ARRT Upper Extremity Procedures 4 — Questions and Answers
Question 1: Which projection of the elbow is performed when the patient cannot fully extend the arm, requiring two separate images taken in partial flexion?
- Jones method
- Coyle method
- Acute flexion method
- Partial flexion AP method (Correct answer)
Correct answer: Partial flexion AP method
When full extension is impossible, two partial flexion AP projections (one centering the distal humerus, one the proximal forearm) are obtained.
Question 2: For the Coyle method of the elbow, imaging the radial head and capitulum requires the CR angled:
- 45° toward the shoulder
- 0° (perpendicular)
- 45° toward the hand (Correct answer)
- 30° medially
Correct answer: 45° toward the hand
The Coyle method for the radial head/capitulum uses a 45° distal CR angle with the elbow flexed 90° and externally rotated.
Question 3: A Bennett fracture involves which structure?
- Base of the fifth metacarpal
- Base of the first metacarpal (thumb) with carpometacarpal dislocation (Correct answer)
- Proximal phalanx of the thumb
- Distal radius and ulnar styloid
Correct answer: Base of the first metacarpal (thumb) with carpometacarpal dislocation
A Bennett fracture is an intra-articular fracture-dislocation at the base of the first metacarpal at the carpometacarpal joint of the thumb.
Question 4: For the PA projection of the wrist, where is the central ray directed?
- Midpoint of the proximal row of carpals
- Midcarpal area (midpoint of wrist) (Correct answer)
- Third MCP joint
- Radiocarpal joint
Correct answer: Midcarpal area (midpoint of wrist)
The CR is directed perpendicular to the midcarpal area (midpoint of the wrist) for the PA wrist projection.
Question 5: The transscapular (scapular Y) lateral projection places the scapular body:
- Perpendicular to the IR (Correct answer)
- Parallel to the IR
- At 45° to the IR
- At 60° to the IR
Correct answer: Perpendicular to the IR
In the scapular Y position the patient is rotated so the scapular body is perpendicular to the IR, creating the characteristic Y shape of the scapula.
Question 6: Which special shoulder view is obtained with the humerus in internal rotation and the CR angled 25–30° cephalad to detect Hill-Sachs lesions?
- Grashey method
- West Point method
- Stryker notch method (Correct answer)
- Lawrence method
Correct answer: Stryker notch method
The Stryker notch method (arm over head, CR 10° cephalad) is used to demonstrate Hill-Sachs defects on the posterolateral humeral head.
Question 7: Mallet finger results from an avulsion injury to which structure?
- Flexor digitorum profundus tendon at the middle phalanx
- Extensor tendon at the base of the distal phalanx (Correct answer)
- Collateral ligament of the PIP joint
- Palmar plate of the DIP joint
Correct answer: Extensor tendon at the base of the distal phalanx
Mallet finger is caused by avulsion of the extensor tendon (with or without a bone fragment) at its insertion on the distal phalanx.
ARRT Upper Extremity Procedures 4
Which projection of the elbow is performed when the patient cannot fully extend the arm, requiring two separate images taken in partial flexion?