Bontrager's Textbook of Radiographic Positioning and Related Anatomy: Chapter 4 upper limb Flashcards
How many phalanges are in the hand?
How many metacarpals?
How many carpals?
How many total bones in the hand?
The two portions of the thumb(first digit) are the:
The three portions of each finger (second through fifth digits) are the:
The three parts of each phalanx starting distally are the
List the three parts of each metacarpal, starting proximally
The name of the joint between the proximal and distal phalanges of the first digit is the
The joints between the metacarpals and the phalanges are the
Which is the largest of the carpal bones?
What is the name of the hooklike process extending anteriorly from the hamate?
What is the most commonly fractures carpal bone?
In the anatomic position, which of the bones of the forearm is located on the lateral (thumb) side? which is on the medial side?
Which joint permits the forearm to rotate during pronation?
proximal radioulnar joint
The articular portion of the medial aspect of the distal humerus is called the
the similar structure found on the lateral aspect of the distal humerus is called the
the deep depression located on the posterior aspect of the distal humerus is the
ellipsoidal joints are classified as freely moveable, or ____, and allow for movement in _____ directions
T/F in addition to the ulnar and radial collateral ligaments, the following five additional ligaments are also important in stabilizing the wrist joint
A. Dorsal radiocarpal
B. Palmar radiocarpal
C. Triangular fibrocartilage complex (TFCC)
which ligament of the wrist extends from the styloid process of the radius to the lateral aspect of the scaphoid and trapezium bones?
radial collateral ligament
What is the name of the two special turning or bending positions of the hand and wrist that demonstrate medial and lateral aspects of the carpal region
ulnar deviation; radial deviation
of the two positions (radial deviation;ulnar deviation), which is most commonly performed to detect a fracture of the scaphoid bone?
There are three concentric arcs of the elbow: the first and smallest
The intermediate double arc, consisting of the outer ridges of:
the smaller arc: capitulum
the larger arc: trochlea
The third arc, which is part of the ulna
trochlear notch of the ulna
carpometacarpal of first joint
elbow joint (humeroulnar or humeroradial)
metacarpophalangeal joint of 2nd to 5th digits
proximal radioulnar joint
Ellipsoidal joints are classified as freely moveable, or _______, and allow movement in _______ directions
How does the forearm appear radiographically if pronated for a posteroanterior (PA) projection?
the proximal radius crosses over the ulna
The fat pads around the elbow joint are valuable diagnostic indicators if the following three technical/ positioning requirements are met with the lateral position
1. elbow flexed 90-degrees
2. optimal exposure factors used
3. in a true lateral position
T/F if the posterior fat pad of the elbow is not visible radiographically, it suggests that a nonobvious radial head or neck fracture is present
T/F trauma or infection makes the anterior fat pad more difficult to see on a lateral elbow radiograph
Which routine projections best demonstrate the scaphoid fat pad
posteroanterior and oblique wrist
Which routine projection best demonstrates the pronator fat stripe
KVP range upper limb
low to medium (60-80)
long or short exposure time upper limb
short exposure time
large or small focal spot upper limb
small focal spot
most common minimum SID upper limb
Grids are used if the body part measures greater than
small-to-medium dry plaster cast increase kvp
large plaster cast increase kvp
fiberglass cast increase kvp
correctly exposed radiographs: visualize _______ margins and ________________ markings of all bones
soft tissue; trabecular
The general rule for upper limb radiography states:
collimation borders should be visible on all four sides
select all pertinent factors that help reduce image distortion during upper limb radiography
B. 40-44 inches SID
C. milliamperage seconds (mAs)
D. minimal object- image receptor distance
E.Correct central ray placement and angulation
F. use of small focal spot
T/F Lead protective shielding is only required for upper limb studies performed on patients who are child age or younger
T/F guardians of young pediatric patients who are undergoing upper limb studies can be asked to hold their child during the radiographic study
______ is a radiographic procedure that uses contrast media injected into the joint capsule to visualize soft tissue pathology of the wrist, elbow, and shoulder joints
what is the positioning routine for the 2nd - 5th digits of the hand
PA, PA oblique, Lateral
How much of the metacarpals should be included for PA projection of the digits
distal aspect of the metacarpals
List the two radiographic criteria used to determine whether rotation is present on the PA projection of the digits
1. the symmetric appearance of shafts of phalanges and distal metacarpals
2. equal amounts of tissue on each side of the phalanges
Identify which positioning modifications should be used for a study of the second digit to reduce distortion for each of the following:
PA oblique: medial oblique instead of lateral oblique to decrease OID
