Lower Extremities
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| The pelvic girdle consists of | 2 hip bones
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| The Pelvis consists of | both hip bones, sacrum, coccyx
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| The hip is made up of the | ilium, ischium, and pubic bone
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| What is the area between the greater and lesser trochanter called on the ANTERIOR aspect of the proximal femur | intertrochanteric line
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| What is the area between the greater and lesser trochanter called on the POSTERIOR aspect of the proximal femur | intertrochanteric crest
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| A true AP of the hip require how much rotation? | 15-20 degree internal rotation
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| kV for the AP Pelvis, AP Hip, and Lateral Hip is | 75-85kV
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| Center for the AP Pelvis is | centered 2" inferior to level of ASIS (crest 1.5" below top of IR)
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| How are you doing? | EXCELLENT!
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| What size IR for a AP Pelvis? | 14x17 CW
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| T/F Lesser trochanters of the femur is included in the AP Pelvis | True
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| How do you detect rotation for Pelvis? |
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| The superior ramus is part of the | pubis
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| The inferior ramus is part of the | Ischium
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| The Judet method demonstrates | the Acetabulum
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| Center for AP hip (with hardware) | 1-2" distal to neck or femur (all of hardware must be demonstrated)
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| Lateral of the hip is also called | Frog or Modified Cleaves or Lauenstein method
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| Trauma Hip most often used is called | Danelius-Miller or Cross-table lateral or Axiolateral (inferiorsuperior)
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| The modified axiolateral trauma hip when both hips can't be moved.is called | Clements-Nakayama method
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| How much should the femur be abducted for the Cleaves method for the hip? | 40-45degrees
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| How much should the femur be abducted for the Lauenstein method for the hip? | 40-45 degrees (with knee flexed 90degrees)
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| Where is the CR placed for a unilateral frog-leg projection | mid femoral neck
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| The AP axial outlet projection for the pelvis requires the CR to be ______for females and _______ for males | 20-35 and males 30-45degrees
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| The AP inlet projection for the pelvic ring requires the CR angle to be | 40deg caudad
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| A male pelvis has an ______ angle while a female pelvis has a ________ | less than 90 degrees acute, female greater than 90 degrees obtuse
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| Three differences in a female and male pelvis are | males have narrower , deeper and less flared, angle of the pubic arch is less than 90deg, shape of the inlet is more narrower and more oval or heart shape
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| What are some important positioning landmarks for the pelvis | iliac crest, ASIS, greater trochanter, symphysis pubis, ischial Tuberosity
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| The pelvis is separated into ______ superior to the inlet and ________pelvis is a cavity that is surrounded by bony structures that is of great importance during birthing process | greater false pelvis, lesser true pelvis forms birthing canal
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| If the femoral neck is foreshortened and the lesser trochanters are in profile medially on a radiograph what is probable cause for positioning | external rotation of the leg and foot
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| When taking a patient history for a hip x-ray it is important to ask about a prosthesis or any hip surgery for what two reasons | so you can position patient without injuring site, and to make sure you center lower to include all hardware
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| What pathology is best demonstrated with the judet method | acetabular fractures
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| Where is the CR placed for a unilateral frog-leg projection | mid femoral neck
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| The ankle joint is formed by what three bones | tibia, fibula, talus
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| A 15deg internal rotated AP oblique projection is called the | mortise projection
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| The mortise position demonstrates the joint and should have even space over entire _____ | talar surface
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| What does the mortise joint do for the body | helps stabilize weight
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| What is the difference between the AP mortise and AP oblique ankle projections for positioning | internal rotation for mortise is 15-20deg and the ankle is internal rotation of 45deg
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| On a true AP of the ankle what is not demonstrated | entire three part joint space of the ankle mortise
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| The ankle is what type of joint with what type of movement | synovial joint, sellar or saddle type and movement is flexion and extension
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| Which malleolus is longer and is an extension of the fibula | lateral malleolus
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| What are the stress views of the ankle important | shows lack of support, from fractures or tears of ligaments
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| Before doing a stress view of the ankle what should be ruled out | make sure there is no fracture
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| What are the two joints are on the tibia | proximal and distal tibiofibular joints
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| What structures are seen in the AP Ankle? | 1/3 of tib/fib, ½ of metatarsals, ankle joint with the medial and upper portion of the joint open.
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| Name the 3 Ankle positions (routine) | AP, AP oblique with medial rotation, Lateral
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| Positioning for the AP ankle | Center to ankle joint, foot dorsiflexed.
