Hand, Wrist, Finger, Thumb Positioning SFMC
What structures are best shown on a lateral thumb?
Entire thumb and 1st metacarpal
What structures are best shown on an AP thumb?
Entire thumb and 1st metacarpal
What do you want to rule out in a lateral extension?
Foreign bodies
What structures are best shown on a lateral finger?
IP and MP joints open
How should the patient be positioned for a AP thumb?
Internally rotate hand with fingers extended
What is the SID for these positions?
40" to table top
An upper limb with a cast requires an ______ in exposure factors.
increase
Fiberglass cast
increase 3-4 kVp
Small to medium dry plaster cast
increase 5-7 kVp
What is the SFMC routine for a hand?
PA hand 45 degree oblique lateral "fan" finger
What is the SFMC finger routine?
PA hand 45 degree oblique hand including 3 fingers lateral finger
What is the routine for a thumb?
PA hand (oblique thumb) AP thumb lateral thumb
What structures are best shown on a PA finger?
PA projection of the entire hand and wrist including about 1 inch of the distal forearm. MP and IP joints open. PA hand will demonstrate oblique image of thumb.
What structures are best shown on a PA hand?
PA projection of the entire hand and wrist including about 1 inch of the distal forearm. MP and IP joints open. PA hand will demonstrate oblique image of thumb.
What structures are best shown on a PA thumb?
PA projection of the entire hand and wrist including about 1 inch of the distal forearm. MP and IP joints open. PA hand will demonstrate oblique image of thumb.
What is the SFMC routine for a wrist?
PA wrist with ulnar deviation Lateral wrist 45 degree semi-supinated oblique (5th digit down) 45 degree semi-pronated oblique (5th digit down)
Where should the CR be on a lateral in extension?
CR perpendicular to IR, to 2nd MP joint. Extend fingers on top of each other.
Where should the CR be on a lateral in flexion?
CR perpendicular to IR, to 2nd MP joint. Flex fingers in a neutral flexed position.
Where should the CR be on a lateral "fan" finger?
CR perpendicular to IR, to 2nd MP joint. Spread fingers in a "fan" pattern to visualize each digit (phalanges)
Where should be CR be on a PA hand?
CR perpendicular to IR, to 3rd MP joint. Pronate hand with palmar surface in contact with cassette.
Where should the CR be for a PA finger?
CR perpendicular to IR, to 3rd MP joint. Pronate hand with palmar surface in contact with cassette.
Where should the CR be on a PA thumb?
CR perpendicular to IR, to 3rd MP joint. Pronate hand with palmar surface in contact with cassette.
Where should the CR be on a 45 degree oblique hand?
CR perpendicular to IR, to 3rd MP joint. Pronate hand. Rotate entire hand and wrist laterally 45 degrees. Digits should be parallel to IR to open up joint spaces.
Where should the CR be on a 45 degree semi-pronated (PA oblique)?
CR perpendicular to midcarpals. From pronated position, externally rotate wrist 45 degrees.
Where should the CR be on a 45 degree semi-supinated (AP oblique)?
CR perpendicular to midcarpals. From supinated position, internally rotate wrist 45 degrees.
Where should the CR be on a lateral wrist?
CR perpendicular to midcarpals. Hand and wrist in true lateral.
Where should be CR be on a PA wrist with ulnar deviation?
CR perpendicular to midcarpals. Palm down Evert hand towards ulnar side
Where should the CR be on a AP thumb?
CR perpendicular to the IR, directed to the first MP joint
Where should the CR be on a lateral thumb?
CR perpendicular to the IR, directed to the first MP joint
Where should the CR be on a lateral finger?
CR to IR to proximal PIP. Finger parallel to IR.
What structures are best shown for stecher method?
Scaphoid. All carpals, and distal radius and ulna
Why do we not need a grid for the hand, finger, thumb, and wrist?
Under 10cm you do not need a grid.
Nursemaid's fracture
subluxation of the radial head, usually caused by hard pull on child's arm by an adult
Colle's fracture
fracture of distal radius with displacement posteriorly
Boxer's fracture
fracture of the distal 5th metacarpal
Simple fracture
fracture when bone does not break through the skin
Comminuted fracture
fracture when bone is crushed in two or more fragments
Compound fracture
fracture when bone protrudes through the skin
Impacted fracture
fracture where one fragment drives into another, usually long bones
Epiphyseal plate fracture
these fractures are hard to see, they may request comparison views of opposite
What area is closest to the IR?
Affected area
What structures are best shown on a 45 degree semi-supinated (AP oblique)?
All carpals with pisiform, triquetrum, and hamate free of superimposition and in profile
What structures are best shown on a 45 degree semi-pronated (PA oblique)?
All carpals, with well demonstrated scaphoid and trapezium
What structures are best shown on a PA wrist with ulnar deviation?
Distal radius and ulna and carpals. Scaphoid seen clearly without superimposition. Adjacent carpal interspaces open.
What structures are best shown on a lateral wrist?
Distal radius and ulna superimposed. Carpals.
Why do we use three fingers?
For comparison
How should the patient be positioned for a lateral finger?
Hand in lateral position with affected area finger extended
How should the patient be positioned for a lateral thumb?
Hand pronated, thumb abducted, fingers slightly arched
What structures are best shown on a lateral in extension and flexion?
Metacarpals, wrist and distal radius and ulna are superimposed. Entire hand and wrist visible.
What structures are best shown on a lateral "fan" finger?
Metacarpals, wrist and distal radius and ulna are superimposed. Phalanges visible in the lateral position.
What structures are best shown on a 45 degree oblique hand including 3 fingers?
Oblique of the affected finger with joint spaces open.
What structures are best shown on a 45 degree oblique hand?
Oblique of the entire hand. MP and IP joints open. Fingers parallel to IR.
How should the patient be positioned for a PA wrist with ulnar deviation?
Patient sitting at the end of the table. Elbow flexed 90 degrees. Hand and wrist resting on table.
Where should be CR be for a 45 degree oblique hand including 3 fingers?
SFMC: CR perpendicular to affected MP joint. (because you want to include metacarpal and finger) Textbook: CR perpendicular to affected PIP.
How should a patient be positioned for a PA finger?
Seat the patient at the end of the table with elbow flexed 90 degrees with hand and forearm resting on the table top
How should the patient be positioned for a PA hand?
Seat the patient at the end of the table with elbow flexed 90 degrees with hand and forearm resting on the table top
What method can you use if a patient cannot do ulnar deviation?
Stecher method
Where should the CR be for stecher method?
When wrist is placed on cassette- CR angled 20 degrees towards the elbow. When wrist is placed on 20 degree angled sponge- CR perpendicular to IR at midcarpals.
How do you position a patient for stecher method?
Wrist placed on cassette OR wrist placed on 20 degree angled sponge
Do you need to shield for these positions?
Yes
Fracture
break in the bone
Contusion
bruise, without fx
Large to wet plaster cast
double mAs OR increase 8-10 kVp
Dislocation
displacement of bone from joint
Incomplete fracture
example: Greenstick- common in pediatric patients where cortex of bone is broken
Sprain
forced wrenching or twisting with rupture or tearing of ligaments
Barton's fracture
intra-articular fracture of the posterior lip of distal radius
Bennet's fracture
longitudinal fracture of the base of the 1st metacarpal
What is the kVp for upper limbs?
lower to medium kVp (50-70)
Baseball or Mallet's fracture
occurs when a hard object (ex. baseball) strikes the ends of an extended finger
Subluxation
partial dislocation, usually seen in the spine
Smith's fracture
reverse of Colle's, anterior displacement