Bontrager's Textbook of Radiographic Positioning and Related Anatomy: Chapter 4 upper limb Flashcards


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1

How many phalanges are in the hand?

14

2

How many metacarpals?

5

3

How many carpals?

8

4

How many total bones in the hand?

27

5

The two portions of the thumb(first digit) are the:

proximal; distal

6

The three portions of each finger (second through fifth digits) are the:

proximal;middle;distal

7

The three parts of each phalanx starting distally are the

head;body;base

8

List the three parts of each metacarpal, starting proximally

base;body;head

9

The name of the joint between the proximal and distal phalanges of the first digit is the

interphalangeal joint

10

The joints between the metacarpals and the phalanges are the

metacarpophalangeal joint

11

Which is the largest of the carpal bones?

capitate

12

What is the name of the hooklike process extending anteriorly from the hamate?

hamulus

13

What is the most commonly fractures carpal bone?

scaphoid

14

In the anatomic position, which of the bones of the forearm is located on the lateral (thumb) side? which is on the medial side?

radius;ulna

15

Which joint permits the forearm to rotate during pronation?

proximal radioulnar joint

16

The articular portion of the medial aspect of the distal humerus is called the

trochlea

17

the similar structure found on the lateral aspect of the distal humerus is called the

capitulum

18

the deep depression located on the posterior aspect of the distal humerus is the

olecranon fossa

19

ellipsoidal joints are classified as freely moveable, or ____, and allow for movement in _____ directions

diarthrodial; four

20

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)

D. Scapulolunate

E. Lunotriquetral

true

21

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

22

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

23

of the two positions (radial deviation;ulnar deviation), which is most commonly performed to detect a fracture of the scaphoid bone?

ulnar deviation

24

There are three concentric arcs of the elbow: the first and smallest

trochlear sulcus

25

The intermediate double arc, consisting of the outer ridges of:

the smaller arc: capitulum

the larger arc: trochlea

26

The third arc, which is part of the ulna

trochlear notch of the ulna

27

interphalangeal joint

ginglymus(hinge)

28

carpometacarpal of first joint

saddle

29

elbow joint (humeroulnar or humeroradial)

ellipsoidal

30

metacarpophalangeal joint of 2nd to 5th digits

ellipsoidal

31

intercarpal

plane

32

radiocarpal

ellipsoidal

33

elbow joint

ginglymus

34

proximal radioulnar joint

pivot

35

Ellipsoidal joints are classified as freely moveable, or _______, and allow movement in _______ directions

diarthrodial; four

36

How does the forearm appear radiographically if pronated for a posteroanterior (PA) projection?

the proximal radius crosses over the ulna

37

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

38

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

False (negative)

39

T/F trauma or infection makes the anterior fat pad more difficult to see on a lateral elbow radiograph

False

40

Which routine projections best demonstrate the scaphoid fat pad

posteroanterior and oblique wrist

41

Which routine projection best demonstrates the pronator fat stripe

lateral wrist

42

KVP range upper limb

low to medium (60-80)

43

long or short exposure time upper limb

short exposure time

44

large or small focal spot upper limb

small focal spot

45

most common minimum SID upper limb

40 inches

46

Grids are used if the body part measures greater than

10 cm

47

small-to-medium dry plaster cast increase kvp

5-7

48

large plaster cast increase kvp

8-10

49

fiberglass cast increase kvp

3-4

50

correctly exposed radiographs: visualize _______ margins and ________________ markings of all bones

soft tissue; trabecular

51

The general rule for upper limb radiography states:

collimation borders should be visible on all four sides

52

select all pertinent factors that help reduce image distortion during upper limb radiography

A. kVp

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

B,D,E,F

53

T/F Lead protective shielding is only required for upper limb studies performed on patients who are child age or younger

false

54

T/F guardians of young pediatric patients who are undergoing upper limb studies can be asked to hold their child during the radiographic study

true

55

______ 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

arthrography

56

what is the positioning routine for the 2nd - 5th digits of the hand

PA, PA oblique, Lateral

57

How much of the metacarpals should be included for PA projection of the digits

distal aspect of the metacarpals

58

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

59

Identify which positioning modifications should be used for a study of the second digit to reduce distortion for each of the following:

