Chapter 4: Forearm and Humerus Flashcards by Jennifer Gonzalez

In an AP forearm how are the epicondyles

The medial and lateral epicondyles should be parallel to the IR and in profile at extreme medial and lateral edges of distal humerus

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What are two other things that should be in profile for the AP forearm

The radial styloid should be in profile when arm is extended
- the radial tuberosity should be in profile medially

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In an AP forearm how is the radial head

The radial head is in a slight superimposition over the lateral aspect of the ulna by about 1/4 inch

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When doing the AP forearm we should use the anode heel effect what body part should be at which side

the wrist should be at the anode
- the elbow should be at the cathode side

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distal forearm rotation occurs from

inaccurate positioning of the hand and wrist

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For an AP forearm what should be included in the x-ray

Both joints on IR. The IR should extend one inch beyond the wrist and elbow
- make sure to get bases of metacarpals
- carpal bones
- elbow joint

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What joint is partially or completely closed in an AP forearm

An partial or completely closed capitulum -radial joint due to the divergence of the beam not centered over the joint

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How do you now you have rotation in AP forearm

the radial styloid is no longer in profile 1/4 inch
distal radius and ulna and MCP bases are superimposed
MCP are not equal

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In an internal rotation of the AP forearm what happens and what is being demonstrated

the MCP’s of the 1st and 2nd are superimposed.
- pisiform and hamate hook are better demonstrated

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pisiform and hamate are better demonstrate what kind of rotation for AP forearm

internal rotation ( medial rotation) hand turned in

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In an external rotation of the AP forearm what happens

the 4th and 5th MCP’s are superimposed

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In a medially rotated ( internal rotation) of the forearm what will be shown

the radial head is demonstrated more or less than 1/4 superimposition on ulna
- when more than 1/4 of the head is over the ulna

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proximal forearm rotation occurs from

poorly positioned humeral epicondyles

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Pt with known or suspected fractures of the forearm what should you do if they are unable to place arm in position

position the area closest to the fracture in a true position ap

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In a externally rotated ( lateral rotation) of the forearm what will be shown

less than 1/4 of the radial head superimposition is over ulna

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In a medial rotation of the forearm

epicondyles are not parallel
pisiform is out
superimposition of the 1st, 2nd, 3rd

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due to the divergence of the x-ray beam what joint space is open in the AP forearm when the central ray is at mid forearm

the radioscaphoid and the radiolunate joint spaces are open

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when you center at midshaft for the AP forearm what joint is closed and open

open wrist joint
closes off elbow joint

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how much of each joint should be on the image for a lateral forearm

IR long enough to extend one inch beyond both the wrist and elbow joint

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where is the most common place for avulsion fracture (hyperextending of the wrist)

ulnar styloid process

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What is in profile for the lateral forearm

ulnar styloid is in profile

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how should the elbow, humerus, hand, and wrist be positioned for a lateral forearm

elbow at 90 degrees, elbow, hand, wrist, in a lateral position
- humerus in the same horizontal plane

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In a lateral forearm how is the distal scaphoid

the distal scaphoid is slightly distal to the pisiform and anterior to the capitate and lunate

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where can you see fluid build up, effusion or fractures

pronator, supinator, or anterior fat pad

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where is the most common to cut off in an lateral forearm

back of the olecranon process

In a lateral forearm what joint space is open due to the divergence of the beam

elbow joint is open

in a lateral forearm what is true lateral

the wrist and thumb are true lateral bring thumb down to the 2nd to not obscure trapezium

why should elbow be at 90 degrees for lateral forearm

to demonstrate a good anterior fat pad

in a lateral forearm what are the soft tissues of interest

anterior, posterior, supinator fat stripe at the elbow

if there is less or more than 90 degrees flexion of the elbow in a lateral forearm what happens

the anterior fat pad is distorted

anterior fat pad is with

radial head fractures

the pronator fat stripe is located

anterior surface of the distal radius

in a lateral forearm if the anterior fat pad does not look like a tear drop what happens

there is a possible indication of a radial head fractured

how is the posterior fat pad if there is an injury in a lateral forearm

you will see it in the extreme lateral edge

The posterior fat pad is pushed out with injury, what does it do to the olecranon

pushing proximal and posterior to the olecranon process

how is the posterior fat pad if its not injured in a lateral forearm

it goes into the olecranon and you wont see it

what is not in profile for a lateral forearm

the radial tuberosity is not in profile

in an external rotation (supinated) of the distal forearm wrist rotation

the pisiform will be anterior to the distal scaphoid - ulna appears anterior to the radius - radius posterior to the ulna

