Musculoskeletal Disorders and Conditions
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Questions and Answers

What is dislocation?

Displacement from joint

What characterizes a Bennett fracture?

Fracture through base of the first metacarpal bone, extending into the CMC joint with subluxation and posterior displacement

What is a Boxer fracture?

Transverse fracture that extends through the metacarpal neck, most commonly seen on the 5th metacarpal

What is Skier's thumb?

<p>Sprain or tear of the ulnar collateral ligament of the thumb near the MCP joint of the hyperextended thumb</p> Signup and view all the answers

What is Osteoarthritis?

<p>Also known as degenerative joint disease, it is the most common type of arthritis.</p> Signup and view all the answers

What is Rheumatoid Arthritis?

<p>Chronic systemic disease with inflammatory changes throughout connective tissues.</p> Signup and view all the answers

What is osteoporosis?

<p>Reduction in the quantity of bone or atrophy of skeletal tissue.</p> Signup and view all the answers

What is each finger and thumb known as?

<p>Digit</p> Signup and view all the answers

How many phalanges are there in each hand?

<p>14</p> Signup and view all the answers

How many metacarpals are present in each hand?

<p>5</p> Signup and view all the answers

What are the three parts of a phalanx?

<p>Head, Body, Base</p> Signup and view all the answers

What is the special name for the thumb?

<p>Digit 1</p> Signup and view all the answers

The carpals make up the ______.

<p>wrist</p> Signup and view all the answers

What is the recommended SID for X-rays of the hand?

<p>40</p> Signup and view all the answers

The first digit consists of 3 phalanges.

<p>False</p> Signup and view all the answers

What is the purpose of a grid in X-ray imaging?

<p>To reduce scatter radiation</p> Signup and view all the answers

A Bennett fracture involves the base of the first metacarpal bone, extending into the ______.

<p>CMC joint</p> Signup and view all the answers

Which of the following is a type of arthritis experienced in the aging process?

<p>Osteoarthritis</p> Signup and view all the answers

What is the positioning consideration for trauma patients during X-rays?

<p>X-rays can be completed with the patient on a stretcher.</p> Signup and view all the answers

What is the recommended collimation for X-ray images?

<p>Collimate to four sides</p> Signup and view all the answers

When x-raying the 2-5th digit, you need to include the entire digit through the MCP joint.

<p>True</p> Signup and view all the answers

What is the total number of bones in each hand?

<p>27 bones</p> Signup and view all the answers

What are the three parts of a phalanx?

<p>Head, Body (shaft), Base</p> Signup and view all the answers

How many metacarpals are there in each hand?

<p>5 metacarpals</p> Signup and view all the answers

What is the special name for the thumb?

<p>Digit 1</p> Signup and view all the answers

The primary joint located between the proximal and distal phalanges of the thumb is called the ______ joint.

<p>Interphalangeal (IP)</p> Signup and view all the answers

What is a Bennett fracture?

<p>Fracture through the base of the first metacarpal bone extending into the CMC joint</p> Signup and view all the answers

The thumb consists of three phalanges.

<p>False</p> Signup and view all the answers

What is the recommended SID for taking X-rays of the thumb?

<p>40 SID</p> Signup and view all the answers

Match the following joints with their locations:

<p>Interphalangeal (IP) = Between proximal and distal phalanges 1st Metacarpophalangeal (MCP) = Between proximal phalanx and 1st metacarpal 1st Carpometacarpal (CMC) = Between proximal metacarpal and associated carpal Distal Interphalangeal (DIP) = Between distal and middle phalanges</p> Signup and view all the answers

What is the common name for degenerative joint disease?

<p>Osteoarthritis</p> Signup and view all the answers

Which of the following is a type of fracture commonly associated with the 5th metacarpal?

<p>Boxer fracture</p> Signup and view all the answers

Study Notes

Dislocation

  • Displacement of a bone from its joint

Fractures

  • Bennett fracture: Fracture at the base of the first metacarpal bone, extending into the carpometacarpal (CMC) joint, with subluxation and posterior displacement.
  • Boxer fracture: Transverse fracture through the metacarpal neck, most commonly seen in the 5th metacarpal.
  • Skier's thumb: Sprain or tear of the ulnar collateral ligament of the thumb near the metacarpophalangeal (MCP) joint due to hyperextension. Occurs from falling on an outstretched arm and hand, causing the thumb to bend back toward the hand.

