positioning hand, wrist, thumb, fingers, forearm

structures shown in a lateral forearm

-radius and ulna superimposed -epicondyles superimposed (looks like a figure 8) -carpals and distal humerus -also can see that the elbow joint is opened

An AP projection of the wrist best demonstrates

carpal interspaces bc of the divergence of the beams

for a Gaynor-hart method hang the image by the

finger tips

joints of the fingers may be closed if the finger is:

flexed too much or the tip of the finger is touching the plate

AP forearm uses what kVp range

62 +/- 5

for the Gaynor-hart method what kvp is used

64 +/* 5

kVp range for lateral projection of the hand

64 +/- 5

lateral forearm uses what kVp

64 +/- 5

what is the kVp range for a lateral wrist

64 +/- 5

If the joint is of interest and the fingers can not be extended for a PA projection of digits 2-5, do a

AP projection instead of a PA projection

if the joints are of interest and the hand cant be extended do a:

AP projection of the hand instead of a PA

what position should you do to demonstrate a boxers fracture

rotate off lateral 5 degrees posteriorly and watch out for thumb

know the rubber duck of the lateral wrist which contains the:

scaphoid (duck beak), lunate (duck body), trapezium (duck hat)

What is a boxer's fracture?

fracture of the head 5th metacarpal results from axial loaded pressure

images of an AP and lateral forearm are hung by the

shoulder

structures shown in a lateral wrist

-radius and ulna should be superimposed -bases of metacarpals should be superimposed

structures shown in a PA oblique projection of digits 2-5

-3 bones, 3 joints -anterior part more concaved than posterior part -fingernail should be oblique -see soft tissue and trabeculae pattern

structures shown on a thumb radiograph

-3 bones: distal and proximal phalanx, metacarpal -3 joints: IP, MCP, CMC joints -must include trapezium -soft tissue and trabeculae pattern

structures shown for a PA projection of digits 2-5

-PA projection with no rotation -equally concaved on the medial and lateral side of the phalanxes -fingernail should look parallel with the plate -every finger shows 3 bones and 3 joints: distal, middle, proximal phalanx and DIP, PIP, MCP joints -the head of the metacarpals -no overlap of soft tissue - should see soft tissue and bone trabeculae pattern -joint spaces are opened

positioning steps for a PA wrist with ulnar deviation

-PA wrist -turn fingers away from the body (toward the ulna) -making thumb line up with the forearm -can curl or straighten the fingers

CR for a PA axial wrist

-angled 20 degrees towards the elbow centered to the scaphoid

positioning steps for a PA projection of the wrist

-axilla is in the same plane as the elbow joint -elbow is flexed 90 degrees -position for a PA hand -either curl the fingers or elevate the hand on a sponge to reduce OID

structures shown in a PA projection of the wrist

-carpals -proximal metacarpals -distal radius and ulns -a slightly oblique ulna -ulnar styloid process medial most -bony trabeculae -soft tissue -scaphoid fat stripe (lateral scaphoid and convexed, if it is not convexed it means there is joint effusion)

PA oblique projection demonstrates what structures

-carpals on the lateral side of the wrist especially the scaphoid and trapezium

an AP oblique wrist shows what structures

-carpals on the medial side of the wrist -pisiform free of superimpositioning -demonstrates trapezium and hamate BEST VIEW FOR PISIFORM

structures shown in the Gaynor-Hart method

-demonstrates the carpal tunnel (be able to label trapezium, scaphoid, captitate, triquetrum, hook of hamate, pisiform) -trying to show the nerve

structures shown in a PA projection of the hand

-entire hand -carpals -distal end of radius and ulna -PA oblique view of the thumb

positioning for a AP projection of the wrist

-extend elbow out and make sure theres no rotation -check to see if it is AP by the ulnar styloid process being rolled towards the radius

positioning steps for a lateral forearm

-from AP forearm, flex the elbow 90 degrees and positon the wrist and hand lateral

positioning steps for a AP oblique wrist or also called semisupination oblique wrist

