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Rad Pro Ch.6
Lower Limbs
| Term | Definition |
|---|---|
| There are ____ bones of one foot? | 26 |
| Phalanges | 14 |
| Metatarsals | 5 |
| Tarsals | 7 |
| Phalanges make up? | The toes or digits |
| Metatarsal bones | 5 bones of the instep |
| Base of the 5th metatarsal | Is expanded laterally into a prominent rough tuberosity which provides for the attachment of a tendon |
| Common trauma site | The proximal portion of the 5th metatarsal including the rough tuberosity and is readily visible on radiographs |
| Interphalangeal (IP) joint | Between the proximal and distal phalanges of the first digit |
| Distal interphalangeal (DIP) joint | Between the middle and distal phalanges |
| Proximal interphalangeal (PIP) joint | Between the proximal and middle phalanges |
| Metatarsophalangeal (MTP) joint | Each of the joints at the head of the metatarsal |
| Tarsometatarsal (TMT) joint | Each of the joints at the base of the metatarsal |
| The base of the _____ metatarsal joint is important because this is the centering point for the AP and Oblique Foot projections. | 3rd |
| Sesamoid bones | Small, detached bones found in the feet and hands that are embedded in certain tendons |
| The largest sesamoid bone in the body is the? | Patella |
| Are always present on the plantar side of the surface at the head of the 1st metatarsal near the MTP joint. | Sesamoid bones |
| Tibial sesamoid | Sesamoid bone on the medial side of the lower limb |
| Fibular sesamoid | Sesamoid bone on the lateral side of the lower limb |
| Tarsals | Larger and less mobile because they provide a basis of support for the body in an erect position compared to more mobile carpals |
| The seven tarsal bones are sometimes referred to as the? | Ankle bones |
| Calcaneus | Alternative name is "os calcis" |
| The largest and strongest bone of the foot? | Calcaneus |
| Calcaneal sulcus | Deep depression b/w the posterior and middle articular facets |
| The ____ can be a common site for bone spurs, which are sharp outgrowths of bone that can be painful on weight baring tuberosity | Tuberosity |
| Achilles tendon | The largest tendon; attached to this rough striated process |
| Lateral Process | Largest |
| Medial Process | Is smaller and less pronounced |
| Peroneal Trochlea | Visualized on an axial projection; also called the trochlear process |
| Sustentaculum | On the medial proximal aspect is larger and more prominent bony process; means a support for the talus |
| Talus | Alternative name is "astragalus"; 2nd largest tarsal bone |
| Cuboid | Lateral aspect of foot |
| Navicular | alternative name is "scaphoid"; medial side of the foot b/w the talus and 3 cuneiforms |
| Cuneiforms (5,6,7) | Medial and mid aspects of the foot |
| Longitudinal | Comprises a medial and lateral component; located on medial and mid aspects of the foot |
| Transverse | Primarily along plantar surface of the distal tarsals and tarsometatarsal joints |
| Ankle joint | Is formed by 3 bones: Tibia, Fibula, & the Talus |
| Lateral Malleolus | Expanded distal end of fibula |
| Medial Malleolus | Medial elongated process of tibia |
| Mortise | Deep "socket" (3 sided opening) formed by inferior portions of tibia and fibula |
| The 3-part joint space of the ankle mortise is _______ seen on a true frontal view (AP) | NOT; because of overlapping by talus |
| Mortise Position | Is a 15° internally rotated AP oblique projection |
| Anterior Tubercle | Expanded process at distal anterior & lateral tibia |
| Tibial Plafond | Distal tibial joint surface that forms the roof of the ankle mortise joint |
| Lateral Ankle View | Demonstrates that the distal fibula is located about 1 cm posterior in relation to the distal tibia |
| "True Lateral" | Requires lateral malleolus to be about 1 cm posterior to the medial |
| Axial Ankle View | Visualizes an "end on" view of the ankle looking from the bottom up, demonstrating tibial plafond; the smaller fibula is shown to be more posterior |
| Axial Ankle View | Lower leg and ankle must be rotated 15°-20° to bring plane parallel to coronal plane |
| The ankle joint is a __________________ of the saddle (seller type) with flexion and extension movements only | Synovial joints |
| Lateral stress can result in a: | Sprained ankle with stretched or torn collateral ligaments and torn muscle tendons leading to an increase in parts of the mortise joint space |
| ____________ views of the ankle can be performed to evaluate the stability of the mortise joint space | AP Stress |
| Synovial joints | Require strong collateral ligaments that extend from the medial and lateral malleoli to the calcaneus and talus |
| Tibia | One of the larger bones of the body; is the weight-bearing bone of the lower leg |
| Intercondylar eminence | Also known as tibial spine |
| Medial & Lateral Intercondylar Tubercles | Small pointed prominences; are located on the superior surface of the tibial head b/w the two condyles |
| Articular facets | Commonly called the tibial plateau; on lateral view they make up the plateau slope posteriorly from 10°-20° in relation to axis of the tibia |