Osteoarthritis

  • Also known as degenerative joint disease.
  • Most common type of arthritis.
  • Considered a normal part of the aging process.

Rheumatoid Arthritis

  • Chronic systemic disease with inflammatory changes throughout connective tissues.
  • Three times more common in women than men.

Osteoporosis

  • Reduction in the quantity of bone or atrophy of skeletal tissue.
  • Occurs in postmenopausal women and elderly men.
  • Results in bone trabeculae that are scanty and thin.

Foreign Objects

  • No information provided.

Anatomy of the Hand and Wrist

  • The hand and wrist are comprised of 27 bones: 14 phalanges, 5 metacarpals and 8 carpals.
  • Digits 2-5 consist of three phalanges: proximal, middle, and distal.
  • The thumb (digit 1) consists of two phalanges - proximal and distal.
  • Each phalanx has three parts: head, body (shaft), and base.
  • Metacarpals make up the palm of the hand.
  • The head of the metacarpal is distal and round.
  • The shaft of the metacarpal is shaped with a concave anterior and convex posterior surface
  • Carpals make up the wrist.

Joints of the Hand

  • Interphalangeal (IP) Joint: Located between the proximal and distal phalanges.
  • Metacarpophalangeal (MCP) Joint: Located between the proximal phalanx and the metacarpal.
  • Carpometacarpal (CMC) Joint: Found between the metacarpal and the carpal.
  • The Thumb CMC Joint is between the proximal metacarpal and the trapezium (carpal).

Positioning and Technique

  • General Positioning Considerations: The patient is seated sideways at the end of the table with the arm fully supported.
  • Trauma Patients can remain on stretchers for x-ray imaging.
  • Pediatric Patients: require immobilization techniques to reduce motion, use sponges and tape, and ensure soothing communication.
  • Geriatric Patients: Require clear and complete instructions as they may have difficulty with strenuous positions. Reduce exposure factors to consider potential osteoporosis.
  • Exposure factors: Lower to medium kVp (60-80) and short exposure time to reveal soft tissue margins and fine trabecular markings.
  • Collimation: Collimate to the area of interest, select the smallest IR size and place the long axis of the part parallel to the long axis of the IR.

Clinical Indications

  • Common imaging indications include dislocations, fractures, osteoarthritis, rheumatoid arthritis, osteoporosis, and foreign objects.

1st Digit (Thumb) Imaging

  • Routine Views: AP, PA oblique, and lateral.
  • AP Projection: Place arm extended in front, rotate arm internally to supinate the thumb, align thumb with long axis of IR, and center CR at the 1st MCP joint.
  • Exception: PA Projection should be used when the patient cannot position for the AP view. The hand is placed nearly lateral and thumb is supported with a block, CR is centered at the 1st MCP joint.
  • PA Oblique Projection: Abduct the thumb slightly with the palmar surface of the hand on the IR, center the CR on the 1st MCP joint.
  • Lateral Projection: Pronate hand and abduct thumb, slightly arch fingers, rotate medially until thumb is in true lateral position, and center CR on 1st MCP joint.

2nd- 5th Finger Imaging

  • Routine Views: PA, PA oblique, and lateral.
  • PA Projection: Pronate the hand with extended fingers, center and align the long axis of the affected finger with the long axis of the IR, center the CR perpendicular to the IR at the PIP joint, and collimate to the affected finger and distal aspect of the metacarpal.
  • PA Oblique Projection: Extend fingers and rotate the hand laterally 45 degrees (medially 45 degrees for the 2nd digit), center the CR at the PIP joint.
  • Lateral Projection: *Mediolateral for the 2nd digit and Lateromedial for 3rd-5th digits, rotate the hand into a lateral position so the finger of interest is parallel to the IR, flex unaffected fingers.

Hand Imaging

  • Routine Views: PA, PA oblique, and lateral “fan” projection.
  • PA Projection: Pronate hand with palmar surface on IR, spread fingers slightly, and center the CR at the 3rd MCP joint.
  • PA Oblique Projection: Pronate hand on IR, rotate hand and wrist laterally 45 degrees, separate all digits.
  • Lateral “Fan” Projection: Rotate hand and wrist into lateral position with thumb up, spread fingers and thumb into a fan position, ensure all digits are parallel to the IR, center the CR on the 2nd MCP joint.

