Upper Extremities

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Question

Answer

kV for AP or AP Axial Clavicle

65-75kV

Centering for Clavicle

perpendicular to mid clavicle

kV for AP or Lateral Scapula

70-80kV

AP Axial of Clavicle, the CR is angled _____?

15-30 degrees cephalad

Bilateral AC joints require what two positions?

with and without 5-8lbs of weights

Name the three angles of the Scapula

Superior, Inferior, and Lateral angles

Name the two fossa on the Dorsal Scapula

Supraspinous and Infraspinous Fossa

The two views of the Scapula

AP and Lateral

Criteria for good Scapula image

entire scapula, lateral border free of ribs and lungs, optimal exposure factors

SID for Scapula and Clavicle

40 inches

SID for AC Joints

72 inches

Centering for AC Joints

1 inch above Jugular Notch

True/False: Bilat. AC joints require markers- R, L, with, without

TRUE

True/False: Bilat. AC Joints can be done WITHOUT a grid

TRUE

Name the 3 arm positions that can be used for a lateral scapula

behind back, across chest, over head.

True/False: Humerus should be superimposed over the scapula

FALSE

Name Criteria for lateral Scapula

entire scapula,in profile,separated from ribs, humerous not superimposed over area of interest.

True/False: Respiration is not important for a AP Scapula

False - Should be slow respiration

True/False: Respiration is not important for a Lateral Scapula

False - Should be suspended respiration

Name the Trauma Shoulder positions

AP neutral rotation, Transthoracic lateral or the Scapular Y view

Name the Routine Shoulder positions

AP with external and internal rotation

Another name for Inferosuperior axial (Shoulder)

Lawrence method

Another name for Superoinferior axial (Shoulder)

Hobbs modification

Another name for Posterior Oblique- glenoid cavity (Shoulder)

Grashey method

Another name for Tangential projection - intertubercal groove(Shoulder)

Fisk modification

Another name for Transthoracic lateral (Shoulder)

Lawrence method

Routine positions for the Humerus are:

AP and Lateral

Trauma positions for the Humerus are:

Lateral for distal Humerus, Transthoracic lateral for proximal Humerus, Y-view for proximal Humerus

Criteria for good AP Humerus

entire Humerus, Greater tubercle in profile, epicondyles in profile, exposure factors.

Criteria for good Lateral Humerus

entire Humerus, Lesser tubercle in profile, epicondyles are superimposed, exp. factors.

Type of joint: Scapulohumeral

Spheroidal (ball and socket)

Type of joint: Sternoclavicular

Plane (gliding)

Type of joint: Acromioclavicular

Plane (gliding)

Describe epicondyles and tubercles with Shoulder AP External rotation

Epicondyles are parallel to IR, Greater tub in profile laterally, Lesser tub anterior

Describe epicondyles and tubercles with Shoulder AP Internal rotation

Epicondyles are perpendicular to IR, Greater tub anterior, Lesser tub in profile medially

Centering point for AP shoulder?

1" inferior of Coracoid process (Scapulohumeral joint)

Where is the Coranoid Process?

The proximal end of the Ulna, articulates with the Trochlea of the Humerus

Where is the Coracoid Process?

Superior border of Scapula and inferior to the Distal end of the Clavicle

What carpal bone articulates with the radius?

Scaphoid

What carpal bone articulates with the radius and the capitate?

Lunate

Which carpal bone is proximal to the first metacarpal (thumb)?

Trapezium

Which carpal bone is proximal to the 2nd metacarpal?

Trapezoid

Which carpal bone is proximal to the 3rd metacarpal?

Capitate

Which carpal bone is proximal to the 4th and 5th metacarpal?

Hamate

The metacarpals are concave on the anterior and convex on the posterior.

True

The wrist joint is an ellipsoidal joint which is the most freely moveable of synovial joints.

True

What is the joint called where the radius articulates with the scaphoid and the lunate?

radiocarpal joint

What is the average range of kV for the fingers hand and wrist?

50-65 kV

Where do you center for a PA hand and an oblique hand?

3rd MCP

Where do you center for a lateral of the hand?

