Chapter 5 Part 1- Finger, Hand, and Wrist

What are Distal Interphalangeal Joints(DIP)? What about Proximal Interphalangeal Joints(PIP)?

1. Articulations between the distal and middle phalanxes 2. Articulations between the middle and proximal phalanxes

What are the three parts of each metacarpal bone?

1. Head 2. Body 3. Base

What are the three groups/divisions of the hand and fingers? How many are in each?

1. Phalanges (14 per hand) 2. Metacarpals (5 per hand) 3. Carpals (8 per hand)

What structures are demonstrated on the PA Axial Scaphoid?

20 degree angulation of the wrist will place the scaphoid at a right angle to the CR. This will show the scaphoid with minimal superimposition

List some of the evaluation criteria for the Fan and True Lateral Hand

Anatomy from the fingertips to the distal radius and ulna shown. Hand in true lateral position with digits superimposed or spread apart in Fan lateral. Distal Radius and Ulna are superimposed. The thumb should be seen free of motion and superimposition.

What are some of the evaluation critter for the PA Hand?

Anatomy of the fingertips to the distal radius and ulna. Digits are slightly separated as to not have any soft tissue overlap. Open MCP and IP Joints to show that the hand was flat on the IR.

What pathology can be demonstrated on the Tangential Projection of the Wrist (Gaynor-Hart Method)?

Calcification of the carpal canal/sulcus and carpal tunnel syndrome. Fractures of the hamate, pisiform, and trapezium can also be seen.

What are some evaluation criteria for the PA Oblique Finger?

Digit is rotated 45 degrees laterally, demonstrated by the concavity of the elevated side of the phalangeal bodies. The IP and MCP joint spaces are open.

What are some evaluation criteria for the PA Oblique Hand?

Digits are extended and separated slightly without soft tissue overlap. 45 degrees of obliquity are seen with decreased amount of separation between the metacarpal bodies of 2-5 with the second and third having the greatest separation. Partial superimposition of the third, fourth, and fifth metacarpal bases and heads. The MCP joints are open and the IP joints are open when the digits are parallel to the IR.

What are some evaluation criteria for the PA Oblique Wrist?

Distal radius, ulna, carpals, and proximal half of metacarpals. 45 degree rotation of the anatomy seen by slight overlap of the carpals as well as slight overlap of the distal radius and ulna. The trapezium and distal half of the scaphoid are free of superimposition. The trapeziotrapezoid and scaphotrapezial joint spaces are open

What are some evaluation criteria for the PA Axial Scaphoid (Stecher Method)?

Distal radius, ulna, carpals, and proximal half of the metacarpals are shown. The scaphoid's adjacent articulations are open without wrist rotation

What are some evaluation criteria for the AP/PA Wrist?

Distal radius, ulna, carpals, and proximal half of the metacarpals. Digits are not over-flexed as to not overlap or obscure metacarpals. No rotation in the carpals, metacarpals, radius or ulna with an open radioulnar joint space

What are some evaluation criteria for the Lateral Wrist?

Distal radius, ulna, carpals, proximal half of metacarpals are seen. The radius and ulna are superimposed as well as the metacarpals.

What is the joint classification and movement type for the Metacarpophalangeal Joints?

Ellipsoidal classification with flexion/extension and abduction/adduction movement

What pathology can be demonstrated on the Lateral Wrist?

Fractures and dislocations. Especially the Barton's Colles' or Smith's fractures

What pathology can be demonstrated on the PA Wrist with Ulnar Deviation?

Fractures of the Scaphoid

What pathology can be demonstrated on the PA/AP Wrist?

Fractures of the carpals and distal forearm, arthritis, and osteomyelitis

What pathology can be demonstrated on the PA Hand?

Fractures, dislocations, foreign bodies, osteoarthritis and osteoporosis

What pathology can be demonstrated on the PA Finger?

Fractures, dislocations, osteoarthritis and osteoporosis

What is the joint classification for the Intercarpal Joint?

Gliding

For the evaluation criteria of the thumb...

