Ch.4- Upper Extremeties

• There are 27 bones in the hand and wrist:

  • 8 carpal
  • 5 metacarpal
  • 14 phalanx
• The hamate has a hooklike process
• The trapezium articulates with the base of the thumb
• The scaphoid is most commonly fractured
• The scaphoid and trapezium carpal bones are located most anteriorly as seen on a lateral wrist x-ray
• the coronoid process is part of the ulna
• The coronoid and radial fossae are located on the anterior aspect of the distal humerus
• There are 3 phalanges in digits 2-5 and 2 phalanges in digit 1 (thumb)
• Phalanges are named by location (ex. Distal phalanx of 3rd digit)
• The tips of distal phalanx are called tufts
• Metacarpals comprise the palm of the hand and are counted laterally to medially
• The heads of metacarpals are distal and the bases are proximal
• Carpal bones (proximal to distal row):

  1. Scaphoid
  2. Lunate
  3. Triquetrum
  4. Pisiform
  5. Trapezium
  6. Trapezoid
  7. Capitate
  8. Hamate
• The lunate is semilunar shaped
• The triquetrum is triangular shaped
• The pisiform is the smallest carpal bone and its pea shaped
• The capitate is the largest carpal bone
• DIP Joint: Distal interphalangeal joint between the distal and medial phalanges
• PIP joint: Proximal interphalangeal joint is between the middle and proximal phalanges
• MCP Joint: The metacarpophalangeal joint is between the proximal phalanges and metacarpals
• CMC Joint: The carpometacarpal joint is between the carpals and metacarpals
• IP Joint: Interphalangeal joint in the 1st digit, between the distal and proximal phalanges
• Forearm consists of the ulna and radius
• The Ulna is on the medial side
• The radius is on the lateral side (RT: Radius and Thumb)
• The Ulna contains:

  • Olecranon process
  • Coronoid process
  • Styloid process
  • Radial notch
• The Radius contains:

  • Radial head
  • Radial tuberosity
  • Radial styloid process
  • Ulnar notch
• The ulna is larger on the proximal end and the radius is larger on the distal end
• The trochlear notch is a semi-lunar notch
• Elbow joint proper: Three joints enclosed in a common capsule
• If the posterior fat pad is visible, that can be evidence of an injury within the connective tissue
• There are 3 elbow fat pads/stripes:

  • Anterior fat pad
  • Posterior fat pad
  • Supinator fat pad
• The 3 concentric arcs:

  • Trochlear sulcus
  • Outer ridges of capitulum and trochlea
  • Trochlear notch of ulna
• The greater tubercle is visible in AP and the lesser tubercle is visible in a lateral position
• 40” SID for all upper limbs
• Norgaard Method is aka ball catchers position
• kVp Ranges:

  • Fingers/Hands: 55 ± 5
  • Wrist: 60 ± 5
  • Forearm: 65 ± 5
  • Elbow: 65 ± 5
  • Humerus: 75 ± 5
  • Shoulder: 80 ± 5
• The elbow joint is a synovial (diarthrodial) joint
• List the joints/articulations of HUMERUS:

  • Glenohumeral/Scapulohumeral Joint
  • Humeroradial Joint
  • Humeroulnar Joint
• External oblique elbow shows no superimposition