Unit 4 (Upper Extremities)
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What makes up the upper limb?
- shoulder girdle
How many bones make up the hand, include groupings:
- 27 bones total
- 14 phalanges (fingers)
- 5 metacarpals (palm)
- 8 carpals (wrist)
Name each bone of the hand (letters and **):
- A. Scaphoid/Navicular
- B. Lunate/Semilunar
- C. Triquetrum/Triangular or Cuneiform
- D. Pisiform
- E. Trapezium/Greater Multangular
- F. Trapezoid/Lesser Multangular
- G. Capitate/Os Magnum
- H. Hamate/Unciform
- I. 5th metacarpal
- J. 4th metacarpal
- K. 3rd metacarpal
- L. 2nd metacarpal
- M. 1st metacarpal
- N. Proximal phalanx of 5th digit
- O. Proximal phalanx of 4th digit
- P. Proximal phalanx of 3rd digit
- Q. Proximal phalanx of 2nd digit
- R. Proximal phalanx of 1st digit
- S. Middle phalanx of 5th digit
- T. Middle phalanx of 4th digit
- U. Middle phalanx of 3rd digit
- V. Middle phalanx of 2nd digit
- W. Distal phalanx of 5th digit
- X. Distal phalanx of 4th digit
- Y. Distal phalanx of 3rd digit
- Z. Distal phalanx of 2nd digit
- ** Distal phalanx of 1st digit
Name the major joints of the hand (numbers):
- 1. Distal Interphalangeal (DIP) Joint of the 5th digit
- 2. Distal Interphalangeal (DIP) Joint of the 4th digit
- 3. Distal Interphalangeal (DIP) Joint of the 3rd digit
- 4. Distal Interphalangeal (DIP) Joint of the 2nd digit
- 5. Proximal Interphalangeal (PIP) Joint of the 5th digit
- 6. Proximal Interphalangeal (PIP) Joint of the 4th digit
- 7. Proximal Interphalangeal (PIP) Joint of the 3rd digit
- 8. Proximal Interphalangeal (PIP) Joint of the 2nd digit
- 9. Metacarpophalangeal (MP) Joint of the 5th digit
- 10. Metacarpophalangeal (MP) Joint of the 4th digit
- 11. Metacarpophalangeal (MP) Joint of the 3rd digit
- 12. Metacarpophalangeal (MP) Joint of the 2nd digit
- 13. Interphalangeal (IP) Joint of the 1st digit
- 14. Metacarpophalangeal (MP) Joint of the 1st digit
- 15. Carpometacarpal (CM) Joint of the 1st MC and the trapezium
- 16. Carpometacarpal (CM) Joint of the 2nd MC and the trapezoid
- 17. Carpometacarpal (CM) Joint of the 3rd MC and the capitate
- 18. Carpometacarpal (CM) Joint of the 4th & 5th MCs to the hamate
- 19. Site of the radiocarpal joint where the radius articulates with the scaphoid and lunate
Name the following Carpal Bones:
Most often displaced:
Most often fractured:
Has a hook-like projection anteriorly:
- Largest proximal: Scaphoid
- Smallest distal: Trapezoid
- Most often displaced: Lunate
- Largest: Capitate
- Smallest: Pisiform
- Most often fractured: Scaphoid
- Has a hook-like projection: Hamate (hamulus process)
What is the carpal canal and how is it best x-rayed?
- it is the anterior surface of the wrist formed by the concave surface of the carpal bones
- it is a tangential projection which best visualizes the anterior pisiform and the hamulus of the hamate
Where are the styloid processes of the radius and ulna located?
- both on the distal ends of the bones
- the radial styloid process is located laterally (thumb side) and extends more distally than the ulnar styloid process
Which joints are the radius and the ulna directly involved in?
- radius: the wrist joint
- ulna: the elbow joint
Where are the heads of the radius and the ulna located?
