RP: Wrist
Radial deviation
Movement of the wrist towards the radius or lateral side
ulnar deviation
Movement of the wrist towards the ulna or medial side
Carpal Canal: Criteria
Carpal sulcus is open, pisiform and hamate are separated, rounded scaphoid and capitate in profile, exposure factors
Wrist: Special Projections
scaphoid projections (CR angle/ulnar deviation, modified stecher), Carpal canal
Carpal Canal: CR
25 to 30° to the long axis of the hand, increase CR angle if patient can't hyper extend wrist to a 90° angle, directed 2 to 3 cm in the distal base of the third metacarpal
PA axial scaphoid--ulnar deviation with CR 10 to 15° angle: CR
Angle 10 to 15° along the long axis of the forearm towards the elbow, enter 2 cm distal medial to the styloid process
PA Wrist Projection: Collimate
Arch hand to minimize OID of the carpals
Carpal Canal: Part Position
Ask patient to hyperextend wrist as far as possible by grasping fingers with the other hand and gently but firmly pulling back until metacarpals and fingers are 90° to the forearm, internally rotate the wrist and hand 10°
Lateral Wrist: Criteria
Distal radius, ulna, and mid metacarpals demonstrated, CR at metacarpals, no rotation, exposure factors
PA Wrist Projection: Criteria
Distal radius, ulna, and mid metacarpals demonstrated, CR at mid carpals, no rotation, exposure factors
PA Oblique Wrist: Criteria
Distal radius, ulna, and mid metacarpals demonstrated, CR at midcarpal, trapezium and scaphoid seen in their entirely, exposure factors
PA Scaphoid-- Modified stretcher: Part Position
Elevate hand 20° using an angle sponge or can clinch the best to bring the hand up 20°, gently evert hand to the ulnar side
PA Wrist Projection: Part Position
Hand pronated, arch finger so the carpal bones come in closer contact with the IR
PA Oblique Wrist: Rotation
Need to see to the mid metacarpal area, trapezium right below the first metacarpal
PA Wrist Projection: Rotation
No rotation is determined by looking at the separation of the radial head and ulna, however there may be slight super imposition of the distal radioulnar joint
Lateral Wrist: Rotation
No rotation is obtained when the ulnar head is super imposed by the distal radius and proximal 2-5 metacarpals should be superimposed
PA Oblique Wrist: Part Position
Palm down, rotate wrist and hand laterally 45°, use wedge support or flex fingers for support
PA Oblique Wrist: CR
Perpendicular to the metacarpal area
Lateral Wrist: CR
Perpendicular to the mid carpal area
PA Wrist Projection: CR
Perpendicular to the midcarpal area
PA Scaphoid-- Modified stretcher: CR
Perpendicular, directed to the scaphoid, 2 cm distal medial to the styloid process
PA axial scaphoid--ulnar deviation with CR 10 to 15° angle: Part Position
Position as in the PA projection, without moving for arm gently evert the hand (move towards ulnar side) as far as the patient can tolerate
Ulnar deviation: Criteria
Scaphoid clearly seen without super imposition, 10 to 15° CR angle evident when adjacent carpal spaces are open
Lateral Wrist: Patient Position
Seated at end of the table elbow flexed 90°
PA Wrist Projection: Patient Position
Seated at the end of the table with elbow flexed 90°, hand and wrist resting and I are dropped shoulder shoulder elbow and wrist are on the same horizontal plane
Carpal Canal: Patient Position
Seated at the end of the table with wrist and hand palm down
Lateral Wrist: Part Position
Thumb up, make sure the wrist is in a true lateral position with fingers flexed, can use support to eliminate motion
PA axial scaphoid--ulnar deviation with CR 10 to 15° angle: Collimation
To the carpal region