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| Positioning for the AP mortise with medial rotation | 15-20 degrees medial rotation, centered to ankle. (demonstrates ankle mortise)
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| How do you accurately position for the AP w/ medial rotation? | rotate medially until the malleoli are parallel (equidistant) to the IR. Rotate the whole leg NOT just the ankle or foot.
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| What is the visual difference between and AP and AP Mortise? | the joint space on the lateral side of the Mortise will be open. In the AP the Fib is superimposed over part of the talus.
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| What is the (rarely used) AP oblique with 45degree medial rotation for? | to show tib/fib joint space.
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| Identify rotation on Lateral ankle | talar domes should be superimposed, lateral malleolus superimposed over posterior half of tibia.
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| What are Inversion/Eversion view of the Ankle for? | stress views that are used to demonstrate ligament damage.
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| What do you do to fit the Tib/Fib on a 14x17? | Try it diagnonally, then try increasing the SID (44-48in)
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| T/F There should be partial superimposition of the Tib and Fib at both proximal AND distal ends? | TRUE
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| You are _____? | ON FIRE! Someone call 9-1-1!
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| Describe positioning for the Lateral TIB/FIB | Mediolateral, flex knee to 45 degrees, center midshaft and include both joints. May increase SID.
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| Identify rotation for the Lateral TIB/FIB | Rotation indicated by condyles of femur and ankle joint. Condyles should be superimposed and the proximal head of FIB superimposed by TIB, distal FIB superimposed over posterior half of TIB.
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| Identify rotation for AP TIB/FIB | evaluate relationship of the fibula to tibia. Lat. Rot. – fib shifts toward or under tib, obscuring medial mortise. Med. Rot – head of fib draws from beneath tib.
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| Boom | Shockalocka!
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| Name the tarsals of the foot | Calcaneus, Cuboid, Cuniforms (1 medial, 2 intermediate, 3 lateral), Navicular, Talus
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| How many Tarsals are there? | Seven 7
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| The heel bone is called | Calcaneus
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| The Calcaneus is a Tarsal | True
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| Where would you find Sesamoid Bones in the foot? | embedded in tendons, near joints, plantar surface
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| How many bones in the foot? | 14 (phalanges), 5 (metatarsals), 7 (tarsals). 26 total bones.
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| Name the arches of the foot | Longitundinal Arch (Lateral and Medial sides of foot) Transverse arch (across the foot)
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| Describe the Longitudinal arch of the foot | Comprised of lateral and medial, most of the arch is on the medial side and in the mid aspect of the foot
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| Describe the Transverse arch of the foot | primary located along the plantar surface of the distal tarsals and TMT joints. Made up mostly of the cuniforms and cuboid (especially 2nd and 3rd cuniforms).
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| Dorsiflexion is | when the foot is raised cephalad
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| Plantar Flexion is | when the foot is extended away from the body (pressing the gas pedal)
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| Inversion (varus) of the foot is | when the bottom of the foot is faced medially
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| Eversion (valgus) of the foot is | when the bottom of the foot is faced laterally
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| Technical factors for the foot | 40in SID, 50-70kV, short exp. time, grid if >10cm
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| Name the Foot positions | AP axial, AP oblique, Lateral
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| Name the Toes positions | AP axial, AP oblique, Lateral
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| Name the Calcaneus positions | Axial and Lateral
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| CR angle for AP axial Toes | 15 degrees cephalic
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| Centering for AP axial Toes | MTP joint
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| Film size for AP axial Toes | 8x10 or 10x12 (depends on projections done and if AP axial FOOT is done as a projection)
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| Special projection for sesamoid bones | tangential of toes – dorsiflex foot 15-20degrees from vertical, CR perpendicular to IR and centered tangentially to posterior of 1st MTP
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| alternative lateral for the foot | lateromedial- outside of the foot, CR mid-cuneiform base of 3rd MT
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| special projection for the foot to show longitudinal arches | AP & lateral weight-bearing CR 15deg posterior to base of MT
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| Name the Calcaneus projections and centering point | Axial Plantodorsal –dorsiflexed, CR 40deg cephalic at base of 3rd MT Lateral-Mediolateral- CR 1in inferior to medial malleolus
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| what is gout? | form of arthritis, uric acid deposits destuct joint space
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| Does Lisfranc joint injury requires a decrease or increase in technique | increase to penetrate tarsal region
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| joint effusions are signs of | fracture,dislocation,soft tissue damage
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| what type of joints are IP joints | hinge (flexion and extension)
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| what type of joints are TMT,intertarsal | plane or gliding (limited movement)
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| what type of joints are MTP | ellipsoidal or condyloid, (4 movements)
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| the calcaneal sulcus and a depression on the Talus form an opening for ligaments to pass through in the middle of the subtalar joint called? | sinus tarsi
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| three articular facets appear at the subtalar or talocalcaneal joint with the Talus through which the weight of the body is transmitted to the ground in an erect position | posterior, anterior and middle articular
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| what does the sustentaculum do? | provides medial support for weight bearing subtalar or talocalcaneal joint
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| You are __________ | the shiznat!
