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Upper & Lower Extremities for Radiology Technologists Ce Course

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Upper & Lower Extremities for Radiology Technologists Ce Course ANATOMY, DISEASES, & CONDITIONS: UPPER & LOWER EXTREMITIES FOR RADIOLOGY TECHNOLOGISTS CE COURSE By Mary Stela Gallegos, ABD, RT, (R), (M) Zapp! Educational Services (559) 859-4725 Zappeducationalservices.com COURSE GOALS There are several goals in presenting the following material. The main objective of this course is to provide an “anatomy review of the upper and lower extremities” for all radiology technologists. The second goal is to provide review material regarding diseases and conditions pertaining to extremities, related terminology, body planes, and bone fractures. COURSE OBJECTIVES By the end of this course students should be able to: 1. Describe the difference between functional and structural joints in the human body 2. Present basic anatomy information concerning the upper extremities: shoulder, clavicle, humerus, elbow, forearm, wrist, hand 3. Present basic anatomy information concerning the lower extremities: pelvis, hip, femur, knee, tibia-fibula, ankle, foot 4. Identify specific anatomy for upper and lower extremities using illustrations provided 5. Describe and recognize the bone diseases and/or conditions associated with upper and lower extremities 6. Define keywords and phrases presented in the content, glossary, and definition sections 7. Describe and recognize the body planes, bone fractures, and body movements associated with all bones 2 An anatomist is a specialist in the field of anatomy. These specialists have divided the upper extremities into four categories: the hand, the forearm, the arm, and the shoulder girdle. Since the purpose of this course is to provide a brief radiological review of the upper and lower extremities with associated diseases and conditions, as well as body planes and bone fractures, the material will be presented in the following manner: Table of Content Page Appendicular Skeleton ………………………………………………… 4 Articulations (Types) …………………………………………………... 5 Section One: Upper Extremities - Anatomy Page Shoulder………………………………………………………… 14 Clavicle…………………………………………………………. 16 Humerus………………………………………………………… 17 Elbow…………………………………………………………… 18 Forearm…………………………………………………………. 20 Wrist……………………………………………………………. 21 Hand……………………………………………………………. 24 Section Two: Lower Extremities – Anatomy Page Hip ...…………………………………………………………… 27 Pelvis ...………………………………………………………… 28 Femur…………………………………………………………… 29 Knee……………………………………………………………. 30 Tibia-fibula……………………………………………………... 33 Ankle…………………………………………………………… 33 Foot……………………………………………………………... 34 Section Three: Extremity Diseases/Conditions Clinodactyly 5th digit …………………………………………... 38 Thumb- Hypoplasia/Aplasia …………………………………… 42 Polydactyly …………………………………………………….. 43 Syndactyly ……………………………………………………… 45 Section Four: Body Planes, Dislocation/Fractures Page Aphoristic body planes………………………………………… 48 Dislocations ……………………………………………............ 50 Fractures ……………………………………………………….. 50 Causes …………………………………………………………. 50 Types ………………………………………………………….. 52 Body Movements ……………………………………………... 57 Section Five: Diseases and conditions (lower extremities).…………………. 60 References…………………………………………………….. 83 3 APPENDICULAR SKELETON In addition to anatomy, osteology, which is the study of bones is also an important subject for all radiologic technologists. These topics are indispensable, however, in this section only a short review of material pertaining to bones will be presented. There are approximately 206 separate bones in the average adult. The skeletal system is divided into two subdivisions, the axial and the appendicular. The axial skeleton, which includes all the bones in the skull, hyoid, auditory ossicles, vertebral column, and the thorax, will not be discussed in this course. Because this course focuses on upper and lower extremities, only the appendicular skeleton system will be presented. The skeletal system (appendicular) – which includes the upper and lower extremities, consists of 126 bones. It should be noted that the pelvic and shoulder girdle are also included. Depicted below are the number of bones to the corresponding anatomical part: APPENDICULAR SKELETON Number of bones A. Shoulder Girdle clavicle – 2 scapula – 2 B. Upper Extremities humerus – 2 radius – 2 ulna – 2 carpals – 16 metacarpals – 10 phalanges – 28 C. Pelvic Hips – 2 D. Lower Extremities Femur – 2 Fibula – 2 Tibia – 2 Patella – 2 Tarsals – 14 Metatarsals – 10 Phalanges – 28 ___________________ TOTAL = 126 4 ARTICULATIONS (JOINTS) Articulations, more commonly referred to as joints, are where the bones intersect and provide the strong connections the body needs to move. The radiology technologists must be aware of the various joints within the body in order to obtain appropriate and accurate radiographs. Each