Chapter 4: Finger and Hand Flashcards
Where do you center at for a finger
center at pip
what do you need to include in a finger
need to include joint between carpal and
metacarpal
what is the CR perpendicular to in a finger
CR perp to the IR
what is the CR parallel to in a finger
Cr parallel to joint to open up joint spaces
what other view can you try to open up joint spaces of a finger
AP
what do you need to make sure you do when taking a finger or hand xray
fully extend
should see twice as much soft tissue on one side than the other
oblique positioning of a finger
for what finger view should you place finger parallel to maintain open joint space
oblique
What should be in profile for a lateral finger
finger nail
what should be superimposed in a lateral finger
head of phalanges should be superimposed
For the AP thumb what should be flat on the IR
finger nail should be flat on the ir
what should be in profile for a lateral thumb
thumb nail in profile.
what should be included in a ap thumb or lateral thumb
down to joint
what should be superimposed in a lateral thumb
heads of phalanges should be superimposed
Proper positioning or criteria for PA hand
Soft tissue outline is uniformed 2nd through 5th
Distance between the MC heads is equal
Midshaft concavity is equal on 2nd through 5th digit
No soft tissue overlap
IP, MP and CM joints are open
Thumb 45 degree oblique
Should show one inch of radius and ulna
how is the thumb in a pa hand
thumb 45 degree oblique
how much of the radius and ulna should be shown in a pa hand
should show one inch of the radius and ulna
criteria for oblique hand
45 degree rotation
2nd-5th MC show more concavity on one side than other
Slight space between 4th and 5th MC shafts
Thumb varies from lateral to oblique
2nd and 3rd MC heads are not superimposed
3rd to the 5th are slightly superimposed
One inch of radius and ulna
why is a true later of the hand usually done?
to check for foreign bodies of the palm, completely extend the fingers
in the fan lateral, what has zero superimposition ?
No superimposition of thumb (vary from oblique to PA)
this will show the 5th metacarpal anterior to the 2nd-4th MC
external rotation of the hand
Which MC is the shortest?
5th MC
which MC is the longest
2nd MC
this will show the 2nd MC anterior to the 3rd-5th MC
Internal Rotation
what MC’s should be superimposed in a lateral view of the hand
Superimpose the 2nd through the 5th MC, placing the knuckles one on top of the other
in what view will you not always get a true lateral wrist
lateral hand
how is the ulna usually in a lateral hand
Instead the ulna is demonstrated slightly posterior to the radius
what should you judge your lateral hand off of
Therefore judge your lateral by the superimposition of the 2nd -5th MC
fully extend the fingers and use same analysis as for the lateral fan hand
Reason- this is done to demonstrate foreign bodies of the palm
It makes for better localization of foreign body in extension
Lateral hand in extension-
what is flexion and extension usually done for
Mobility
flex the 2nd -5th fingers until they meet the first finger but do not superimpose it
Lateral hand in Flexion-
Reason- distinguish the degree of anterior or posterior displacement of a fracture MC
Lateral hand in Flexion-
Density of 2nd-5th digit and MC is uniform, but the 1st MC density is overexposed
Lateral hand in Flexion-
what hand do you usually do of a pediatric bone age
none dominant hand
obtained to assess the skeletal versus the chronological age
Pediatric Bone Age
Must be assess from infancy through adolescence
Reasons-illness, metabolic or endocrine dysfunction, certain meds and therapies
Left PA hand and wrist are normally taken
Pediatric Bone Age
Analysis
The side of the digit facing the thumb demonstrates greater phalangeal midshaft concavity and soft tissue width. The finger was externally rotated for the projection.
What is the correction:
Internally rotate the finger, placing it flat against the IR.
If the patient is unable to extend their finger, what is the best thing to do
Do an AP
Analysis
The IP and MP joints are closed, and the phalanges are foreshortened. The finger was flexed.
what is the correction
Extend the finger, and place the palm flat against the IR. If the patient is unable to extend the finger, position it in an AP projection, aligning the phalanx of interest parallel with the IR or affected joint space perpendicular to the IR.
for a PA oblique projection,
If the phalangeal midshaft concavity and soft tissue width on both sides of the digit are more nearly equal, the finger was rotated more or less
less than the required 45 degrees
for a pa oblique projection,
If the soft tissue width on one side of the digit is more than twice as much as that on the other side, and when one aspect of the phalangeal midshaft is concave but the other aspect is slightly convex, the finger was rotated more or less
rotated more than the required 45 degrees
Analysis
The soft tissue width and midshaft concave are nearly equal on both sides of the phalanx. The finger was positioned at less than 45 degrees of obliquity for the projection. The IP and MP joints are closed. The finger was not aligned parallel with the IR.
what is the correction
correction:
Increase the finger obliquity to 45 degrees. Keep finger parallel with the IR.
Analysis
The proximal aspect of the affected finger is obscured. The fifth finger was fanned posteriorly and the third finger was fanned anteriorly.
what is the correction
Draw all of the unaffected fingers into a fist
Analysis
The midshafts of the proximal phalanx and the MC demonstrate some degree of concavity on both sides, indicating a PA oblique projection. The hand was not flexed enough.
what is the correction
correction:
Flex the hand until the thumb rolls to a lateral projection with the thumbnail in profile.
Analysis
in a pa oblique thumb
The IP and MCP joints are closed, and the phalanges are foreshortened. The palm surface was not positioned flat against the IR, and the thumb was tilting down toward the IR.
what is the correction
Correction
Place the palmar surface and thumb flat against the IR.
in a pa hand
Analysis
There is unequal midshaft concavity on either side of the phalanges and MCs, and uneven spacing of the MC heads. The hand was in slight external rotation. Less than 1 inch (2.5cm) of the distal forearm is included on the projection.
what is the correction
Correction
Internally rotate the hand and place the palm and fingers flat against the IR. Open the longitudinal collimation 0.5 inch (1.25cm).
in a pa hand
Analysis
The IP and CM joints are closed, and the phalanges and MCs are foreshortened. The thumb demonstrates a lateral projection. The hand and fingers were flexed for this projection.
what is the correction
Fully extend the hand and fingers, and place them flat against the IR. If the patient is unable to extend the hand and fingers, position the hand in an AP projection with the MC aligned parallel with the IR. If the phalanges are of interest, tilt the hand until the bony structure of greatest interest is parallel with the IR