| Tibial tuberosity | On the proximal extremity of the tibia is a rough-textured prominence |
| Body | Anterior crest (border) is along the anterior surface |
| Medial malleolus | Ends in a short pyramid-shaped process which is easily palpated on the medial aspect of the ankle |
| Fibular Notch | Lateral aspect of the distal extremity of the tibia; forms a flattened triangular notch for articulation with the distal fibula |
| Fibula | Is located laterally and posteriorly to the larger tibia |
| Patellar surface | Is the smooth, shallow, triangular depression at the distal portion of the anterior femur that extends up under the lower part of the patella |
| Intercondylar sulcus, trochlear grove & patellar surface | Are all referred to as a smooth shallow depression |
| Intercondylar fossa | Or notch above which is the popliteal surface |
| Medial condyle | Extends lower or more distally than the lateral condyle when the femoral shaft is vertical |
| CR must be angled _____ to ____ cephalic for a lateral knee? | 5°-7° for the 2 condyles to be superimposed when the femur is parallel to the IR |
| Adductor tubercle | A slightly raised area that receives the tendon of an adductor muscle |
| Posterolateral aspect of the medial condyle | Adductor tubercle is present on |
| Patella | Is a flat triangular bone about 2" in diameter |
| Apex | Is located along the inferior bored |
| Base | Is the superior or upper border |
| Anterior surface | Is convex and rough (outer) |
| Posterior surface | Is smooth and oval-shaped for articulation with the femur |
| Patella | Serves to protect anterior aspect of knee, acts as a pivot to increase leverage of large quadriceps femurs muscle, superior position: loose and moveable, Flexed: moves distally & becomes locked into position, articulates with the femur & never the tibia |
| Knee Joint | Primarily involves femorotibial joint b/w femur condyles & corresponding tibial condyles |
| Fibular (lateral) Collateral Ligament (LCL) | Extends from the femur to the lateral proximal fibula |
| Collateral ligaments | Are strong bands at the sides of the knee that prevent adduction and abduction movements of the knee |
| Cruciate ligaments | Are strong rounded cords that cross each other as they attach to the respective anterior and posterior aspects of the intercondylar eminence of the tibia |
| Patellar ligament | Help to maintain the integrity of the knee joint |
| Articular capsule (bursa) | Complex, saclike structure filled with a lubricating type synovial fluid; demonstrated in arthrogram |
| Suprapatellar Bursa | Bursa of the knee joint extending upward and superior to the patella |
| Infrapatellar Bursa | Distal to the patella and separated by fat pad |
| Infrapetellar fat pad | Separates the bursa |
| Menisci (Articular Disks) | Are crescent-snapped fibrocartilage disks b/w the articular facets of the tibia and femoral condyles |
| Menisci (Articular Disks) | -located b/w the articular facets of the tibia (plateau) & the femoral condyles -act as shock absorbers to reduce some of the direct impact and stress that occur @ knee joint -produce synovial fluid w/ synovial membrane |
| Knee | The _________ has great potential for traumatic injury |
| A tear of the ______ frequently is associated with a tear of the ACL and medial meniscus | MCL |
| Distal tibiofibular joint | Is classified as a fibrous joint |
| Syndesmosis type | Is only slightly moveable or amphiarthrodia |
| Dorsum | Top or anterior surface of the foot |
| Dorsum pedis | Which refers to the upper surface or the surface opposite the sole of the foot |
| Plantar surface | Sole of the foot |
| AP projection of the foot = | Dorsoplantar Projection (DP) |
| PA projection = | Plantodorsal Projection (PD) |
| AP Toes | -MTP joint of digit in question centered to IR -10°-15° toward calcaneus and perpendicular to phalanges |
| AP Oblique- Medial Rotation | -knee flexed 45° -rotate leg and foot 45° medially -directed to MTP joint in question |
| 1st-3rd digits= | Medial rotation |
| 4th-5th = | Lateral rotation; toes flexed and separated |
| Lateral Toes | -true lateral; digit free of superimposition -IP joint for 1st digit & PIP for 2nd-5th digits |
| Tangential-Sesamoids | -profile image of sesamoid, min of 3 metatarsals -dorsiflex foot so that the plantar surface forms a 15°-20° angle; dorsiflex 1st digit (great toe) and res on IR; no rotation -tangentially to posterior aspect of 1st MTP joint |
| AP Foot | -entire foot, no rotation, MTP joints open -angle CR 10 degrees posteriorly to base of 3rd Metatarsal |
| AP oblique (Medial) Foot | -entire foot, 3rd-5th metatarsal free of superimposition, tuberosity demonstrated at base of 5th metatarsal -rotate medially 30°-40° to plane of IR |
| Lateral Foot | -entire foot, tibiotalar joint, MT superimposed -lateral recumbent -knee flexed 45°, opposite behind injured limb to prevent over-rotation; dorsiflex foot -CR to medial cuneiform |
| AP Weight-Bearing Foot | -only way to look at arches; bilateral feet demonstrated, no rotation -full weight evenly distributed, feet directed straight ahead and parallel to each other -CR 15° posterior to midpoint b/w feet at level of base of metatarsals |
