Image Analysis digits and hand, Image Analysis: Wrist & Forearm

Lateral Thumb Projection

IP, MCP, and CM joints are demonstrated as open spaces -Phalanges are not foreshortened -MCP joint is at the center of the exposure field -Phalanges, MC, and CM joint are included within the exposure field

Which WRIST projection shows an open Radioulnar articulation open

PA projection

How many phalanges are there?

14

WRIST: PA, PA Oblique, AP Oblique Projection technique _________ mAs @ _____

2.0 mAs @ 66 kVp

FOREARM: AP, Lateral Projection ______ mAs @ ______ kVp

2.2 mAs @ 70 kVp

WRIST: Lateral projection technique _______ mAs @ ______ kVp

2.5 mAs @ 70 kVp

What is the technique for Thumb projections?

2.8 MAS @ 50 KVP

which projection shows the carpal bones one the medial side of the wrist?

AP Oblique Projection

which bones are shown on the medial side of the wrist?

AP Oblique Projection: -Pisiform -Triquetrum -hook of Hamate

What part of the ulna is the ulnar styloid process?

at the most distal point

Why should the hand be fisted when doing a WRIST projection?

pushes the carpals down

What forms you wrist joint? (ulna or radius)

radius *with scaphoid and lunate

What type of joint is the thumb?

saddle joint

What is the most broken/fracture carpal in the HAND?

scaphoid

Identifying Rotation on a Lateral Projection of FOREARM:

*DISTAL FOREARM: INTERNAL ROTATION. -If the wrist and distal forearm are internally rotated instead of being in a lateral projection, the distal radius is demonstrated anterior to the ulna -If the wrist is internally rotated, the radial tuberosity is is seen posteriorly *DISTAL FOREARM: EXTERNAL ROTATION -If the wrist and distal forearm are externally rotated, the radius is visible posterior to the ulna. -If the wrist is externally rotated, the radial tuberosity is demonstrated anteriorly

Which fractures are associated with the hand?

Boxers and Bennett fracture

Projections of the hand

PA PA Oblique Lateral(fan or extention)

which projection shows the carpal bones on the lateral side of the wrist?

PA Oblique

where is the centering for WRIST Projections?

CR enters mid-carpal joint

which digit does not have a PIP and DIP

first (thumb)

AP Oblique Projection (internal): WRIST

*HIS PROJECTION SHOWS THE CARPAL BONES ON THE MEDIAL SIDE OF THE WRIST- -PROVIDES A DISTINCT RADIOGRAPH OF THE PISIFORM,TRIQUETRUM AND HOOK OF HAMATE- -SEPARATES THE PISIFORM FROM THE ADJACENT CARPAL BONES -TRIQUETRUM, PISIFORM FREE OF SUPERIMPOSITION. THE HOOK OF HAMATE SLIGHTLY SUPERIMPOSED ROTATION OCCURS: If the wrist is rotated more than 45 degrees then the distal scaphoid superimposes the pisiform but if the wrist is rotated less then 45 degrees then the pisiform superimposes the triquetrum-NTK

Identify rotation on an AP Projection of FOREARM:

*PROXIMAL FOREARM: INTERNAL ROTATION -Proximal forearm rotation results when the humeral epicondyles are poorly positioned. -When more than 1/8th of the radial head is superimposed over the ulna, the elbow has been internally rotated *PROXIMAL FOREARM: EXTERNAL ROTATION -When less than 1/8th of the radial head is superimposed over the ulna, the elbow has been externally rotated

Identifying a rotation on an LATERAL projection WRIST:

*Rotated correctly- If the pisiform and the distal scaphoid are superimposed then the wrist was correctly positioned *Rotated medially- IF the wrist was rotated medially from the lateral projection, then the projection will start to look like an pa oblique projection. *Rotated laterally- IF the wrist was rotated laterally from the lateral projection, then the projection will start to look like an ap oblique projection.

PA Oblique projection

-1st and 2nd MC heads are not superimposed, the 3-5 MC heads are slightly superimposed -The is no soft tissue overlap from the thumb or adjacent fingers * IP and MCP joints are demonstrated as open spaces. * Phalanges are not foreshortening. *3rd MCP joint is at the center of the exposure field *Phalanges, MC's, Carpals, and distal radius and ulna are included within the exposure field. CR 3RD MCP TECHN-3MAS@50KVP

Projections of FOREARM:

-AP PROJECTION -LATERAL PROJECTION

what are some of the fractures of the wrist?

-Bennet's fracture -Colle's fracture (outward) -Smith's fracture (inward) -Boxer's fracture

Lateral Projection: FOREARM

-Distal radius and ulna are superimposed. -Radial tuberosity is not demonstrated in profile. -Ulnar styloid is demonstrated in profile posteriorly. -Elbow joint space is open. -Anterior aspect of the radial head and coronoid process are aligned. -Forearm midpoint is at the center of the exposure -Wrist and elbow joint and forearm soft tissue are included within the exposure field .

