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Upper ExtremityWRIST

RTEC 123 # 1B LECTURE

Contributions by:MOSBY – MERRILLS & BONTAGER

XRAY2000.CO.UK rev 10/10/11

2ANATOMY REVIEWWRIST

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5TEST YOURSELF

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7www.rad.washington.edu

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•Use a FULL SHIELD

•PROTECT THE BREAST & THYROID

•HAVE PATIENT TURN THEIR HEAD

POSITIONING

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WRIST (5)

• PA

• OBLIQUE (MEDIAL)- PA OBLIQUE

• LATERAL

• OBLIQUE (LATERAL) AP OBLIQUE

• ULNAR DEVIATION (SCAPHOID “view”)

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Note incorrect position of patient ! ↑

PA WRIST

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14PA vs AP WRIST

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PA OBLIQUE WRIST

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PA OBLIQUE

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PA OBLIQUE

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AP OBLIQUE WRIST

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Alternate positioning for obliques

21THESE ARETHE SAME POSITIONON THE IMAGE

PA OBLIQ / AP OBLIQ : LAT ROTATION

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Which Oblique & What is seen?

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OBLIQUE WRISTPA OBL (LAT ROT) / AP OBLIQ (MED ROT)

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PA Oblique / AP Oblique

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“true” Lateral

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MOST COMMONLY FX CARPAL BONE

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SCAPHOID

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When the hand is turned toward the ulnar side, it is termed:

• A. adduction

• B. abduction

• C. ulnar deviation

• D. radial deviation

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When the hand is turned toward the ulnar side, it is termed:

• A. adduction

• B. abduction

• C. ulnar deviation

• D. radial deviation

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ADDITONAL VIEWS - WRIST

• CARPAL CANAL

• LECTURE ONLY –

• NOT FOR LAB PRACTICE

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41CRITIQUEWRIST

Digital “issues”

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PATHOLOGYFOR UPPER EXTREMITY 1

SEE CHART PG ______

Avulsion fx

Bone cyst

Bursitis

fractures

Joint effusion

Osteoporosis

Rheumatoid Arthritis

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AP/LAT wrist

showing complete dislocation of the lunate

46Fracture type?

Fracture type? 47

What else should be done?

Problem/ Path?48

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greenstick

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Torus or Buckle

Impacted fracture with

bulging of the periosteum.

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51This fracture is most common in children between the ages of 5 and 11.

Typically, the child reports having

fallen onto his or her outstretched hand.

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impacted52

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scaphoid

• If the fracture is not recognized early, it may not heal properly. This can lead to problems later.

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54Scaphoid fxnew 3 wks later

55SCAPHOID FX

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Colles’ Fracture Extension-Compression Fracture of Distal Radius

FX WITH

POSTERIOR

DISPLACEMENT

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Colles' fracture

• of the distal radius and ulnar styloid

• with posterior displacement

• (of the hand)

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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.

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• Smith's fracture is caused by a fall on a hyperflexed, outstretched hand.

• It is sometimes referred to as a "reverse Colle's fracture."

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Smith's fracture

• of the distal radius and ulnar styloid

• with anterior displacement.

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SMITH’S FXFlexion-Compression

FX WITH

ANTERIOR

DISPLACEMENT

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Smith’s FX

BARTON’S fx68

FX/DISLOCATIONOF POSTERIOR LIP OF DISTAL RADIUS

unstable intra-articular fracture of the dorsal lip of the radius with dorsal subluxation of the carpus along with the dorsal radius fragment

Colles vs Barton’s69

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Colles' fracture?

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www.rad.washington.edu

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QUESTIONS ?

OPEN LABS SIGN UP

? Days TBA

NOTE: NO OPEN LABS BEFORE I DO

DEMONSTRATIONS