if the hand is pronated for a forearm, how is the distal scaphoid (medial rotation)

the distal scaphoid is anterior to the pisiform and the radius is anterior to the ulna

if the elbow is still lateral

the radial tuberosity is facing anteriorly

radial tuberosity facing medially in what projection

AP forearm

poor elbow placement

can displace the fat pads

in external rotation what happens to pisiform

push pisiform out, becoming more anterior

for a lateral forearm if the proximal forearm is elevated what happens to the capitulum and trochlea

capitulum - too far anteriorly medial trochlea- too posteriorly which closes off the elbow joint space

what is connected to the radial head

the capitulum

Poor humeral position in a lateral forearm results in

in the capitulum and medial trochlea misalignment and also the radial head and coronoid process

when the proximal humerus ( shoulder) is elevated not in the same plane

The radial head is positioned posterior to the coronoid process

if the proximal humerus is depressed

the radial head is positioned anterior to the coronoid process

in a lateral forearm how are the epicondyles

epicondyles are perpendicular

how are the medial and lateral humeral epicondyles in a AP humerus

Medial and lateral humeral epicondyles are in profile ( parallel with the IR

In an AP humerus how is the radial head

the radial head and tuberosity are superimposed over the lateral aspect of the proximal ulna 1/4 inch

What is demonstrated in profile for the AP humerus

the greater tubercle is demonstrated in profile laterally

thumbs follows what

the greater tubercle

what is demonstrated in medial profile in an AP humerus

humeral head is demonstrated in medial profile

what is visible halfway between greater tubercle and humeral head

Vertical cortical margin of lesser tubercle

how is the radial tuberosity when the hand is supinated in AP humerus

medially

what is superimposed over the glenoid fossa in AP humerus

head superimposed over glenoid fossa

what is a result of poor humeral epicondyle positioning

rotation of humerus

how to determine the amount of rotation needed by in an AP humerus

by looking at the radial tuberosity superimposition over the ulna

how is the radial tuberosity when the hand is supinated in AP humerus

radial tuberosity is facing medially

if less than 1/4 of radial tuberosity off ulna what kind of rotation it is for the AP humerus

excessive external (laterally)

if there is more than 1/4 inch of radial tuberosity is shown on ulna , how is the rotation

the elbow and humerus has been medially rotated (internally)

what can excessive rotating due of there is a fracture of the humerus

forearm should not be externally rotated excessively , this may cause an increase risk of radial nerve damage

what should you do if there is a suspected fracture of the humerus you can't externally rotate the humerus

move the whole body

how should you position someone with an injury that is unable to move

Joint closest to the injury should be aligned in the true AP position

what is in profile for a mediolateral humerus

the lesser tubercle is in profile medially

What is superimposed in a mediolateral humerus

humeral head and greater tubercle are superimposed

in a mediolateral humerus how is the radial head

the radial head is demonstrated anterior to the coronoid process

what else is in profile for a mediolateral humerus

the radial tuberosity is in profile

how are the epicondyles in the mediolateral humerus

the epicondyles are perpendicular to IR

which lateral of the humerus decreases distortion

mediolateral humerus

what is seen better in a mediolateral humerus

the radial tuberosity or radial head is seen better

what is seen better in a lateromedial humerus

the coronoid process is better seen

what happens when there is over rotation of the mediolateral projection of the humerus ( no longer in a PA position)

This would cause a decrease in density of the proximal humerus compared to the distal humerus - you won't see the proximal humerus

how are the epicondyles in a lateromedial humerus

epicondyles are perpendicular to IR

for a good lateral elbow in a lateral humerus how should the hand be

hand turned up

in a lateralomedial projection what is superimposed

the radial head and coronoid process are superimposed

what is not in profile no more in a lateromedial humerus

the radial tuberosity is no longer in profile

in a lateromedial projection how is the capitulum

the capitulum is visible distal to the medial trochlea

for a fracture of the proximal humerus what two projections can you do

- scapular y - transthoracic lateral

use a 3 second breathing technique, proximal humerus is halfway between the sternum and the thoracic vertebrae

Transthoracic lateral position

why do we do a bluring technique for a transthoracic lateral position

it shows fracture and dislocation - to blur ribs and lungs

Chapter 4: Forearm and Humerus Flashcards

(82 cards)