Lateral: perform a thumb- down lateral (mediolateral) to decrease OID
where is the CR placement for a PA oblique projection of the second digit
proximal interphalangeal joint (PIP)
The AP axial projection ( Brewerton method) is commonly used to evaluate for early signs of
the hand is flexed _____ in relation to the IR for the AP axial projection (brewerton method)
how much rotation is required for an oblique projection of the wrist
which alternative projection to the routine PA wrist best demonstrates the intercarpal joint spaces and wrist joint
which positioning error is involved if a majority of the carpal bones are superimposed in a PA oblique wrist
excessive lateral roatation
which of the following fractures is not demonstrated in a wrist routine
During the PA axial scaphoid projection with central ray angle and ulnar flexion, the central ray must be angled
10-15 degrees proximally
How much are the hand and wrist elevated from the IR for the modified Stretcher method
how much central ray angulation to the long axis of the hand is required for the carpal canal (tunnel) projection
which special projection of the wrist best demonstrates the interspaces on the ulnar side of the wrist between the lunate, triquetrum, pisiform, and hamate bones
PA projection with radial deviation
which special projection of the wrist helps rule out abnormal calcifications in the carpal sulcus
tangential inferosuperior ( gaynor-hart)
how much central ray angulation from the long axis of the forearm is required for the carpal bridge (tangential) projection
the hand and wrist form a ________ angle to the forearm with the carpal bridge (tangential) projection
fracture and dislocation of the posterior lip of the distal radius
most common type of primary malignant tumor occurring in bone
reduction in the quantity of bone or atrophy of skeletal tissue
sprain or tear of the ulnar collateral ligament
an abnormality of the cartilage affecting long bones
transverse fracture extending through the distal aspect of the metacarpal neck, most often the 5th metacarpal
hereditary condition marked by abnormally dense bone
transverse fracture of the distal radius with posterior displacement of the distal fragment
narrowing of joint space with periosteal growths on the joint margins
fluid-filled joint space with possible calcification
Carpal tunnel syndrome
possible calcification in the carpal sulcus
soft tissue swelling and loss of fat pad detail visibility
mixed areas of sclerotic and cortical thickening along with radiolucent lesions
advanced paget disease
increase exposure factors
keep exposure factors
advanced rheumatoid arthritis
decrease exposure factors
decrease exposure factors
increase exposure factors
keep exposure factors
which routine projections are required for a study of the forearm
T/F for a forearm study, the technologist needs to include only the joint closest to the site of the injury
to position a patient properly for an AP projection of the elbow, the epicondyles must be ______ to the IR
If the patient cannot fully extend the elbow for the AP projection, what alternative projection should be performed
two AP projections (partially flexed), one with the humerus parallel to the IR and one with the forearm parallel to the IR
which routine projection of the elbow best demonstrates the radial head, neck, and tuberosity with slight (if any) superimposition of the ulna
AP oblique with 45-degree lateral rotation
the best position to evaluate the posterior fat pads of the elbow joint
Lateral, flexed 90-degrees
which projection of the elbow best demonstrates the coronoid process in profile
AP oblique with medial rotation
Which special projection of the elbow should be performed instead of the routine AP if the patient's elbow is tightly flexed and cannot extend at all
two projections - central ray perpendicular to humerus and central ray perpendicular to forearm (acute flexion projections)
how much is the upper limb rotated for a lateral (rotation) oblique projection of the elbow
How much and in which direction should the central ray be angled for the trauma axial lateral projection (coyle method) involving the radial head
45 degree toward shoulder
how much and in which direction should the central ray be angled for the trauma axial lateral projection (coyle method) involving the coronoid process
45-degrees away from the shoulder
what is the amount of elbow flexion required for the trauma lateral projection (coyle method) to demonstrate the coronoid process
80-degrees of flexion
what is the only difference among the four radial head lateral projections of the elbow
rotational position of hand and wrist
A three-projection study of the hand was taken using the following exposure factors: 64kVp, 1000 mA, 1/100 second, large focal spot, and 36-inch SID. Which of these factors should be changed on future hand studies to produce more optimal images
small focal spot, 40-inch SID
A radiograph of a PA projection of the second digit shows that the phalanges are not symmetric on both sides of the bony shafts. Which specific positioning error is involved
A radiograph of a PA oblique projection of the hand shows that the fourth and fifth metacarpals are superimposed. Which specific positioning error is involved?
