Radiology: X-ray Imaging of First CMC Joint

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Questions and Answers

What is the primary issue with the radiograph in the example?

The central ray is not angled correctly to capture the joint

The radiograph is not taken at the correct angle to show the joint

The soft tissue of the palm is obstructing the view of the first CMC joint (correct)

The first CMC joint is not visible due to the patient's handedness

What modification would be beneficial to show the joint in this patient?

Temporal modification of the central ray

Rafert modification of the central ray

Radial modification of the central ray

Long-Rafert or Lewis modification of the central ray (correct)

What is the significance of the arrow in the radiograph example?

It points to the first CMC joint

It marks the edge of the radiograph

It highlights the soft tissue of the palm (correct)

It indicates the direction of the central ray

What is the main goal of modifying the central ray in this case?

To improve the visibility of the first CMC joint Signup and view all the answers

What is the primary advantage of using the Long-Rafert or Lewis modification?

It allows for better visualization of the first CMC joint Signup and view all the answers

What is the name of the method used for the AP Oblique Projection?

Norgaard Method Signup and view all the answers

In which direction is the wrist positioned for the PA Axial Projection using the Rafert-Long method?

Ulnar deviation Signup and view all the answers

What is the name of the series used for the PA and PA Axial wrist projections?

Rafert-Long Series Signup and view all the answers

What is the type of projection used for the Stecher Method?

PA Axial Projection Signup and view all the answers

What is the name of the bone being projected in the given images?

Scaphoid Signup and view all the answers

What is the primary purpose of adjusting the central ray angle in the radiographic examination of the wrist?

To achieve a more direct view of the wrist bones Signup and view all the answers

What is the primary difference between radiographs (A) and (B)?

The angle of the central ray Signup and view all the answers

What is the primary purpose of the Folio method in radiology?

To diagnose ulnar collateral ligament (UCL) tears in the MCP joint Signup and view all the answers

What is the purpose of using a 10-degree cephalad angle in radiograph (B)?

To reduce the distortion of the wrist bones on the radiograph Signup and view all the answers

What is the significance of the 13-degree difference in the MCP joint angle between the left and right sides?

It is a sign of UCL tear Signup and view all the answers

What is the significance of the radiographs being from the same patient?

It ensures that the radiographic images are not affected by patient variables Signup and view all the answers

What is the primary advantage of using a PA axial view in radiograph (B)?

It provides a more accurate representation of the wrist bones Signup and view all the answers

What is the purpose of the PA Oblique projection in hand radiology?

To evaluate the MCP joint Signup and view all the answers

What is the importance of the marker on the radiograph?

To identify the radiographic view Signup and view all the answers

What is the significance of the metacarpal index in hand radiology?

It assesses the length of the metacarpal bones Signup and view all the answers

What is the role of the flexible strip in the Folio method?

To hold the hand in place Signup and view all the answers

What is the purpose of the Lateral projection in hand radiology?

To assess the lateral aspect of the hand Signup and view all the answers

What is the significance of the 20-degree angle measurement in the UCL tear?

It indicates the severity of the tear Signup and view all the answers

What is the importance of the hand position in the PA projection?

It should be placed on the flat surface Signup and view all the answers

What is the role of the radiographic markers in the evaluation of hand anatomy?

To identify the radiographic view Signup and view all the answers

What is the name of the projection method used to visualize the carpal canal?

Gaynor-Hart method Signup and view all the answers

What is the orientation of the central ray in a tangential carpal canal projection?

Inferosuperior Signup and view all the answers

What is the purpose of modifying the central ray in a carpal canal projection?

To demonstrate the carpal canal Signup and view all the answers

What is the name of the anatomical structure visualized in a tangential carpal canal projection?

Carpal canal Signup and view all the answers

What is the benefit of using a tangential projection for the carpal canal?

It provides a unique view of the carpal canal Signup and view all the answers

Study Notes

Radiograph Projections

A typical repeat radiograph may obscure the first CMC joint, which can be improved by using the Long-Rafert or Lewis modification of the central ray.

Axial CT Scan

An axial CT scan through the distal carpals can help well visualize the CMC joint.

Folio Method

The Folio method is used to diagnose a tear in the ulnar collateral ligament (UCL) of the first metacarpophalangeal (MCP) joint, also known as "skier's thumb".
Key points to note in this projection include:
- Evidence of proper alignment and the presence of a marker without anatomy.
- The hand in a PA projection without rotation.
- The first metacarpal and first MCP joint.
- The ulnar side of the wrist and the soft tissues around it.
- The thumb in the center of the image.
- Trabecular bone details and surrounding soft tissues.

Hand PA Projection

Evaluation criteria for a hand PA projection include:
- Evidence of proper alignment and the presence of a marker without anatomy.
- Anatomy from the fingertips to the distal radius and ulna.
- Fingers slightly separated without soft tissue overlap.
- No hand rotation.
- The MCP and IP joints are open, indicating that the hand is placed on the receiver flat.
- Trabecular bone details and surrounding soft tissues.

PA Oblique Projection

No specific details mentioned.

Lateral Projection

No specific details mentioned.

Lateromedial in Flexion

No specific details mentioned.

AP Oblique Projection (Norgaard Method)

No specific details mentioned.

Scaphoid PA Axial Projection (Stecher Method)

No specific details mentioned.

Rafert-Long Method Scaphoid Series

PA and PA axial wrist in ulnar deviation are used in this series.
Radiographs are all from the same patient.

Carpal Bridge Tangential Projection

No specific details mentioned.

Carpal Canal Tangential Projection (Gaynor-Hart Method)

No specific details mentioned.

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Description

This quiz is about radiography techniques, specifically the use of Long-Rafert or Lewis modification to visualize the first CMC joint on a radiograph.