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how many bones are in the hand and wrist
27
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how many phalanges are in the hand
14
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how many metacarpals are in the hand
5
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how many carpals are in the hand
8
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name the carpal bones
- Scaphoid
- Lunate
- Triquetrum
- Pisiform
- Trapezium
- Trapezoid
- Capitate
- Hamate
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which bone is the shorest in the forearm
the radius is the shorter of the two bones
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what procedure is done while in a modified sims position
Barium enema tip inserion
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what are the two positionig rules or principles
- 1. Minimum of 2 projections
- 2. Minimum of three projections when joint are prime interest area
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what is the radial tuberosity
the rough oval process on the medial and anetior side of the radius, just distal to the neck
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what is the trochlear notch
large concave depression, or notch, that articulates with the distal humerus
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what is the radial notch
the small, shallow depression located on the lateral aspect of the proximal ulna
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what is the humeral chondyle
the expanded distal end of the humerus
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the articular portion of humeral chondyle is divided into 2 parts what are they?
the trochlea and the capitulum
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how is the trochlea shaped and what does it articulate with
it is shapped like a pulley or spool with smooth depression called the trochlear sulcus. it is located laterally and atriculates with the ulna
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where is the capitulum located and what does it articulated with
located on the later aspect of the humerus and it articulates with the head of the radius
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what is the lateral epichondyle
it is a small projection on the lateral aspect of the distal humerus above the capitulum
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what is the medial epichondyle
a larger and more pominent projection thatn the lateral epichondyle and is located on the medial edge of the distal humerus.
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what are the 2 anterior depressions on the humerus
- coronoid fossa
- radial fossa
- As teh elbow is completely flexed, the coronoid process and the radila head are received by these respective fossae
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what is the posterior depression in the distal humerus
the olecranon fossa
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what are the 2 processes of the proximal ulna
the olecranon and the coronoid process
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what is the median margin of the coronoid process
the coronoid tubercle
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waht is the large concave depression, that articulates with the distal end of the humerus on the ulna
the trochlear notch
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waht is the small, shallow depression located on the lateral apect of the proximal ulna
the radial notch
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which bone(s) are best demonstrated during ulnar deviation
the scaphoid
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which bone(s) are best demonstrated during radial deviation
- hamate
- pisiform
- triquetrum
- lunate
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what do you do for a small to medium cast
incrase mAs 50-60% or 5-7 kV
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what do you do for a large plaster cast
increase mAs 100% or 8-10 kV
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what do you do for a fiberglass cast
increase mAs 25-30% or 3-4 kV
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what is bone metastases
transfer of desease or cancerous lesions from one organ of part that may not be derectly connected
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what is bursitis
inflamation of a the bursae of fluid filled sacs that enclose the joints
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what is carpal tunnes syndrome
commonly painful disorder of the wrist and hand that results from compression fo the median nerve as it passes through the center of the wrist
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describe a barton's fracture
a fracture and dislocation of the posterior lip of the distal radius involving the wrist joint
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describe a Bennett's fracture
fracture of the base of the first metacarpal bone, extending into the carpometacarpal joint.
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describe a Boxer's fracture
a transverse fracture htat extends through the metacarpal neck, most commonly seen in the fifth metacarpal.
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describe a Colle's fracture
Transverse fracture of the distal radius in which the distal fragment is displaced posteriorly
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describe a Smith's fracture
reverse of Colle's. a transverese fracture of the distal radius wiht the distal fragment displaced anteriorly
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what is the rotation fo the humeral epichondyles required for an AP medial oblique of elbow
45 degrees
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what is joint effusion
accumulated fluid in the joint cavity. it is a sign of an uderlying condition, such as fracture, dislocation, soft tussue damage, or inflammation
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what is osteoarthritis
degenerative hoint disease, a noninflamatory joint disease charaterized by gradula deterioration of the articular cartilage with hypertrophic (enlarged or overgrown) bone formation. it is the common type of arthritis
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what is osteomyelitis
a local or generalized infection of bone or bone marrow that may be caused by bacteria introduced by trauma or surgery.
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describe a nursemaids elbow
is a dislocation of the elbow joint caused by a sudden pull on the extended pronated arm
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what makes a radiograph a legal document
markers, patient ID, initials and all of the anatomy
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what is the Gaynor Hart method
Gaynor-Hart Method. Canal or tunnel view, a hyperextended wrist that demonstrates the palmar aspect of the carpals
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how should the epichondyles be aligned to IR for a lateral humerus
perpendicular
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what is a dislocation
displacement from joint
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what is a subluxation
partial dislocation
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what is a sprain
rupture or tearing of connective tissue
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what is a contusion
bruise without fracture
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what are some types of fractures
- simple fx
- compund (open) fx
- comminuted fx(spintered or crushed)
- impacted (fragments driven into e/o
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what is a baseball fracture
mallet finger occurs when the outermost joint of the finger is injured
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what is the image criteria for a PA finger
- entire finger and a minimum of 1/3 of MCP demonstrated.
