Radiology: wrist projections

standard wrist projections

-PA -PA oblique -lateral

other wrist projections

-PA in radial deviation -lateral in flexion -lateral in extension -PA in ulnar deviation -PA axial (stretcher method) -tangential (Gaynor-Hart Method)

PA wrist

-SID=40" -flex elbow 90 degrees, keep upper limb in the same plane=bring up table -flex digits to place wrist in contact with IR -CR enters perpendicular to mid-carpal area=wrist -collimate 2.5" proximal and distal to the wrist joint and 1" on the sides=distal to MCP joint -shield gonads

PA oblique wrist

-SID=40" -flex elbow 90 degrees, keep upper limb in the same plane=move table -flex digits to place wrist in contact with IR -CR enters perpendicular to mid-carpal area -from PA position, rotate wrist laterally until it forms 45 degree angle with IR=sponges makes this easier -collimate 2.5" proximal and distal to the wrist joint and 1" on sides -shield gonads -on x-ray slight space between the 3rd, 4th, and 5th metacarpals

PA axial scaphoid (stretcher method)

-SID=40" -position patient so that arm is in the same plane, flex elbow 90 degrees -elevate fingers 20 degrees to help distort scaphoid=20 degrees up with fingers -may also place wrist in ulnar deviation to further lessen scaphoid superimposition -CR perpendicular to table and enters at scaphoid -collimate 2.5" proximal and distal to the wrist joint and 1" on sides -if proper support is not available, CR may be angled 20 degrees toward the elbow instead

lateral wrist

-SID=40" -flex elbow 90 degrees, keep upper limb in the same plane=move table -adjust forearm and hand so that wrist is in true lateral position= radius and ulna should be superimposed -CR enters perpendicular or wrist joint -collimate 2.5" proximal and distal to wrist joint and 1" on sides -shield gonads

tangential carpal tunnel (Gaynor-Hart method)

-SID=40" -rest forearm on table. hyperextend wrist the place long axis of hand as vertical as possible -center IR to joint at level of radial styloid -grasp digits with opposite hand/or suitable device to maintain extended position or tape -CR angled 25-30 degrees toward the palm of the hand centered to a point 1" distal to the base of 3rd metacarpal

PA wrist in ulnar deviation

-manipulate wrist to see different parts -position the wrist on the IR for a PA projection=set up like PA wrist -without moving the forearm, turn the hand outward until the wrist is in extreme ulnar deviation=deviate hand in ulnar direction -CR is perpendicular centered to the scaphoid -collimate 2.5" proximal and distal to wrist joint and 1" on sides