Radiology: Hand and finger projections

essential projections of first digit

-AP or PA -PA oblique -Lateral

essential projections for digits 2-5

-PA -PA Oblique -Lateral

essential projections of hand

-PA -PA oblique -lateral= fan lateral position, lateral in extension

PA Digits 2-5

-SID: 40inches -palmar surface of hand lies flat on IR -CR enters perpendicular to PIP joint -collimate to 1" on all sides of digit, including 1" proximal to the MCP joint -some facilities require a comparison second digit to be included in collimated field -shield gonads -marker on lateral side, with right or left

PA oblique digits 2-5

-SID=40" -extend digits, rotate palmer surface 45 degrees laterally -45 degree positioning sponge very helpful aid -CR entered perpendicular to IR at PIP joint -collimate to 1" on all sides of digit, including 1" proximal to MCP joint -shield gonads -2nd digit PA oblique frequently done with medial rotation -2nd digit is closer to IR, and positioning can be easier for patient -markers laterally with left or right

AP 1st digit

-SID=40" -extreme internal (medial) rotation of hand to put thumb in AP position -CR enters perpendicular to IR at MCP joint -collimate to 1" on all sides of digit, including 1" proximal to CMC joint -want to see 1" into carpals -shield gonads -marker lateral and right or left

PA oblique hand

-SID=40" -rotate palm away from IR until MCP joints form 45 degree angle with IR -45 degree wedge sponge is helpful to support hand -digits parallel with IR -CR perpendicular to IR, entering at 3rd MCP joint -collimate to 1" on all sides of hand, including 1" proximal to ulnar styloid -shield gonads -markers lateral with right or left

lateral 1st digit

-SID=40" -rotate thumb until lateral surface is on IR -CR enters perpendicular to IR at MCP joint -collimate to 1" on all sides of digit, including 1" proximal to CMC joint -shield gonads -markers lateral and right or left

lateral digits

-SID=40" -2nd and 3rd digits= extend digit with lateral surface in contact with IR (mediolateral lateral projection) -4th and fifth digits= extend digit with medial surface in contact with IR (lateromedial lateral projection) -CR perpendicular to IR entering at PIP joint -collimate to 1" on all sides of digit, including 1" proximal to MCP joint

lateral hand (fan lateral)

-SID=40" -hand rests on medial surface, radial and ulnar styloid superimposed and perpendicular to IR -digits positioned out of superimposition -metacarpals superimposed -CR perpendicular to IR, entering at 2nd MCP joint -collimate to 1" on all sides of hand, including 1" proximal to ulnar styloid -shield gonads -markers lateral and right and left

PA hand

-SID=40" -palmar surface of hand lies flat on IR -forearm in same plane -CR is perpendicular to IR, entering at 3rd MCP joint -collimate to 1" on all sides of hand, including 1" proximal to ulnar styloid -want wrist flat on surface -shield gonads -markers lateral with right or left

PA oblique 1st digit

-SID=40" -place palmar surface of hand on IR with slight ulnar deviation -turn hand out a little -CR enters perpendicular to IR at MCP joint -collimate to 1" on all sides of digit, including 1" proximal to CMC joint -shield gonads -markers lateral and right or left

AP Oblique (Norgaard Method or Ballcatcher's position)

-doctor would order if wanted -assists in detecting early radiologic changes in the dorsoradial aspects of the 2nd through 5th proximal phalangeal bases that may be associated with rheumatoid arthritis -look at MCP joints to see arthritis -bilateral markers

PA 1st digit

-only performed if AP 1st digit is not possible -place hand in lateral position, putting elevated thumb in PA position -supports 1st digit -CR enters perpendicular to IR at MCP joint

digits in extension

-superimposed digits=on top of each other -done when evaluation for foreign body, or evaluating for metacarpal fx -looking for splinters -metacarpal fractures -digits in natural flexion= projection is useful when a hand injury prevents the patient from extending the digits -ex=gun shot wound

PA 1st MCP joint (Folio Method)

-this projection is useful for diagnosis of ulnar collateral ligament (UCL) rupture in the MCP joint of the thumb -commonly referred to as "skier's thumb" -put spacer between thumbs -rubber band on thumbs -then when you have to take image pull a little on band -angles show if ligament is torn -bilateral marker -shield gonads