10.0 Wrist & Hand Imaging
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