Upper extremity anatomy & positioning
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Transcript of Upper extremity anatomy & positioning
![Page 1: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/1.jpg)
Radiographic Anatomy and Positioning of the Upper
Extremity
Dennis Winders
Jeff Ahrendsen
![Page 2: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/2.jpg)
Anatomy
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Upper extremity consists of:
• Phalanges
• Metacarpals
• Carpals
• Radius
• Ulna
• Humerus
![Page 4: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/4.jpg)
Anatomy of the Hand &
Wrist
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The hand & wrist consists of :
• 27 Bones– Phalanges - 14– Metacarpals - 5– Carpals - 8
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Phalanges• Fingers & thumb
• 3 separate bones Digits 2-5– Proximal– Middle– Distal
• Tuft
• Thumb– Proximal– Distal
![Page 7: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/7.jpg)
Naming of Digits
• 1• 2• 3• 4• 5
• Thumb• Index• Middle• Ring• Little
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Joints• Interphalangeal
• Metacarpophalangeal
• Distal Interphalangeal
• Proximal Interphalangeal
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Metacarpals• Palm
• Numbering
• Three parts– Head– Shaft– Base
• Joints– MP– Carpometacarpal
Head
BaseShaft
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Carpals (Wrist)• 8 bones
• Proximal rowa Navicular - Scaphoidb Lunate - Semilunarc Triquetral - Cuneiformd Pisiform
a b
c
d
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Carpals (continued)
• Distal rowa Greater Multangular - Trapeziumb Lesser Multangular - Trapezoidc Capitate - Os Magnumd Hamate - Unciform
ab c d
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Mnemonic
• Never• Lower• Tillies• Pants• Grandma• Might • Come• Home
• Some• Sassy• Children• Play• Through• Their• Old• Underwear
• Some• Lovers• Try • Positions • That• They • Can’t • Handle
Alternative mnemonic
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Carpal Joints
• Radiocarpal
• Intercarpal
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Distal Radius & Ulna
• Radial Styloid Process
• Ulnar Styloid Process
• Distal Radioulnar Jt.
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Radiographic Anatomy
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A.B.
C.
D.
E.
F.
G.
H.
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Tuft
2nd DIP Jt.2nd PIP Jt.
2nd MP Jt.IP Jt.
1st MP Jt.
CM Jt.
Radiocarpal Jt.
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A.
B.
C.
D.
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Trapezium
Trapezoid
Scaphoid
Pisiform
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A.
B.
C.
D.
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Os Magnum
Semilunar
Unciform
Cuneiform
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Carpal Canal
• Trapezium
• Os Magnum
• Unciform
• Pisiform
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Motions of the Hand & Wrist
• Radial Flexion (Ulnar Deviation)
• Ulnar Flexion (Radial Deviation)
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Positioning of the Hand & Wrist
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Finger
• Routine projections– PA– Medial Oblique– Lateral Oblique– Lateral
• Film size• SID• CR
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PA
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Lateral
![Page 28: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/28.jpg)
Medial oblique
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Lateral oblique
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Parallel vs. Not Parallel
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Structures shown
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Technique
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Prevention of
• Immobilize– Sandbags– Tape
• Short exposure time– 10mAs = 200mA x .05s– 10mAs = 400mA x .025s
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Thumb
• Routine projections– AP– PA Oblique– AP Oblique– Lateral
• Film size• SID• CR
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AP
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Lateral
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PA Oblique
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AP Oblique
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Structures shown
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Technique
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Hand
• Routine projections– PA– PA Oblique-Lateral
Rotation– Fan Lateral
• Non-routine projections– Lateral for Foreign Body
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Routine Hand Projections
• Routine projections– PA– PA Oblique-Lateral
Rotation– Fan Lateral
• Film size• SID• CR
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PA
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PA Oblique-Lateral Rotation
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Fingers Down vs. Fingers Straight
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Fan Lateral
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Structures Shown
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Technique
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Non-routine projections of the Hand
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Lateral for Foreign Body
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Wrist
• Routine projections– PA (Ulnar Flexion)– PA Oblique-Lateral
Rotation– Lateral
• Non-routine projections– PA-no flexion– Stetcher– Carpal Canal (Gaynor-
Hart)– Lateral for Pisiform
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Routine Wrist Projections
