Assignment Task

Part 1: Hand and wrist

1. Which projection views are depicted in X-ray 1 and X-ray 2?

2. In x-ray 1 the arrows are pointing to three structures. Identify each structure.

3. Is high or low radiographic contrast evident between the bones and soft tissues? 

4. In X-ray 2, the arrows are pointing to what anatomical structure? Identify what type of pathology or injury is depicted.

5. What other views are recommended to complete a wrist series?

Part 2: When answering the questions in part 2, 

6. Define what mode of imaging is depicted in Figure 1. What would be a reason to use this type of imaging?

7. Is there a finding that is evident in Figure 1, and if so, what is it?

8. Identify the image projection depicted in Figure 2. Be specific.

9. Describe the anatomic site in Figure 2. Be specific as to the actual location.

10. Is this an external or internal fixator appearing in the image?

11. What is the direction of the fracture line as referenced to the longitudinal axis of the bone?

Part 3: Ankle case study

A 54-year-old male was playing basketball. During the game he experienced a sudden, sharp pain while running. He heard an audible snap and at the same time he felt the pain in the right heel. He was unable to play after the incident.

Results of the clinical exam

Observation: Swelling and ecchymosis above the right heel, with loss of normal outline of the Achilles tendon

Strength: Fair grade manual muscle test to resistive ankle plantarflexion

Range of Motion: Dorsiflexion of the right ankle appears slightly increased, compared with the contralateral ankle

Palpation: Palpable defect 5 cm above the right os calcis

Ankle Case Study Questions 

12. Review the x-ray Does there appear to be any signs of a fracture? Is there anything within the ABCS assessment that would warrant further imaging other than clinical history?

13. Did this patient warrant an X-ray according to the Ottawa rules for trauma to the ankle and foot? Justify your answer.14. How would you describe the dark area seen at the tendon site? 

14. Describe which scanning plane the image was taken.

15. What would be an explanation for using an ultrasound image before doing an MRI?

16. Identify the three structures depicted in the MRI