-from AP wrist, medially rotate 45 degrees and the ulna is down

positioning steps for a PA wrist with radial deviation

-from PA wrist, move fingers towards the body -if patient has a hard time get them to use their other hand to hold the fingers

positioning steps for PA oblique projection of Digits 2-5

-from PA, oblique hand 45 degrees -ulnar surface is down - fingers are extended - long axis of the part is parallel with the long axis of the plate -digits are immobilized (may have to use sponge) - PIP is centered to the plate

positioning steps for a lateral wrist

-from PA, turn lateral so heads of metacarpals are superimposed

positioning steps for a PA oblique projection of the hand

-from the PA, oblique hand 45 degrees -let thumb relax -3rd MCP is centered to the plate

structures shown in a PA Oblique projection of the hand

-minimal overlap of metacarpals 3,4,5 -heads of metacarpals 2 and 3 should not touch -minimal amount of soft tissue overlap

positioning steps for a PA projection of the hand

-patient is seated -hand and forearm resting on the table -axilla is in the same plane as the elbow -elbow is flexed 90 degrees -palm surface is down -extend and separate fingers -center the 3rd MCP to the plate

positioning steps for a Gaynor-hart method

-patient seated -forearm parallel with the plate -pull the fingers back until the hand is vertical -rotate slightly to the lateral side (pulls hamate off pisiform)

positioning steps for a AP forearm

-patient seated -axilla and elbow must be in the same plane -extend the elbow and supinate the hand you may want to put something in the palm -long axis of the forearm is parallel with the plate -patient may need to lean laterally

AP projection of the thumb positioning steps

-patient turn hand in extreme internal rotation -hold fingers back with other hand -make sure thumb is not rotated (fingernail is parallel) -long axis of the part is parallel with the long axis of the plate

PA oblique projection of the thumb positioning steps

-place hand palm down -long axis of part parallel with the long axis of the plate

positioning steps for a carpal bridge (tangential projection)

-place hand palm up on the plate -the forearm is vertical -everything is 90 degrees or you could built up with sponges

Lateral projection of the thumb positioning steps

-place hand with palmar surface down -arch fingers 2-5 and rest them on the plate (fingernail is perpendicular to the plate)

positioning steps for a PA axial wrist

-position for a PA wrist and add some ulnar deviation

positioning steps for PA projections of digits 2-5

-remove foreign bodies -seated beside table -rest hand on plate -fingers are extended and flat on the plate -digits are separated slightly to prevent soft tissue overlap -center PIP to the plate -make sure the long axis of the part is parallel with the long axis of the IR

positioning steps for lateral projection of digits 2-5

-show patient what you want them to do and then bring the plate to them -if it is digit 2 or3: place the radial side down -if it is digit 4 or 5: place the ulnar side down -digit is extended and parallel to the plate -fingernail should be perpendicular to the plate -make sure digit is lateral -PIP is centered to the plate -heads of the metacarpals are perpendicular

what are the positioning steps for a PA oblique projection of the wrist also called semipronation oblique

-start from PA wrist and rotate laterally 45 degrees -add some ulnar deviation (shows navicular)

positioning steps for lateral projection of the hand

-start from PA, turn hand lateral with ulnar surface down -heads of metacarpals are perp. -pull thumb down 1. lateral in extension- fingers 2-5 are extended and superimposed 2. lateral in flexion- fingers 2-5 are superimposed and relaxed in a natural arch 3. fan lateral- fingers 2-5 are extended and separated and heads of metacarpals are superimposed

the lateral projection of the hand demonstrates what structures

-superimposed metacarpals 2-5 -superimposed radius and ulna -gives a PA projection of the hand -lateral extension is best to demonstrate foreign bodies, allows soft tissue to not pile on itself -lateral inflexion demonstrates anterior and posterior fracture displacement

structures shown on lateral projection of digits 2-5

-the anterior aspect is very concaved -posterior aspect is straight or convexed -heads of the metacarpals are superimposed -demonstrates trabecular pattern and soft tissue

