Chapter 4: Finger and Hand Flashcards
Where do you center for a PA finger?
- perpendicular to IR
- enters patient at PIP joint
What joint should be included for PA finger?
include joint between carpal and metacarpal
What should you make sure regarding the elbow for PA finger
make sure everything is in the same plane elbow bent at 90 degrees. Hand nice and flat
What should you do with the fingers for PA finger
make sure to separate fingers and make sure joint space is open
What should you include in collimation for PA finger
entire digit from fingertip to distal portion of the adjoining metacarpal
- no soft tissue overlap from adjacent digits
How do you know if there’s no rotation on PA finger
no rotation of the digit demonstrated by concavity, of the phalangeal bodies and an equal amount of soft tissue on both sides of phalanges
What joint space should be open for PA finger
open IP and MCP joint spaces without overlap of bones
How is the fingernail for PA finger
fingernail if visualized and normal centered over distal phalanx
To open up joint space how should the CR be centered to IR and how should the CR be centered to joint
CR perpendicular to IR
CR parallel to the joint
pulling the bone away
avulsion
What should you make sure for the palmar surface for PA finger
extended with palmar surface in center of unmasked portion of IR
If patient can’t extend their fingers for PA finger what do you do
you do an AP to open joint spaces
How should the palmar surface be for an oblique PA finger
extended with palmar surface resting on 45- degrees wedge sponge
How should the digit be for oblique PA finger
digit of interest separated to prevent soft tissue overlap
What is the CR for oblique PA finger?
perpendicular to PIP joint of affected digit
What is the proper collimation for oblqiue PA finger
entire digit, including the distal portion of the adjoining metacarpal
How do you know if the digit is rotated 45 degrees for the oblique positioning for PA finger
digit rotated at 45 degrees demonstrated by concavity of the elevated side of the phalangeal bodies
What joint spaces should be open for oblique of PA finger
open IP and MCP joint spaces
Is there superimposition for oblique PA finger
no superimposition of the adjacent digit over the proximal phalanx or MCP joint
What should you see for oblique PA finger
should see twice as much soft tissue on one side than the other
To maintain open joint space what should you do for the finger
place finger parallel to maintain open joint space
What is the proper positioning for lateral finger in regards to the 2nd and 3rd digit
2nd/ 3rd digit with lateral surface in contact with IR (mediolateral projection)
What is the proper positioning for lateral finger in regards to the 4th and 5th digit
4th/ 5th digit digit extended with medial surface in contact with iR (lateromedial projection)
How is the CR for a lateral finger
- directed perpendicular to the IR
- enters patient at PIP joint
What is in profile for the lateral finger
fingernail in profile if visualized and normal
Evidence of proper collimation for lateral finger
entire digit in a true lateral position
How is the anterior surface for the lateral finger
- how about rotation
concave anterior surfaces of the phalanges
- no rotation of phalanges
What should you make sure relating to obstruction of the phalanges for lateral finger
no obstruction of the proximal phalanx or MCP joint by adjacent digits
what joint should be open for lateral finger
open IP joint spaces
What’s in profile for the lateral finger
fingernail is in profile for the lateral
What should you make sure to get for lateral finger
get head of metacarpals up to carpal joint
What should be superimposed for the lateral finger
head of phalanges should be superimposed ( round balls)
How should the hand be for AP thumb and what should touch the IR
- hand in extreme internal rotation
- posterior surface of thumb on IR
What should be flat on the IR for AP thumb
fingernail is flat on the IR
What joint should we get all way down for AP thumb
get all the way down to the MCP joint
What articulation should you get down for the AP thumb
Make sure to get articulation between thumb and trapezium
- area from the distal tip of the thumb to the trapezium
- no rotation
How is the concavity for AP thumb
there should be equal concavity of the phalangeal and metacarpal bodies
What do you do if you have fatty fingers
angle 10 degrees
What view will magnified the thumb
PA thumb
What should you do with the fingers for a lateral thumb
drag fingers up to make thumb true lateral
what digit is in a true lateral projection for lateral thumb
first digit
What is in profile for a lateral thumb
thumbnail
what should be superimposed for lateral thumb
heads of phalanges superimposed
What area should you get for lateral thumb
area from the distal tip of the thumb to the trapezium
What should you look in the 2nd to 5th digit regarding the PA hand?