- CR perpendicular to MCP
- must include articulatin carpal
- symetric appearance (no rotation of fingers)
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what is the image criteria for a finger PA oblique
- Entire finger and MCP joint demonstrated
- IP and MCP joints open
- CR perpendicular with MCP
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what is the image criteria for a lateral finger
- entire finger and MCP joint demonstrated
- CR perpendicular to MCP joint
- true lateral position
- digit parallel to IR
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what is the image criteria for an AP thumb
- entire thumb demonstrated (includig articulating carpal)
- CR perpendicular to MCP joint
- no toration of phalanges
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what is the image criteria for a PA oblique thumb
- enrite thumb demonstrated
- joints partially opened (as in 45degree oblique)
- CR perpendicular to MCP joint
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what is the image criteria for a lateral thumb
- entire thumb demonstrated
- CR --> MCP joint
- no rotation from lateral evident
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what is the image criteria for a PA hand
- entire cand and crpals demonstrated
- CR to 3rd MCP joint
- no rotation of phalanges or metacarpals
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what is the image criteria for a hand PA oblique
- entire hand and carpals and 1/3 of distal radius and ulna
- CR--> 3rd MCP joint
- adequate separation fo phalanges and metacarpals
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what is the image criteria for a "fan" lateral
- entire hand and carpals demonstrated
- CR-->2nd MCP joint
- fingers equally separated
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what is the image criteria for a lateral hand
- entire hand and carpals demonstrated
- CR--> 2nd MCP joint
- phalanges and metacarpald supperimposed
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what is the image criteria for a AP oblique bilateral (norgaard method) projection
- bilateral hands in 45 degree oblique position
- midshafts of 2nd - 5th metacarpal and base of phalanges not overlapped
- MCP joints should open
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what is the image criteria for a PA wrist
- distal radius, ulna and carpals demonstrated
- CR--> midcarpal region
- no rotation
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what is the image criteria for a PA oblique wrist
- Distal radius, ulna and carpals demonstrated
- CR--> mid carpal region
- trapezium seen on its entirety
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what is the image criteria for a lateral wrist
- distal radius, ulna and carpals demonstrated
- CR--> midcarpal region
- no rotation
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what is the image criteria for a carpal canal (tangential inferosuperior projection--Gaynor Hart method)
- carpal sulcus is open
- pisiform and hamate are separated
- rounded scaphoid in profile
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what is the image criteria for a carpal bridge (tangential projection) posterior aspect of the wrist
- tangential view of dorsal aspect
- CR--> proximal third metacarpal
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what is the image criteria for a AP forearm
- carpals to distal humerus included
- humeral epichondyles are in profile
- only slight, if any, superimposition fo distal radioulnar joint
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what is the image criteria for a lateral forearm
- carpals and distal humerus included
- elbow flexed 90 degrees
- head of ulna superimposed over radius
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what is the image criteria for an AP elbow
- distal humerus
- proximal radius and ulna
- epichondyles parallel
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if AP cannot be done what is an alternate view
2 partially flexed AP projections
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what is the image criteria for a lateral oblique elbow
- radial head, neck and tuberosity in profile
- lateral epicohdyle and capitulum in profile
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what is the image criteria for a medila oblique elbow
- coronoe process in profile
- trochlea and medila epicondyle in profile
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what is the image criteria for a lateral elbow
- three concentric arcs visible
- olecranon in profile
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the jones method
- PA axial
- acute flexion of the elbow.
- forearm and humerus should be superimposed
- medal and lateral epicondyles and parts of trochlea, capitulum and olecranon process all should be seen in profile
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coyle method
- erect for radial head 90 degrees
- erect for coronoid process 80 degrees
- supine, angled 45 for radial head 90 degrees
- supine, angled 45 for coronoid process flexed 80 degrees
- the joint space between radialhead and capitulum should be open and clear.
- the radial head, neck and tuberosity should be in profile and free of superimposition except for a small part in the coronoid process
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radial head lateral projections
- hand supinated
- hand lateral
- hand pronated
- hand with maximum internal rotation
- elbow should be flexed 90 in true lateral position.