PA oblique

Lateral position

PA oblique: medial oblique instead of lateral oblique to decrease OID

Lateral: perform a thumb- down lateral (mediolateral) to decrease OID

60

where is the CR placement for a PA oblique projection of the second digit

proximal interphalangeal joint (PIP)

61

The AP axial projection ( Brewerton method) is commonly used to evaluate for early signs of

rheumatoid arthritis

62

the hand is flexed _____ in relation to the IR for the AP axial projection (brewerton method)

65-degrees

63

how much rotation is required for an oblique projection of the wrist

45-degrees

64

which alternative projection to the routine PA wrist best demonstrates the intercarpal joint spaces and wrist joint

anteroposterior projection

65

which positioning error is involved if a majority of the carpal bones are superimposed in a PA oblique wrist

excessive lateral roatation

66

which of the following fractures is not demonstrated in a wrist routine

Pott

67

During the PA axial scaphoid projection with central ray angle and ulnar flexion, the central ray must be angled

10-15 degrees proximally

68

How much are the hand and wrist elevated from the IR for the modified Stretcher method

20-degrees

69

how much central ray angulation to the long axis of the hand is required for the carpal canal (tunnel) projection

25-30 degrees

70

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

71

which special projection of the wrist helps rule out abnormal calcifications in the carpal sulcus

tangential inferosuperior ( gaynor-hart)

72

how much central ray angulation from the long axis of the forearm is required for the carpal bridge (tangential) projection

45-degrees

73

the hand and wrist form a ________ angle to the forearm with the carpal bridge (tangential) projection

90-degree

74

Barton Fracture

fracture and dislocation of the posterior lip of the distal radius

75

Multiple Myeloma

most common type of primary malignant tumor occurring in bone

76

Osteoporosis

reduction in the quantity of bone or atrophy of skeletal tissue

77

Skiers thumb

sprain or tear of the ulnar collateral ligament

78

achondroplasia

an abnormality of the cartilage affecting long bones

79

Boxer's fracture

transverse fracture extending through the distal aspect of the metacarpal neck, most often the 5th metacarpal

80

Osteopetrosis

hereditary condition marked by abnormally dense bone

81

Colles fracture

transverse fracture of the distal radius with posterior displacement of the distal fragment

82

Osteoarthritis

narrowing of joint space with periosteal growths on the joint margins

83

Bursitis

fluid-filled joint space with possible calcification

84

Carpal tunnel syndrome

possible calcification in the carpal sulcus

85

osteomyelitis

soft tissue swelling and loss of fat pad detail visibility

86

osteopetrosis

mixed areas of sclerotic and cortical thickening along with radiolucent lesions

87

advanced paget disease

increase exposure factors

88

joint effusion

keep exposure factors

89

advanced rheumatoid arthritis

decrease exposure factors

90

osteoporosis

decrease exposure factors

91

osteopetrosis

increase exposure factors

92

bursistis

keep exposure factors

93

which routine projections are required for a study of the forearm

AP, lateral

94

T/F for a forearm study, the technologist needs to include only the joint closest to the site of the injury

false

95

to position a patient properly for an AP projection of the elbow, the epicondyles must be ______ to the IR

parallel

96

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

97

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

98

the best position to evaluate the posterior fat pads of the elbow joint

Lateral, flexed 90-degrees

99

which projection of the elbow best demonstrates the coronoid process in profile

AP oblique with medial rotation

100

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)

101

how much is the upper limb rotated for a lateral (rotation) oblique projection of the elbow

45-degrees laterally

102

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

103

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

104

what is the amount of elbow flexion required for the trauma lateral projection (coyle method) to demonstrate the coronoid process

80-degrees of flexion

105

what is the only difference among the four radial head lateral projections of the elbow

rotational position of hand and wrist

106

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

107

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

rotation

108

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

109

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

110

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

111

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

112

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

113

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)

114

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

115

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

116

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

117

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

118

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)

119

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)

120

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

121

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)

122

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

123

How many bones make up the phalanges of the hand

14

124

How many bones make up the carpal region

8

125

What is the total number of bones that make up the hand and wrist?