• Routine projections– PA (Ulnar Flexion)– PA Oblique-Lateral
Rotation– Lateral
• Film size• SID• CR
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PA (Ulnar Flexion)
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PA Oblique-Lateral Rotation
![Page 55: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/55.jpg)
Lateral
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Structures shown
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Technique
![Page 58: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/58.jpg)
Non-routine projections of the Wrist
![Page 59: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/59.jpg)
PA-no flexion
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Scaphoid views (Stetcher)
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Carpal Canal (Gaynor -Hart)
![Page 62: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/62.jpg)
10° Supination Lateral
![Page 63: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/63.jpg)
Casted Extremities
![Page 64: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/64.jpg)
Changes in technique
• No cast– Extremity film
– 10mAs @ 60kV
• Casted– Regular film– Lower mAs 10 times
• Wet cast– Add 15 to the kV
• Dry cast– Add 10 to the kV
• Fiberglass– Add 5 to the kV
![Page 65: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/65.jpg)
Anatomy of the Forearm
& Elbow
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Radius
• Distal– Styloid Process
– Ulnar Notch
• Proximal– Head
– Neck
– Tuberosity
• Shaft
![Page 67: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/67.jpg)
Ulna• Distal
– Head– Styloid Process
• Proximal– Olecranon process– Coronoid process– Trochlear notch– Radial notch
• Shaft
![Page 68: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/68.jpg)
Effects of pronation
on the forearm
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Distal Humerus
• Humeral Condyle– Trochlea (Medial condyle)– Capitulum (Lateral condyle)
• Lateral epicondyle• Medial epicondyle• Depressions
– Coronoid fossa– Radial fossa– Olecranon fossa
![Page 70: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/70.jpg)
Classification of Joints
• Radioulnar– Proximal– Distal
• Elbow
![Page 71: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/71.jpg)
Radiographic Anatomy
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A.
B.
C.
D.
E.
F.
G.
H.
I.
J. (Jt.)
K.
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Medial Epicondyle
Coronoid Process
Shaft (Ulna)
Ulnar Head
Ulnar StyloidProcess
Lateral Epicondyle
Radial Head
Radial Tuberosity
Shaft (Radius)
Distal Radioulnar Jt.
Radial Styloid Process
![Page 74: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/74.jpg)
A.
B.
C. (Jt.)
D.
E.
F.
G. Post.
H.
I.
J.
![Page 75: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/75.jpg)
Lateral epicondyle
Capitulum
Proximal radioulnarjt.Radial head
Radial neck
Radial tuberosity
Olecranon fossa
Medial epicondyle
Trochlea
Coronoid process
![Page 76: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/76.jpg)
C. B. A.
D.
E. (not the jt.)
F.
G. (depression)
![Page 77: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/77.jpg)
Coronoid Process Radial head Radial neck
Condyles
Trochlear notch
Olecranon process
Radial notch
![Page 78: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/78.jpg)
Positioning of the Forearm & Elbow
![Page 79: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/79.jpg)
Forearm
• Routine projections– AP– Lateral
• Film size• SID• CR
![Page 80: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/80.jpg)
AP
![Page 81: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/81.jpg)
Lateral
![Page 82: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/82.jpg)
Structures shown
![Page 83: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/83.jpg)
Technique
![Page 84: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/84.jpg)
Elbow
• Routine projections– AP– Lateral– Coyle
• Non-routine– Obliques– Reverse Coyle– Partial Flexion– Rotational views of
the radial head
![Page 85: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/85.jpg)
Routine Elbow
• Routine projections– AP– Lateral– Coyle
• Film size• SID• CR
![Page 86: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/86.jpg)
AP
![Page 87: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/87.jpg)
Lateral
![Page 88: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/88.jpg)
Coyle
![Page 89: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/89.jpg)
Structures shown
![Page 90: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/90.jpg)
Technique
![Page 91: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/91.jpg)
Non-routine projections of the Elbow
![Page 92: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/92.jpg)
Obliques
![Page 93: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/93.jpg)
Reverse Coyle
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Partial Flexion
![Page 95: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/95.jpg)
Humerus parallel
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Forearm parallel
![Page 97: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/97.jpg)
Rotational views of the Radial Head
![Page 98: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/98.jpg)
Hand supinated
![Page 99: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/99.jpg)
Hand AP oblique
![Page 100: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/100.jpg)
Hand lateral
![Page 101: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/101.jpg)
Hand pronated
![Page 102: Upper extremity anatomy & positioning](https://reader033.fdocuments.us/reader033/viewer/2022061205/54815053b4af9f5c758b46ca/html5/thumbnails/102.jpg)
Lateral positioning