Go to your PowerPoint and review. Those would take up 5 individual notecards

What is the joint classification and movement type for Interphalangeal Joints?

Hinge classification with flexion and extension movement

Describe the patient, part, and CR position for the PA Hand

Patient is seated at the end of the XR table with forearm in contact with table and IR. Pronate the hand with fingers extended and spread slightly. Long axis of hand is parallel to the edge of the IR. CR is perpendicular to the IR centered to the 3rd MCP joint

Describe the patient, part, and CR position for the PA Wrist with Ulnar Deviation

Patient is seated at the end of the XR table with hand and arm resting on the IR. Pronate their hand and flex the wrist towards the ulna while keeping the forearm parallel to the edge of the IR. The CR is perpendicular to the scaphoid (may require a 10-15 degree angle proximally or distally).

Describe the patient, part, and CR position for the lateral thumb

Patient is seated at the end of the XR table with their hand and forearm in contact with the IR. Pronate their hand and flex their 2-5 digits to place the thumb in a lateral position in relation to the IR. Slightly abduct the thumb and place long axis parallel to the edge of the IR. CR is perpendicular to the IR centered to the MCP of the thumb

Describe the patient, part, and CR position for the PA Oblique Hand

Patient is seated at the end of the XR table with their hand and forearm in contact with the table/IR. Pronate the hand with fingers extended and slightly spread apart. Rotate the hand so that the MCP creates a 45 degree angle to the IR. Long axis of the hand is parallel to the IR. CR is perpendicular to the IR centered to the 3rd MCP joint

Describe the patient, part, and CR position for the PA Oblique thumb

Patient is seated at the end of the XR table with their hand and forearm on the table/IR. Abduct the patient's thumb so to place the long axis is parallel to the edge of the IR. The CR is perpendicular to the IR at the MCP joint

Describe the patient, part, and CR position for the Lateral Wrist

Patient is seated at the end of the XR table with their hand and forearm resting on the IR with elbow flexed at 90 degrees. Wrist is in true lateral with fingers slightly flexed so the long axis of the hand and arm is parallel to the edge of the IR. The CR is perpendicular to the IR and centered to the mid carpal area

Describe the patient, part, and CR position for the Lateral Finger

Patient is seated at the end of the XR table with their hand in the lateral position. The affected finger is extended with the long axis of that finger parallel to the edge of the IR while all others flexed. The side of the hand (medial/lateral) that's in contact with the IR is determined by the affected finger. The CR is perpendicular to the IR entering the PIP joint.

Describe the patient, part, and CR position for the AP/PA Wrist

Patient seated at end of XR table with hand and forearm resting on IR. For PA, pronate hand and arch hand by making a loose fist so the wrist is closer to the IR. For AP, supinate hand and extend fingers to show the carpal interspaces. CR is perpendicular to the IR and centered to the midcarpals(1/2" distal to styloids of radius and ulna)

What's some evaluation criteria for the PA Finger?

Proper collimation with marker placed clear of anatomy of interest. The entire digit from the fingertip to the distal portion of the adjoining metacarpal seen without tissue overlap from adjacent digits.

What structures are shown on the PA/AP Wrist?

Proximal Metacarpals, carpals, and distal forearm

Describe the patient, part, and CR position for the PA Finger

Pt is seated at the end of the XR table with hand and forearm on table/IR. Pronate the hand with palm down and fingers extended and separated. Long axis of finger parallel to edge of IR. The CR is perpendicular to the IR at the effected fingers PIP joint

Describe the patient, part, and CR position for the PA Oblique Finger

Pt is seated at the end of the XR table with hand and forearm on table/IR. Their fingers are extended and separated with their hand rotated 45 degrees lateral to get the desired obliquity of the desired finger. The CR is perpendicular to the IR at the PIP joint of the affected finger.

Describe the patient, part, and CR position for the AP Thumb

Pt seated at the end of the XR table with their hand rotated to place the thumb supinated. Have the patient move their other fingers out of the way of the thumb. The long axis of the thumb is parallel to the edge of the IR. The CR is perpendicular to the IR and centered to the MCP joint affected.

