RTE 121 Ch.4 part 2
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Created by:
michaelrudy1 on October 17, 2011
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147 terms
Terms | Definitions |
|---|---|
 # of bones in hand and wrist | 27 bones in each: 14 phalanges (fingers and thumb) 5 metacarpals (palm) 8 carpals (wrist) |
| Where are the phalanges? | Most distal bones of the hand |
| What are the metacarpals? | make up the palm |
| Where are the carpals? | bones of the wrist |
| Each phalanx has X number of parts | 3 parts to each phalanx: head - distal rounded part body - shaft base - most proximal part |
| Each metacarpal has # number of parts | 3 parts - metacarpals: head - distal rounded part body - shaft - rounded part. Anterior is concave, posterior is convex base - most proximal part - articulates with carpals |
| Another name for articulations | joints |
| Small chip fractures may occur near the | joint spaces. |
| Where are the interphalangeal joints (IP) | The thumb's joint between the 2 phalanges |
| Where are the metacarpophalangeal (MCP) joints? | the joints b/w the head of the metacarpal and the base of the proximal phalanx |
| Where are the distal interphalangeal (DIP) joints? | joints between the distal and middle phalanges |
| Where are the proximal interphalangeal (PIP) joints? | joints between the middle and proximal phalanges |
| Where are the carpometacarpal (CMC) joints? | articulate at the metacarpal's proximal end with the carpals |
| The metacarpals articulate with specific carpals | First MC with trapezium 2nd MC with trapezoid 3rd MC with capitate 4th and 5th MC with hamate |
| Most often fractured carpal | the scaphoid |
| What is a carpal sulcus | Groove (concave area) through with major nerves and tendons pass. tangential view - formed by concave anterior or palmar aspect of the carpals. Best view to visualize the pisiform and hamate's hamulus. Also can easily view the trapezium and its relations to the thumb and trapezoid. |
| Lateral position of the hand shows | the trapezium and scaphoid are located more anteriorly. |
| What does the carpal canal projection show? | shows the hamulus process of the hamate and the pisiform |
| Where is the proximal radioulnar joint? | Articulation between the proximal radius and ulna. Allows for rotational movement of the wrist and hand |
| Where is the distal radioulnar joint? | Articulation between the distal radius and ulna. Allows for rotational movement of the wrist and hand |
| Where are the styloid processes? | conical projections on the extreme distal ends of both the radius and ulna. Radial styloid extends more distally than the ulnar styloid process. |
| What/where is the ulnar notch? | Small depression on the medial aspect of the distal radius.It's where the head of the ulna fits to form the distal radioulnar joint. |
| Where is the head of ulna? | at the distal end of ulna near wrist. Can palpate easily when pronated on little finger side. |
| Where is the head of radius | at the proximal end of the radius near the elbow joint. Disk-shaped head |
| Which is shorter? radius or ulna? | Radius. Primarily involved in the formation of the wrist joint. |
| Radius | directly involved in the wrist joint. Rotates around the more stationary ulna. |
| Neck of radius | tapered constricted area below the head. |
| Radial tuberosity | rough oval process on the medial and anterior side of the radius, distal to the neck. |
| Define Ulna | longer of the 2 forearm bones. Mainly involved to form the elbow joint. |
| Define Olecranon | proximal beaklike projection from the ulna |
| Define Coronoid process | distal beaklike projection from the ulna |
| Define Coronoid tubercle | medial margin of the coronoid process opposite the radial notch. |
| Define Trochlear notch | large concave depression that articulates with the distal humerus. |
| Define Radial notch | small, shallow depression located on the lateral aspect of the proximal ulna. Head of radius articulates with ulna here to form the proximal radioulnar joint. |
| Purpose of fistal and proximal radioulnar joints | allow rotation of the forearm during pronation. The radius crosses over the ulna near the upper third of the forearm. |
| Define humeral condyle | expanded distal end of the humerus. The articular portion of the humeral condyle is divided into 2 parts: the trochlea and the capitulum |
| Define trochlea | pulley; spool. Has 2 rimlike outer margins and a smooth depressed center called the trochlear sulcus or groove. Trochlea is more medially located and articulates with the ulna. |