27

126

joint between the two phalanges of the first digit

Interphalangeal projection

127

joint between the first metacarpal and the proximal phalanx of the thumb

first MCP

128

joint between the middle and distal phalanges of the fourth digit

fourth DIP

129

Joint between the carpals and the first metacarpal

first CMC

130

joint between the forearm and the carpals

radiocarpal

131

joint with the distal radius and ulna

distal radioulnar

132

which carpal contains a "hooklike" process?

hamate

133

Which carpal articulates with the base of the thumb?

trapezium

134

Which carpal is most commonly fractured?

scaphoid

135

Which two carpal bones are located most anteriorly as seen on a lateral wrist radiograph?

scaphoid and trapezium

136

which bone of the upper limb contains the coronoid process?

ulna

137

where are the coronoid and radial fossas located?

anterior aspect of distal humerus

138

which two bony landmarks are palpated to assist with positioning the upper limb?

lateral and medial epicondyles

139

where is the coronoid tubercle located

medial aspect of coronoid process

140

in an erect position, which of the following structures is considered most inferior or distal?

head of ulna

141

intercarpal joints

plane

142

radiocarpal joint

ellipsoidal

143

elbow joint

ginglymus

144

first carpometacarpal joint

saddle

145

third carpometacarpal joint

plane

146

T/F to visualize fat pads surrounding the elbow, exposure factors must be aligned to see both bony and soft tissue structures

true

147

T/F anterior and posterior fat pads of the elbow are best seen on a correctly positioned and correctly exposed AP elbow projections

false

148

why should a forearm never be taken as a PA projection

causes the proximal radius to cross over the ulna

149

in what position should the hand be for an AP elbow projection

Supinated (palm up)

150

in what position should the hand be for an AP medial rotation oblique elbow projection

pronated

151

coronoid process in profile

AP, medial oblique elbow

152

radial head and tuberosity without superimposition

AP, lateral rotation oblique

153

olecranon process in profile

lateral elbow

154

coronoid tubercle

AP elbow

155

trochlear notch in profile

lateral elbow

156

capitulum and lateral epicondyle in profile

AP, lateral rotation oblique

157

olecranon process seated in olecranon fossa

AP elbow

158

T/F placing multiple images on the same digital IP is recommended as long as close collimation is applied for each projection

false

159

the long axis of the anatomic part being imaged should be placed

parallel to the long axis of the IR

160

Arthrography is a radiographic study of

soft-tissue structures within synovial joints

161

Accumulated fluid within the joint cavity

joint effusion

162

a reduction in the quantity of bone or atrophy of skeletal tissue

osteoporosis

163

local or generalized infection of bone or bone marrow

osteomyelitis

164

reverse of a colles fracture

smith fracture

165

inflammation of the fluid-filled sacs enclosing the joints

bursitis

166

fracture of the base of the first metacarpal

bennet fracture

167

sprain or tear of the ulnar collateral ligament

skier's thumb

168

painful disorder of hand and wrist from compression of the median resulting nerve

carpal tunnel syndrome

169

which of the following clinical indications requires a decrease in manual exposure factors?

advanced osteoporosis

170

where is the central ray centered for a PA projection of the second digit

affected PIP joint

171

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)

172

where is the central ray placed for a PA projection of the hand

third MCP joint

173

what is a major disadvantage of performing a PA projection of the thumb rather than an AP

increased OID

174

what type of fracture is best demonstrated with a modified robert method

bennett fracture

175

T/F the Brewerton method requires a CR angle of 15-degrees proximal

true

176

T/F the hand(s) is(are) placed in a true PA position when using the brewerton method

false

177

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

178

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

179

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

180

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

181

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

182

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

183

A patient with a possible barton fracture enters the emergency room. Which positioning routine should be performed to confirm the diagnosis?

wrist

184

A patient with a possible smith fracture enters the emergency room. Which positioning routine should be performed to confirm diagnosis?

wrist/forearm

185

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?

68-70kVp

186

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.

Coyle Method