Upper extremity week 9 lecture #3-A PATHOLOGY & POSITIONING 1 Upper extremity week 9 lecture #3-A PATHOLOGY & POSITIONING RT 123 FALL 2011 REVISED

2 Position? Taken For ? Bilateral Oblique – “ball cathers” taken for arthritis

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Why the digits need to stay parallel to the IR 4

A- SHOWS INSUFFICIENT ROTATION What is the criteria to decide? 5

6 Problem ? Look at wrist and elbow - why was this taken this way?

What pathology do you see (look at distal end) 7

8 B- OVER FLEXED, HAND NOT LATERAL (ROTATION)

9 NOTE – epicondyles not completely superimposed Why? Humerus is not // to IR 9

Positions? What needs to be corrected on the image on your RIGHT? 10

11 Age? Positioning? How can you determine the childs age?

Any corrections needed? 12

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Image review from Elsevier 20 Image review from Elsevier Fall 2008

Acceptable for scaphoid? Why or why not 21

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Positioning error? 23

The separation of the proximal radius and ulna indicates that the elbow was rotated from a true AP projection 24

and the elbow is extended beyond 90°. The humerus and forearm are not in the same parallel plane to the IR (epi’s) and the elbow is extended beyond 90°. (?) 25

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27 PATHOLOGY

? fx boxers 28

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30 ?                                           <> bennetts

Bennett's fracture 31 is caused by forced abduction of the thumb there is a dislocation of the base of the first metacarpal although a fragment continues to articulate with the trapezium.                                           <> bennetts

Rheumatoid Osteo Arthritis 32 Rheumatoid Osteo Arthritis RA - inflammatory 3x more common in women OA – non- inflammatory joint disease – involves the articular cartilage

33 RHEUMATOID ARTHRITIS

Rheumatoid arthritis RA - inflammatory disease 3x more common in females

Osteoarthritis of fingers Osteoarthritis of fingers. Note narrowing of interphalangeal joints with spurring and erosions OA - Non inflammatory joint disease involves the articular cartilage – Aging /erosion

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Transradial styloid perilunate fracture-dislocation 37 Transradial styloid perilunate fracture-dislocation

Fracture of the trapezium (greater multangular) 38

39 greenstick

Torus /buckle fx 40

Torus or Buckle Impacted fracture with bulging of the periosteum. 41

Which carpel bone is the most common for fracture? 42

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Colles’ Fracture Extension-Compression Fracture of Distal Radius FX WITH POSTERIOR DISPLACEMENT 44

?                                            <> 45

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SMITH’S FX Flexion-Compression FX WITH ANTERIOR DISPLACEMENT 47

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Colle's fractures usually occur when an adult falls on a hyperextended, outstretched hand. There is frequently an associated fracture of the ulnar styloid. Secondary degenerative arthritis may develop at the wrist joint. Same as Colles except there is volar displacement and angulation of the distal fragment

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Fat pad sign w elbow injury 52

5yo fell off swingset not 90º flexed 53

Monteggia fracture- disclocation of radial head and displaced fx of ulnar shaft 54

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Subtle radial head fx 57

A swollen elbow usually contains a fracture injury A swollen elbow usually contains a fracture injury. In some instances, a joint effusion (posterior fat pad sign or enlarged anterior fat pad sign) can be seen in the absence of a visible fracture. 58

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61 the other oblique view shows an obvious fracture of the lateral (external) condyle.

Lateral condlye fx 62

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SIMPLE BONE CYST 67

Practice in LAB SIGN UP = MONDAY TUESDAY WED – NOTE: NO LAB BEFORE DEMOS…. 68