Upper Extremity fingers (digits) & hand RTEC 123 # 1 A LECTURE Contributions by: MOSBY – MERRILLS & BONTAGER XRAY2000.CO.UK rev 10/10/11 1
ANATOMY REVIEW UPPER EXT : FINGERS/ HAND 2
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Anatomy &Positioning Review Upper Limb 8 POSITIONING
RE: LATERALS PG 80 PROJECTION VS POSITION CHEST / ABDOMEN / SKULL The lateral is referred to the POSTION – which is the SIDE TOUCHING THE IR SO LEFT LATERAL (position ) in referred to as a LATERAL PROJECTION LIMBS : Pos/Pro – side entered by IR MEDIOLATERAL OR LATERALMEDIAL 9
LEFT LATERAL POSITION – LT LATERAL PROJECTION 10 RIGHT LATERAL POSITION – RT LATERAL PROJECTION
Lateromedial mediolateral 11
FINGERS “series” PA FINGER (PA HAND) OBLIQUE * LATERAL *OBLIQUE (med or lat rot) depending on which digit 12
FINGER “series” PA OBL LATERAL 13
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DO NOT PLACE PATIENT’S LEGS UNDER THE TABLE 15
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WHICH DIGIT? 17
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LATERAL MEDIAL ROTATION 19
? Which rotation is this? 20 PA oblique - medial rotation
YES NO Keep fingers // to IR 21
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THUMB (1 ST DIGIT) PA / AP PA OBLIQUE LATERAL 26
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PA AP 29
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OBLIQUE 31
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LATERAL 33
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HAND Series (3vw or 4*vw) PA PA OBLIQUE (lat rotation) LATERAL (FAN) *AP OBLIQUE (med rotation) or PA OBLIQUE (med rotation) 35
HAND Series Re: LATERAL MEDIOLATERAL OR LATEROMEDIAL FAN /TRUE LATERAL/ FLEXION 36
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Note: Incorrect position of hand and forearm Forearm should be parallel with end of the table – elbow flexed 40
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HAND Series Re: LATERAL MEDIOLATERAL OR LATEROMEDIAL P 128 FAN /TRUE LATERAL/ FLEXION 48
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52 Projection ?
Alternate lateral (FB) 53
AP OBLIQUE OPENS SPACES BETWEEN 4 TH & 5 TH mc 54 Additional projection of hand
AP OBLIQUE HAND (medial rotation) May be required as the 4 th “routine view” Hand supinated (AP) then rotated medially 45º (keep fingers straight) 55 PA OBLIQUE Medial rotation another -alternate method – Radiographically image will look the same
PA OBLIQUE another -Alternate method keep hand PA then rotate hand 45º PA lateral medial 56
Compare :OBLIQUE OF RT HAND PA & AP What anatomy is seen specific to each position? 57
BILATERAL AP OBLIQUES 58 ?
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For Arthritis “ballcatchers” 60
Keep arm level and elbow flexed 90º (not like this!) Legs should be at the side of the table – and where is the shield! 61
FILM CRITIQUE & Pathology 62 Reduce OID, magnification
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PATHOLOGY FOR UPPER EXTREMITY 1 SEE CHART PG 109 Bone cyst Bursitis Fractures /Dislocations Joint effusion Osteoporosis Rheumatoid Arthritis 66
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73 What abnormality do you see?
Alternate method if you can’t get the fingers straight!!!! Do 2 projections – 1 for hand, 1 for fingers in this position 74
OSTEOSARCOMA 75
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Bennett’s FX fx at base of 1 st MC 78
Mutilating rheumatoid arthritis. 79
RHEUMATOID ARTHRITIS 80
Rheumatoid arthritis 81 RA - inflammatory disease 3x more common in females
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Osteoarthritis of fingers. Note narrowing of interphalangeal joints with spurring and erosions 83 OA - Non inflammatory joint disease involves the articular cartilage – Aging /erosion
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BOXER’S FX 87
88 <> 88 Bennett's fracture 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.
CONGENTIAL ABNORMALITIES 89
What abnormality do you see? 90
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G S W 92
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QUESTIONS ? End of Upper Extremity #1 Wrist will be covered if there is time … 97