Projection of the WRIST:

-PA PROJECTION -PA OBLIQUE- LATERAL ROTATOIN -AP OBLIQUE-MEDIAL ROTATION -LATERAL PROJECTION

AP Projection: FOREARM

-Radial styloid is demonstrated in profile laterally. -Superimposition of the MC bases and of the radius and ulna is minimal. -Radius and ulna run parallel. -Olecranon process is situated within the olecranon fossa. -Coronoid process is visible on end. -Forearm midpoint is at the center of the exposure field -Wrist and elbow joints and forearm soft tissue are included within the exposure field.

Identify rotation on an PA Oblique WRIST:

-Rotated correctly- If the trapezium and the trapezoid are free of superimposition then the wrist obliquity was correct -Rotated more than 45 degrees- IF the wrist obliquity is more than the required 45 degrees, the trapezium superimposes a small part of the trapezoid. -Rotated less than 45 degrees- IF the wrist obliquity is less than the required 45 degrees, then the trapezoid superimposes one-half of the trapezium-

Lateral Finger Projection

-There is no soft tissue overlap from adjacent digits -When visualized, the fingernail is demonstrated in profile -IP joint are open -Entire finger and MC head are included within the exposure field CENTER PIP

PA finger projection

-There is no soft tissue overlap from adjacent digits -IP and MCP joints are demonstrated as open spaces -PIP joint is at the center -fingers and half of the MC are included within the exposure field CENTER AT PIP

PA Projection: WRIST

-Ulna styloid is in profile medially.-When looking at this in the anatomical position -Radial styloid is in profile laterally. When looking at this in the anatomical position -Radiolulnar articulation is open -Trapezium and Trapezoid are superimposed on one another-NTK. -2nd-5th MC joint spaces are open. -Carpal bones are at the center of the exposure filed. -Carpal bones, 1/4th of the distal ulna and radius, and half of the proximal MC's are included within the exposure field.

PA Oblique Projection (external ): WRIST

-Ulna styloid is in profile medially.-When looking at this in the anatomical position -Trapezoid and trapezium are demonstrated without superimposition.-NTK -Scaphoid is demonstrated in profile and slightly superimposed by the capitate and lunate.-NTK -Carpal bones are at the center of the exposure field.

Lateral Projection: WRIST

-Ulnar styloid is demonstrated in profile posteriorly- ntk -Anterior aspects of the distal scaphoid and pisiform are aligned. -Distal radius and ulna are superimposed. -Thumb is parallel with the forearm. -Trapezium is demonstrated without superimposition of the first proximal MC. -Carpal bones are at the center of the exposure field.

Boxers fracture; what is it?

-break at the 4th and 5th metacarpal shafts

PA hand projection

-distance between the MC heads are equal -There is no soft tissue overlap from adjacent fingers -IP,MCP, and CM joint are open -Thumb demonstrates a 45 degree oblique projection -phalanges, MC, Carpals, and distal radius and ulna are included within the exposure CENTER 3RD MCP

What should be shown on an AP thumb projection?

-equal soft tissue width on each side -IP,MCP, and CM joints are demonstrated as open spaces -Phalanges are not foreshortened -Superimposition of the medial palm soft tissue over the proximal first MC and the CM joint is minimal -MCP joint is at the center of exposure field -Phalanges, MC, and CM joint are all included in exposure

Projections of the digits?

1st- AP,PA Obli, and Lateral 2-5; PA,PA Obli, and lateral

how many bones are in the hand

27

Which rotation is used for the lateral projection of the digits 2-5?

2nd-internal rotation 3rd-internal or external 4th-5th-external rotation

How many degrees should you rotate the WRIST for a PA Oblique projection?

45 degrees

How many metacarpals are there?

5 in each hand

How many carpal bones are there?

8

Bennets Fracture:

A fracture at the base of the first metacarpal bone which extends into the carpometacarpal (CMP) joint

Lateral hand (fan) Projection

CR @ 2nd MCP * 2nd-5th MCs are superimposed. *2nd-5th digits are separated, demonstrating little superimposition of the proximal bony tissue structures. * IP joints are opened. * Phalanges are not foreshortening. *MCP joints are at the center of the exposure field *Phalanges, MC's, Carpals, and distal radius and ulna are included within the exposure field. TECHN:4MAS@50KVP

name all of the carpal bones.

Distal Row: -trapezium -trapezoid -capitate -hamate Proximal Row: -scaphoid -lunate -triquetrum -pisiform

who is the bennetts fracture named after?

Edward Hallaran Bennett- professor of surgery at Trinity college of the university of Dublin

Where does the CR enter on a correct AP first digit projection?

MCP joint

Where does the CR enter at a PA oblique projection of the first digit?

Mcp Joint

Rolando's Fracture: what is it?

Named after Silvio Rolando- it is a complete articular, T or Y shaped fracture of the first metacarpal

What is another name for the capitate carpal?

Os magnum

PA oblique finger projection

Twice as much soft tissue width is demonstrated on one side of the phalanges as on the other side -There is no soft tissue overlap from adjacent digits -IP and MCP joints are open -PIP joint is at the center of the exposure field -Fingers and half of the MC are included within the exposure field CENTER AT PIP

What is a Bennett's fracture?

an oblique intra articular fracture of the base of the first metacarpal with subluxation or dislocation of the metacarpal