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BONTRAGER CHAPTER 4 WORKBOOK
Identify the number of bones: Phalanges (fingers and thumb) 14 Identify the number of bones: Metacarpals (palm) 5 Identify the number of bones: Carpals (wrist) 8 Identify the number of bones: Total 27 The two portions of the thumb (first digit) are the: A. Proximal phalanx B. Distal phalanx The three portions of each finger (second through fifth) are the: A. Proximal phalanx B. Middle phalanx C. Distal phalanx The three parts of each phalanx, starting distally, are the: A. Head B. Body (shaft) C. Base List the three parts of each metacarpal, starting proximally: A. Base B. Body (shaft) C. Head The name of the joint between the proximal and distal phalanges of the first digit is the ___________. Interphalangeal joint The joints between the metacarpals and the phalanges are the _____________________. Metacarpophalangeal (MCP) joints What is the largest of the carpal bones? Capitate
What is the name of the hooklike process extending anteriorly from the hamate? Hamulus/Hamular process Which is the most commonly fractured carpal bone? Scaphoid List two of the mnemonics given in the textbook that uses the first letter of each of the preferred terms of the eight carpal bones. Either of these two mnemonics is acceptable: 1.) Send Letter To Peter To Tell'im (to) Come Home 2.) Steve Left The Party To Take Carol Home A. In the anatomic position, which of the bones of the forearm is located on the lateral (thumb) side? B. Which is on the medial side? A. Radius B. Ulna Indicate whether the following structures are part of the radius, ulna, or distal humerus: Trochlear notch Ulnar Indicate whether the following structures are part of the Radius, Ulna, or Distal Humerus: Radial notch Ulnar Indicate whether the following structures are part of the radius, ulna, or distal humerus: Olecranon fossa Distal Humerus Indicate whether the following structures are part of the radius, ulna, or distal humerus: Trochlea Distal Humerus Indicate whether the following structures are part of the radius, ulna, or distal humerus: Coronoid tubercle Ulnar Indicate whether the following structures are part of the radius, ulna, or distal humerus: Coronoid process Ulnar Indicate whether the following structures are part of the radius, ulna, or distal humerus: Olecranon process Ulnar
Joint movement type: Radiocarpal Ellipsoidal Joint movement type: Intercarpal Plane Joint movement type: Elbow joint Ginglymus Joint movement type: Proximal radioulnar joint Pivot Ellipsoidal joints are classified as freely movable, or ____________, and allow movement in __________ directions. diarthrodial; 4 True/False: In addition to the ulnar and radial collateral ligaments, the following five additional ligaments are also important in stabilizing the wrist joint. A. Dorsal radiocarpal B. Palmar radiocarpal C. Triangular fibrocartilage complex (TFCC) D. Scapulolunate E. Lunotriquetral True Which ligament of the wrist extends from the styloid process of the radius to the lateral aspect of the scaphoid and trapezium bones? Radial collateral ligament What is the name of the two special turning or bending positions of the hand and wrist that demonstrate medial and lateral aspects of the carpal region? A. Ulnar Deviation B. Radial Deviation Of the two positions listed in the previous question, which is most commonly performed to detect a fracture of the scaphoid bone? Ulnar Deviation How does the forearm appear radiographically if pronated for a PA projection? The proximal radius crosses over the ulna
The two important fat stripes or bands around the wrist joint are the: A. Scaphoid fat stripe B. Pronator fat stripe The fat pads around the elbow joint are valuable diagnostic indicators if the following three technical/positioning requirements are met with the lateral position. A. Elbow flexed 90 degrees B. Optimal exposure factors used C. In a true lateral position. True/False: If the posterior fat pad of the elbow is not visible radiographically, it suggests that a non-obvious radial head or neck fracture is present. False True/False: Excessive kV may obscure the visibility of a fat pad True True/False: Trauma or infection makes the anterior fat pad more difficult to see on a lateral elbow radiograph. False Which routine projections best demonstrate the scaphoid fat pad? PA and Oblique wrist Which routine projection best demonstrates the pronator fat stripe? Lateral wrist Identify the technical factors most commonly used for upper limb radiography: kV range 60-80 kV Identify the technical factors most commonly used for upper limb radiography: Long or short exposure time Short exposure time Identify the technical factors most commonly used for upper limb radiography: Large or small focal spot Small focal spot Identify the technical factors most commonly used for upper limb radiography: Most common minimum SID 40" (102 cm) Identify the technical factors most commonly used for upper limb radiography: Grids are used if the body part measures greater than ___________ cm
