X-RAY PROJECTIONS

what is a variation of the stecher scaphoid method?

keep the IR flat and angle the central ray 20 degrees toward the elbow

what projection of the hands is used in detecting early radiographic changes in the dorsoradial aspects of the second through fifth proximal phalangeal bases that may be associated with rheumatoid arthritis?

AP oblique/Norgaard method/baseball catcher

AP OBLIQUE WRIST part position - rest forearm on table and supinate hand - center IR to dorsal surface of wrist - rotate wrist medially __ degrees central ray - perpendicular to where? structures shown - separates what bone from adjacent carpal bones? - also provides more distinct image of what carpal bones?

- 45 degrees - mid carpal area - pisiform - triquetrum and hamate

CARPAL BRIDGE TANGENTIAL PROJECTION part position - hand lie palm upward on the IR, with the hand at a right angle to the forearm central ray - direct where at what angle? structures shown - carpal bridge - fractures of the scaphoid, lunate dislocations, calcifications and foreign bodies in the dorsum of the wrist, and chip fractures of the dorsal aspect of the carpal bones

- 1 1/2 inches proximal to the wrist joint at a caudal angle of 45 degrees

AP THUMB part position - hand in extreme medial rotation - hold extended digits back - rest thumb on IR - center long axis of the thumb parallel with long axis of the IR - Lewis suggested directing the central ray __ to __ degrees along the long axis of the thumb toward the thumb toward the wrist to show the first metacarpal free of the soft tissue of the palm central ray - perpendicular to what? structures shown - area from where to where to should be seen? - what joint spaces should be open?

- 10 to 15 - MCP joint - distal tip of thumb to the trapezium - IP and MCP joint spaces

PA AXIAL SCAPHOID (STECHER METHOD) part position - place arm and axilla in contact with the table - rest forearm on table - place one end of the IR on a support so the finger end of the IR is elevated __ degrees - adjust wrist for a PA projection central ray - perpendicular to where? structures shown - the angulation places the scaphoid at right angles to the central ray so it is projected with minimal superimposition

- 20 - scaphoid

PA AXIAL OBLIQUE TRAPEZIUM - CLEMENTS-NAKAYAMA METHOD fractures of the trapezium are rare, but if undiagnosed can lead to difficulties. in certain cases, the articular surfaces of the trapezium should be evaluated to treat patients with osteoarthritis part position - place wrist in lateral position - place __ degree sponge on anterior surface and rotate hand on sponge - ulnar deviate the hand - if unable to ulnar deviate, rotate the elbow end of IR and arm __ degrees away from the central ray central ray - angled __ degrees to enter where? structures shown - trapezium free of other carpal bones with exception of the articulation with what?

- 45 - 20 - anatomic snuffbox of wrist and pass through the trapezium - scaphoid

PA OBLIQUE HAND part position - pronate hand with palm resting on the IR - adjust obliquity of the hand so the MCP joints form an angle of __ degrees - use a sponge to support fingers to show what? - rotate the hand externally from pronated position until fingertips touch the IR to show what? central ray - perpendicular to what? structures shown - what joint spaces should be open?

- 45 - MCP joints - metacarpals - third MCP joint - IP and MCP joints

PA OBLIQUE WRIST part position - place axilla in contact with the table - rest palmar surface of wrist on IR and rotate wrist laterally __ degrees - center the IR where? - when the scaphoid is under examination, how should you position the wrist? central ray - perpendicular to where? structures shown - carpals on what side of the wrist? - open trapeziotrapezoid and scaphotrapezial joint spaces

- 45 degrees - under the scaphoid - ulnar deviation - mid carpal area - just distal to the radius - lateral (trapezium and scaphoid)

PA OBLIQUE THUMB part position - with thumb abducted, place palmar surface of hand in contact with the IR - ulnar deviate the hand slightly - align longitudinal axis of thumb with long axis of IR - center IR to where? central ray - perpendicular to what? structures shown? - area from where to where seen? - what joint spaces are open?

- MCP joint - MCP joint - distal tip of thumb to trapezium - IP and MCP joints

LATERAL THUMB part position - place hand in natural arched position with the palmar surface down and fingers flexed - place midline of IR parallel with the long axis of the digit - center the IR to the MCP joint - adjust arching of the hand until a true lateral position of thumb is obtained central ray - perpendicular to what? structures shown - area from where to where? - what joint spaces should be open?