| Define capitulum | "little head" - located on lateral aspect and articulates with the head of the radius. "cap" and "head" go together. Earlier, it was called the capitellum. Articular surface that makes up the rounded articular margin is just smaller than that of the trochlea. Significant in lateral positioning. |
| Define Epicondyles | projections off the distal humerus |
| Define lateral epicondyle | small projection on lateral side of distal humerus above capitulum |
| Define medial epicondyle | larger and more prominent than the lateral epicondyle. In a true lateral position, the directly superimposed epicondyles - difficult to recognize. Appear as a proximal to the circular appearance of the trochlear sulcus |
| Define coronoid fossa and radial fossa | 2 shallow anterior depressions of the humerus. Receive the coronoid process and radial head |
| Define olecranon fossa | posterior humerus depression. The olecranon process of the ulna fits into this depression when arm is fully extended. Has fat pads within the deep olecranon fossa - important when diagnosing trauma to the elbow joint. |
| Define a true lateral elbow | 90° flexion. Appearance should have 3 concentric arcs: 1. trochlear sulcus - first and smallest 2. capitulum and trochlea - 2nd - outer ridges/rounded edges 3. trochlear notch of the ulna. Arcs will appear symmetrically aligned when pure 90° |
| Define Synovial joints | all joints of the upper limb are this classification - freely moveable |
| Define diathrodial joint | freely movable joint |
| Define ellipsoidal joint | condyloid - allow movement in 4 directions: flexion, extension, abduction and adduction. And circumduction. - 2nd to fifth MCPs. - most freely moveable. Wrist joint. |
| Define circumduction | conelike sequential movement in 4 directions. |
| 1st MCP joint (thumb) movement | ellipsoidal (condyloid) joint but limited due to the less rounded head of the first metacarpal |
| Intercarpal joints are considered | plane (gliding) |
| Wrist joint is | ellipsoidal (condyloid) - most freely moveable. Only the radius articulates with the wrist - at the scaphoid and lunate carpal bones. |
| Radiocarpal joint | the radius articulates with the wrist - at the scaphoid and lunate carpal bones. |
| Triquetral bone is considered part of | the wrist because it's opposite the articular disk |
| Define articular disk | part of the total wrist articulation, including a joint b/w the distal radius and ulna - the distal radioulnar joint |
| Define distal radioulnar joint | joint b/w the distal radius and ulna |
| Define ulnar deviation | toward the side of the ulna - opens up and best demonstrates the carpals on the opposite side: scaphoid, trapezium and trapezoid. This projection is often called the "special scaphoid projection" |
| Define radial deviation | toward the side of the radius: less frequently used projection. Opens and best demonstrates carpals on the opposite or ulnar side of the wrist: hamate, pisiform, triquetrum and lunate |
| Elbow rotation | AP - no rotation. Radius and ulna partially superimposed at proximal joint. AP - lateral rotation - separation of radius and ulna AP, medial rotation - superimposed radius and ulna |
| Fat pads | accumulations of fat (aka fat bands, stripes). A displacement of a fat pad may indicate a disease of injury, fracture within a joint, etc. |
| # of shots required for the wrist | 3 |
| Ulnar deviation best shows | the scaphoid opened up. Ulnar deviation is sometimes called the "scaphoid projection" |
| Radial deviation best shows | the lunate, triquetrum, pisiform and hamate opened up |
| Which forearm bone is directly involved in the wrist joint | Radius |
| In which position of the hand does the radius cross over the ulna | pronation |
| Which bone's styloid process sticks out more distally? | the radius' styloid process |
| Define trochlear sulcus (groove) | the smooth depressed center portion of the trochlea. Appears circular on a lateral end-on view. More radiolucent on a radiograph. |
| The 3 concentric arcs are formed by? | 1. trochlear sulcus - first and smallest arc 2. Double-line outer ridges or rounded edges of the capitulum (smaller of the 2) and trochlea (the larger) 3. Trochlear notch |
| Which epicondyle of the distal humerus is larger? | the medial epicondyle |
| What indicates a true lateral elbow position? | the directly superimposed epicondyles are seen as proximal to the circular appearance of the trochlear sulcus |