excessive lateral rotation
A PA axial scaphoid projection of the wrist using a 15-degree distal central ray angle and ulnar flexion was performed. The resultant radiograph shows that the scaphoid bone is foreshortened. How must this projection be modified to produce a more diagnostic image of the scaphoid.
central ray angled 15-degrees proximally
A radiograph of an AP elbow projection shows the considerable superimposition between the proximal radius and ulna. Which positioning error is involved?
elbow rotated medially
A routine radiograph of an AP oblique elbow with lateral rotation shows that the radial tuberosity is superimposed on the ulna. In what way must this position be modified during the repeat exposure.
increase the lateral rotation of the elbow to separate the radius from the ulna
A radiograph of a lateral projection of the elbow shows that the humeral epicondyles are not superimposed and the trochlear notch is not clearly demonstrated. Which specific type of positioning error is involved
the forearm and humerus are not on the same horizontal plane
A patient with a possible fracture of the radial head enters the emergency room. When the technologist attempts to place the arm in the AP oblique-lateral rotation position, the patient is unable to extend or rotate the elbow laterally. Which other positions can be used to demonstrate the radial head and neck without superimposition of the proximal ulna?
Coyle method for radial head (lateral elbow, CR 45-degrees toward shoulder)
A patient with a trauma injury enters the ER with an evident Colles fracture. Which positioning routine should be used to determine the extent of the injury
AP and lateral forearm projections to include the wrist
A patient with a metallic foreign body in the palm of the hand enters the emergency room. Which specific positions should be used to locate the foreign body
PA and lateral-in extension projections
A patient with a dislocated elbow enters the ER. The patient has the elbow tightly flexed and is careful not to move it. Which specific positioning routine can be used to determine the extent of the injury.
two AP projections with acute flexion and a lateral projection
A patient with a possible fracture of the trapezium enters the ER. The routine projections do not clearly demonstrate a possible fracture. What other special projection can be taken?
Modified Robert Method
A patient with a history of carpal tunnel syndrome comes to radiology department. The orthopedic physician suspects that bony changes in the carpal sulcus may be causing compression of the median nerve. Which special projection best demonstrates this region of the wrist.
Carpal canal position (Gaynor-Hart method)
A patient comes to the radiology department for a hand series to evaluate early evidence of rheumatoid arthritis. Which special position can be used in addition to the routine hand projections to evaluate this patient
AP axial projection (brewerton method)
A patient is referred to radiology with a possible injury to the ulnar collateral ligament. The patient complains of pain near the first MCP joint. Initial radiographs of the hand do not indicate any fracture or dislocation. Which special projection can be performed to rule out an injury to the ulnar collateral ligament
PA Stress (folio method) projection
A patient enters the ER with a possible foreign body in the dorsal aspect of the wrist. Initial wrist radiographs are inconclusive in demonstrating the location of the foreign body. What additional projection can be performed to demonstrate this region of the wrist.
tangential projection (carpal bridge projection)
A patient has a routine elbow series performed. the AP projection indicates a possible deformity or fracture of the coronoid process. However, the patient is unable to pronate the upper limb for the AP oblique medial-rotation projection because of an arthritic condition. WHat other projection could be performed to demonstrate the coronoid process?
trauma axial lateral position - coyle method for coronoid process
How many bones make up the phalanges of the hand
How many bones make up the carpal region
What is the total number of bones that make up the hand and wrist?
joint between the two phalanges of the first digit
joint between the first metacarpal and the proximal phalanx of the thumb
joint between the middle and distal phalanges of the fourth digit
Joint between the carpals and the first metacarpal
joint between the forearm and the carpals
joint with the distal radius and ulna
which carpal contains a "hooklike" process?
Which carpal articulates with the base of the thumb?
Which carpal is most commonly fractured?
