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