Ch 4 Upper Limb; Flash Cards

Question 1

What are the four main groups of the upper limb?

Answer 1

1- hand & wrist
2- forearm
3-arm (humerus)
4- shoulder girdle

Question 2

How many bones are in each hand & wrist?

Answer 2

27 bones

Question 3

What are the three groups the hand & wrist are divided into? & how many bones in each group?

Answer 3

1- phalanges (fingers & thumb) ; 14 bones
2- metacarpals (palm) ; 5 bones
3- carpals (wrist) ; 8 bones

Question 4

What are the joints of the hand?

Answer 4

1- Interphalangeal (IP) Joint
2- Metacarpophalangeal (MCP) Joint
3-Carpometacarpal (CMC( Joint
4- Distal Interphalangeal (DIP) Joint
5- Proximal Interphalangeal (PIP) Joint

Question 5

Where is the interphalangeal (IP) Joint located?

Answer 5

The thumb between the two phalanges

Question 6

Where is the first Metacarpophalageal (MCP) Joint located?

Answer 6

This joint is located between the first metacarpal and the proximal phalanx of the thumb

Question 7

Where is the Distal Interphalangeal (DIP) Joint located?

Answer 7

starting from the most distal portion of each digit.

Question 8

Where is the Proximal Interphalageal (PIP) Joint located?

Answer 8

these are after the DIP joint

Question 9

Where is the Carpometacatpal (CMC) Joint located?

Answer 9

these are at the proximal end. the metacarpals articulate with the respective carpals.

Question 10

What are the five metacarpals that articulate with specific carpals?

Answer 10

1. first metacarpal with trapezium
2. second metacarpal with trapezoid
3. third metacarpal with capitate
   4/5. fourth and fifth metacarpal with hamate

Question 11

What are the two rows of carpals?

Answer 11

1. Proximal Row
2. Distal Row

Question 12

What bones consists of the Proximal Row of the wrist?

Answer 12

1- Scaphoid ; first & is on thumb side
2- Lunate; second carpal. it is moon shaped
3. Triquetrum; third. distinguished by its pyramidal shape
4. Pisiform; fourth & is pea shaped. it is the smallest

Question 13

What bones consists of the Distal Row of the wrist?

Answer 13

1. Trapezium; first & on the thumb side
2. Trapezoid; second and is the smallest in the distal row
3. Capitate; third & it a large bone
4. Hamate; the last carpals in the distal row . it is easily distinguished by the hooklike process.

Question 14

What two bones are in the forearm?

Answer 14

1. Radius
2. Ulna

Question 15

Describe what sides the Radius & Ulna are on.

Answer 15

1. Radius is lateral, or thumb side
2. Ulna is on the medial side

Question 16

What joints do the radius & the unla use to articulate with each other?

Answer 16

1. the proximal radioulnar joint
2. the distal radioulnar joint

Question 17

What do the proximal & distal radioulnar joints allow for the radius & ulna to do?

Answer 17

these joints allow for the rotational movement of the wrist and hand.

Question 18

What is a True Lateral Elbow?

Answer 18

A true lateral elbow is an accurate lateral with 90 degree flexion along with possible associated visualization of fat pads.

Question 19

What are the three concentric arcs you should see in a true lateral elbow radiograph?

Answer 19

1. Trochlear Sulcus (the smallest)
2. an intermediate arc that appears double lined as the outer ridges or rounded edges of the capitulum and trochlea
3. the trochlear notch of the ulna is the third arc.

Question 20

Why is it important to evaluate the far pads in a radiograph?

Answer 20

Because in some cases displacement of an adjoining fat pad or band may be the only indication of disease or significant injury or fracture within a joint region

Question 21

Name the two important fat stripes in the wrist

Answer 21

1. Scaphoid fat stripe
2. Pronator fat stripe

Question 22

Name the three significant fat pads/stripes of the elbow

Answer 22

1. Anterior fat pad
2. Posterior fat pad
3. Supinator fat stripe

Question 23

How are ambulatory patients generally positioned for a radiograph of the upper limb?

Answer 23

the patient is seated sideways at the end of the table, in a position that is neither strained nor uncomfortable

Question 24

What is the common minimum SID (source to image distance) for upper limb radiographs?

Answer 24

the common minimum SID is 40 to 44 inches

Question 25

What are the principal exposure factors for Radiography of the upper limbs?

Answer 25

1. lower to medium kVp (60 to 80) 2. short exposure time 3. small focal spot 4. adequate mAs for sufficent density (brightness)

Question 26

Are grids generally used for upper limb examinations?

Answer 26

No, they are not unless the body part measures greater than 10 cm

Question 27

What is the most common radiographic examination for bursitis & what does it show?

Answer 27

AP and lateral joint. It will show fluid-filled joint space with possible calcification

Question 28

What are the most common radiographic examination for carpal tunnel syndrome & what does it show?

Answer 28

PA and lateral wrist. this will show possible calcification in carpal sulcus, enlargement of wrist ligaments and median nerve compression

Question 29

What is the most common radiographic examination for fractures & what does it show?