Distal aspect of metacarpals List the two radiographic criteria used to determine whether rotation is present on the PA projection of the digits. A. Symmetric appearance of both sides of the shafts of phalanges and distal metacarpals B. Equal amounts of tissue on each side of the phalanges Identify which positioning modification(s) should be used for a study of the second digit to reduce distortion for each of the following: A. PA Oblique projection B. Lateral position A. Perform the medial oblique rather than lateral oblique to decrease OID B. Perform a thumb-down lateral (mediolateral projection) to decrease OID Where is the CR centered for a PA oblique projection of the second digit? Proximal Interphalangeal (PIP) joint Why is it important to keep the affected digit parallel to the IR for the PA oblique and lateral projections? A. To prevent distortion of the phalanx B. To prevent distortion of the joints C. To demonstrate small, non-displaced fractures near the joint D. All of the above D. All of the above Why is the AP projection of the thumb recommended instead of the PA? The AP position produces a decrease in OID and increased resolution. Which projection of the thumb is achieved naturally by placing the palmar surface of the hand in contact with the IR? PA oblique Which IR size should be used for a thumb projection? 8 x 10" A sesamoid bone is frequently found adjacent to the ____________________ joint of the thumb. MCP - metacarpophalangeal True/False: The entire metacarpal and trapezium must be demonstrated on all projections of the thumb. True Where is the CR centered for an AP projection of the thumb? A. First interphalangeal (IP) joint B. Mid-aspect of proximal phalanx
C. First metacarpophalangeal (MCP) joint D. First proximal interphalangeal (PIP) joint C. First metacarpophalangeal (MCP) joint A Bennett's fracture involves: A. Base of first metacarpal B. Trapezium bone C. Scaphoid bone D. Fracture extending through first IP joint A. Base of first metacarpal A. Which special positioning method can be performed to demonstrate a Bennett's fracture? B. What degree of CR angulation is required for this projection? A. Modified Robert's Method B. 15 degrees proximal Where is the CR centered for a PA projection of the hand? A. Third MCP joint B. Mid-aspect of third metacarpal C. Second MCP joint D. Third PIP joint A. Third MCP joint A minimum of _______ inches of the forearm should be included radiographically for a PA projection of the hand. 1" True/False: Slight superimposition of the distal third, fourth, and fifth metacarpals may occur with a well positioned PA oblique projection of the hand. True Which preferred lateral position of the hand best demonstrates the phalanges without excessive superimposition? Fan lateral Which lateral projection of the hand best demonstrates a possible foreign body in the palm of the hand? Lateral in extension What is the proper name for the position referred to as the "ball-catcher's position"? Norgaard method The "ball-catcher's position" is commonly used to evaluate for early signs of: A. Osteoporosis B. Osteomyelitis
Tangential inferosuperior or Gaynor-Hart projection How much CR angulation from the long axis of the forearm is required for the carpal bridge (tangential) projection? 45 degrees The hand and wrist form a _________ degrees angle to the forearm with the carpal bridge (tangential) projection. 90 degrees Pathology term for this description: Fracture and dislocation of the posterior lip of the distal radius Barton's fracture Pathology term for this description: Most common type of primary malignant tumor occurring in bone Multiple Myeloma Pathology term for this description: Reduction in the quantity of bone or atrophy of skeletal tissue Osteoporosis Pathology term for this description: Sprain or tear of the ulnar collateral ligament Skier's thumb Pathology term for this description: An abnormality of the cartilage affecting long bones Achondroplasia Pathology term for this description: Transverse fracture extending through the distal aspect of the metacarpal neck, most often the fifth metacarpal Boxer's fracture Pathology term for this description: Hereditary condition marked by abnormally dense bone Osteopetrosis Pathology term for this description: Transverse fracture of the distal radius with posterior displacement of the distal fragment Colles' fracture Pathology term for this description: Narrowing of joint space with periosteal growths on the joint margins
Osteoarthritis Pathology term for this description: Fluid-filled joint spaced with possible calcification Bursitis Pathology term for this description: Possible calcification in the carpal sulcus Carpal tunnel syndrome Pathology term for this description: Soft tissue swelling and loss of fat-pad detail visibility Osteomyelitis Pathology term for this description: Mixed areas of sclerotic and cortical thickening along with radiolucent lesions Osteopetrosis Change in manual exposure factors? Advanced Paget's disease increase (+) Change in manual exposure factors? Joint effusion none (0) Change in manual exposure factors? Advanced rheumatoid arthritis decrease (-) Change in manual exposure factors? Osteoporosis decrease (-) Change in manual exposure factors? Osteopetrosis increase (+) Change in manual exposure factors? Bursitis none (0) Which routine projections are required for a study of the forearm? AP and lateral