Which two carpal bones are located most anteriorly as seen on a lateral wrist radiograph?
scaphoid and trapezium
which bone of the upper limb contains the coronoid process?
where are the coronoid and radial fossas located?
anterior aspect of distal humerus
which two bony landmarks are palpated to assist with positioning the upper limb?
lateral and medial epicondyles
where is the coronoid tubercle located
medial aspect of coronoid process
in an erect position, which of the following structures is considered most inferior or distal?
head of ulna
first carpometacarpal joint
third carpometacarpal joint
T/F to visualize fat pads surrounding the elbow, exposure factors must be aligned to see both bony and soft tissue structures
T/F anterior and posterior fat pads of the elbow are best seen on a correctly positioned and correctly exposed AP elbow projections
why should a forearm never be taken as a PA projection
causes the proximal radius to cross over the ulna
in what position should the hand be for an AP elbow projection
Supinated (palm up)
in what position should the hand be for an AP medial rotation oblique elbow projection
coronoid process in profile
AP, medial oblique elbow
radial head and tuberosity without superimposition
AP, lateral rotation oblique
olecranon process in profile
trochlear notch in profile
capitulum and lateral epicondyle in profile
AP, lateral rotation oblique
olecranon process seated in olecranon fossa
T/F placing multiple images on the same digital IP is recommended as long as close collimation is applied for each projection
the long axis of the anatomic part being imaged should be placed
parallel to the long axis of the IR
Arthrography is a radiographic study of
soft-tissue structures within synovial joints
Accumulated fluid within the joint cavity
a reduction in the quantity of bone or atrophy of skeletal tissue
local or generalized infection of bone or bone marrow
reverse of a colles fracture
inflammation of the fluid-filled sacs enclosing the joints
fracture of the base of the first metacarpal
sprain or tear of the ulnar collateral ligament
painful disorder of hand and wrist from compression of the median resulting nerve
carpal tunnel syndrome
which of the following clinical indications requires a decrease in manual exposure factors?
where is the central ray centered for a PA projection of the second digit
affected PIP joint
why is it important to keep the long axis of the digit parallel to the IR
to reduce distortion of the phalanges; to visualize joints properly; to demonstrate small fractures (all of the above)
where is the central ray placed for a PA projection of the hand
third MCP joint
what is a major disadvantage of performing a PA projection of the thumb rather than an AP
what type of fracture is best demonstrated with a modified robert method
T/F the Brewerton method requires a CR angle of 15-degrees proximal
T/F the hand(s) is(are) placed in a true PA position when using the brewerton method
choose the best set of exposure factors for the upper limb radiography
64 kVp, 200 mA, 1/20 second, small focal spot, and 40 inch SID
A radiograph of a Pa oblique of the hand shows that the third, fourth, and fifth, metacarpals are superimposed. WHat must be done to correct this positioning problem on the repeat exposure
decrease obliquity of the hand
A radiograph of an AP elbow projection demonstrates total separation between the proximal radius and ulna. What must be done to correct this positioning error on the repeat exposure
rotate upper limb medially
A radiograph of the carpal canal (inferosuperior) projection shows that the pisiform and hamulus are superimposed. What can be done to correct this on the repeat exposure?
rotate wrist laterally 5-10 degrees
A radiograph of an AP oblique-medial rotation shows that the coronoid process is not in profile and the radial head is not superimposed over the ulna. What specific positioning error was involved?
insufficient medial rotation
A radiograph of a lateral projection of the elbow shows that the epicondyles are not superimposed and the trochlear notch is not clearly seen. What must be done to correct this positioning error during the repeat exposure?
Place humerus/forearm in the same horizontal plane
A patient with a possible barton fracture enters the emergency room. Which positioning routine should be performed to confirm the diagnosis?
A patient with a possible smith fracture enters the emergency room. Which positioning routine should be performed to confirm diagnosis?
A patient has a Colles fracture reduced, and a large plaster cast is placed on the upper limb. The orthopedic surgeon orders a post-reduction study. The original technique, used before the cast placement, involved 60 kVp and 5 mAs. How should the exposure factors be altered with a large plaster cast?
A pediatric patient with a possible radial head fracture is brought into the emergency room. It is too painful for the patient to extend the elbow beyond 90-degrees or to rotate the hand. What type of special projection could be performed on this patient to confirm the diagnosis without causing further discomfort.