Answer 29

AP and lateral of long bones; AP, lateral and oblique if the joint is involved. It will so disruption in bony cortex with soft tissue swelling

Question 30

Explain the part position for a PA Projection on Fingers

Answer 30

- pronate hand with fingers extended -center and align long axis of affected finger with long axis of IR -separate adjoining fingers from affected finger

Question 31

What is the central ray position for the PA Projection for Fingers

Answer 31

the CR is perpendicular to the IR, directed to the PIP joint

Question 32

what anatomy is demonstrated in a PA Projection (Fingers)

Answer 32

the anatomy demonstrated is the Distal, middle, and proximal phalanges, distal metacarpals, and the associated joints.

Question 33

What is the part position for PA Oblique Projection- Medial or Lateral Rotation for fingers?

Answer 33

-with fingers extended against 45 degree foam wedge block, place hand in a 45 degree lateral oblique (thumb side up) -position hand on IR so that the long axis of the finger is aligned with the long axis of the IR -separate fingers and carefully place finger that is being examined against block, so it is supported in a 45 degree oblique and parallel to IR

Question 34

what is the central ray for a PA Oblique projection; medial or lateral rotation-fingers?

Answer 34

the central ray is perpendicular to IR, & directed to the PIP joint

Question 35

what is the anatomy demonstrated for a PA Oblique projection; medial or lateral rotation-fingers?

Answer 35

the anatomy demonstrated is the oblique view of distal, middle, and proximal phalanges along with the distal metacarpals and associated joints

Question 36

what are the clinical indications for a lateromedial/mediolateral projections of the finger?

Answer 36

-fractures and dislocations of the distal, middle, and proximal phalanges, distal metacarpals and associated joints -pathologic processes, such as osteoporosis and osteoarthritis

Question 37

how is the patient positioned for a lateromedial/mediolateral projections of the finger?

Answer 37

the patient is seated at the end of the table, with elbow flexed about 90 degrees with hand and wrist resting on IR and fingers extended

Question 38

what anatomy is demonstrated on a lateromedial/mediolateral projections of the finger?

Answer 38

the anatomy demonstrated is the lateral views of distal, middle, and proximal phalanges, along with distal metacarpals and associated joints are visible

Question 39

what is the IR Size for an AP Projection of the Thumb

Answer 39

the IR Size is 8 x 10 inches (18 x 24 cm), portrait

Question 40

what is the central ray for an AP Projection of the thumb?

Answer 40

the central ray is perpendicular to the IR, to first MCP joint

Question 41

what is the part position for a PA hand?

Answer 41

-pronate hand with palmar surface in contact with IR; spread fingers slightly -align long axis of hand and forearm with long axis of IR -center hand and wrist to IR

Question 42

what is the part position for a PA oblique projection of the hand?

Answer 42

-pronate hand on IR; center and align long axis of hand with long axis of IR -rotate entire hand and wrist laterally 45 degrees and support with radiolucent wedge or step block so that all digits are separated and parallel to IR

Question 43

what is the central ray for a "FAN" lateral/lateromedial projection of the hand?

Answer 43

the central ray is perpendicular to IR, directed to second MCP joint

Question 44

What projections are alternatives for the Fan Lateral projection?

Answer 44

the alternatives are lateral in extension and flexion

Question 45

what is the part position for a PA (AP) Projections of the wrist?

Answer 45

-align and center long axis of hand and wrist to IR, with carpal area centered to CR -with hand pronated, arch hand slightly to place wrist and carpal area in close contact with IR

Question 46

How should you collimate for a PA (AP) Projection of the wrist?

Answer 46

you should collimate to wrist on all four sides; include distal radius and ulna and midmetacarpal are

Question 47

What are the clinical Indications for a Lateromedial Projection of the wrist?

Answer 47

the clinical indications are -fractures or dislocations of the distal radius or ulna, specifically anteroposterior fragment displacements for Barton, Colles, or Smith fractures -osteoarthritis also may be demonstrated primarily in the trapezium and first CMC joint

Question 48

what is the central ray for a PA and PA Axial Scaphoid with Ulnar Deviation of the Wrist?

Answer 48

the central ray is -angle CR 10 degree to 15 degrees proximally, along long axis of forearm and toward elbow -center CR to scaphoid

Question 49

What are the clinical indications for Carpal Canal (Tunnel)- Tangential, Inferosuperior Projection of the wrist?

Answer 49

the clinical indications are -rule out abnormal calcification and bony changes in the carpal sulcus that may impinge on the median nerve, as with carpal tunnel syndrome -possible fractures of the hamulus process of the hamate, pisiform, and trapezium

Question 50

how should you collimate for an AP Projection of the Forearm?

Answer 50

collimate lateral borders to actual forearm area with minimal collimation at both ends to avoid excluding anatomy at either joint. considering divergence of the x-ray beam, ensure that a minimum of 1 to 1.5 inches distal to wrist and elbow joints is included on IR