80 degrees of flexion What is the only difference among the four radial head lateral projections of the elbow? The rotational position of the hand and wrist A radiograph of a PA projection of he second digit shows that the phalanges are not symmetric on both sides of the bony shafts. Which specific positioning error is involved? Rotation A radiograph of a PA oblique projection of the hand shows that the fourth and fifth metacarpals are superimposed. Which specific positioning error is involved? Excessive lateral rotation In a radiograph study of the forearm, the proximal radius crossed over the ulna in the frontal projection. Which specific positioning error led to this radiographic outcome? PA forearm projection was performed rather than AP A PA axial scaphoid projection of the wrist using a 15-degree distal CR angle and ulnar flexion was performed. The resultant radiograph shows that the scaphoid bone is foreshortened. How must this projection be modified to produce a more diagnostic image of the scaphoid? The CR needs to be angled 15 degrees proximally, toward the elbow A radiograph of an AP elbow projection shows considerable superimposition between the proximal radius and ulna. Which specific positioning error is involved? The elbow is rotated medially A routine radiograph of an AP oblique elbow with lateral rotation reveals that the radial tuberosity is superimposed on the ulna. In what way must this position be modified during the repeat exposure? Increase lateral rotation of the elbow to separate the radius from the ulna A radiograph of a lateral projection of the elbow shows that the humeral epicondyles are not superimposed and the trochlear notch is not clearly demonstrated. Which specific type of positioning error is involved? The forearm and humerus are not on the same horizontal plane Situation: A patient with a possible fracture of the radial head enters the ER. When the technologist attempts to place the arm in the AP oblique-lateral rotation position, the patient is unable to extend or rotate the elbow laterally. Which other positions can be used to demonstrate the radial head and neck without superimposition on the proximal ulna? Coyle method for radial head (lateral elbow, CR 45 degrees toward shoulder) Situation: A patient with a metallic foreign body in the palm of the hand enters the ER. Which specific positions should be used to locate the foreign body? PA and lateral-in-extension projection
Situation: A patient with a trauma injury enters the ER with an evident Colles' fracture. Which positioning routine should be used to determine the extent of the injury? AP and lateral forearm projections to include the wrist Situation: A patient with a dislocated elbow enters the ER. The patient has the elbow tightly flexed and is careful not to move it. Which specific positioning routine can be used to determine the extent of the injury? Two AP projections with acute flexion and a lateral projection Situation: A patient with a possible fracture of the trapezium enters the ER. The routine projections do not clearly demonstrate a possible fracture. Which other special projection can be taken? Modified Robert's method Situation: A patient with a history of carpal tunnel syndrome comes to the radiology department. The orthopedic physician suspects that bony changes in the carpal sulcus may be causing compression of the median nerve. Which special projection best demonstrates this region of the wrist? Carpal canal position (Gaynor-Hart method) Situation: A patient comes to the radiology department for a hand series to evaluate early evidence of rheumatoid arthritis. Which special position can be used in addition to the routine hand projections to evaluate this patient? Norgaard method - ball catcher's position Situation: A patient is referred to radiology with a possible injury to the ulnar collateral ligament. The patient complains of pain near the first MCP joint. Initial radiographs of the hand do not indicate any fracture or dislocation. Which special projection can be performed to rule out an injury to the ulnar collateral ligament? PA stress (Folio method) projection Situation: A patient enters the ER with a possible foreign body in the dorsal aspect of the wrist. Initial wrist radiographs are inconclusive in demonstrating the location of the foreign body. What additional projection can be performed to demonstrate this region of the wrist? Tangential projection - Carpal bridge projection Situation: A patient has a routine elbow series performed. The AP projection indicates a possible deformity or fracture of the coronoid process. However, the patient is unable to pronate the upper limb for the AP oblique-medial rotation projection because of an arthritic condition. What other projection could be performed to demonstrate the coronoid process? Trauma axial lateral projection - Coyle method for coronoid process How many bones make up the phalanges of the hand? 14
