How many total bones are in the hand? Phalanges? Metacarpals? Carpals?
- 27 total
- 14 phalanges
- 5 metacarpals
- 8 carpals
Label the joints.
- A. distal interphalangeal joint
- B. proximal interphalangeal joint
- C. Metacarpophalangeal joint
- D. Interphalangeal joint
- E. Metacarpophalangeal joint
- F. carpometacarpal joint
- G. radiocarpal joint
What are the secondary names for the Scaphoid, Lunate, Triquetrum, and Pisiform?
- Triangular or cuneiform
- (no secondary name)
What are the secondary names for the Trapezium, Trapezoid, Capitate, and Hamate?
- Greater Multangular
- Lesser Multangular
- Os Magnum
Label the carpal bones.
- A. Scaphoid
- B. Lunate
- C. Triquetrum
- D. Pisiform
- E. Trapezium
- F. Trapezoid
- G. Capitate
- H. Hamate
- (Remember: Steve Left The Party To Take Carol Home!)
What are the largest and smallest carpal bones?
- largest: Capitate
- smallest: Pisiform
What is the most commonly fractured carpal bone?
Which carpal bone forms the saddle joint?
Which forearm bone is directly involved with the wrist joint?
Which forearm bone is directly involved with the elbow joint?
The styloid process of which bone of the forearm is more palpatable?
What are the two beak-like processes of the ulna?
- Olecranon process
- Coronoid process
In a true lateral position, the epicondyles of the radius and ulna are:
What are the two anterior depressions of the distal humerus?
- coronoid fossa
- radial fossa
What is the name of the posterior depression of the distal humerus?
What classification and movement type do the joints of the hand, wrist, forearm, and elbow have?
- diarthrodial (freely moveable)
When the patient has a large, wet plaster cast, you should increase the kVp by:
10 kv or double the mAs
When the patient has a synthetic or fiberglass cast, you should up the kVp by:
When x-raying an upper extremity, when is a grid needed?
When part thickness is 10 cm or greater
In the PA, oblique, and lateral projections of a digit, where should the CR be centered?
to the PIP joint
What are two other names for the pinky side of the arm?
What are two other names for the thumb side of the arm?
Will the lateral projection of the 2nd digit be a lateromedial or mediolateral projection?
Will the lateral projections of the 3rd-5th digits be lateromedial or mediolateral projections?
In the AP, PA oblique, and Lateral projections of the thumb, where is the CR centered?
1st MCP joint
What is a fracture at the bast of the first metacarpal?
Bennet's fracture (most common thumb fracture)
Why is the Robert's Method (modified AP thumb) generally used?
to demonstrate a Bennett's fracture or a dislocation of the thumb
For the Robert's Method of the thumb, where is the CR centered?
1st CMC joint
What are three modifications of the AP thumb projection?
- Robert Method
- Lewis modification
- Long and Rafert modification
For the PA, and oblique projections of the hand, where should the CR be centered?
3rd MCP joint
For the fan lateral projection of the hand, where should the CR be centered?
2nd MCP joint
What is a Boxer's fracture?
Fracture of a metacarpal neck (usually 4th and 5th metacarpals, common with punching)
When would you use the lateral projection of the hand in extension?
to localize foreign bodies or demonstrate a Boxer's fracture.
Describe the AP oblique bilateral projection of the hands. (Norgaard Method)
- both hands on one cassette
- supinate hands and place in the ball catcher's position
- internally rotate hands 45 degrees
- CR directed at mipoint between hands at the level of 5th MCP joints
- mark both left and right hands
For PA, oblique, and lateral projections of the wrist, where should the CR be centered?
For the PA oblique projection of the wrist, which carpal bones are best demonstrated?
the lateral carpals (mainly trapezium and scaphoid)
Which carpal bones are in profile and free of superimposition in a AP oblique projection of the wrist?
triquetrum, hamate, and pisiform
Label the carpal bones.
- A. Capitate
- B. Lunate
- C. Trapezium
- D. Scaphoid
Which carpal bones are projected most anteriorly on the lateral projection of the wrist?
trapezium and scaphoid
In an ulnar deviation of the wrist, where should the CR be centered?
to the scaphoid
What important factor are you looking for on a radiograph of an ulnar deviation?
open articulation all the way around the scaphoid
Which projection is used to best demonstrate the medial carpal bones?
radial deviation (stress movement toward the thumb)
How should the CR be angled and centered for the Stecher Method?
- degrees proximally
- center to the scaphoid
What geometric property will be demonstrated on a Stecher Method of the wrist?
elongation of the carpal bones
What method for the wrist is used to demonstrate the carpal canal?
How should the CR be angled and centered for the Gaynor-Hart method?
- 25-30 degrees to the long axis of the hand
- 1 1/2 inches distal to the base of the 3rd MC
What size cassette should you use for the forearm?
10x12 diagonally or 11x14 lengthwise
Where should the CR be centered for AP and lateral projections of the forearm?
midforearm and halfway between skin margins
How should the hand be positioned for an AP projection of the forearm?
supinated (palm up)
Where should the CR be centered for AP, oblique, and lateral projections of the elbow?
midelbow joint between epicondyles of the humerus
Label the AP elbow
- A. medial epicondyle
- B. olecranon fossa
- C. lateral epicondyle
- D. slight superimposition of the radius and ulna
When is the posterior fat pad visible on a lateral projection of the elbow?
when pathology is present
What is the name of the fat pad that can be seen on the lateral projection of the elbow, anterior to the radius?
Supinator fat stripe
For an AP oblique projection of the elbow with medial rotation, is the hand pronated or supinated?
pronated (palm down)
What process of the elbow is best demonstrated with an AP oblique with internal rotation?
Label the oblique elbow with medial rotation.
- A. olecranon process
- B. olecranon fossa
- C. medial epicondyle
- D. coronoid process
Which two projections should be done on a trauma elbow with acute flexion?
- AP of the distal humerus
- AP of the proximal forearm
Describe the axiolateral projection of the elbow which demonstrates the radial head. (Coil Method)
- pronate the hand
- flex elbow 90 degrees
- direct CR proximally and angle 45 degrees
- center midelbow joint
- (to demonstrate the coronoid: direct CR distally)
For the AP and rotational lateral projections of the humerus, where should the CR be centered?
to the midpoint of the humerus
What size cassette should be used for the humerus?
11x14 or 14x17 lengthwise (long enough to include the entire arm)
What breathing technique is used for projections of the humerus?
With a rotational lateral projection of the humerus, is the arm rotated internally or externally?
What method is used for a transthoracic lateral projection of the humerus?
the Lawrence Method
Which side should be closer to the IR when performing a transthoracic lateral of the humerus?
the injured side.
During a transthoracic lateral of the humerus, should the mid coronal plane of the body be parallel or perpendicular to the IR?
Where should the CR be centered for a transthroacic lateral of the proximal humerus?
the region of the surgical neck
What breathing technique should be used during a transthoracic lateral projection of the proximal humerus?
have the patient take short panting breaths
To utilize motion during a transthoracic lateral projection, what two things should you do?
- have the patient take short panting breaths
- use a long exposure time