| The total wrist joint is enclosed by? | an articular synovial capsule strengthened by ligaments that allow movement in 4 directions, plus circumduction. |
| Which elbow rotation separates the ulna and radius? | The AP, lateral rotation |
| Which elbow rotation partially superimposes the radius and ulna? | The AP, without rotation |
| Which elbow rotation superimposes the radius and ulna? | AP, medial rotation |
| Define bone metastases | transfer of disease/cancerous lesions from one organ to another |
| Define bursitis | inflammation of the bursae or fluid-filled sacs that enclose joint. |
| Define carpal tunnel syndrome | compression of median nerve as it passes thru the center of the wrist |
| Define fracture | break in the bone |
| Define joint effusion | accumulated fluid in jt cavity. sign of an underlying condition |
| Define osteoarthritis | noninflammatory jt disease - degenerative. Gradual deterioraion of articular cartilage with hypertrophic bone formation |
| Define osteomyelitis | infection of bone or bone marrow |
| Define osteoporosis | reduction in quantity of bone; atrophy of skeletal tissue. Most fractures are secondary to osteoporosis. |
| Define Paget's disease | "osteitis deformans" - destructive bone disease followed by reparative overproduction of very dense yet soft bones that fracture easily. Bowed legs, e.g. Most common bones: pelvis, femur, skull, vertebrae, clavicle, and humerus. |
| Define rheumatoud arthritis | chronic inflammatory changes. Earliest found is soft tissue swelling around ulnar styloid of wrist. |
| Define skier's thumb | sprain or tear of ulnar collateral ligament of the thumb near the MCP jt of the hyperextended thumb. |
| Define multiple myeloma | malignant. Most common of primary cancerous bone tumors. Arises from bone marrow or marrow plasma cells. Usually fatal within a few years. |
| Define Osteogenic sarcoma | "osteosarcoma" - 2nd most common Malignant tumor. May develop in people with Paget's disease. |
| Define Ewing's sarcoma | In children and young adults. "Onion peel" appearance. Arises in bone marrow. Prognosis is poor |
| Define Chondrosarcoma | Slow growing tumor of the cartilage. |
| Define endochondroma | Slow-growing cartilaginous tumor of small bones of hands and feet |
| Define Osteochondroma | "exostosis" - arise from outer cortex, Most common benign bone tumor. |
| Define Bennett's fracture | A fracture at the base of the first metacarpal. Often the result of fist fights. |
| Define Boxer's fracture | A fracture of the fifth metacarpal, often caused by direct force to a closed fist. |
| Define Colles fracture | Fracture of the distal radius and ulnar styloid with posterior displacement. More frequent in older adults who fall on an outstretched hand. |
| Define Smith's fracture | Fracture of the distal radius and ulnar styloid with anterior displacement. Often referred to as a reverse Colles' |
| Define Torus or Buckle Fracture | Impacted fracture with a bulging of the periosteum. Most common fracture of the distal radius and ulna in young children. |
| For an arm view, what does supinating hand the hand do (AP)? | keeps the ulna and radius apart |
| For an arm view, what does pronating the hand do (PA)? | radius crosses over ulna |
| Best projection(s) for scaphoid fat strip | PA and oblique views |
| Best projection(s) for pronator fat stripe | lateral view |
| AP lateral rotation - elbow shows | separation of radius and ulna |
| AP no rotation - elbow shows | radius and ulna partially superimposed |
| AP medial roation - elbow shows | superimposed radius and ulna |
| CR centereing for a AP projection of thumb | First metcarpophalangeal (MCP) joint |
| Define Bennett's fracture | fracture at the base of the first metacarpal |
| Position used to be demonstrate a Bennett's fracture | Roberts' Method, with a 15° proximal CR angle |
| How do you tell a finger is not rotated? | symmetric appearance of concavities of the shafts of the phalanges and same amount of soft tissue on each side |
| Where should the CR be centered for thumb projections | at the first MCP joint |
| What should be included in thumb projections | distal and proximal phalanges, the entire metacarpal and trapezium |
| Where is CR centered for the modified Robert's method of the thumb? | at the first CMC |
| What degree of CR angle is used for the Robert's method? | 15° proximally toward wrist |
| Where is the CR centered for the hand projections? | at the third MCP joint |
| What is the preferred lateral position if phalanges are area of interest? | the "fan" lateral position |