Where is the coronoid tubercle located? Medial aspect of coronoid process In an erect anatomic position, which of the following structures is considered most inferior or distal? A. Head of ulna B. Olecranon process C. Radial tuberosity D. Head of radius A. Head of ulna Joint movement type for: Intercarpal Joints Plane Joint movement type for: Radiocarpal Joint Ellipsoidal Joint movement type for: Elbow Joint Ginglymus Joint movement type for: First Carpometacarpal Joint Sellar (Saddle) Joint movement type for: Third Carpometacarpal Joint Ellipsoidal True/False: To visualize fat pads surrounding the elbow, exposure factors must be adjusted to see both bony and soft tissue structures. True True/False: Anterior and Posterior fat pads of the elbow are best seen on correctly positioned and correctly exposed AP elbow projections. False; lateral Why should a forearm never be taken as a PA projection? Causes the proximal radius to cross over the ulna In what position should the hand be for an AP elbow projection? Supinated
In what position should the hand be for an AP medial rotation oblique elbow position? Pronated Which projection of the elbow best demonstrate: Coronoid process in profile AP, medial rotation oblique Which projection of the elbow best demonstrate: Radial head and tuberosity without superimposition AP, lateral rotation oblique Which projection of the elbow best demonstrate: Olecranon process in profile Lateral Elbow Which projection of the elbow best demonstrate: Coronoid tubercle AP Elbow Which projection of the elbow best demonstrate: Trochlear notch in profile Lateral Elbow Which projection of the elbow best demonstrate: Capitulum and lateral epicondyle in profile AP, lateral rotation oblique Which projection of the elbow best demonstrate: Olecranon process seated in olecranon fossa AP Elbow True/False: Placing multiple images on the same digital IP is recommended as long as close collimation is applied for each projection. False; it is recommended that only one projection be placed on a digital IP, the anatomy should be centered on the IP The long axis of the anatomic part being imaged should be placed: Parallel to long axis of the IR Arthrography is a radiographic study of: Soft-tissue structures within certain synovial joints Clinical Indication defined: Accumulated fluid within the joint cavity. Joint Effusion
True/False: Both hands are examined with one single exposure when using the Norgaard method. True True/False: The hand(s) is (are) placed in a true PA position when using the Norgaard method. False A radiograph of a PA oblique of the hand reveals that the third, fourth, and fifth metacarpals are superimposed. What must be done to correct this positioning error on the repeat exposure? Decrease obliquity of hand. A radiograph of an AP elbow projection demonstrates total separation between the proximal radius and ulna. What must be done to correct this positioning error on the repeat exposure? Rotate upper limb medially. A radiograph of the carpal canal (inferosuperior) projection reveals that the pisiform and hamulus are superimposed. What must be done to correct this positioning error on the repeat exposure? Rotate wrist laterally 5 to 10 degrees. A radiograph of an AP oblique-medial rotation reveals that the coronoid process is not in profile and the radial head is not superimposed over the ulna. What specific positioning error was involved? Insufficient medial rotation. A radiograph of a lateral projection of the elbow reveals that the epicondyles are not superimposed and the trochlear notch is not clearly seen. What must be done to correct this positioning error on the repeat exposure? Place humerus/forearm in same horizontal plane. Situation: A patient with a possible Barton's fracture enters the ER. Which positioning routine should be performed to confirm the diagnosis? Wrist Situation: A patient with a possible Smith's fracture enters the ER. Which positioning routine should be performed to confirm the diagnosis? Wrist/Forearm Situation: A patient has a Colles' fracture reduced, and a large plaster cast is placed on the upper limb. The orthopedic surgeon orders a postreduction study. The original technique, used before the cast placement, involved 60 kV and 5 mAs. How should the exposure factors be altered with a large plaster cast? Increase kV by 8 to 10.
Situation: A pediatric patient with a possible radial head fracture is brought in the ER. It is too painful for the patient to extend the elbow beyond 90 degrees or rotate the hand. What type of special projection could be performed on this patient to confirm the diagnosis without causing further discomfort? Coyle method