What's the SID, and IR size for the PA Hand?

SID is 40" and IR is 8 x 10. These remain the same for each hand projection/position

What is the SID and IR size for the PA Finger? Is it table top(TT)?

SID is 40" and the IR size is 8 x 10. It's TT. This is the same for all other finger projections.

What structures are demonstrated on the PA Wrist with Ulnar Deviation?

Scaphoid free of superimposition or foreshortening

What are Intercarpal Joints?

The articulations between the carpal bones

What are Carpometacarpal Joints?

The articulations of the base of the metacarpals with the carpal bones

What are Metacarpophalangeal Joints?

The articulations of the head of the metacarpals with the proximal phalanges

What are some evaluation criteria for the Tangential Projection of the Wrist (Gaynor-Hart Method)?

The carpals are seen in the arrangement of an arch. The Pisiform is in profile and free of superimposition. The Hamulus of the Hamate (hook of Hamate) is also seen.

What structures are demonstrated on the AP Thumb?

The entire thumb from the distal phalanx to the adjacent carpal bones (trapezium)

Which digit only has two phalanges?

The first digit/thumb

Describe the patient, part, and CR position for the Tangential Projection of the Wrist (Gaynor-Hart Method)

The patient is seated at the end of the XR table with hand and forearm in contact with the IR. The hand is hyperextended to place it close to 90 degrees to the IR and internally rotated 10 degrees. The opposite hand can be used to hold the other in position. The CR is 25-30 degrees towards the elbow, centered to the mid palm area around 1" distal to the base of the 3rd metacarpal

Describe the patient, part, and CR position for the PA Oblique Wrist

The patient is seated at the end of the XR table with the hand and forearm resting on the IR. Pronate the hand and rotate the wrist 45 degrees laterally with the long axis of the hand and forearm parallel to the edge of the IR. The CR is perpendicular to the IR and centered to the mid carpal area

Describe the patient, part, and CR position for the Fan Lateral Hand and True Lateral Hand

The patient is seated at the end of the XR table with their hand and forearm in contact with the table/IR. For the Fan, rotate the hand and forearm into the lateral position with the fingers extended and fanned apart. For the true lateral, extend all the fingers together. The CR is perpendicular to the IR and centered to the 2nd MCP Joint

Describe the patient, part, and CR position for the PA Axial Scaphoid (Stecher Method)

The patient is seated at the end of the XR table with their hand and forearm resting on the IR. The IR is on a 20 degree elevated support at the *finger* end. The CR is perpendicular to the table and directed to enter the scaphoid. The CR may be angled 20 degrees towards the forearm if the IR cannot be elevated.

What are some specific evaluation criteria for the PA Wrist with Ulnar Deviation? (Think about the anatomy of interest)

The scaphoid's adjacent articulations are open while maintaining no rotation of the wrist. Maximum ulnar deviation as seen by the angle formed between the longitudinal axis of the ulna and the fifth metacarpal.

What is the joint classification and movement type for the Carpometacarpal Joints?

The thumb is a saddle classification while the other fingers are plane/gliding. The movement types are flexion/extension, abduction/adduction, circumduction, opposition and rotation

What structures are demonstrated in the PA Hand?

Entire hand and wrist with about an inch distal of the radius and ulna

How many total bones are there in the hand and fingers?

Total of 27 and they're divided into 3 groups

What structures are demonstrated on the PA Finger?

Affected finger from the distal phalanx to distal metacarpal. This is the same for the other finger projections.

What structures are demonstrated on the Tangential Projection of the Wrist (Gaynor-Hart Method)?

Bones in the anterior surface of the wrist: Pisiform, Hamate, Capitate, and Trapezium

What is the carpal sulcus and why is it important?

It's the concave anterior surface of the carpal bones. It's important because multiple nerves and tendons pass through this area of the wrist.

What is an Interphalangeal Joint?

The joint space between the proximal and distal phalanges of the thumb