| What is alternative to the Fan Lateral? | the lateral in extension or flexion |
| Which alternative to the Fan Lateral is preferred for localization of foreign bodies? | the lateral in extension projection |
| What pathology best benefits from the Norgaard (ball-catcher's position)? | Rheumatoid arthritis |
| How much should hands be rotated for the Norgaard method? | 45° medially |
| Where should the CR be centered for the Norgaard method? | midpoint b/w both hands at the level of the 5th MCP joints |
| What is a good way to do a PA wrist to visualize the carpals? | Arch the hand slightly to place the wrist and carpals in close contact with the cassette |
| How do you know a true 45° angle is on the PA oblique wrist? | ulnar head partially superimposed by distal radius, proximal 3-5 metacarpals are mostly superimposed |
| Where is the CR centered for wrist projections | at the midcarpal area |
| What is the CR angle for a PA/PA axial scaphoid | 10-15° proximally |
| Barton's Colles' of Smith's fractures are best demonstrated by | a lateral (lateromedial) wrist projection |
| What is the degree of elevation with the Stecher method? | 20° with ulnar deviation |
| For those with severe pain, what should be changed if using the Stecher method? | no ulnar deviation |
| What is the alternative projection to the PA/PA axial scaphoid wiht ulnar deviation projection? | The Stecher method - places the scaphoid parallel to the IR. |
| What projection best demonstrates the lunate, trigquetrum, pisiform and hamate? | The PA projection, radial deviaion of the wrist |
| What projection best rules out abnormal calcifications and bony changes in the carpal sulcus? | carpal canal (tunnel) - tangential projection |
| What is the CR angle on the carpal canal projection | 25-30° to the long axis of the hand. Increase if the pt cannot hyperextend wrist as far as 90° |
| What is another name for the carpal canal tangential projection? | The Gaynor-Hart method |
| What projection could you use to demonstrate the pisiform and hamulus process in profile without superimposition? | The carpal canal tangential projection |
| What projection best demonstrates pathologies of the dorsal aspect of the carpal bones? | the carpal bridge - tangential projection of the wrist |
| Where is the CR centered for the carpal canal projection? | 2-3 cm distal to the base of the 3rd metacarpal. |
| Where is the CR centered for the AP forearm projection? | to the midforearm |
| Where should the CR be centerd for the AP elbow projection? | to mid elbow joint - 2cm distal to midpt of a lien between epicondyles |
| What set of projections should be used if the pt cannot fully extend the elbow? | Two projections - one withe forearm parallel to the IR and one with the humerus parallel to the IR. - AP projection, elbow not fully extended |
| What projection best visualizes the radial head and neck of the radius and capitulum of humerus? | the AP oblique lateral rotation of the elbow |
| How much should the arm be rotated on an AP oblique lateral rotation of the elbow | Enough that the epicondyles are 45° to the cassette |
| What projection best visualizes the coronoid process and trochlea in profile | AP oblique projection - medial rotation of elbow |
| What is evidence of the AP oblique medial rotation? | Radial head and neck superimposed and centered over the pxoximal ulna. Trochlear notch partially open |
| What projection should be used for radial head and coronoid process fractures? | The Coyle method - 2 projections, one for the radial head and one for the coronoid process - |
| What angle CR is used for the Coyle method? | 45°, either toward the shoulder for the radial head projection, or away from the shoulder for the coronoid process projection |
| What radial head lateral indicates a slightly anterior radial tuberosity? | Hand supinated to maximum external rotation |
| What radial head lateral indicates a not in profile, superimposed over radial shaft radial tuberosity? | Hand lateral |
| What radial head lateral indicates a slightly posterior radial tuberosity? | Hand pronated |
| What radial head lateral indicates a posterior, adjacent to ulna radial tuberosity? | Hand with maximum internal rotation |
| Which alternative to the PA wrist best demonstrates the intercarpal joint spaces and wrist joint? | the AP with the hand slightly arched |
| In the elbow, what are the 3 joints enclosed in a common capsule? | Proximal radioulnar joint Humeroulnar joint Humeroradial joint |
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