- epicondyles superimposed
- radial head and neck should be partially superimposed by ulna
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which projection/routine would best demonstrate a Bennets fracture
hand study
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which projection would best demonstrate a possible evevated fat pad near the elbow joint
lateral
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where is the CR centered for a PA projectin of 2nd digit
MCP joint
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what type of CR angle ir required for the modified roberts method
15 degrees proximal
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what is a modified roberts method
- AP projection of thumb
- CR--> directed 15 degrees proximally, entering at the first CMC joint
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what is diagnosed most often with the folio method
ulnar collateral ligament injury (skier's fx)
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what is the folio method
- position hands side by side to center of cassette, rotated laterally into +- 45 oblique position, resulting in true PA projections of both thumbs
- place round spacer between proximal thumb region and rubber band around distal thumbs
- -- image criteria show entire thumbs from first metacarpals to distal phalanges.
- demonstrates MCP angles and joint spaces at MCP joints
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what is the image criteria for an AP humerus projection
- entire humerus is demonstrated
- greater tubercle in profile
- medial and lateral epicondyles in profile
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what is the image criteria for a lateromedila and medolateral humerus projection
- epicondyles perpenducular to CR
- CR to mid humerus
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what is the image criteria for a lateral humerus - recumbent
- entire humerus demonstrated
- lesser tubercle in profile
- epicondyles superimposed
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lwhat is the image criteria for a lateral mid and distal humerus trauma position
- mid and distal humerus
- distal 2/3 of humerus demonstrated
- 90 degree perspective from AP projection
- Epicondyles superimposed
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what is the image criteria for a horizontal beam transthoracic lateral humerus (tauma)
- demonstrates entire humerus without rotation
- unaffected limb raised over head
- CR to mid aspect of humerus
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what is the image criteria for a transthoracic lateral -proximal humerus
- proximal humerus clearly seen
- humeral head and glenoid cavity seen
- humeral head in neutral rotation
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positions, central ray, film size and distance for a thumb
AP- perpendicular to MCP joint 8x10 40"tabletop
OBL-perpendicular to MCP joint 8x10 40"tabletop
LAT- perpendicular to MCP joint 8x10 40"tabletop
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positions, central ray, film size and distance for 2nd - 5th digits
PA - perpendicular to MCP joint to include articulating carpal, 8x10, 40" tabletop
OBL- perpendicular to MCP joint to include articulating carpal, 8x10, 40" tabletop
LAT-perpendicular to MCP joint to include articulating carpal, 8x10, 40" tabletop
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positions, central ray, film size and distance for a hand
PA- perpendicular to 3rd MCP joint, 10x12, 40" tabletop
OBL- perpendicular to 3rd MCP joint, 10x12, 40" tabletop
LAT- perpendicular to 3rd MCP joint, 8x10, 40" tabletop
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positions, central ray, film size and distance for a wrist
PA- perpendicular to mid-carpal area, 10x12, 40" tabletop
OBL-perpendicular to mid-carpal area, 10x12, 40" tabletop
LAT-perpendicular to mid-carpal area, 10x12, 40" tabletop
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positions, CR, film size and distance for the carpal bones
PA - stecher for semi-supine, perpendicular to navicular, 8x10, 40" tabletop
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positions, CR, film size and distance for special views of the hand
"Ball catcher's" AP oblique - perpendicular to a point midway between both hands at the level of the 5th MCP joint, 10x12, 40" tabletop
Gaynor Hart(carpal tunnel)- 25-30 degress cephalad to the palm of the hand, 8x10, 40" table top
Radial and ulanar deviation- perpendicular to midcarpal area, 8x10, 40" talbe top
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positions, CR, film size and distance for a forearm
AP (arm on same plane)- perpendicular to shaft of the forearm, 14x17, 40" tabletop
LAT(elbow flexed at 90 degrees)-perpendicular to shaft of the forearm, 14x17, 40" tabletop
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positions, CR, film size and distance for an elbow
AP (arm on same plane)- perpendicular to midportion of elbow joint, 10x12, 40" tabletop
Oblique(hand pronated)- perpendicular to midportion of elbow joint, 10x12, 40" tabletop
LAT(flex at 90 degrees)- perpendicular to midportion of elbow joint, 8x10, 40" tabletop
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positions, CR, film size and distance for a humerus
AP- perpendicular to shaft of humerus, 14x17, 40" to bucky or tabletop
LAT- perpendicular to shaft of humerus, 14x17, 40" to bucky or tabletop
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positions, CR, film size and distance for a humerus special position
- Transthoracic lateral Lawrence method
- perpendicular to head of humerus, 10x12, 40" to bucky, full inspiration
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