Procedures wrist and forearm
PA Oblique Position: Seated at the end of the table Arm on the same plane Rest wrist on IR Flex elbow joint 90 degrees rotate wrist laterally 45 degrees CR: perpendicular @ midcarpal area Structure shown: Trapezium Scaphoid carpals on the lateral side of the wrist
Big 4
PA ulnar deviation position: patient seated at end of table Arm on the same plane patient rest wrist and palm flat on IR flex elbow joint 90 degrees turn hand outward toward ulna side until the wrist is in extreme ulnar deviation CR: perpendicular @ the scaphoid (may require CR angulation of 10-15 degrees proximal or distally if pt cannot ulnar deviate enough) Structure shown: Scaphoid elongated open articulations between the adjacent carpals
Big 4
AP Position: Patient seated at the end of the table Arm on the4 same plane Rest dorsal of forearm surface against IR Extend elbow joint and supinate hand CR: perpendicular @ mid forearm Structure shown: Forearm elbow joint proximal row of carpal bones
Big 4
Carpal canal Tangential gaynor-hart method position: Patient seated at end of table seat patient low enough to place forearm II to table/IR patient rest wrist and palm flat on IR INFERIORSUPERIOR hyperextend the wrist long axis of hand as vertical as possible Rotate hand slightly to the radial side use opposite hand or suitable device to hold wrist in the extended position SUPEROINFERIOR Stand patient at end of table patient dorsiflex wrist as much as possible lean forward to place carpal canal tangent to the IR CR: Directed to the palm of hand @ 1" distal to the base of the third metacarpal Angle 25-30 degrees toward the hand Structure shown: Carpal canal AKA carpal tunnel (palmar aspect of the trapezium, the tubercle of the trapezium, scaphoid, capitate, hook of hamate, and the entire pisiform)
Big 4
Lateral Position: Patient seated at the end of the table Arm on the same plane Flex elbow joint 90 degrees thumb side of hand must be up CR: perpendicular @ mid forearm Structure shown: Forearm elbow joint proximal row of carpal bones
Big 4
Lateral Position: Left wrist Pt. Seated at the door end of the table Arm on the same plane Flex elbow joint 90 degrees Rotate wrist laterally until ulna is against IR in lateral position Hand in extension lateral CR: perpendicular @ wrist joint Structure demonstrated Proximal metacarpals Carpals Distal radius and ulna Demonstrate anterior or posterior displacement in fractures
Big 4
PA Position: Patient seated at end of table Arm on the same plane Palm on IR Flex fingers CR: perpendicular to IR Enters midcarpal area Structure shown: Carpals Distal radius and ulna Proximal metacarpals
Big 4
PA Axial Stretcher method Position: Patient seated at the end of the table Arm on the same plane rest wrist and palm flat on the IR VARIATIONS PREFERRED METHOD - 1. Elevate IR 20 degrees so the finger end of the IR is elevated 2. Angle the central ray 20 degrees towards the elbow joint. 3. Patient clench the fist (elevates the distal end of the scaphoid so that it lies II with the IR) CR perpendicular @ scaphoid Structure shown: scaphoid free of superimposition
Big 4
