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RAD Upper Extrem
| Question | Answer |
|---|---|
| Number of bones in hands, wrist, fingers | 27 - 14 phalanges (bones of fingers) - 5 metacarpals (bones of palm) - 8 carpals (bones of wrist) |
| Arch of the wrist | carpal sulcus - arch created by natural curve of wrist |
| anterior and posterior surfaces | anterior - palm / palmar posterior - dorsum / dorsal |
| types and numbers of phalanges | - 5 proximal - 4 intermediate - 5 distal - the thumb lacks an intermediate bone |
| metacarpals | 5, numbered starting from the medial aspect (1 is thumb, 5 is pinky) |
| carpals | arranged in two rows, proximal and distal proximal - scaphoid, lunate, triquetrum, and pisiform distal - trapezium, trapezoid, capitate, and hamate |
| sesamoids | - accessory bones located inferior to the first metacarpal head - embedded within tendon - reduces strain during weight bearing |
| Proximal row of carpal bones | Scaphoid, lunate, triquetrum, pisiform |
| distal row of carpal bones | trapezium, trapezoid, capitate, hamate |
| Mnemonic device to remember carpals | Some Lovers Try Positions That They Can't Handle (lateral -> medial both rows) scaphoid, lunate, triquetrum, pisiform trapezium, trapezoid, capitate, hamate |
| forearm bones | radius - lateral (thumb side) ulna - medial side articulate at - proximal radioulnar joint, distal radioulnar joint |
| Interphalangeal joints of the hand | - named by location (proximal or distal) ex: proximal interphalangeal or distal interphalangeal - synovial hinge type joint (allows for flexion and extension) |
| Metacarpophalangeal joints of the hand | - synovial ellipsoid joints - proximal bone named first |
| Carpal Canal | - passageway created between the carpal sulcrus and the flexor retinaculum |
| articulations between phalanges | - identified by location and digit number |
| interphalangeal joint atriculations | - between phalanges |
| metacarpophalangeal joint articulations | between metacarpals and the phalanges |
| carpometacarpal joint articulations | joint between carpal bones and metacarpals |
| intercarpal joint articulations | - between carpal bones |
| Essential projections of the fingers | - PA - PA oblique - medial rotation digits 1-3 - lateral rotation digits 4-5 Lateral - mediolateral digits 1-3 - lateromedial digits 4-5 |
| PIP, DIP, MCP, CMC, IP joints | PIP - proximal interphalangeal joint DIP - distal interphalangeal joint MCP - Metacarpophalangeal joint CMC - carpometacarpal joints IP - interphalangeal joint (thumb) |
| Hand series | - PA hand - IR centered to 3rd MCP - oblique hand - IR centered to 3rd MCP - lateral fan - IR centered to 2nd MCP - 50-60 kVp, 1-3 mAs - 40" SID - blue is at elbow - collimate to within 1" of skin margin |
| Wrist series | - PA wrist - IR centered midcarpal - oblique wrist - IR centered midcarpal - lateral wrist - IR centered midcarpal, show radius + ulna - 52 - 60 kVp, 1.5-3 mAs - 40" SID - blue is at elbow - collimation - include distal radius/ulna, carpals, tissue |
| forearm series | - AP forearm - lateral forearm - LANDSCAPE - 55 - 65 kVp, 2-4 mAs - 40" SID - blue is at elbow - 14x17 for both - IR centered to mid-forearm - collimation includes wrist and elbow joints, radius, ulna, soft tissues |
| elbow series | - AP elbow - internal oblique - external oblique - lateral - LANDSCAPE - IR centered to center of elbow 55-65 kVp, 2-4 mAs - 40" SID - HAND is at blue - include distal humerus, proximal radius/ulna, tissue |
| Where is the CR centered to in a PA finger shot? | PIP joint of affected finger |
| Collimation for finger shot | include entire finger with MCP joint with surrounding soft tissue |
| essential projections of the thumb | - PA - PA oblique (medial rotation) - lateral |
| Which two shots use a 14x17 collimation? | - AP forearm - lateral forearm (also uses landscape) |
| Which shots use landscape? | - lateral forearm - lateral elbow |
| Ballcatcher / Norgaard method | - purpose is to assess skeletal age - uses single X ray of the elbow - evaluates ossification centers |
| Folio method | - special thumb positioning technique - designed to better visualize the ulnar collateral ligament - helps identify small avulsion fractures - used to evaluate skier's thumb |
| Carpal Canal Syndrome / Gaynor-Hart method | compression of the median nerve in the carpal tunnel |
| most fractured carpal bone | scaphoid |
| Jones method | - CR perpendicular to forearm or humerus |
| Coyle method | - images of the radial head and coronoid process on patients who cannot fully extend elbow |
| Coyle method (radial head) | - pronate hand and flex elbow 90 degrees - directed toward the shoulder at an angle of 45 degrees |
| Coyle method (coronoid process) | - pronate the hand and flex the elbow 80 degrees - directed away from shoulder at an angle of 45 degrees |
| bone age | - radiographic assessment of skeletal maturity, estimates child's biological age rather than chronological - indicates abnormal growth, pubertal disorders, endocrine disease, clinical planning - single low dose X ray of left hand and wrist |
| All markers must be placed | lateral or anterior |
| PA hand shot must include what joint? | distal radioulnar |
| In a hand projection, equal spacing should be seen through which metacarpals? | 2nd through 5th |
| in a wrist projection, ulnar deviation best demonstrates what? | the scaphoid bone |
| in an elbow shot, the internal oblique position best demonstrates what? | the coronoid process |
| in an elbow shot, the external oblique position best demonstrates what? | the radial head |
| the lateral elbow shot best demonstrates what? | the fat pads |
| ulnar deviation | PA projection, wrist put into extreme ulnar flexion (toward 5th digit) - demonstrates scaphoid bone |
| radial deviation | PA projection, wrist put into extreme radial flexion (towards first digit) - demonstrates medial carpals |
| Stecher method | - used if patient can't perform ulnar deviation - PA projection, forearm resting on table with IR on a support so that it's angled up 20 degrees |
| evidence of proper rotation in hands | - concavity on one side of phalangeal bodies - flat appearance on the opposite side of phalangeal bodies - articulation between each phalanx and metacarpal should be visualized |
| on what wrist shot do you need to show the radius and ulna | lateral, they should be superimposed |
| evidence of proper rotation for oblique wrist shot | - superimposition of 3rd-5th metacarpals - superimposition on radius and ulna |
| evidence of proper rotation for lateral wrist shot | - complete superimposition of 2nd-5th metacarpals - distal radius/ulna superimposed |
| In an AP forearm shot, what landmark should be parallel to the IR? | humeral epicondyles |
| evidence of proper rotation in lateral forearm | - superimposition of distal radius over ulnar head - superimposition of radial head over coronoid process - superimposed humeral condyles |
| special view used to determine skeletal age | ballcatches / Norgaard method |
| special view used to demonstrate carpal canal | Gaynor-Hart method |
| special view used when elbow cannot be extended | Coyle method |
| special view used when patient can't perform ulnar deviation | Stecher method |
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