Fingers, Hand, Wrist Flashcards
How many bones are in a hand?
27 bones
The hand is divided into what groups?
- Phalanges
- Metacarpals
- Carpals
What are phalanges? How many bones does it consist of?
Bones of the digits (fingers and thumbs), (14)
What are metacarpals? How many bones does it consist of?
Bones of the palm (5)
What are carpals? How many bones does it consist of?
Bones of the wrist (8)
What is each finger called?
First digit (thumb)
Second digit (index finger)
Third digit (middle finger)
Fourth digit (ring finger)
Fifth digit (small finger)
What is a tuft?
Tip of phalanx
Define displacement
Removal from normal or usual position
A minimum of how many exposures is necessary to demonstrate displacement?
2 minimum
Define dislocation
Displacement of a bone from the joint space
Define fracture
A disruption in the continuity of the bone
Define joint effusion
Accumulation of fluid in the joint associated with an underlying condition
Identify the lateral and medial side as well as the tuft, distal interphalangeal joint, proximal interphalangeal joint, and metacarpophalangeal joint in the picture
Which digit is on the lateral side and which digit is on the medial side?
First digit= lateral side
Fifth digit= medial side
Identify the anatomy of the hand
Identify the anatomy of the hand
Identify the anatomy of the finger
What bone is circled?
Sesmoid bone
What are the routine projections for the first digit/thumb?
AP, obliques (internal and external), and lateral
What is the SID and KVP for a first digit/thumb x-ray?
SID= 40”
KVP= 60
In what position does a patient turn their hand for an AP projection of their thumb?
Extreme internal rotation (the extended digits may need to be held with the patient’s other hand)
Where do you direct the central ray and where do you cone to when doing an AP thumb x-ray?
AP thumb CR= directed to the first metacarpophalangeal (MCP) joint
AP thumb coning= entire first digit
What does an AP thumb projection demonstrate and what does it open?
Demonstrates 2 phalanges and opens IP and MCP joint space
How do you position the patient for an internal oblique x-ray of their thumb?
Where is the CR directed?
From the AP position, rotate hand inward so that second digit is resting on IR
CR directed to first MCP joint
How is the patient placed for an external oblique position?
Patient places hand in a naturally arched position with palmar surface in contact with IR
(This placement of hand positions thumb in oblique position)
How is the patient positioned for a lateral thumb x-ray?
The hand is positioned in a natural arched position with palmar surface down – adjust arch of hand until a true lateral position of thumb obtained
CR directed to first MCP joint
Where is the CR directed in all thumb x-rays?
First MCP joint
What are the routine projections for digits 2-5?
PA, PA obliques (internal, external), lateral
What is the SID and KVP for a digits 2-5 x-ray?
SID= 40”
KVP= 60
How is the patient positioned for a PA x-ray of digits 2-5?
A) Affected finger in the center of IR with palmar surface down
B) Fingers fanned
Where is the CR directed on a PA x-ray of digits 2-5?
CR directed to proximal interphalangeal joint (PIP)
What does a PA x-ray of digits 2-5 demonstrate?
Demonstrates the 3 phalanges and distal portion of adjoining metacarpal
How is a patient positioned for an oblique x-ray of digits 2-5?
From pronated position, rotate hand externally (elevate thumb side) 45° for lateral rotation and 45° for internally (elevate 5th digit side) for medial rotation
(Then separate digits and place affected digit in center of IR)
In an oblique of digits 2-5, why must the digits be parallel to the IR?
So that interphalangeal (IP) joint spaces are open
What joint do you direct the CR to on an oblique x-ray of digits 2-5?
PIP joint
How is a patient positioned for a lateral x-ray of digits 2-5?
Patient extends affected finger and closes the rest of the fingers into a fist
How do you place the affected finger in a true lateral position in center of IR?
Hand rests on radial surface for second and third fingers
Hand rests on ulnar surface for fourth and fifth finger
(A support - sponge, balsa wood, pen, can be used on palmar surface of affected finger if adjacent fingers obscure proximal phanalx of the affect finger)
Where is the CR directed to in all digits 2-5 x-rays?