| Lateral Weight-Bearing | -entire foot; plantar surfaces of MT superimposed -erect w/ weight on affected; stand on wood blocks; take lateral image of other foot for comparison -CR horizontally to level of base of 3rd metatarsal |
| Calcaneus Plantdorsal (Axial) Projection | -entire calcaneus -dorsiflex foot so plantar surface is near perpendicular to IR -40°cephalad to base of 3rd MT to emerge posterior malleoli |
| Lateral Calcaneus | -calcaneus and talus visualized -lateral recumbent w/ affected side down -ankle/foot in true lateral -CR directed to a point 1" inferior to medial malleolus |
| AP Mortise | -opens mortise; distal 1/3 of tibia & fibula, proximal 1/2 of metatarsals -15°-20° internal rotation -CR midway between malleoli |
| AP Oblique Ankle | -distal tibiofibular open; distal 1/3 of tibia & fibula; proximal 1/2 of MT -dorsiflexion so plantar surface is at least 80°-85° from IR; rotate leg and foot medially 45° |
| Lateral Ankle | -entire talus and calcaneus; lateral malleolus superimposed over posterior 1/2 of tibia -true lateral position of foot -CR to medial malleolus |
| AP Stress (inversion & eversion) | -distal aspect of tibia/fibula; ankle joint to center of collimation field -dorsiflex 90°; stress applied for true AP with no rotation; assistance from physician to hold part in place -CR midway between malleoli |
| AP Tib Fib | -entire tibia/fibula; knee and ankle joints; partial superimposition of fibula and tibia at proximal and distal ends -true AP; knee and ankle 1-2" from ends of IR -midpoint of lower leg |
| Lateral Tib Fib | -entire tibia/fibula; knee and ankle joints; proximal head of fibula superimposed by tibia; distal fibula superimposed over posterior 1/2 of tibia -true lateral position -CR midpoint of lower leg |
| AP Knee | -femorotibial joint open; articular facets profiled -rotate leg internally 3°-5° for true AP knee or until inter-epicondylar line is parallel to IR -CR parallel to tibial plateau 1/2" distal to apex of patella |
| AP Oblique Medial Knee | -semi-supine with body & leg rotated partially away from side of interest; support under elevated hip -rotate entire leg internally 45° -CR to midpoint of knee at level 1/2" distal to apex of patella |
| AP Oblique Lateral Knee | -proximal tibiofibular joint open; fibula superimposed over mid-tibia -semi-supine with body and leg partially rotated away from side of interest; support under elevated hip -45° lateral rotation -1/2" distal to patella |
| Lateral Knee | -femoral condyles superimposed; patella in profile (indicates no rotation); patellofemoral joint space open -horizontal beam (unable to flex knee) or lateral recumbent (20°-30° knee flexion; affected side down; opposite limb behind knee being examined) |
| Ap Weight-Bearing Bilateral | -joint spaces open; no rotation -erect & on stool high enough for horizontal beam; feet straight w/ even weight distribution -perpendicular to IR; directed to midpoint b/w knee joints at a level 1/2" below apex of patella |
| PA Axial Weight-Bearing Bilateral (Rosenburg) | -bilateral for comparison -erect, standing on step high enough for 10° ciudad angle; feet and knees flexed 45° -CR 10° caudad & directly to midpoint between knee joints at level 1/2" below apex of patella |
| AP Axial: Intercondylar Fossa (Beclere Method) | -intercondylar fossa, femoral condyles, tibial plateau and intercondylar eminence -supine with support under flexed knee; legs in anatomic position -flex knee 40°-45° -CR 1/2" distal to apex of patella; perpendicular to lower leg |
| PA (Camp Coventry/Holmblad) | -intercondylar fossa in profile; no rotation; articular facets and intercondylar eminence well visualized -Prone CC: 40°-50° knee flexion H: on all 4's while leaning 20°-30° forward -CR perpendicular to lower leg |
| PA Patella | -knee joint and patella -legs exteneded; support under ankle and lower leg with smaller support under femur above knee -ture AP= inter-epicondylar line parallel to IR -CR mid-patella area (popliteal crease) |
| Lateral Patella | -patella and knee joint -lateral recumbent; affected side down -knee in true lateral and flexed 5°-10° -CR perpendicular to mid-patellofemoral joint |
| Tangential: Axial or Sunrise/Skyline (infrosuperior hughston & settegast) | -supine 40°-45° degree knee flexion;legs together |
| Tangential: Axial or Sunrise/Skyline (Merchant Bilateral) | -intercondylar sulcus and patella; femorpatellar joint spaces open -supine with knees flexed 40° over end of table using adjustable leg support & IR holder (merchant board) |
| Tangential: Axial or Sunrise/Skyline (Merchant Bilateral) | -distal femurs parallel to tabletop; knees and feet together; lower legs secured together, IR on edge against legs 12" below knees & perpendicular to x-ray beam -CR angled 30° from horizontal plane; midway b/w patella; adjust angle if needed for true tan |
| Superoinferior Sitting Tangential Method (Hobbs Modification) | -seated, knees flexed w/ feet slightly underneath the chair -CR mid-patellofemoral joint -IR on foot stool or support to reduce OID |
| Synovial Joints | joints or articulations of the lower limb (freely moveable) |
Created by:
sassyrad
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