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| in what projection is the tuberosity on the 5th MT demonstrated | oblique-medial of the foot
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| what is a common trauma site for the foot that provides attachment of a tendon | tuberosity of the 5th MT
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| weight of the body is transmitted by this bone through the important ankle and talocalcaneal joints | TALUS
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| what type of joint is the ankle | synovial-sellar type w/flexion and extension
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| Longest and strongest bone | femur
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| Four major ligaments for the knee joint | posterior cruciate, anterior cruciate, fibular collateral, tibial collateral
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| Name three knee positions that are tunnel projections | BeClere, camp Coventry, homblad
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| Name two tangential knee projections | merchant and sunrise
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| A distinguishing difference between the lateral and medial condyle is the presence of _____________ | adductor tubercle on the posterior side of the medial condyle that receives the tendon of the adductor muscle
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| What do all tunnel views demonstrate | intercondylar fossa
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| How do you position a patient for the camp-coventry method | patient supine, flex knee 40-50degrees, CR to knee joint or popliteal depression, CR perpendicular to tib/fib, 40 SID.
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| What two tunnel projections are PA | holmblad and camp Coventry
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| What one tunnel view requires the CR to be perpendicular to the IR | Homblad method
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| The settegast method also called the inferosuperior projection requires the knees to be flexed __________ deg and the CR angle __________ to the lower legs | 40-45d, 10-15d
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| The joints at each end of the femur are a frequent source of pathology when trauma occurs because why | The entire weight of the body is transferred through the femur and associated joints
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| What do the medial and lateral condyles of the femur articulate with | the tibia
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| Why must the CR angle for a lateral knee be 5-7 degrees cephalad | the medial femoral condyle extends lower than the lateral femoral condyle when the femoral shaft is vertical
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| The medial and lateral epicondyles are attachments for what | the medial and lateral collateral ligaments
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| What is the largest sesmoid bone in the body | the patella
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| When the leg is extended the patella is where | superior to the patellar surface
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| When the leg is flexed the patella is where | downward over the patellar surface
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| Where is the apex of the patella located | along the inferior border
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| Where is the base of the patella located | the superior border
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| Does the patella articulate with the tibia | no! only with the femur
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| Where is the femorotibial joint located | between the two condyles of the femur and the condyles of the tibia
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| What is the femorotibial joint classified as | a synovial joint, bicondylar and diarthrodial that allows flexion and extension
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| Where is the patellofemoral joint located | where the patella articulates with the anterior surface of the distal femur
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| What is the patellofemoral joint classified as | synovial , SELLAR (saddle)
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| What is the largest joint space of the human body | cavity of the knee joint
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| What is the knee joint | the knee joint is synovial type enclosed in an articular capsule or bursa
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| What are the medial and lateral menisci | fibrocartilage disks between the articular facets of the tibia and the femoral condyles
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| What projection shows the articular facets in profile | AP knee
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| Where do you center for an AP knee | parallel to the tibial plateau
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| Why are the femoral condyles superimposed but never completely | because of magnification
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| What is the same for all tunnels of the knee | CR perpendicular to tib/fib and demonstrates intercondylar fossa
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| Why is a PA patella preferred over an AP | less OID
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| What is demonstrated on an AP proximal femur | lesser trochanter superimposed and the greater trochanter in profile
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| What is demonstrated on an AP Distal femur | epicondyles parallel to IR
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| What is demonstrated on a Lateral proximal femur | lesser trochanter in profile and the greater trochanter is superiposed
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| What is demonstrated on a lateral distal femur | condyles are in line with long axis of femur for no rotation
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| Beclere method (ap axial) for tunnel knee requires _____degree knee flexion, CR angle of ____ degrees and the CR centered _______ | 40-45, 40-45 cephalad, ½ inched distal to apex of patella
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| Holmblad method (pa axial) for tunnel knee requires ______degree knee flexion, and the CR angle of ______degrees. | 60-70 degree knee flexion and no angle on CR (perp to IR)
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| Camp Coventry method (pa axial) for tunnel of knee requires _____degree knee flexion, and CR angle of ______ degrees. | 60-70 degree knee flexion and 40-50 degree caudad angle on CR
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| Do you rotate the knee for a true AP? | yup, 5 degree internal rotation of anterior knee will align interepicondylar line parallel to plane of IR.
