Upper Extremity Flashcards by Courtney Goodhew

PA wrist criteria

Styloid processes are at the extreme edges
CMC joint spaces are open (MC’s do not obscure carpal bones)
Scapholunate joint space is open
Ulnar border of pisiform is positioned outside of ulnar border of the
triquetrum
Minimal overlap of distal radius
Radioulnar joint is open
Posterior surface of wrist and hand
parallel to IR

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What is the positioning fault?
How would you fix it?

scapholunate joint is closed (obliqued)
trapezoid and trapezium are seperated
thumb is away from IR

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What is the positioning fault?
How would you fix it?

CMC joints are closed - caused by extension of the wrist
2nd MC obscuring trapezoid/trapezium
flex wrist so its flat on IR to open joint spaces

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What causes foreshortening of the scaphoid

radial deviation causes foreshortening - signet ring sign
proximal forearm being higher than the dital forearm

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What happens with wrist extension (like a clenched fist with the metacarpals on a steep angle)??

closes CMC joint
scaphoid is less foreshortened
proximal part of the 2nd metacarpal obscures the trapezoid/trapezium

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Lateral Wrist Criteria

Superimposed distal
radius and ulna
Anterior part of distal
scaphoid is nearly aligned
with anterior part of
pisiform

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What is the positioning fault?
How would you fix it?

radius is more anterior meaning wrist is internally rotated
need to externally rotate to true lateral to SI radius and ulna

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What is the positioning fault?
How would you fix it?

The wrist is externally rotated and needs to be internally rotated

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AP elbow criteria

Medial and lateral humeral epicondyles
are in profile
* 1/4” overlap of radial head on ulna
* 50% of the radius at the radial
tuberosity is superimposed by the ulna
* Capitulum-radial joint space is open
↳have all 3 jointson same plane
* Radius and ulna are parallel

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What is the positioning fault?
How would you fix it?

Too much overlap with the radius and ulna - elbow slightly internally rotated

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What is the positioning fault?
How would you fix it?

Elbow externally rotated. No overlap of the radius at the radial tuberosity

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What is the positioning fault?
How would you fix it?

joint space is closed (radius and capitulum)
all 3 joints are not on the same plane
olecranon not in fossa

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AP external Oblique Elbow Criteria

capitulum- radial head joint space is open
radio-ulnar joint is open
no overlap of radius and ulna

good image for radial head/neck fractures

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What is the positioning fault?
How would you fix it?

too much external rotation causing rad/ulnar joint to be closed
forearm not perp to CR

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What is the positioning fault?
How would you fix it?

radial head/capitulum joint space closed
all 3 joints not on same plane
marker not on lateral side

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What is the positioning fault?
How would you fix it?

not enough external rotation
radio-ulnar joint is closed

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AP Internal Oblique Elbow Criteria

trochlear notch & coronoid process are seen in profile
3/4 of radial head is superimposed on ulna

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What is the positioning fault?
How would you fix it?

under rotated
radial head not 3/4 under ulna

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Lateral Elbow Criteria

Study These Flashcards

elbow flexed 90
capitulum and trochlea superimposed
articulating surfaces of the radial head and coronoid process are aligned

What is the positioning fault?
How would you fix it?

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hand is too low
lateral condyle more distal
need to raise hand

What is the positioning fault?
How would you fix it?

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Lower hand and raise elbow (or lower shoulder)
- go over this one again

What is the positioning fault and how would you fix it

Study These Flashcards

Raise hand and raise elbow slightly

What is the positioning fault?
How would you fix it?

Study These Flashcards

Flex elbow to 90°
Lower hand
Raise elbow

What is the positioning fault?
How would you fix it?

Study These Flashcards

hand up
elbow down

What is the positioning fault? How would you fix it?

Great superimposition…but flexed slightly too much

AP Shoulder (EXT) Criteria

Greater tuberosity in profile on lateral side * Humeral epicondyles are parallel to IR ## Footnote `

AP Shoulder (INT) Criteria

- Lesser tuberosity in profile medially (greater is ant) - Humeral epicondyles are perpendicular to IR

AP Shoulder (NEU) Criteria

- Both tuberosities are anterior on the humeral head - Smooth appearance on circumference of humeral head * Humeral epicondyles are on a 45° angle

What position is this AP Shoulder & how do u know

- external rotation - greater tuberosity is in profile

How do you open subacromial space on AP shoulder

- add a 10* caudad angle

What is the positioning fault

- no caudad angle - AP shoulder in external rotation demonstrating the entire shoulder girdle

What position is this AP shoulder image

- internal rotation - lesser tuberosity in profile medially

What position is this AP shoulder image

- neutral rotation - has lightbulb effect

AP Glenoid Criteria

- Open joint space * Coracoid process superimposes humeral head by 0.25” or 0.6 cm * Ribs are not superimposing the joint - patient at 45 oblique - hand on side (not across abdomen)

What is the positioning fault? How would you fix it?

- joint space not open - Oblique the patient more (right shoulder further away from IR)

What is the positioning fault? How would you fix it?

- not enough rotation - ribs too far from glenoid & joint space not open

What is the positioning fault? How would you fix it?

- needs more rotation

What is the positioning fault? How would you fix it?

- too much rotation - ribs too close to glenoid and doesnt appear to have joint space

What is the positioning fault? How would you fix it?

- needs more oblique - supraspinatous head causing humeral head to move up

Y Scap Criteria

Superimposed lateral and vertebral scapular borders - Lateral border of scapula appears as 2 parallel lines (If AP, hit lateral border first) - Medial or vertebral border appears as 1 thinner line - If PA, hit medial border first * Open subacromial joint space

What is the positioning fault in these images? How would you fix it?

Both images are over rotated 2nd image doesnt have subacromial space, could use caudad angle

What is the positioning fault in these images? How would you fix it?

both images are under rotated, lateral border of scapula has not reached medial border

Axillary Shoulder Criteria

- SI'd glenoid cavity - glenoid cavity lines up with coracoid process - lesser tuberosity in profile anteriorly - hand higher than shoulder confirms humerus is || to ground ## Footnote good image to confirm dislocation

What is the positioning fault & how would u fix it?

Decrease the angle between the CR and side of the body - because we hit glenoid first and it is medial to border of coracoid

What is the positioning fault & how would u fix it?

- border of the glenoid are lateral to the coracoid thus we need to increase angle between CR and body

Upper Extremity Flashcards

(45 cards)