specific joint has various structural components which allows the possibility for range of motion. Consequently, joints may be classified by either function or by structure. STRUCTURAL JOINTS Structural Joints is one type of classification for joints which is established because of their function. The basis stems from the consideration of whether there is a joint cavity or whether the connecting bones are sturdily affixed to one another by or fibrous-connective tissue or cartilage. Consequently, these variables serve to establish three structural classifications: fibrous, cartilage, and synovial. Fibrous: Tough collagen fibers make up the first type of structural joint. These fibrous joints consist of connective tissue which do not allow movement. Examples of structural fibrous joints include (a). syndesmosis joint that holds the ulna & radius of the forearm together, (b). sutures of the skull, and (c). gomphoses, tooth in its socket - immovable joint. Figure 1.0 illustrates three examples of fibrous articulations. Figure 1.0 Fibrous Joints. Copyright: Creative Commons Attribution-ShareAlike Cartilaginous: Composed of a band of cartilage which binds bones together, cartilaginous joints are a second type of structural joint. This type of joint (cartilaginous) does not allow very much movement between the articulating bones. Cartilaginous joints play a vital role in forming the growth regions of immature long bones. Presently, joints may be categorized into two groups: synchondroses and symphyses. The first type of joints are synchondroses and consist of 5 hyaline cartilage. Joints that are symphyses are made up of fibrocartilage. Figure 2.0 illustrates that intervertebral disks of the spine and joints between the ribs and costal cartilage (see section Amphiarthrosis) are types of cartilaginous joints (Barclay, 2018). Another example of a cartilaginous joint is between the manubrium and the sternum. Figure 2.0 Cartilaginous Joints. Copyright: Studyblue.com. Labeled to reuse. Synovial joints: Synovial joints are identified as the upmost common group of joints and are described as joint spaces that are fluid-filled at their articulating site (Barclay, 2018). The articulating bone ends of synovial joints are situated within an all-inclusive joint cavity filled with lubricating fluid. It should be noted that the articulating end of bones do not connected with one another. The joint capsule is surrounded by dense and tough tissue (connective) that is lined with synovial membrane. This membrane creates oily fluid that lubricates the articulation to reduce wear and tear, as well as reducing the amount of friction. Ligaments which are strong 6 bands reinforce the articulating joint and keep it moving in any undesirable fashion, or from dislocating. Figure 3.0 illustrated the human body’s synovial joints which can be classified in several methods: • Pivot • Hinge • Saddle • Plane • Condyloid, • Ball and socket joints Figure 3.0 Synovial Joints. Copyright: Labeled for reuse 7 a. Pivot joints: Pivot articulations allow rotational movement (on its axis) by fitting into a notch formed by the receiving articulating bone. Both C1 and C2 of the cervical spine are examples of pivot joints as the head pivots back and forth (see Figure 4.0). A second example of a pivot joint is the wrist as the hand has the capability to flip up and down (Barclay, 2018). Figure 4.0. Cervical Spine – Synovial Joint (Pivot). Copyright: courses.lumenlearning.com. Free to share and use commercially. b. Hinge joints: Joints that have the capability to increase and decrease the angle of the two articulating bones is referred to as a hinge joint. The knee is an example of a hinge joint because it can only move in one direction thus having limited movement. The elbow is another example of a hinge bone. The structure design of hinge joints provides the muscles and bones more strength and support. c. Saddle joints: Joints such as the one between the first metacarpal and trapezium bone, are called saddle joints. They permit a 360-degree range of motion by allowing the bones to pivot along two axes. d. Planar (Gliding) joints: The joints such as the ones between the wrist (carpals) with articulating surfaces have slightly curved or flat faces which allow for the bones to glide past one another in any direction. Thus, the reason they are called gliding joints. When describing planar (gliding) joints, it is essential to note that there is no rotation among the articulating bones because the range of motion is limited. In addition to the carpal bones, planar joints are also found in tarsal bones of the foot and between vertebrae (lumenlearning, n.d.). e. Condyloid (Ellipsoid) joints: Bones having oval-shaped ends will articulate effortlessly with the receiving end which also has a similar hollow end (lumenlearning, n.d.). The articulations in the fingers
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