. Elbow joint centered |
| Ap oblique (med) elbow | coronoid in profile, trochlea . Elongated med humeral epicondyle. Ulna superimposed by rad head and neck. Olecranon process in fossa. Soft tissue and bony trabiculae |
| Ap oblique (lat) elbow | rad head, neck, tuberosity projected free of ulna, capitulum. Open elbow joint. Soft tissue and bony trabiculae |
| PA digits eval | no rotation, concavity of phalangeal shafts. = amount of soft tissue, open ip and mcpj |
| Lat elbow eval | open elbow joint. Elbow flexed 90 degrees. Superimposed humeral epicondyle. Radial tuberosity facing anterior, radial head partially superimposing coronoid porcedd. Olecranon in profile. Bony trabiculae adn soft tissue |
| Ulnar Deviation Eval | no rotation, extreme ulnar deviation, scaphoid w adjacent articulations |
| Ap Forearm eval | wrist distal to radius slightly superimposition of rad head, neck adn tuberosity. Pariatlly open elbow. No elongation or foreshortening. = distance between wrist and elbow |
| PA oblique aval | Carpals on lat wrist, trapezium and distal scaphoid shown. Distal rad, ulna, carpals and Mc open trapizotrapzoid and scaphotrapezial joint. Slightly overlap of distal rad. Space between 3rd-4th and 4th-5th mc shafts |
| AP Thumb eval | no rotation, =concavity of phalangea and MC shafts. Open IP adn MCPJ spaces |
| PA thumb eval | No rotation, =concavity of phalanges adn mc shafts. Open IP adn MCPJ spaces |
| Oblique thumb eval | Proper rotation of phalanges, soft tissue and 1st MC. Area from distal tip to trapezium. open Ip adn MCPJ, soft tissue and bony trabiculae |
| Ap Humerus eval | Elbow and shoulder joint. Max. visability of epicondyle w/o rotation. Humeral head and greater tunercle inprofile. outline of lesser tubercle between humeral head and greater tubecle. No great variation in density of prox and distal humerus |
| Lat Humerus eval | Elbow and shoulder joint superimposed epicondyles. lesser tubercle in profile. Greater tubercle superimposed over humeral head. No variation of density between prox and distal humerus |
| Lat digits eval | entire digit true lat. concave ant. srface of phalanges. No rotation. open ipj, no obstruction of porx phalanx or mcpj |
| Lat thumb | 1st digit in true lat position. Concave ant surface of prox phalanx. No rotation. open ip and mcpj. Soft tissue and bony trabiculae |
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