10.0 Wrist & Hand Imaging

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displacement vs apex

ulnar vs radial palmar/volar vs. dorsal *depends on direction of distal bone *apex will be opposite of displacement

SPATIAL ALIGNMENT: volar tilt/palmar inclination

* similar to radial articular angle, but volar dorsal direction normal= 16-25

Normal PA pediatric hand

-3, 8 , 10 years old

MRI Hand Views

-Axial -Coronal -Sagittal

Oblique infant hand

-hand and wrist are often used as indicators of skeletal age of children -secondary ossification centers of carpals start at around 6 months EPIPHYSEAL PLATES -distal radius -distal ulna -metacarpal heads -base of 1st metacarpal -proximal phalanges

SPATIAL ALIGNMENT: arcuate lines

Arc I Arc II Arc III

RADIOGRAPHS: Hand Oblique View

CARPALS METACARPALS 1-5 PHALANGES 1-5 -proximal -middle -distal JOINT SPACES -CMC -MCP -PIPS -DIPS

RADIOGRAPHS: Hand PA View

CARPALS -scaphoid -lunate -triquetrium -pisiform -hamate -capitate -trapezoid -trapezium METACARPALS 1-5 -thumb with sesamoid bones PHALANGES -proximal -middle -distal -distal interphalangeal joint JOINTS -carpal metacarpal joints -metacarpal phalangeal joints -proximal interphalangeal joints -distal interphalangeal joints

RADIOGRAPHS: Wrist PA View Anatomy

ORIENTATION: as if looking at hands RADIUS (larger articular surface at wrist) -radial styloid ULNA -ulna styloid CARPALS (So Long To Pinky, Here Comes The Thumb) -scaphoid -lunate -triquetrium -pisiform -hamate (hook of hamate) -capitate -trapezoid -trapezium METACARPALS 1-5 JOINT SPACES -distal radioulnar joint

RADIOGRAPHS: Wrist Lateral View Anatomy

ORIENTATION: looking and hands, neutral pronation/supination - palmar/volar vs. dorsal RADIUS and ULNA -superimposed CARPALS row 1: lunate (half moon- articulates with radius) row 2: capitate, scaphoid row 3: hamate (articulates with 5th metacarpal), trapezium (articulates with thumb), METACARPALS

RADIOGRAPHS: Lateral View

ORIENTATION: looking at hands CARPALS METACARPALS 1-5 -PA of thumb PHALANGES 1-5 JOINT SPACES -CMC joint -MCP joint -PIPS -DIPS -distal radius -distal ulna

RADIOGRAPHS: Wrist Oblique View Anatomy

ORIENTATION: looking at hands with thumbs up RADIUS -radial styloid ULNA -ulna styloid CARPALS (So Long To Pinky, Here Comes The Thumb) -Scaphoid -Lunate -Triquetrium -Pisiform -Hamate -Capitate -Trapezoid -Trapezium JOINT SPACES -1st CMC (carpal metacarpal joint) -scaphoid-trapezium -trapezium-trapezoid

SPATIAL ALIGNEMENT: radial articular angle

RADIAL ARTICULAR ANGLE/INCLINATION ANGLE -ulnar slant of radius normal: 15-25 degrees

Wrist Radiograph Views

ROUTINE -PA -Lateral -Oblique SPECIALTY: stress views -PA with radial deviation -PA with ulnar deviation

Hand Radiograph Views

ROUTINE -PA -Lateral: true PA for thumb -Oblique

SPATIAL ALIGNMENT: ulnar variance

ULNAR VARIANCE: space for TFCC -neutral articulating surface with the lunate -neutral (normal) -positive: ulnar higher than radius (compression) -negative: ulnar lower than radius (traction)

SPATIAL ALIGNMENT: hand

a. second phalange aligned with radius b. slight ulnar variance of proximal phalange c. line from fourth and fifth metacarpal heads should align with the 3rd met head

SPATIAL ALIGNMENT: scapholunate angle

angle from bottom of trapezium to dorsal aspect of radius normal is 30-60 degrees (VISI)

SPATIAL ALIGNMENT: capitolunate angle

angle from carpals to volar aspect of radius normal is less than 20 degrees greater than 20 degrees is carpal instability (DISI)

SPATIAL ALIGNMENT: radiolunate angle

line from wrist to 3rd metacarpal -parallel axes -VISI: volar displacement -DISI: dorsal displacement

RADIOGRAPHS: PA View with Ulnar and Radial Deviation

radial: bend towards thumb ulnar: bend towards pinky *good for viewing occult fractures of scaphoid, wrist and carpal instability


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