RAD-141 CH.4 WRIST AND FOREARM

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anatomy12
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243939
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RAD-141 CH.4 WRIST AND FOREARM
Updated:
2013-12-14 13:38:23
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xray
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  1. what is the preferred carpal mnemonic
    Steve Left The Party To Take Carol Home

    Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate
  2. what is the secondary carpal mnemonic
    Never lower tillies pants grandma might come home

    navicular Lunate(semilunar) Triangular Pisiform Greater Multangular Lesser Multangular Capitate (Os Magnum) Hamate (unciform)
  3. when viewing a radiograph what appearance on the bone details we have good use of technical factors
    what causes a loss of details in the bone
    • bony trabeculae or small spaces in the bones
    • from motion of the patient
  4. what is best visualized in radial deviation
    ulnar deviation (2)?
    • best to visualize bones on the medial side
    • Best visualizes carpal bones on the lateral side of the wrists and isolates the scaphoid
  5. what are the joints in between the carpal movements and what is there is synovial movement
    joints are intercarpals and are gliding type
  6. what bone does the 1st metacarpal articulate with
    trapezium
  7. where are fat pads located
    what do we need to to visualzise fat pads radiographically
    • they are located outside of the synovial sac but within the joint capsule
    • long scale of contrast and are generally not visualized w/o enhancing the image
  8. what happens if fat pads are displaced and is an indication
    disease or significant injury
  9. what anatomical structrure is missiing from the ulna
    neck
  10. what does an AP radiograph of the forearm show between the ulna and the radius
    it shows separation between the two bones
  11. what position error happens when the ulnar and radius are crossed over each other
    it is a pa positioning error forearms are only done in an ap
  12. list the exposure factors for doing a forearm
    • lower to medium kvp 50-70
    • short exposure time
    • small focal spot
    • adequate mAs for sufficient density
    • increase exposure w/cast
  13. What are the three wrist positioning routines
    pa oblique lateral
  14. what are all the special positioning of the wrist
    • AP, PA scahpoid w/angle and ulnar deviation
    • PA scaphoid w/hand elevated and ulnar deviation "modified Stecher Method"
    • PA projection - Radial Deviation
    • Carpa Canal (tunnel)-tangential, inferosuperior  Projection "gaynoe-Hart Method"Carpal bridge -Tangential Projection
  15. List the four factors when taking a PA wrist radiograph
    • 8x10 or 10x12
    • 40'' SID
    • hand pronated and slight arch in hand to put carpals in close contact with the IR
    • CR to midcarpal
  16. what position would we use to visualize carpal interspaces
    Alternative AP positions
  17. List all the factors when doing a PA oblique wrist
    all the same as PA wrist except the hand is externally rotated 45 degrees like in a regular oblique hand
  18. List all the factors for a lateral of the wrist
    • 8x10 or 8x12
    • 40 SID
    • CR to mid carpal
    • MUST FLEX ELBOW 90 DEGREES AND PLACE THE WRIST AND HAND IN THUMB UP LATERAL POSITION
  19. what are the two following conditions the prove a true lateral position of the wrist on radiograph
    ulnar head should be superimposed over distal radius; proximal second though 5th metacarpals all should appear aligned and superimposed
  20. where is the CR for a PA scahpoid w/ CR angle and Ulnar Deviation
    at scahpoid bone
  21. How do we position for a PA scahpoid w/ CR angle and Ulnar Deviation
    what is the angle of the tube
    • position as we would for a pa wrist but we been the wrist towards the ulnar side without moving the forearm bones
    • 10-15 degrees proximally alongng the axis of the forearm toward elbowq
  22. what is the reasoning behing doing a PA scahpoid w/ CR angle and Ulnar Deviation
    free the scaphoid bone of foreshortening and elongating it with the angle of the tube also it opens up the intercarpal spaces
  23. what other method or position is used to view free foreshortening of the scaphoid and intercarpal spaces
    PA scaphoid-Modified Stecher Method
  24. what is a PA scaphoid-Modified Stecher Method
    it is where we angle the the body part (the wrist) on a 20 degree sponge
  25. If the patient is in pain how do we view the scaphoid
    we would position the patients hand with no ulnar deviation no Cr angle but we elevate the hand 20 degrees
  26. what are the positioning requirements for a PA projection - Radial Deviation
    • Same thing as ulnar deviation except we are inverting the wrist towards the radial side while keeping the forearm bones straight
    • no CR angle
    • CR to mid carpal area
    • 40'' SID
    • 8x10 or 10x12
  27. what is the purpose of radial deviation
    opens view of the bones on the medial side of the wrist bone
  28. what is the alternative name for carpal tunnel
    (gaynor-Hart method)
  29. how do we perform the carpal canal (tunnel) position
    what is the angle of our tube
    where is the CR
    • ask patient to hold their wrist out in front of them palms out and hyperextend the fingers and wrist with the other hand to a near vertical position as possible
    • 25-30 degrees up the arm
    • CR 1 inch distal to the base of third metacarpel (in the middle)
  30. why do we use the carpal canal position
    to locate abnormal calcification and bony changes in the carpal sulcus that may impinge on the median nerve which is carpal tunnel syndrome
  31. carpal bridge?
  32. what are the routine positions for a forearm
    ap and lateral
  33. List all factors needed for a forearm
    • 40 SID
    • 11x14 or 14x17
    • fully extend hand and arm palm up
    • instruct patient to lean a bit on his lateral side to place entire wrist forearm and elbow in a true frontal position
    • CR to midforearm
  34. what must we have on a radiograph of the forearm
    both joints of the wrist and elbow (minimum of 1-1.5inch of both joints)
  35. list all factors when performing the lateral forearm
    • everything is same as AP forearm except
    • elbow is bent 90 degrees
    • shoulder is dropped to place entire upper limb on same horizontal plane
    • rotate hand and wrist into a true lateral position
    • CR to mid forearm
    • must get both joints
  36. what is a colles fracture
    • is a fracture of the distal radius in the forearm with dorsal (posterior) displacement of the wrist and hand
    • usually happens to people with osteoperosis and people who fall with their hands first

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