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| How much should you flex the knee for a Lateral-Mediolateral Knee projection? | 5-10 degrees additional flexion may cause separation of a fracture (p.253)
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| Define Baker Cyst | When an excess of knee joint fluid is compressed by the body weight between the bones of the knee joint, it can become trapped and separate from the joint to form the fluid-filled sac in the posterior knee.
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| The cavity in the hipbone that articulates with the femoral head is called the | acetabulum
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| The hip bone consists of what three parts? | Ischium, Pubic bone, and Ilium
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| The ilium and sacrum articulates at the _________ joint | Iliosacral
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| The junction of what 2 bones forms the obturator foramen of the pelvis? | Ischium and Pubic bone
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| Name the bones that make up the pelvic girdle | Right and Left Hip bones
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| Name the bones that make up the pelvis in an adult | Sacrum, Coccyx, Right and Left Hip
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| The prominent ridge extending between the tochanters at the base of the neck on the posterior surface of the femur is the | intertrochanteric crest
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| Name one or more structures that may be helpful in order to evaluate rotation on an AP pelvis radiograph (not proximal femur) | Symetry of the Obturator formina or Ischial spines, and alignment of the Coccyx and Pubis symphisis.
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| How much do you medially rotate the feet and lower limbs to place the femoral necks parallel with the plane of the IR on an AP projection of the pelvis? | 15-20 degrees
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| What position, projection or method is useful in diagnosing fractures of the acetabulum? | Judet (axiolateral)
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| What is the projection of the Modified Cleaves often called? | Frog leg
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| Do you see the lesser trochanter with the Modified Cleaves method? | Yes
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| What projection/position of the hip best demonstrates the greater trochanter in profile? | AP hip/pelvis
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| The angulation of the tube for the axiolateral projection (Danelius-Miller Method) is angled perpendicular to what structure? (not the film) | Femoral Neck (and IR)
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| Where is the central directed for the unilateral frog-leg? | Femoral Neck
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| The largest sesamoid bone in the body is the | patella
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| The tube angle for the Camp Coventry method for the PA axial (knee) is | 40 degrees
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| In order to better visualize the joint space in the AP projection of the knee on a large patient, the central ray should be angled how many degrees and in what direction? | 3-5 degrees cephalic
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| In the Be'clere position the patient is placed (supine, prone, or lateral)? | Supine
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| The centering point for the AP of the knee is | 1/2" distal from apex of Patella
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| This acts as a shock absorber in the knee | Meniscus
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| In the AP projection of the proximal femur, the foot should usually be slightly rotated internally ________ degrees. | 15-20
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| Which projection of the patella provides sharper recorded detail, AP or PA? | PA
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| What is the name of the prominence on the posterior aspect of the femur that forms the popliteal surface? | Linea Aspera
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| What is the protrusion on the anterior side of the proximal tibia called where the patellar ligament inserts | tibial tuberosity
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| When looking at a lateral ankle radiograph, how do you determine if it is rotated | the talar domes should be superimposed and there should be superimposition of the posterior tibia
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| Is the sustentaculum tali on the medial or lateral side of the calcaneus | medial
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| The lateral malleolus is part of this bone | fibula
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| The fibula articulates with the condyles of the femur (T or F?) | False
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| When doing an oblique ankle that is for the mortice, how much do you rotate the leg and in which direction | 15-20 degrees medial rotation
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| Describe how to position a tib/fib for an AP | condyles should be parallel to IR and foot should be AP
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| Where is the centering point on an AP projection of the ankle | ankle joint
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| If an x-ray of the toes are requested, how much do you angle your tube on the AP axial projection to open the joint spaces | 15 degrees
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| If an x-ray of the foor is requested, how much do you angle your tube for an AP projection which opens the joint spaces | 10 degrees
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| On an AP oblique projection of the foor, which oblique and how many degrees obliquity is most often performed | 30 degrees medial oblique
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| When doing an AP oblique projection of the foor which rotation best demonstrates the sinus tarsi | medial rotation
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| Where is the central ray directed for the lateral first toe | IP
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| Where is the central ray directed for the AP foot | base of the 3rd metatarsal
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| To obtain an axial projection of the caclcaneus, the number of the degrees the central tay is angled____ when the long axis of the foot is perpendicular to the plane of the IR | 40 degrees
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