- how about the concavity
2nd/ 5th digit should look like PA fingers
- equal concavity on shaft
Which digit will be oblique for the PA hand
thumb will be oblique
how is the tissue for the PA hand for 2nd and 5th digit
soft tissue outline should be uniform in 2nd through 5th digit
how is the distance in the MCP and heads for PA hand
distance between the MCP and heads is equal
how is the concavity throughout the digits for PA hand
midshaft concavity is equal throughout the 2nd to 5th digit
what should you make sure you do for PA hand in regards to the fingers
make sure to separate fingers to have no soft tissue overlap
what joints should be open for PA hand when hand is flat
IP, MCP, and CMC joints are open
How is the thumb in PA hand
thumb 45 degrees oblique
what should be on the table for PA hand
forearm on table
What should you make sure you get on for PA hand
should show 1 inch of radius and ulna
Where is the CR for PA hand
perpendicular to 3rd MCP joint
What is the proper collimation for PA hand
- anatomy from fingertips to distal radius and ulna
- equal distance between the metacarpal heads
How many degrees is the hand rotated for Oblique hand
45 degrees rotation
How should the fingers be for oblique hand
fingers should be parallel with IR and extended
How do you know you have a good obliquity for PA oblique hand in relationship to the 2nd and 5th MCP
2nd and 5th MCP show more concavity on one side than the other side turn up best
Where should there be a space in PA oblique hand
There should be a slight space between the 4th and 5th MCP shafts
When there’s no space in PA oblique hand what does that mean
no space means over rotated
What happens the more you close up space in PA oblique Hand
The more you close up space externally rotated you went gone to lateral
What varies from lateral to oblique
the thumb
What are not superimposed in a PA oblique hand
2nd and 3rd MCP heads are not superimposed
What are slightly superimposed for PA oblique hand
3rd to 5th MCP heads are slightly superimposed
What should you make sure you get for PA oblique hand
one inch of radius and ulna
What anatomy should you include for PA oblique hand
anatomy from fingertips to distal radius and ulna
How should the digits be for PA oblique hand
digits separated slightly
What’s the CR for PA oblique hand
perpendicular to 3rd mcP joint
If you see skin folds on PA oblique hand
hand was turn in
What x-ray do we typically do for a lateral hand
we do a fan lateral
Why do we do a fan lateral
looking for foreign body
What should you make sure you do when doing a fan lateral
strengthen our fingers when doing ok sign to not close up joint space
What should be superimposed for a fan lateral
metacarpals
- radius / ulna
Where is there no superimposition for fan lateral
no superimposition of thumb (vary from oblique to PA)
What is the part position for fan lateral
- forearm on table with elbow flexed 90 degrees
- hand restingon medial surface
- palmar surface perpendicular to IR
What is the CR for fan lateral
perpendicular to 2nd MCP joint
- digits positioned out of superimposition
proper positioning for true lateral hand full extension
check for foreign bodies of the palm, completely extend the fingers
- first digit abducted to right angle to palm
- elbow flexed 90 degrees hand on medial surface
What is the CR for true lateral hand full extension
perpendicular to 2nd MCP joint
what’s free of motion and superimposition in a true lateral hand full extension
thumb
done for foreign bodies of the metacarpals
true lateral hand full extenson
What should be superimposed for lateral hand
superimpose the 2nd through the 5th MCP placing the knuckles one on top of the other
digits and long axis of hand aligned parallel
true lateralfull extension
in a lateral what may you not always be able to get
in a lateral you may not always be able to get a true lateral wrist ( radius and ulna to directly superimpose
How should the ulna be in regards to the radius in a lateral hand
the ulna is demonstrated slightly posterior to the radius
How should you judge your lateral hand
judge your lateral by the superimposition of the 2nd to 5th MCP
What MCP is the shortest
5th MCP
In an external rotation of the lateral hand
this will show the 5th metacarpal anterior to the 2nd and 4th MCP posterior. Thumb going back. Radius goes externally and ulna going anteriorly
What MCP is the longest
2nd MCP
radius will go externally (posteriorly) and ulna will go anteriorly in what
external rotation of the lateral hand
Internal rotation of the lateral hand
This will show the 2nd MCP anterior to the 3rd-5th MCP posterior. Thumb coming closer in. Ulna coming externally and radius coming anteriorly
Ulna coming externally (posterior) and radius coming anteriorly
internal rotation of lateral hand
thumb coming closer in to the IR
internal rotation of lateral hand
fully extend the fingers and use same analysis as for the lateral fan hand
lateral hand in extension
done to demonstrate foreign bodies of the palm
lateral hand in extension
it makes for better localization of foreign body in
extension
flexion and extension of the lateral hand are done for what
for mobility
flex the 2nd to 5th fingers until they meet the first finger but do not superimposed it
lateral hand in flexion
distinguish the degree of anterior or posterior displacement of a fracture MCP
lateral hand in flexion
PA or AP hand done for
medial / lateral displacement
lateral hand done for
anterior or posterior fractures
obtained to assess the skeletal versus the chronological age of the child
- must be assess from infancy through adolescence
pediatric bone age
there’s a difference between males and females in
a pediatric bone age
What hand do we usually do for pediatric bone age
none dominant hand
If the pediatric is not dominant in one hand then what hand do we x-ray
Left PA hand and wrist are normally taken
What is the reason for pediatric bone age
illness, metabolic or endocrine dysfunction, certain meds and therapies
posteroanterior (PA) projection of finger, concavity of the phalanges is
equal on both sides
in the lateral projection of the finger what happens to the surfaces
the anterior surface is concave and the posterior surface is slightly convex
As the finger is rotated medially for a PA oblique projection
the amount of concavity increases on the side that the anterior surface is rotated toward and decreases on the side that the posterior surface is rotated toward.
Position finger in PA projection with the palmar surface placed flat against and centered on the IR.