the lateral wrist in flexion demonstrates

-the dorsum of the wrist -carpal boss also called carpe bossu -bony prominence on dorsum or 2nd view of carpal boss is tangential carpal bridge

carpal bridge (tangential projection) demonstrates

-the dorsum of the wrist (carpal bridge) -demonstrates carpal boss

what to do before starting exam

1. aidet 2. What is the patient wearing? 3.patients position - sit close to the table, get gonads out of primary beam DONT put lap under the table 4. table height- shoulder in the same plane as elbow joint 5. use a 10 x 12 plate line part up with long axis of plate and center part to the plate, position to patient 6. central ray placement- right angle to plate and use centering points 7. collimation- within 1 inch of soft tissue and joints 8. shielding- gonads within 2 inches, reproductive, not in field of view, SHIELD EVERY PT 9. markers- markers are face up 10. hanging protocol- fingers, hands, wrists are hung by the fingertips 11. comparisons- should be done separately

you can also angle the part instead of the tube for a PA axial wrist by these two options

1. angle the plate on the sponge and do PA wrist with ulnar deviation and the central ray is perp. 2. leave plate flat and place wrist on a 20 degree sponge but will give magnification (not the best choice)

collimation for a PA projection of the wrist

2 1/2 inches from wrist joint

PA wrist with radial deviation uses what kVp

60 +/- 5

PA wrist with ulnar deviation uses what kVp

60 +/- 5

kVp range for PA oblique projection of digits 2-5

60 +/- 5

kVp range for PA oblique projection of the hand

60 +/- 5

kVp range for PA projection of digits 2-5

60 +/- 5

kVp range for a PA projection of the hand

60 +/- 5

kVp range for lateral projection of digits 2-5

60 +/- 5

kVp range for radiographs of the thumb

60 +/- 5

kvp range for a PA axial wrist

60 +/- 5

what is the kVp range for a AP oblique wrist

60 +/- 5

what is the kVp range for a PA oblique projection of the wrist

60 +/- 5

what is the kVp range for a PA projection of the wrist

60 +/- 5

the best view for the scaphoid is

a PA Axial wrist also known as stecher method

For a thumb radiograph, if the patient can't do an internal rotation, you can do:

a PA but the OID will increase

the CR for a carpal bridge (tangential projection)

angled 45 degrees towards the finger tips centered 1 1/2 inches proximal to the wrist joint

CR for Gaynor-Hart method

angled 25-30 degrees proximally, enter 1 inch distal to the base of the 3rd metacarpal -if your patient cant bring the palm vertical, angle 15 degrees to the long axis of the metacarpals

for a carpal bridge (tangential projection) hang markers by the

dorsum of the wrist

structures shown in a PA wrist with ulnar deviaton

it corrects the foreshortening of the scaphoid also opens up the intercarpals spaces on the lateral side

what structures do a PA wrist with radial deviation show

open interspaces between carpals on the medial side

the CR for a lateral forearm

perp. to mid forearm

CR for a AP oblique wrist

perp. to mid-carpal area

CR for a PA oblique projection

perp. to mid-carpal area

CR for a PA projection of the wrist

perp. to mid-carpal area

CR for a PA wrist with radial deviation

perp. to mid-wrist

CR for a PA wrist with ulnar deviation

perp. to scaphoid (clinically perp. to mid wrist)

CR for lateral projection of the hand

perp. to the 2nd MCP

CR for a PA oblique projection of the hand

perp. to the 3rd MCP

CR for a PA projection of the hand

perp. to the 3rd MCP

what is the CR for the lateral wrist

perp. to the mid-carpal area

CR is what for a AP forearm

perp. to the mid-forearm -collimate an inch beyond soft tissue on each side and 2 inches beyond each joint

CR for a lateral projection of digits 2-5

perpendicular to PIP

CR for thumb radiographs

perpendicular to the MCP

CR for PA oblique projection of digits 2-5

perpendicular to the PIP

central ray for PA projection of digits 2-5

perpendicular to the PIP (proximal interphalangeal joint)

structures shown by a AP forearm

radius and ulna with humerus and carpals showing