Positioning of the Hand, Wrist, Elbow and Forearm

SID for ap elbow

40 inches

SID for lateral elbow

40 inches

What is the SID of a hand?

40 inches

SID for a wrist

40 inches table top

What should you use to straighten a patients hand if they cannot straighten it on their own?

a pen

Where should you measure for a PA hand?

at the 3rd metacarpophalangeal joint

anatomy of interest for medial oblique elbow

coronoid process is free of superimposition

Positioning of the Lateral Wrist

hand is now resting on the ulnar side in full extension, remeasure for technique, feel carpal bones, metacarpals, and distal forearm to verify in a true lateral position (roll wrist back more), collimate side to side, place marker adjacent to forearm

What is the anatomy to be seen on a PA hand?

8 carpals, 5 metacarpals, 14 phalanges, 5 MCP joints, 4 DIP and PIP joints and 1 IP joint

Anatomy to be see on a PA wrist

8 carpals, proximal metacarpals, distal 1/3 of radius and ulna

IR collimation requirement for a PA wrist

8 x 10 inches and can collimate tighter

What is the IR collimation for a hand?

8x10 or 10x12 lengthwise

anatomy of interest on AP forearm

AP projection of radius and ulna, elbow joint, wrist joint

Positioning of an ulnar deviation wrist view

PA wrist position and technique, flex fingers toward the ulna

What are the views for a hand x-ray?

PA, PA oblique, Fan lateral and Lateral in extension

CR details for oblique elbow

CR is perpendicular to elbow joint

CR details of AP elbow

CR is perpendicular to elbow joint

CR details of lateral elbow

CR is perpendicular to elbow joint

CR details of lateral forearm

CR is perpendicular to midpoint of IR and forearm

CR details of AP forearm

CR is perpendicular to midpoint of forearm

What is the CR details for the lateral hand?

CR is perpendicular to the 2nd metacarpophalangeal joint

CR details of a PA oblique hand

CR is perpendicular to the 3rd MCP joint

What are the CR details for a PA hand?

CR is perpendicular to the 3rd metacarpophalangeal joint

CR details for the scaphoid wrist view

CR is perpendicular to the mid carpal area

CR details of the AP oblique wrist

CR is perpendicular to the midpoint of carpals

CR details for a PA wrist

CR is perpendicular to the midpoint of the carpals

CR details for a PA oblique wrist

CR is perpendicular to the midpoint of the wrist

CR details of the wrist

CR is perpendicular to the midpoint of the wrist

Anatomy to be seen on the scaphoid wrist view

scaphoid free of superimposition

What view is only routine at Palmetto Health of the wrist?

scaphoid view or ulnar deviation

What should the anatomy look like on an lateral extension hand?

soft tissue and all bones are super imposed

IR collimation for AP elbow

10 x 12

IR collimation for oblique elbow

10 x 12

IR collimation for forearm

14 x 17 and collimate side to side and top to bottom

How many views are there of the wrist and what are they?

5, PA wrist, lateral, PA oblique, AP Oblique, Scaphoid deviation

Positioning for a AP oblique wrist

Pt is in AP oblique position with hand supine, 45 degrees rotation with ulnar side down, collimate side to side, place marker near the radius and on lateral aspect, arm can be straight out for this view

positioning on the AP elbow

all 3 joints on the same plane, remove clothing and artifacts, measure through the elbow joint and set technique, hand supine, epicondyles of humerus are parallel, collimate side to side with no radial crossover

positioning of medial oblique elbow

arm fully extended, all 3 joints on same plane, rotate arm to make epicondyles 45 degrees medial side down, remeasure if needed, collimate side to side

anatomy to be seen of the lateral wrist

carpal bones are super imposed

anatomy to be seen on AP elbow

distal 1/3 of humerus, elbow joint, proximal 1/3 of forearm

Positioning on lateral elbow

elbow is flexed 90 degrees, all 3 joints on same plane, remeasure, hand is in full extension, epicondyles in humerus are perpendicular, collimate to reduce scatter

Image/eval criteria for AP elbow

evidence of proper collimation, radial head, neck, tuberosity slightly superimposed over proximal ulna, elbow joint open and centered to central ray, no rotation of humeral epicondyles, soft tissue and bony trabecular detail

positioning of AP forearm

forearm in center of IR with long axis, all 3 joints on same plane, include base of metacarpals, hand must be supinated so radius isn't crossed over, measure at midpoint of forearm, set technique, remove clothing, collimate, place marker at bottom near wrist, epicondyles are parallel, shield

position of lateral forearm

from AP projection, flex elbow 90 degrees resting forearm on ulna, hand in full extension, epicondyles are perpendicular, remeasure if needed, collimate side to side, marker near wrist on lateral aspect, shield, adjust IR so the long axis is parallel to forearm

Positioning of a hand PA oblique

from PA position, rotate hand ulnar side down 45 degrees. You may use a sponge if available, make sure fingers are parallel to the IR to demonstrate open joint spaces, use the same technique from the PA, place marker at the wrist

Positioning for a PA oblique wrist

from PA position, rotate wrist 45 degrees ulnar side down, use the same technique from the PA, collimate side to side

Positioning of lateral oblique elbow

from ap position, rotate entire arm externally 45 degrees, lateral epicondyles against table, collimate side to side

What is the positioning of a fan lateral hand?

hand resting on ulnar side with an OK or duck bill sign with the first and 2nd digits open. All the fingers must be separated and metacarpals are super imposed

What is the positioning of an extension lateral?

