week 8: upper extremity

Question 1

display these as if the patient were hanging from the fingertips

Answer 1

finger, wrist, and forearm

Question 2

display these as if they were hanging from the shoulder

Answer 2

elbow, humerus

Question 3

what determines whether you use table top versus bucky?

Answer 3

grids not used when anatomic part is less than 10cm (4 inches) and less than 60 kVp is needed = tabletop

over 10cm and greater than 60 kVp = bucky

Question 4

non-bucky table top exams

Answer 4

fingers
hand
wrist
forearm
elbow

Question 5

gray scale for extremity work = ____________

Answer 5

high contrast, sharp definition

Question 6

no gown for these exams

Answer 6

fingers, hands, wrist

Question 7

maybe a gown for these exams

Answer 7

forearm, humerus, shoulder girdle

Question 8

what is to note about seating the patient for a table top exam?

Answer 8

“Oblique” their body so primary beam is not directed at their lap

Question 9

for upper extremity work, patients need __________

Answer 9

to have gonadal shielding

Question 10

what does PIP joint stand for?

Answer 10

proximal interphalangeal joint

Question 11

what type of rotation do you have the patient preform for oblique finger digits 3-5?

Answer 11

lateral rotation

Question 11

why is medial rotation preferred for 2nd digit oblique finger XR?

Answer 11

keeping the anatomy of interest closer to the IR

Question 12

what type of rotation do you have the patient preform for oblique finger digit 2?

Answer 12

medial rotation

Question 13

Finger: Lateral projections for which digits?

Answer 13

2nd digit = mediolateral projection
3-5th = lateromedial projection

Question 14

how to determine a true lateral on lateral finger XR?

Answer 14

one side (posterior) straight, one side (palmar) on concave

Question 15

routine projections for finger

Answer 15

PA, oblique, lateral

Question 16

routine projections for thumb

Answer 16

AP, PA oblique, lateral

Question 17

what type of joint is the thumb

Answer 17

saddle

Question 18

where is the CR centered for thumb exams?

Answer 18

first MCP joint

Question 19

where is the CR centered for PA oblique projection of hand?

Answer 19

third MCP joint

Question 20

where is the CR centered for PA projection of hand?

Answer 20

third MCP joint

Question 21

where is the CR centered for fan lateral/lateral in extension of hand?

Answer 21

second MCP joint

Question 22

where is the CR centered for PA and AP projection of the wrist?

Answer 22

midcarpal area

Question 23

where is the CR centered for a PA oblique projection of wrist?

Answer 23

midcarpal area

Question 24

where is the CR centered for a lateromedial projection of the wrist?

Answer 24

midcarpal area

Question 25

where is the CR centered for a PA projection with ulnar deviation of the wrist?

Answer 25

scaphoid, angled 10-15 degrees proximally

Question 26

where is the CR centered for a PA projection with radial deviation of the wrist?

Answer 26

midcarpal aera

Question 27

what does MCP joint stand for?

Answer 27

metacarpophalangeal joint

Question 28

what is another name for scaphoid bone?

Answer 28

navicular bone

Question 29

what does ulnar deviation "move"?

Answer 29

scaphoid

Question 30

what does radial deviation "move"?

Answer 30

lunate, triquetrum, pisiform, and hamate

Question 31

what are the proximal row carpal bones, moving from radius to ulna (lateral to medial in anatomical position)

Answer 31

scaphoid, lunate, triquetrum, pisiform

Question 32

what are the distal row carpal bones, moving from radius to ulna (lateral to medial in anatomical position)

Answer 32

trapezium, trapezoid, capitate, hamate

Question 33

for wrist x-rays, the elbow and the wrist need to be ______________

Answer 33

on the same plane (not necessarily same position)

Question 34

Ulna “out” anteriorly for a lateral wrist x-ray means you have ________ the hand

Answer 34

supinated

Question 35

Radius “out” anteriorly for a lateral wrist x-ray means you have ________ the hand

Answer 35

pronated

Question 36

for forearm and elbow x-rays, ________________ are all in same plane

Answer 36

shoulder, elbow, wrist

Question 37

does the radius cross over the ulna, or does the ulna cross over the radius?

Answer 37

radius crosses over the ulna

Question 38

AP forearm with hand pronated is _______ because _____________

Answer 38

incorrect, radius crosses over the ulna

Question 39

where is the CR center for AP forearm and lateromedial forearms? any CR angulation?

Answer 39

mid-forearm area, 0 angulation

Question 40

how much of carpal bones/humerus are needed to be shown in forearm x-rays?

Answer 40

⅓ distal humerus ⅓ proximal carpal bones

Question 41

Olecranon process is on the ______

Answer 41

proximal end of the ulna

Question 42

where does the CR enter for an AP elbow?

Answer 42

mid-elbow joint (a point approx. 3/4 inch distal to midpoint of a line between epicondyles), 0 angulation

Question 43

where does the CR enter for a lateral elbow?

Answer 43

mid-elbow joint (a point approx. 1 1/2 inches medial to easily palpated posterior surface of olecranon process)

Question 44

what are the "three concentric arcs" of the lateral elbow?

Answer 44

trochlear sulcus outer ridges of capitulum and trochlea trochlear notch of ulna

Question 45

how many fat pads are of note in a lateral elbow? what are they?

Answer 45

3 anterior fat pad supinator fat pad posterior fat pad within olecranon process

Question 46

this view of the elbow best visualizes radial head and neck of the radius and capitulum of humerus

Answer 46

AP oblique projection lateral (external) rotation

Question 47

this view of the elbow that best visualizes coronoid process of ulna and trochlea in profile

Answer 47

AP oblique projection medial (internal) rotation

Question 48

the AP oblique projection of elbow with medial (internal) rotation best demonstrates _________________

Answer 48

coronoid process of ulna, trochlea in profile

Question 49

the AP oblique projection of elbow with lateral (external) rotation best demonstrates _________________

Answer 49

radial head and neck of the radius and capitulum of humerus

Question 50

for thumbs and fingers, raise ___________________

Answer 50

IR so forearm and hand are on same plane

Question 51

what is another name for wrist ulnar deviation?

Answer 51

"scaphoid view"

Question 52

which lateral hand projection is preferred for the hand if phalanges are the area of interest?

Answer 52

fan lateral

Question 53

Which lateral hand projection is preferred if localization of a metallic foreign body in the palm of the hand is of interest (best demonstrates the metacarpals)?

Answer 53

lateral in extension

Question 54

Hand x-rays _________ is best for demonstrating metacarpals; _________ is best for demonstrating phalanges

Answer 54

lateral in extension = metacarpals fan lateral = phalanges

Question 55

the 2nd through 5th CMC joints are _______ joints, which allow the ___________

Answer 55

plane (gliding)-type joints, least amount of movement of the synovial joints

Question 56

in a PA oblique wrist x-ray, ___________ should be well visualized with _____________ on their _____ aspects

Answer 56

trapezium and scaphoid, only slight superimposition of other carpals, medial

Question 57

in a PA wrist x-ray, all intercarpal spaces (do/do not) appear open. what is the reasoning behind this?

Answer 57

do not, irregular shapes that result in overlapping

Question 58

External finger rotation = if anterior surface is rotated towards ______________________

Answer 58

thumb

Question 59

Internal finger rotation = ______________

Answer 59

thumb prevents this movement

Question 60

For a PA finger, if patient cannot extend fingers, _________________ can help visualize phalanxes and joint spaces

Answer 60

switching to an AP projection