Wrist Evaluation Criteria
Gaynor Hart Wrist
Anatomy - Carpals in tunnel like arched arrangement Position - Pisiform & Hamulus should be separated & in visible profile without superimposition - Rounded palmer aspect of Capitate & Scaphoid visualized in profile & Trapezium articulating with 1stmetacarpal
Lateral Wrist
Anatomy - Distal radius & ulna - Carpals -Midcarpalarea Position: - TRUE Lateral evidenced by: - Ulnar head superimposed over distal radius - Proximal 2nd- 5thmetacarpals aligned & superimposed
PA Oblique Wrist
Anatomy - Distal radius, ulna, and carpals demonstrated - Midcarpalarea visible - Trapezium & Scaphoid seen in its entirety - Slight superimposition of other carpals on medial side Position - True 45 degreeoblique - Obliquity Evidenced by: - Ulnar head partially superimposed by distal radius - Proximal 3rd- 5thmetacarpals (BASES) should appear mostly superimposed
PA Wrist
Anatomy - Midmetacarpals - Proximal metacarpals - Carpals - Distal radius - Ulna - Soft tissue of wrist joint - Fat pads & fat strips Position - Long axis of hand, wrist & forearm run with long axis of IR - TRUE PA: - Equal concavity on each side of the shafts of the proximal metacarpals - Near equal distance proximal metacarpals - Separation of distal radius & ulna, minimal superimposition at distal radioulnar joint
Ulnar Deviation
Anatomy: - Distal radius & ulna - Carpals - Proximal metacarpals - Scaphoid should be clearly demonstrated without foreshortening, adjacent carpal interspaces open ´Position: - Position for PA wrist- palm down - Hand & wrist aligned long axis of IR - Scaphoid centered to CR - Without moving forearm - Gently evert hand (move toward ulnar side) as far as patient can tolerate without tilting or rotating distal forearm
PA Axial Sketcher Method
Anatomy: - Distal radius & ulna - Carpals - Carpals more open on lateral (radius) - Proximal metacarpals - Scaphoid should be clearly demonstrated without foreshortening, adjacent carpal interspaces open Position: - Place hand & wrist palm down on IR with hand elevated om 20 degreesponge - Ensure wrist is in direct contact with IR -Gently evert hand outward toward ulnar side