Hand Anatomy

  • The hand contains 27 bones and is composed of three sections: phalanges, metacarpals, and carpals.
  • Phalanges consist of the bones of the fingers and thumb.
  • The thumb is considered digit 1 and the pinky is digit 5.
  • Digits 2-5 each have 3 phalanges: proximal, middle, and distal.
  • The thumb has 2 phalanges: proximal and distal.
  • Each phalanx has 3 parts: the head, body, and base.
  • Metacarpals make up the palm of the hand.
  • There are 5 metacarpals numbered 1-5, and each is composed of a head, body, and base.
  • Carpals comprise the wrist and there are 8 carpals in total.

Joint Anatomy

  • Interphalangeal (IP) joints are located between the proximal and distal phalanges.
  • Metacarpophalangeal (MCP) joints are located between the proximal phalanx and the metacarpal.
  • Carpometacarpal (CMC) joints are located between the metacarpal and the carpal.

Positioning

  • The 1st digit must include the 1st metacarpal and trapezium on imaging.
  • The 2nd-5th digits only need to include the MCP joints on imaging.

Positioning and Exposure

  • The hand should be positioned with the long axis of the bone parallel to the long axis of the IR.
  • Use the smallest IR available and collimate as much as possible.
  • Exposure factors should be between 60-80 kVp, short exposure time, and small focal spot.
  • Grids are not typically used unless the body part is greater than 10cm.

General Positioning Considerations

  • Patients should be seated sideways at the end of the table with their arm supported at shoulder height.
  • For trauma patients, x-rays can be completed with the patient on a stretcher.
  • Pediatric patients need immobilization techniques like sponges and tape.
  • Geriatric patients may require clear and complete instructions, sponges, and possibly reduced exposure factors.

Clinical Indications for Hand Imaging

  • Dislocation
  • Fractures
    • Bennett fracture - fracture through the base of the 1st metacarpal bone that extends into the CMC joint with subluxation and posterior displacement
    • Boxer fracture - Transverse fracture through the metacarpal neck, most commonly seen in the 5th metacarpal.
    • Skier's thumb - Sprain or tear of the ulnar collateral ligament of the thumb near the MCP joint due to hyperextension of the thumb.
  • Osteoarthritis
  • Rheumatoid arthritis
  • Osteoporosis
  • Foreign objects

Specific Postioning and Evaluation Criteria

  • 1st Digit:
    • AP:
      • Entire thumb including the first CMC joint
      • Centered at the first MCP joint
      • No rotation of phalanges.
    • PA Oblique:
      • Entire thumb demonstrated.
      • Joints open as in 45° oblique.
      • Centered at the first MCP joint.
    • Lateral:
      • Entire thumb demonstrated.
      • Centered at first MCP joint.
      • No rotation from lateral evident.
  • 2nd-5th Digits:
    • PA:
      • Entire finger and minimum 1/3 of the MCP demonstrated.
      • Centered at the PIP joint.
      • No rotation of phalanges.
    • PA Oblique:
      • Entire phalanx and MCP joint demonstrated
      • IP and MCP joints open.
      • Centered at the PIP joint.
    • Lateral:
      • Entire phalanx and MCP joint demonstrated
      • Centered at the PIP joint.
      • True lateral position with digit parallel to the IR.
  • Hand:
    • PA:
      • Entire hand and carpals demonstrated.
      • Centered at the 3rd MCP joint.
      • No rotation of phalanges or metacarpals.
    • PA Oblique:
      • Entire hand and carpals demonstrated.
      • Centered at the 3rd MCP joint.
      • Joints open.
      • Adequate separation of phalanges and metacarpals.
    • Lateral Fan:
      • Entire hand and carpals demonstrated.
      • Centered at the 2nd MCP joint.
      • Fingers are equally separated.
  • Other:
    • The PA projection is not recommended for the 1st digit.
    • The "Fan" lateral is the preferred lateral projection for the hand if phalanges are of interest.

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Description

This quiz covers important musculoskeletal disorders such as dislocations, fractures, and types of arthritis. Participants will learn about specific conditions including Bennett and Boxer fractures, as well as osteoporosis and rheumatoid arthritis. Test your knowledge on these common orthopedic issues!

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