- the head of the radius is on the proximal end
- the head of the ulna is on the distal end
Name the two processes and the two notches on the proximal ulna:
- Olecranon Process (larger and more proximal)
- Coronoid Process (smaller and more distal)
- Trochlear/Semilunar Notch (between the 2 processes)
- Radial Notch (smaller, lateral)
Name the important bony processes and depressions of the distal humerus (9):
- Humeral condyle - made up of Trochlea and Capitulum
- Trochlea - medial aspect of the humeral condyle
- Capitulum - lateral aspect of the humeral condyle
- Trochlear sulcus/groove - where trochlea/capitulum meet
- Lateral epicondyle - (smaller) superior to capitulum
- Medial epicondyle - (larger) superior to trochlea
- Radial fossa - anterior, receives the radial head
- Coracoid fossa - anterior, receives the coracoid process
- Olecranon fossa - posterior, receives the olecranon process
What classification and mobility type are the joints of the wrist and elbow?
- classification: synovial (articular capsule containing synovial fluid)
- mobility: diarthrodial (freely movable)
What movement types are the different joints that make up the hand, wrist, and elbow?
- Interphalangeal: hinge (ginglymus)
- Metacarpophalangeal: condyloid (ellipsoidal)
- Carpometacarpal of 1st digit: saddle (sellar)
- Carpometacarpal of 2nd-5th digits: gliding (plane)
- Intercarpal : gliding (plane)
- Wrist/radiocarpal: condyloid (ellipsoidal)
- Radioulnar: pivot (trochoidal)
- Elbow: hinge (ginglymus)
How many projections are normally taken for long bones?
- two (both to include the proximal and distal joints)
- AP and lateral
How many projections are normally taken for joints?
- at least three
- AP, lateral, and one oblique
How many projections are usually taken for post-reduction or follow-up exams?
- two projections, 90° apart from each other
- (wet plaster: up kVp by 10 or double the mAs)
- (synthetic fiberglass: up kV by 3 or 4)
Where do you center the CR for digits:
- for 2nd-5th digit: the PIP joint
- for 1st digit: the MP joint
What is the projection of the thumb that centers the CR to the CMC joint instead of the MP joint?
the Modified Roberts Method
What is the projection of the thumb that centers the CR to the CMC joint instead of the MP joint and also utilizes a 15° proximal angle (toward the wrist)
the Lewis Modification
Where do you center the CR for the hand:
- the 3rd metacarpophalangeal (MCP) joint
- (2nd MCP joint for fan lateral)
What projection is of both hands, supinated and angled 45°, with the CR centered to the 5th MCP joints of both hands?
the Norgarrd Method, or the "ball-catcher's position"
Where should the CR be centered for the wrist?
- mid-carpal area
- (schaphoid/anatomical snuffbox for ulnar deviation and Stecher Method)
What is the projection of the wrist where the tube or the wrist is angled 20°?
the Stecher Method
What is the projection of the wrist where the patient hyperextends the wrist as much as possible and the tube is angled 25-30° in order to take a tangential projection?
- the Gaynor-Hart Method
- Inferiosuperior projection
Describe the desired alignment for the different projections of the forearm:
- AP forearm: epicondyles of humerus should be parallel to IR, hand supinated, arm straight
- Lateral forearm: thumb should point up, radius and ulna directly superimposed, epicondyles superimposed, elbow bent 90°
Describe the desired alignment for the different projections of the elbow:
- AP elbow: epicondyles parallel to IR, arm straight
- Obl. elbow medial rotation: epicondyles 45°, hand pronated
- Obl. elbow lateral rotation: epicondyles 45°, extreme rotate
- Lateral elbow: epicondyles perpendicular, arm bent 90°
For a trauma elbow with acute flexion, what projections should be used?
- AP projection of distal humerus
- AP projection of proximal forearm
Describe the desired alignment for the projections of the humerus:
- AP humerus: pt rotated until shoulder and proximal humerus touch IR, epicondyles parallel
- Lateral humerus: pt rotated until shoulder and proximal humerus touch IP, arm rotated internally until epicondyles perpendicular
What is the projection of the humerus that is often used in trauma situations, where the arm is left hanging neutrally and the affected side is placed agains the IR with the opposite arm raised above the head while the CR is centered at the level of the surgical neck of the affected side?
- the Lawrence Method
- (transthoracic lateral)
What are the breathing instructions for the Lawrence Method for the humerus?
short, panting breaths to blur out the lung and rib markings
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