PIP joint
What are the routine projections for a hand x-ray?
PA, oblique, and lateral
What is the SID and KVP for a hand x-ray?
SID= 40”
KVP= 60
How do you position a patient for a hand x-ray?
Place patient’s hand at center of IR with palmar surface downward and digits slightly spaced
What do you direct the CR to on a PA hand x-ray?
The third metacarpophalangeal (MCP) joint
What does the hand x-ray demonstrate?
Phalanges, metacarpals, carpals, and distal radius and ulna
How do you position the patient for an oblique hand x-ray?
Oblique the hand externally by elevating the thumb side so that the metacarpophalangeal joints form an angle of approximately 45° with the plane of film
What do you direct the CR to in an oblique hand x-ray?
To the third MCP joint
What will an oblique hand x-ray demonstrate?
Displacement
How do you position the patient for a lateral hand x-ray?
Place patient’s hand in a lateral position with the ulnar surface down then extend fingers and fan them (to prevent superimposition of the phalanges)
What do you direct the CR to for a lateral hand x-ray?
To the second digit MCP joint
What does a lateral hand x-ray demonstrate?
Displacement
What type of x-ray of the hand is the customary position for localization of foreign bodies?
Lateral hand
Where is the CR directed to in hand x-rays?
Third MCP joint for PA and oblique
Second MCP joint for lateral
What is the SID and KVP for a wrist x-ray?
SID= 40”
KVP= 60
What are the routine projections for a wrist x-ray?
PA, oblique, and lateral
How do you position a patient for a PA wrist?
Place wrist in center of IR, palmar surface down and cup fingers to bring carpals in close contact with IR
What do you direct the CR to in a wrist x-ray?
To carpals
What does a PA wrist x-ray demonstrate?
Carpals, distal radius and ulna, and proximal metacarpals
How do you position the patient for an oblique wrist?
Prom the pronated position, rotate wrists laterally until it forms an angle of 45° with plane of IR
What do you direct the CR to in a wrist x-ray?
To carpals
What will an oblique wrist x-ray demonstrate?
The scaphoid and trapezium without self-superimposition
What is the most commonly fractured carpal bone?
Scaphoid
How do you position a patient for a lateral wrist?
Place wrist in a lateral position with ulnar surface parallel to IR and fingers extended
What do you direct the central ray to in a lateral wrist?
Carpals
If properly positioned, how should the distal radius and ulna look on a lateral wrist?
Superimposed
What does a lateral wrist demonstrates?
Anterior or posterior displacement in fractures
What are the other additional wrist positions
- Ulnar deviation
- Radial Deviation
- Carpal Canal - Gaynor Hart Method
- Stretcher Method
How do you position the patient for an ulnar deviation? What do you direct the CR to?
Wrist in center of IR, palmar surface down then turn hand outward (bend toward ulna) until wrist is in extreme ulnar deviation
CR= Carpals
What does the ulnar deviation position do?
Shows the scaphoid and opens spaces between lateral carpals
How do you position the patient for a radial deviation? What do you direct the CR to?
Wrist center of IR palmar surface down then turn hand medially (bend towards radius) until wrist is in external radial deviation
CR= Carpals
What does the radial deviation position do?
Opens the interspaces between medial carpals, specifically the pisiform
How do you position the patient for a carpal canal or gaynor hart method? What do you direct the CR to?
Wrist in center of IR, palmar surface down and have patient grasp fingers with opposite hand and hyperextend the wrist make palm as vertical as possible
CR= Direct at palm at an angle of 25° toward elbow
What does the carpal canal/gaynor hart method demonstrate?
Carpal canal and entire pisiform
How do you position the patient for the stretcher method? What do you direct the CR to?
Place the IR on a 20° angled sponge and position hand at center of IR palmar surface down
CR= perpendicular to table through carpals
How can you achieve the stretcher method without an angled sponge?
Place IR and wrist horizontally
CR= Directed at 20° towards elbow
What does the stretcher method demonstrate?
The scaphoid without self-superimposition
Cheat-Cheat