- MCP joint - distal tip of thumb to the trapezium - IP and MCP joints spaces

PA HAND part position - place hand palmar surface down on IR - center the IR where? - adjust long axis of the IR parallel with long axis of hand and forearm - spread fingers slightly central ray - perpendicular to where? structures shown - what joints should be open? *when the MCP joints are under examination and the patient cannot extend the hand enough to place its palmar surface in contact with the IR, what can be done?

- MCP joints - third MCP joint - MCP and IP *AP projection

LATERAL HAND part position - place hand in lateral position with either ulnar or radial aspect down (radial being more difficult) - extend digits and adjust first digit at a right angle to the palm - palmar surface of hand is perpendicular to the IR - center the IR to where? - the two extended digit positions show superimposition of the phalanges - what modification is used which eliminates superimposition of the phalanges? central ray - perpendicular to where? structures shown - what position is used for foreign bodies and metacarpal fracture displacement - what position superimposes the metacarpals but shows all the individual phalanges. the most proximal phalanges remain superimposed

- MCP joints - fan lateral - second digit MCP joint - lateral extension - fan lateral

PA FINGER part position - place extended digit with palmar surface down - separate digits slightly - center the what to the IR? central ray - perpendicular to where? structures shown/evaluation criteria - what joint spaces should been seen open?

- PIP - PIP joint - IP and MCP joint spaces

LATERAL FINGER part position - extend the digit, close the rest of the digits into a fist - have the hand rest on what side for the second and third digit? - have the hand rest on what side for the fourth and fifth digit? - center what to the IR? - rest the second or fifth digit directly on the IR, elevate the third and fourth digits and use a sponge to support central ray - perpendicular to where? structures shown/evaluation criteria - what joint spaces should be seen and open?

- lateral/radial (2,3) - medial/ulnar (4,5) - PIP joint - PIP joint - IP joint spaces

PA WRIST part position - place axilla in contact with the table to place the shoulder, elbow, and wrist joints in the same plane to permit rotation - center wrist joint to IR (just distal to the ulnar styloid) - slightly arch the hand at the MCP joints by flexing the digits to place the wrist in close contact with the IR central ray - perpendicular to where? structures shown - carpals, distal radius and ulna, proximal metacarpals - slight oblique rotation to the ulna - when ulna is under examination what should be taken?

- mid carpal area - AP projection

AP WRIST part position - supinate hand - center IR to carpals - elevate digits on a support to place wrist in contact with IR - lean laterally to prevent rotation of the wrist central ray - perpendicular to where? structures shown - carpals, distal radius and ulna, proximal half of metacarpals - what is better seen on the AP image than the PA image because of their oblique direction, they are more parallel with the divergence of the x-ray beam

- mid carpal area - carpal interspaces

PA OBLIQUE FINGER part position - place patients forearm on the table with the hand ________ and the palm resting on the IR - rotate the hand laterally until the digits are separated and support on __ degree sponge - center what to the IR? central ray - perpendicular to what? structures shown/evaluation criteria - what joint spaces should be seen and open?

- pronate - 45 - PIP joint - PIP joint - IP and MCP joint spaces

PA PROJECTION ULNAR DEVIATION part position - position wrist for PA projection - turn hand outward in extreme ulnar deviation central ray - perpendicular to where? - angulation of 10 to 15 degrees proximally or distally sometimes required for clear delineation structures shown - reduced ______________ of the scaphoid, which occurs with a perpendicular central ray - opens joint spaces between adjacent carpals

- scaphoid - foreshortening

to show the scaphoid and capitate better with a PA projection of the wrist, Daffner recommended angling the central ray. a central ray 30 degrees toward the elbow elongates what? a central ray 30 degrees toward the finger tips elongates what?

- scaphoid and capitate - only the capitate

what can be done after a routine wrist does not show a fracture but a scaphoid fracture is suspected?

- scaphoid series-PA and PA axial projections-Rafert long method-ulnar deviation - projections made at 0, 10, 20, and 30 degrees cephalad

LATERAL WRIST part position - flex elbow 90 degrees to rotate the ulna to a lateral position - center IR to wrist joint (radiocarpal) central ray - perpendicular to where? structures shown - carpals, proximal metacarpals, distal radius and ulna - what should be superimposed? - what position can be used to show anterior or posterior displacement fractures?

- wrist joint - radius, ulna, and metacarpals - lateral position with radial surface against the IR

what lateral wrist position can be used to better show the scaphoid by rotating the bone anteriorly into a dorsovolar position, and also shows the small bony growth on the dorsal surface of the third CMC joint-the carpe bossu?

lateral wrist with palmar flexion