Soft tissue width and midshaft concavity are equal on both sides of phalanges
Separate fingers slightly for PA finger
There is no soft tissue overlap from adjacent digits
Fully extend finger aligning it parallel with the IR. for PA finger
IP and MCP joints are demonstrated as open spaces.
* Phalanges are seen without foreshortening
Center the CR to the PIP joint.
PA finger
If the anterior surface is rotated toward the longest second metacarpal (MC) or thumb
the finger was externally rotated
what prevents the hand or finger from doing an internal rotation?
the thumb
If the finger is flexed or tilted toward the IR,
the CR will be poorly aligned with the joint spaces and phalanges, causing the phalanges to foreshorten and be superimposed on the joint spaces, closing them
If the patient is unable to extend the finger,
it may be best to use an anteroposterior (AP) projection to demonstrate open IP and MCP joint spaces and to visualize the phalanges of greatest interest without foreshortening
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.
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 finger, If the phalangeal midshaft concavity and soft tissue width on both sides of the digit are more nearly equal, the finger
was rotated 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 than the required 45 degrees
When the hand and fingers are rotated to obtain the PA oblique
all but the fifth finger are positioned away from the IR at varying object
Begin with finger in PA projection with the palmar surface placed flat against and centered on the IR.
* Externally rotate the hand until the affected finger is at a 45-degree angle with IR.
PA oblique of PA fingers
Twice as much soft tissue width is demonstrated on one side of the phalanges as on the other side.
* More concavity is seen on one aspect of the phalangeal midshafts than the others
Fully extend finger, aligning it parallel with the IR.
* Use radiolucent support under fingertip as needed to keep finger parallel with IR and prevent motion.
PA oblique finger
IP and MCP joints are demonstrated as open spaces.
* Phalanges are not foreshortened
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.
If the hand is not drawn into a tight fist for a lateral finger
the unaffected fingers will superimpose the proximal phalanx of the affected finger, preventing adequate visualization
Form the hand into a tight fist, with affected finger extended.
* Use device as needed to extend finger only if the device can be placed proximal to the injured area
lateral finger
There is no overlap from adjacent fingers
Center finger on the IR, with the lateral surface resting on the IR if imaging the second or third finger and medial surface for fourth or fifth finger.
* Adjust hand rotation to obtain a lateral projection with fingernail in profile.
Anterior surface of the middle and proximal phalanges demonstrate midshaft concavity and the posterior surfaces show slight convexity.
* More than twice as much soft tissue width is demonstrated on the anterior surface than the posterior surface
Align finger parallel with the IR.
IP joints are demonstrated as open spaces.
* Phalanges are not foreshortened.
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
Extend and internally rotate arm until the thumb is in an AP projection, with the thumbnail not visible on either side.
* Center thumb on IR.
Concavity on both sides of the phalanges and MC midshafts is equal.
* There is equal soft tissue width on each side of the phalanges
Fully extend the thumb, aligning it parallel with the IR.
IP, MCP, and CM joints are demonstrated as open spaces.
* Phalanges are not foreshortened
The fifth MC and the medial palm soft tissue are superimposing the proximal first MC and CM joint. There is slightly more phalangeal concavity on the side of the thumb that is closest to the hand. The MCs and palmar surface have not been drawn away from the thumb and the thumb was internally rotated slightly more than needed.
Correction
Using the opposite hand, draw the medial side of the affected hand and palmar surface away from the thumb. Make sure that the thumb does not rotate from an AP projection with this movement.
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.
Center a perpendicular CR to the MCP joint.
AP thumb
Using the unaffected hand, draw the medial palmar surface away from the thumb without rotating thumb from the AP projection.
Superimposition of the medial palm soft tissue over the proximal first MC and the CM joint is minimal
Abduct the thumb drawing it away from the second finger.
First proximal MC is only slightly superimposed by the second proximal MC
If the hand is not flexed enough to place the thumb in a lateral projection,
the midshafts of the proximal phalanx and the MC will show some degree of concavity on both sides, indicating a PA oblique versus a lateral projection
Place the palmar surface flat against the IR.
* Center the thumb on the IR.
* Flex the hand and fingers only until the thumb naturally rolls into a lateral projection and thumbnail is in profile
Anterior proximal phalanx and MC demonstrate midshaft concavity, and the posterior proximal phalanx and MC demonstrate slight convexity.
* When visualized the thumbnail is demonstrated 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.
Pronate and extend the hand and fingers, and place the palmar surface flat against the IR in a PA projection.
* Center hand on IR.
PA hand
Soft tissue outlines of the second through fifth phalanges are uniform.
* Distance between the MC heads is equal.
* Equal midshaft concavity is seen on both sides of the phalanges and MCs of the second through fifth fingers.
* Thumb demonstrates a 45-degree PA oblique projection
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
The thumb was abducted and the CR was centered to the second MCP joint.
Position the thumb closer to the hand and center the CR to the third MCP joint.
The midshaft of the fourth and fifth MCs are superimposed. The hand was placed at more than 45 degrees of obliquity. The phalanges are foreshortened, and the IP joint spaces are closed. The fingers were flexed toward the IR.
Internally rotate the hand until the MCs and IR form a 45-degree angle and extend the fingers, placing them parallel with 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).