2nd MCP

What is another name for the Norgaard Method and what is it used to diagnose?

Ball Catcher's Position - diagnoses rheumatoid arthritis

Where do you center for a PA and oblique wrist?

mid carpal area

WHere do you center for a lateral wrist?

Perpendicular to wrist joint

How much of a CR angle is used for the Stecher Method (Scaphoid)?

20 degrees up hand centered over the scaphoid

Where do you ceneter on the thumb?

At 1st MCP joint

What position is used for an oblique of the thumb?

PA hand

WHat needs to be demonstrated on an exam of the thumb?

Entire thumb including the 1st MCP

Where do you center for the 2nd-5th digits?

PIP joint

The radial head is proximal/near the elbow on the lateral or thumb side.

True

The ulnar head is distal/near the wrist on the medial side.

True

When does the radius cross over the ulna?

during pronation

When do the radius and ulna show no superimposition?

external rotation (oblique with lateral rotation)

What does a true lateral of the forearm show?

THe proximal head and neck of the radius, the radial tuberosity, and the trochlear notch.

Does the forearm need to show both joints?

YES

What exam shows the coronoid process free of superimposition?

AP oblique (medial rotation)

Acute flexion is also called?

Jones method

Technical factors for the Shoulder? (kV/mAs)

Medium kV (70-80) High mA/low exposure time

The lesser tuberosity of the humerus is seen in profile with the arm in ________ .

Internal rotation

Which part of the scapula does the humerus articulate with?

glenoid fossa

To demonstrate the shoulder and upper humerus in anatomical position, the arm should be rotated __________

Externally

The AP internal rotation of the shoulder places the humerus _______ in the position

Lateral

What is the centering point for AP shoulder WITH external rotation?

1" inferior of the coraCoid process

Which shoulder position shows the lesser tubercle in profile?

AP with internal rotation

Another name for inferosuperior, axial projection of the shoulder is?

Lawrence method

In the inferiosuperior, axial projection of the shoulder, the ______ tubercle is in profile

Lesser

The AP shoulder with neutral rotation is done for?

Trauma

When doing the humerus how many, and which joints are demonstrated?

2, Scapulohumeral and elbow joint (includes humeralulna, humeralradial, and proximal radioulnar joints.)

When doing a dislocated shoulder exam, what positions would be performed?

AP shoulder with neutral rotation and the Y view

What is the centering point for a transthoracic lateral of the humerus?

surgical neck

What is the Grashey method and how much is the patient rotated?

AP oblique of the shoulder, 35degrees toward the affected side

What is the position of the scapula when doing a Y view?

Lateral

The Grashey method is used to demonstrate?

profile of the glenoid cavity

For the oblique of the Hand, what do you use to measure your rotation and what is the degree?

The styloid processes should be at a 45degree angle

Why are the fingers parallel to the IR and not bent in a hand exam?

to show joint spaces

What should you do with the fingers in a wrist projection?

curl them, to move the carpals closer to the IR

What is the name of the furthest lateral carpal on the proximal row?

Schapoid

Name the carpals in order, proximal row first.

Schaphoid, Lunate, Triquetrium, Pisiform, Trapezium, Trapazoid, Capitate, Hamate

Ok Hotshot, what are the OLD names the carpals in order ?

Navicular, Semilunar, Triangular, Pisiform, Greater Multiangular, Lesser Multiangular, Os magnum, Unciform

WOW, you are good!

Yeah, I know you know.

In the anatomical position, what is it called when the hand is moved medially, but the arm is kept straight?

Ulnar deviation

R______ A_______ is a common pathology that hand and wrist exams are ordered for.

Rhumatoid Artharitis

How many bones are in the hand?

How many bones in the Phalanges?

How many carpals?

What kind of joint is the 1st MCP?

Sellar (saddle)

What kind of joint is the DIP?

Ginglymus (hinge)

What kind of joint are the intercarpals?

Plane (Gliding)

What kind of joint is the Wrist (carpal to ulna and radius)?

Ellipsoid (condyloid)

What ind of joint is the proximal and distal radioulnar joints?

Trochoid (pivot)

What kinda of joint is the elbow?

