Hand, Wrist, Finger, Thumb Positioning SFMC

What structures are best shown on a lateral thumb?

Entire thumb and 1st metacarpal

What structures are best shown on an AP thumb?

Entire thumb and 1st metacarpal

What do you want to rule out in a lateral extension?

Foreign bodies

What structures are best shown on a lateral finger?

IP and MP joints open

How should the patient be positioned for a AP thumb?

Internally rotate hand with fingers extended

What is the SID for these positions?

40" to table top

An upper limb with a cast requires an ______ in exposure factors.

increase

Fiberglass cast

increase 3-4 kVp

Small to medium dry plaster cast

increase 5-7 kVp

What is the SFMC routine for a hand?

PA hand 45 degree oblique lateral "fan" finger

What is the SFMC finger routine?

PA hand 45 degree oblique hand including 3 fingers lateral finger

What is the routine for a thumb?

PA hand (oblique thumb) AP thumb lateral thumb

What structures are best shown on a PA finger?

PA projection of the entire hand and wrist including about 1 inch of the distal forearm. MP and IP joints open. PA hand will demonstrate oblique image of thumb.

What structures are best shown on a PA hand?

PA projection of the entire hand and wrist including about 1 inch of the distal forearm. MP and IP joints open. PA hand will demonstrate oblique image of thumb.

What structures are best shown on a PA thumb?

PA projection of the entire hand and wrist including about 1 inch of the distal forearm. MP and IP joints open. PA hand will demonstrate oblique image of thumb.

What is the SFMC routine for a wrist?

PA wrist with ulnar deviation Lateral wrist 45 degree semi-supinated oblique (5th digit down) 45 degree semi-pronated oblique (5th digit down)

Where should the CR be on a lateral in extension?

CR perpendicular to IR, to 2nd MP joint. Extend fingers on top of each other.

Where should the CR be on a lateral in flexion?

CR perpendicular to IR, to 2nd MP joint. Flex fingers in a neutral flexed position.

Where should the CR be on a lateral "fan" finger?

CR perpendicular to IR, to 2nd MP joint. Spread fingers in a "fan" pattern to visualize each digit (phalanges)

Where should be CR be on a PA hand?

CR perpendicular to IR, to 3rd MP joint. Pronate hand with palmar surface in contact with cassette.

Where should the CR be for a PA finger?

CR perpendicular to IR, to 3rd MP joint. Pronate hand with palmar surface in contact with cassette.

Where should the CR be on a PA thumb?

CR perpendicular to IR, to 3rd MP joint. Pronate hand with palmar surface in contact with cassette.

Where should the CR be on a 45 degree oblique hand?

CR perpendicular to IR, to 3rd MP joint. Pronate hand. Rotate entire hand and wrist laterally 45 degrees. Digits should be parallel to IR to open up joint spaces.

Where should the CR be on a 45 degree semi-pronated (PA oblique)?

CR perpendicular to midcarpals. From pronated position, externally rotate wrist 45 degrees.

Where should the CR be on a 45 degree semi-supinated (AP oblique)?

CR perpendicular to midcarpals. From supinated position, internally rotate wrist 45 degrees.

Where should the CR be on a lateral wrist?

CR perpendicular to midcarpals. Hand and wrist in true lateral.

Where should be CR be on a PA wrist with ulnar deviation?

CR perpendicular to midcarpals. Palm down Evert hand towards ulnar side

Where should the CR be on a AP thumb?

CR perpendicular to the IR, directed to the first MP joint

Where should the CR be on a lateral thumb?

CR perpendicular to the IR, directed to the first MP joint

Where should the CR be on a lateral finger?

CR to IR to proximal PIP. Finger parallel to IR.

What structures are best shown for stecher method?

Scaphoid. All carpals, and distal radius and ulna

Why do we not need a grid for the hand, finger, thumb, and wrist?

Under 10cm you do not need a grid.

Nursemaid's fracture

subluxation of the radial head, usually caused by hard pull on child's arm by an adult

Colle's fracture

fracture of distal radius with displacement posteriorly

Boxer's fracture

fracture of the distal 5th metacarpal

Simple fracture

fracture when bone does not break through the skin

Comminuted fracture

fracture when bone is crushed in two or more fragments

Compound fracture

fracture when bone protrudes through the skin

Impacted fracture

fracture where one fragment drives into another, usually long bones

Epiphyseal plate fracture

these fractures are hard to see, they may request comparison views of opposite

What area is closest to the IR?

Affected area

What structures are best shown on a 45 degree semi-supinated (AP oblique)?

All carpals with pisiform, triquetrum, and hamate free of superimposition and in profile

What structures are best shown on a 45 degree semi-pronated (PA oblique)?

All carpals, with well demonstrated scaphoid and trapezium

What structures are best shown on a PA wrist with ulnar deviation?

Distal radius and ulna and carpals. Scaphoid seen clearly without superimposition. Adjacent carpal interspaces open.

What structures are best shown on a lateral wrist?

Distal radius and ulna superimposed. Carpals.

Why do we use three fingers?

For comparison

How should the patient be positioned for a lateral finger?

Hand in lateral position with affected area finger extended

How should the patient be positioned for a lateral thumb?

Hand pronated, thumb abducted, fingers slightly arched

What structures are best shown on a lateral in extension and flexion?

Metacarpals, wrist and distal radius and ulna are superimposed. Entire hand and wrist visible.

What structures are best shown on a lateral "fan" finger?

Metacarpals, wrist and distal radius and ulna are superimposed. Phalanges visible in the lateral position.

What structures are best shown on a 45 degree oblique hand including 3 fingers?

Oblique of the affected finger with joint spaces open.

What structures are best shown on a 45 degree oblique hand?

Oblique of the entire hand. MP and IP joints open. Fingers parallel to IR.

How should the patient be positioned for a PA wrist with ulnar deviation?

Patient sitting at the end of the table. Elbow flexed 90 degrees. Hand and wrist resting on table.

Where should be CR be for a 45 degree oblique hand including 3 fingers?

SFMC: CR perpendicular to affected MP joint. (because you want to include metacarpal and finger) Textbook: CR perpendicular to affected PIP.

How should a patient be positioned for a PA finger?

Seat the patient at the end of the table with elbow flexed 90 degrees with hand and forearm resting on the table top

How should the patient be positioned for a PA hand?

Seat the patient at the end of the table with elbow flexed 90 degrees with hand and forearm resting on the table top

What method can you use if a patient cannot do ulnar deviation?

Stecher method

Where should the CR be for stecher method?

When wrist is placed on cassette- CR angled 20 degrees towards the elbow. When wrist is placed on 20 degree angled sponge- CR perpendicular to IR at midcarpals.

How do you position a patient for stecher method?

Wrist placed on cassette OR wrist placed on 20 degree angled sponge

Do you need to shield for these positions?

Yes

Fracture

break in the bone

Contusion

bruise, without fx

Large to wet plaster cast

double mAs OR increase 8-10 kVp

Dislocation

displacement of bone from joint

Incomplete fracture

example: Greenstick- common in pediatric patients where cortex of bone is broken

Sprain

forced wrenching or twisting with rupture or tearing of ligaments

Barton's fracture

intra-articular fracture of the posterior lip of distal radius

Bennet's fracture

longitudinal fracture of the base of the 1st metacarpal

What is the kVp for upper limbs?

lower to medium kVp (50-70)

Baseball or Mallet's fracture

occurs when a hard object (ex. baseball) strikes the ends of an extended finger

Subluxation

partial dislocation, usually seen in the spine

Smith's fracture

reverse of Colle's, anterior displacement