hand resting on ulnar side, fingers fully extended and super imposed, use 1/2 was measure from before, may point to wound or puncture

Anatomy to be seen on lateral forearm

lateral projection of radius and ulna, elbow joint, wrist joint, radius and ulna superimposed over each other at distal end only

anatomy to be seen of lateral elbow

lateral view of distal 1/3 humerus, elbow joint, proximal 1/3 forearm

What is the anatomy to be seen for the lateral hand?

lateral view of the phalanges and PA/oblique of thumb, superimposed 2nd-5th metacarpals, and super imposed carpal bones

Anatomy to be seen on a PA oblique hand

oblique position of 14 phalanges, 5 metacarpals, 8 carpals, and the distal 1-2 inches of radius and ulna

anatomy to be seen on a PA oblique wrist

oblique view of carpal bones with emphasis to scaphoid

Anatomy of interest of the AP oblique wrist

oblique view of carpals with pisiform in profile

anatomy of interest for lateral oblique elbow

oblique view of elbow with radial head free of super imposition

Positioning of a PA wrist

patient sitting alongside of the table and shielded, forearm/elbow resting on the table, artifacts removed, wrist centered to the IR with the shoulder in the same plane, fingers slightly curved to reduce OID, measure at midpoint of the wrist, collimate side to side, place marker alongside the wrist on lateral aspect, make sure the head of the metacarpals and 1.2 inches of the distal radius on the image

Image/Eval criteria for medial oblique elbow

proper collimation elbow joint open and centered to CR 45 degree medial rotation of elbow- coronoid process in profile, elongated medial humeral epicondyle, ulna superimposed by radial head and neck trochlea olecranon process with olecranon fossa soft tissue and bony trabecular detail

Image/Eval criteria for lateral oblique elbow

proper collimation elbow joint open and centered to CR 45 degrees lateral rotation of elbow- radial head, neck, and tuberosity projected free of the ulna, elongated lateral humeral epicondyle capitulum soft tissue and bony trabecular detail

image/eval criteria for AP forearm

proper collimation entire forearm including wrist and distal humerus slight superimposition of the radial head, neck, and tuberosity over proximal ulna no elongation ore foreshortening of the humeral epicondyles partially open elbow joint if should was placed in same plane open radioulnar space similar image brightness and contrast of proximal and distal forearm soft tissue and bony trabecular detail

image/eval criterial for lateral forearm

proper collimation entire forearm including wrist and distal humerus in a true lateral position- S/I of the radius and ulna at the distal end, S/I of radial head over coronoid process, radial tuberosity facing anteriorly, S/I humor epicondyles, elbow flexed 90 degrees, soft tissue and bony trabecular detail along entire length of the radial and ulnar bodies

image/eval criteria of PA oblique hand

proper collimation, anatomy from fingertips to distal radius and ulna, digits separated slightly with no overlap of the soft tissues, 45 degrees of rotation of anatomy, open IP and MCP joints and soft tissue and bony trabecular detail

Image/Eval criteria for a lateral hand x-ray?

proper collimation, anatomy from fingertips to distal radius and ulna, extended digits, hand in a true lateral with the phalanges, metacarpals, and radius and ulna super imposed, thumb free of motion and super imposition, soft tissue and bony trabecular detail

Evaluation/Image criteria for a PA hand?

proper collimation, anatomy from the finger tips to distal radius and ulna, slightly separate digits with no soft tissue overlap, no rotation of the hand, open MCP and IP joints indicating that the hand is flat on the IR, soft tissue and bony trabecular detail

Image/Eval criteria for the PA oblique wrist

proper collimation, distal radius and ulna, carpals, and proximal half of metacarpals, 45 degrees rotation of anatomy, carpals on lateral side of wrist, trapezium and distal half of the scaphoid without superimposition, open trapeziotrapezoid and scaphotrapezial joint space, and soft tissue and bony trabecular detail.

image/eval criteria of an AP oblique wrist

proper collimation, distal radius and ulna, carpals, and proximal half of metacarpals, carpals on the medial side of wrist, triquetrum, hook of hamate, and pisiform free of superimposition and in profile, soft tissue and bony trabecular detail

image/eval criteria of the lateral wrist

proper collimation, distal radius and ulna, carpals, and proximal half of metacarpals, super imposed distal radius, ulna, and metacarpals and soft tissue and bony trabecular detail

Image/Eval criteria of a PA wrist

proper collimation, distal radius, ulna, carpals, and proximal half of metacarpals, no excessive flexion of digits to overlap and obscure metacarpals, no rotation carpals, metacarpals and radius and ulna, open radioulnar joint space and soft tissue and bony trabecular detail

Image/eval criteria for lateral elbow

proper collimation, elbow joint open and centered to central ray, elbow in a true lateral position- S/I humeral epicondyles, radial tuberosity facing anteriorly, radial head partially superimposing the coronoid process, olecranon process in profile, elbow flexed 90 degrees, bony trabecular detail and any elevated fat pads in soft tissue

What is the positioning of a patient for a PA hand?

pt sitting alongside the table and shielded, forearm resting on the table, elbow at 90 degrees flexion, place marker near the wrist, make sure hand is as flat as possible, remove artifacts, measure at the 3rd metacarpophalangeal joint and set technique

When is an extension lateral done?

to look for foreign bodies in soft tissue

When is a lateral hand x-ray done?

to look for fractures

why is a lateral wrist done?

to look for fractures of distal radius and ulna and look for anterior or posterior displacement

Why is a ulnar deviation view used?

to move the bones away from scaphoid and reduces super imposition that enhances visitation of the scaphoid bone