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Upper extremity///

Procedures and Positions

Digits (2-5) AP projections *8 x 10, 40" SID *Seated at end of table, extend digit with palm down, separate digits slightly, center affected digit to portion of IR. *CR- perpendicular to PIP, collimate.
Digits (2-5) Oblique projection *8 x 10, 40"SID *Seated at end of table, forearm on table with hand pronated, palm resting on IR, rotate hand either internal or external until digits are separated. (45 degrees) *CR- perpendicular to PIP jt, collimate
Digits (2-5) lateral projection *SHOW THEM HOW TO!. Extend affected digit, close remaining digits into a fist, support arm if needed. Rest pts. hand on affected side(lateral-2 or 3 digit, medial-4 or 5) *CR-perpendicular to PIP jt. of the affected digit, collimate
Thumb (1st digit) PA projection *8 x 10, 40"SID *Seated at end of table with arm internally rotated, adjust body position on chair, rest thumb on IR, long axis of thumb parallel with long axis of IR, avoid superimposition of remaining digits
Thumb (1st digit) Lateral projection *8x10, 40"SID *seated at end of table with relaxed hand placed on IR, place hand in natural arched position with surface down, adjust hand until a true lateral of thumb
Thumb (1st digit) oblique projection *8x10, 40"SID *Seated at end of table with the palm of the hand resting on IR, thumb abducted, palmer surface of the hand in contact with IR, ulnar deviate hand slightly, align longitudinal axis of the thumb with the long axis of IR
Hand PA *adjust table for heighth *palmer surface down, center IR to MCP jts. *adjust long axis of IR parallel with long axis of the hand and forearm *CR-perpendicular to the 3rd MCP jt
Hand PA oblique *hand pronated, resting on IR *MCP jts form 45 degree angle with the IR, can use a foam wedge *rotate pts hand laterally from pronated position, elevate fingers to open jt spaces *CR-perpendicular to 3rd MCP joint
Hand fan lateral *hand in lateral position with ulnar aspect down *extend pts digits, palmer surface perpendicular to the IR, center IR to MCP jts *CR-perpendicular to 2nd digit MCP jt
Hand Extension Lateral *extend pts digits and adjust 1st digit @ right angle to the palm *Center IR to MCP joints and adjust midline to be parallel with the long axis of the hand and forearm *CR-perpendicular to the 2nd digit MCP jt
Wrist PA *palmer surface down *slightly arch hand @ the MCP jt (flexing the wrist) *CR-perpendicular to midcarpal area
Wrist PA Oblique *rotate the wrist laterally until it forms an angle of 45 degrees with the plane of the IR *CR-perpendicular to the midcarpal area (just distal to the wrist)
Wrist Lateral *pt should flex elbow 90 degrees to rotate ulna to the lateral position *CR- perpendicular to the wrist joint
Wrist Ulnar Deviation *wrist is on IR for a PA projection, turn the affected wrist outward in extreme ulnar deviation *CR-perpendicular to the scaphoid
Wrist Radial Deviation *wrist is on the IR for a PA projection *turn wrist inward in extreme ulnar deviation *CR-perpendicular to midcarpal area
Stecher Method-PA Axial (scaphoid) *adjust wrist on IR *CR-directed 20 degrees toward the elbow
Gaynor-Hart method (inferosuperior) *hyperextend the wrist and center to the IR, rotate hand slightly toward the radial side, have pt grab the digits with opposite hand *CR-directed to the palm of the hand@ 1" distal to the base of the 3rd metacarpal
Gaynor-Hart method (superioinferior) *pt should dorsiflex the wrist, lean forward and place the carpal canal tangent to the IR *CR-Tangential to the carpal canal@ the midpoint of the wrist. Can be angled toward the hand @ 25-30 degrees
Forearm AP *14x17 *supinate the hand and extend the elbow *make sure both jts are included! *CR- perpendicular to the midpoint of the forearm
Forearm Lateral *flex elbow 90 degrees *Include both proximal and distal joints of affected forearm, adjust the limb in a true lateral(thumb side of hand is up) *CR- perpendicular to the midpoint of the forearm
Elbow AP *extend elbow, supinate hand, and center elbow joint *humeral epicondyles are parallel with IR *CR- perpendicular to the elbow joint
Elbow Lateral *flex the elbow 90 degrees-olecranon process can be seen in profile *places the humerus and elbow joint in same plane *CR-perpendicular to the elbow jt.
Elbow AP Oblique *medially rotate or pronate the hand surface of the elbow is 45 degrees from IR *CR-perpendicular to elbow jt.
Distal Humerus-partial flexion AP *performed when pt cannot extend the elbow *depending on the degree of flexion angle the CR distally into the jt *CR-perpendicular to the humerus
Proximal forearm-Partial flexion AP *seat pt high enough to permit the dorsal surface of the forearm to rest on the table *CR-perpendicular to elbow jt and long axis of the forearm (midpoint)
Jones Position- Acute Flexion *14x17 *fully flex elbow, long axis parallel with IR, center the IR proximal to the epicondylar area of the humerus & adjust arm to prevent rotation *CR-perpendicular to the humerus @ 2" superior to the olecranon process
Humerus AP *14x17, upright, 40"SID *abduct the arm slightly and supinate the hand, epicondyles are parallel to IR *CR-perpendicular to the midportion of the humerus and center of IR
Humerus Lateral *Internally rotate the arm, flex elbow 90 degrees and place hand on hip or stomach *CR-perpendicular to midportion of the humerus and center of the IR
Transthoracic Lateral-Lawrence Method *when trauma exists and cannot rotate or abduct *raise uninjured arm, rest on head and elevate shoulder *elevation drops the injured side *CR-perpendicular to IR entering midcoronal plane @ the level of the surgical neck
Created by: gsmith0141