Radiography of wrist

PA Oblique Wrist Criteria Evaluation

1.) The trapezium and trapezoid should be demonstrated without superimposed. 2.) The tuberosity of the scaphoid should be demonstrated. 3.)The medial carpals are superimposed. 4.) The ulnar styloid should be in profile and the medial carpal bones superimposed.

PA (Patient) Oblique Wrist Projection

1.) Seated, elbow flexed 90 degree 2.) Hand and forearm resting palm down 3.)Shoulder, elbow and wrist are in same plane.

PA (Patient) wrist Projection

1.) Seated, elbow flexed 90 degrees. 2.)Shoulder, elbow, wrist in same plane

Situation: A radiograph of the PA scaphoid projection in ulnar flexion reveals extensive superimposition of the scaphoid and adjacent carpals. SOLUTIONS: Insufficient ulnar_________ can lead to this problem.

Flexion

Perpendicular

at an angle of 90° to a given line, plane, or surface.

SUPINE, AP, ANATOMICAL POSITION, or EXTERNAL ROTATION are _____ terms in this case.

Interchangeable

situation: A radio-graph of a tangential, inferosuperior projection of the carpal canal reveals that the hamate is superimposed over the pisiform. SOLUTION: Repeat the exposure rotating the wrist and hand 10 degrees _________.

Internally

The elbow is flexed_____ degrees for a lateral projection of the forearm. The distal radius and ulnar are _______by placing the hand laterally.

90°, superimposed

When performing a lateral projection of the wrist, the elbow is flexed how many degrees?

90°; (The hand is in the lateral position. The distal radius and ulna are SUPERIMPOSED .)

The carpal inter-spaces of the wrist are best demonstrated in what type of Projection?

AP; (however, the PA projection is obtained routinely for the patient comfort.)

Structures shown

Carpals, distal radius, and ulna and proximal metacarpals.

The Gaynor-Hart method is a __________projection used to demonstrate the carpal canal of the wrist.

Tangential Projection; it shows chip fractures of the DORSAL aspect of the carpal bones, particularly of the scaphoid bone. CR ANGLED 45 ° to the long axis of the forearm.

The Carpal bridge is demonstrated by the ________ projection and shows chip fractures of the ___________ aspect of the carpal bones, particularly of the scaphoid bone. The CR is angled _______ degrees to the Long axis of the forearm.

Tangential projection; dorsal aspect; 45°

PA (Part Position) wrist Projection

1.) Hand pronated 2.) Fingers arched 3.)Mid-carpal area centered to the IR

AP (Patient) oblique projection

1.) Patient position; seated 2.) Forearm in supine position

PA (Part Position) Oblique Wrist Projection

1.) From pronated position, rotate wrist laterally to form 45 degree angle with IR. 2.) Wrist in semipronation

AP (Part Position) Oblique projection

1.) From supine position, rotate wrist medially/internally 45 degree angle with IR 2.) Wrist in semisuperination

PA wrist Criteria for Evaluation

1.)The long axis of the hand is aligned with the long axis of the IR. 2.) The radius and ulna are separated the distal radioulnar joint is open. 3.)The scaphoid is demonstrated. 4.) There equal concavity on each side of the shaft of a proximal MC. 5.)The trapezoid is superimposed on the trapezium.

The PA oblique projection of the wrist is rotated to what degrees?

45°; (elbow is flexed 90°, and best demonstrates the CARPALS ON THE LATERAL SIDE ESPECIALLY THE SCAPHOID AND TRAPEZIUM bones of the wrist.)

Smith fractures involve a______________ displacement.

Anterior Displacement

On a PA projection of the wrist, how should the hand (fingers) be positioned?

Arched; for better contact with the image receptor in the carpal area.

Optional AP projection

Best demonstrates the interspaces

Situation: A patient with a history of carpal tunnel syndrome comes to radiology. The physician wants to rule out abnormal calcifications in the carpal canal. SOLUTION: The _________ method would best demonstrate this region.

Gaynor-Hart

Central Ray

Perpendicular to mid-carpal area

Colles fractures involve a _________ displacement of the distal radius.

Posterior Displacement

The Stecher Method is a supplementary position used to demonstrate the __________bone of the wrist.

Scaphoid bone of the wrist.

Ulnar Flexion (ulnar deviation) with the hand turned outward best describes the what?

Scaphoid bone; (Not foreshortened on the radial (lateral) side of the wrist. The CR may be angled 90° or 10°-30°)

Situation: Patient enters the ER with a possible scaphoid fracture. The patient is unable to assume the ulnar flexion position. Solution: A modified________ position with the CR angled _____ toward the elbow could be performed to confirm a scaphoid fracture.

Stecher; 20°

For AP projection of the forearm the hand should be ___________. Pronation of the hand on the AP projection of the forearm would cause _________________ of the radius and ulna. The humeral epicondyles should be __________ to the IR.

Supinated; crossing or (Superimposition); PARALLEL

When performing an AP oblique projection of the wrist rotated 45 degrees, the forearm is in what type of position?

Supine; (Best demonstrates the pisiform primarily but it also shows the triquetrum, lunate, and hamate bone of the wrist in profile.

PA Projection of wrist collimated field

The long axes of the 3rd metacarpal and mid-forearm should be aligned with the long axis of the collimated field.

Oblique wrist error

Wrist is over rotated; To correct: oblique wrist LESS by rotating it internally until it forms a 45 degree angle with IR.