Ginglymus (hinge)

kV AP hand?

50-60

kV Lateral hand?

kV Oblique hand

55-65

kV wrist and trauma wrist?

55-65 and 50-70

Define Subluxion

partial dislocation

Define Sprain

rupture or tearing of ligaments

Define Contusion

bruise without fracture

Define Greenstick

incomplete fracture

fx means?

fracture

Baseball mallet fx is?

fx of distal phalynx

Boxer's fx is?

broken knuckle

Name the fat pads of the elbow

anterior fat pad, posterior fat pad, supinator fat stripe.

To obtain a lateral forearm:

Thumb side must be up & forearm & humerus must be in the same plane

To clearly see the olecranon process in profile, which position should be used?

AP Oblique w/medial rotation

For some soft tissue injuries the lateral elbow is only flexed:

30-35 degrees

The proximal radioulnar joint is considered a:

pivot joint and is diarthrodial

For a lateral view of the elbow to be accurate, what should be superimposed?

epicondyles of the humerus

For a trauma elbow, how many AP projections should be taken

Which projection of the elbow superimposes the forearm and the humerus?

AP projection;acute flexion

Are both joints usually visualized when taking a forearm on an 11 x 14?

YES

Which ligament of the wrist extends from the styloid process of the radius to the lateral aspect of the scaphoid & trapezium bones?

radial collateral ligament

The two important fat stripes around the wrist joint are:

scaphoid fat stripe & pronator fat stripe

Pathology revealed in a AP forearm?

Fractures, dislocations,and pathologic processes such as osteomyelitis or arthritis.

Describe Positioning for an AP forearm

Entire limb in the same planeShoulder at table levelAlign and centre forearm to long axis of IRSupinate hand (2nd to 5th metacarpal heads against IR)Elbow fully extendedCheck the humeral epicondyles are equidistant from the IR

A forearm film is hung from which end?

from the fingers...or wrist end.

A shoulder is hung from which end?

from the shoulder.

You are _______

Amazing!

Rotation of the forearm is shown by ?

separation of ulna and radius(lat. rot.) or MORE THAN SLIGHT superimposition (med. rot.) or pronation- if radius is rotated across ulna (hand not supinated)

Name wrist fat pads?

scaphoid fat stripe and pronator fat stripe

Name Elbow fat pads?

Anterior fat pad, posterior fat pad, supinator fat stripe.

Define Bursitis

Inflammation of the bursae (fluid filled sacs that enclose joints)

Define Osteroarthritis

degenerative joint disease

Define Osteoporosis

reduction in quantity of bone or atrophy of skeletal tissue

Define Rheumatoid Arthritis

systemic chronic inflammation of connective tissue.

Detect rotation on AP thumb or fingers by?

should be symmetric concave sides of phalanges and equal soft tissue.

Detect rotation of AP hand.

should be symmetric concavity of sides of metacarpals and phalanges 2 thru 5.

Detect rotation of Oblique hand

true 45degree oblique will have some overlap of 3rd, 4th, and 5th metacarpal head only.

Detect rotation for lateral hand

radius and ulna should be superimposed. metacarpals should also be superimposed.

Detect rotation AP wrist

should be equal concavity of proximal metacarpals and near equal distance between proximal carpals.

Detect rotation of Lateral wrist

true lateral ulnar head will be superimposed over distal radius 2-5 metacarpals aligned and superimposed.

Detect rotation for AP Forearm

should be humeral epicondyles in profile. radial head, neck, and tuberosity slightly superimposed by ulna.

Detect rotation for Lateral Forearm

head of ulna and radius SHOULD be superimposed and humeral epicondyles should be superimposed.

the wrist joint is also called the

radiocarpal joint

ellipsoidal joints move in how many directions

cast conversions

fiberglass-^25-30%ma or kV^3-4, sm to dry- ^mas 50-60% or kV^5-7, heavy or wet- ^mas 100% or kV ^8-10

CR for carpal canal-tangential inferiorsuperior projection for carpal tunnel syndrome

25-30deg 1 inch distal to base of third metacarpal

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Created by: StudyGroup on 2009-10-19