Fingers, Wrist and Hand Flashcards
How many bones are in the hand?
27
- 14 phalanges
- 5 metacarpals
- 8 carpals
What makes up the finger?
5 sets of phalanges (3 for each finger - distal, middle and proximal) and (2 for each thumb - distal and proximal)
How are the digits numbered?
1-5 from lateral to medial
What are the interphalangeal joints?
connect phalanges, proximal interphalangeal joint (PIP) connects middle and proximal phalanx, distal interphalangeal joint (DIP) connects middle and distal phalanx
What are the metacarpals?
5 per hand, numbered in the same manor as the phalanges, usually 2 sesamoid bees at the distal end of the 1st metacarpal
What are the carpals?
8 short bones, roughly laid out into 2 horizontal rows, develop at different ages
What are all 8 metacarpals and the pneumonic to remember them?
Some Lovers Try Positions That They Can’t Handle
Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate and Hamate
What are the fat pads of the wrist and why are they important?
Scaphoid fat pad and pronator quadrates fat pad
Sometimes you find fractures from fat pad being abnormal
What is the Bennett’s fracture?
fracture of the proximal end/base of the first metacarpal
What is the Boxer’s fracture?
fracture of the head of the 5th metacarpal
What are FOOSH injuries?
injuries obtained from falling on an out stretched hand
What are the Colles’ and Smith’s fractures? and which is more common?
fractures of the distal radius
Colles’ more common due to FOOSH, posterior displacement
Smith’s less common would be obtained by being smacked on the back of the wrist, anterior displacement
How many projections would be required of the fingers, hand and wrist?
3 because there are joints
Finger - PA Projection
- hand prone, extend digit parallel in the centre of the IR
- Separate digits
- CR - perpendicular to IR
- CP - PIP
Include the distal metacarpal
Finger - PA Evaluation Criteria
- Entire digit on image, including distal metacarpal
- No overlap of digits
- No rotation: equal soft tissue and concavity bilaterally, an d fingernail centered on distal phalanx
- Open joint spaces: IP and MCP
- See boney trabeculae and soft tissue
Finger- Lateral Projection
- Hand in fist, only digit of interest extended
- lateral surface in contact for 2nd, medial for 3rd-5th
- CR - perpendicular to IR
- CP - PIP
Include 1/3 to 1/2 distal metacarpal
Marker face down for 2nd digit
Finger - Lateral Evaluation Criteria
- entire digit and distal metacarpal on image
- true lateral: concave anterior aspect, fingernail in profile
- no superimposition of other digits
- open joint spaces
Finger - PA Oblique Projection
- hand pronated, rotate externally/laterally until at 45 degree angle: Keep parallel to IR, can use sponge as support, keep fingers separate
- CR - perpendicular to IR
- CP - PIP
Include distal metacarpal
Finger - PA Oblique Evaluation Criteria
- entire digit and distal metacarpal
- rotated 45 degrees: concave lateral aspect
- no superimposition of other digits
- open joint spaces
Thumb - AP projection
- Extreme internal/medial rotation: may extend entire arm to help, keep parallel
- CR - perpendicular to IR
- CP - MCP
Include entire digit and metacarpal
Marker face down
Thumb - AP Evaluation Criteria
- Tip of thumb to trapezium
- No rotation: Concavity on both sides, equal soft tissue bilaterally, thumbnail in centre on distal phalanx
- Open joints: IP, MCP and CMC
Thumb - PA Projection
- Hold hand lateral, elevate and abduct thumb: may need support, ensure thumb is not rotated
- CR - perpendicular to IR
- CP - MCP joint
- Include entire digit and metacarpal
Thumb - PA Evaluation Criteria
- Tip of thumb to trapezium
- No rotation: Concavity on both sides, equal soft tissue bilaterally, thumbnail in centre on distal phalanx
- Open joints: IP, MCP and CMC
More magnified than AP view
Better visualization of trapezium
Thumb - Lateral Projection
- Pronate hand, then curve fingers or raise with sponge to rotate thumb to lateral
- CR - perpendicular to IR
- CP - MCP joint
- Include entire digit and metacarpal
Thumb - Lateral Evaluation Criteria
- Tip of thumb to trapezium
- True lateral: fingernail in profile, concave anterior aspect
- Open joint spaces: IP and MCP
Thumb - PA Oblique Projection
- pronate hand, thumb normally sits around 45 degrees: ulnar deviation
- CR - perpendicular to IR
- CP - MCP joint
- Include entire digit and metacarpal
Thumb - PA Oblique Evaluation Criteria
- Tip of thumb to trapezium
- Proper rotation: concave medial aspect
- Open joint spaces
Hand - PA Projection
- Hand Pronated, digits separated: keep forearm on table
- CR - perpendicular to IR
- CP - 3rd MCP
- Include tips of fingers to distal forearm
Hand - PA Evaluation Criteria
- Tips of finger to distal forearm
- No overlap of fingers
- No rotation
- Open joint spaces
Hand - PA Oblique Projection
- pronate hand, rotate externally/laterally to 45 degrees: may use sponge to stabilize and separate fingers
- CR - perpendicular to IR
- CP - 3rd MCP
- Include tips of fingers to distal forearm
Hand - PA Oblique Evaluation Criteria
- tips of finger to distal forearm
- separation of digits: metacarpals will have separation between 2nd and 3rd, less between others
- open joints
Hand - AP Oblique Projection
- supinated, then rotate internally/medially until 45 degrees: can use sponge to support
- CR - perpendicular to IR
- CP - 3rd MCP joint
Include tips of fingers to distal forearm
Hand - AP Oblique Evaluation Criteria
- minimal overlap of metacarpals
- demonstrate medial hand and carpals, note the pisiform
- open joints
Hand - Fan Lateral Projection
- medial surface of hand in contact with IR
- 1st and 2nd digits almost (but not) touching, others spread out
- CR - perpendicular to IR
- CP - anterior to the MCPs
- tips of fingers to distal forearm
Hand - Fan Lateral Evaluation Criteria
- Tips of fingers to distal forearm
- Superimposition of metacarpals and radius/ulna
- Fingers superimposed only at proximal bases
Hand - Lateral Extension Projection
- Medial surface in contact with the IR, fingers extended
- thumb abducted from hand
- CR - perpendicular to IR
- CP - 3rd MCP joint
- include tips of fingers to distal forearm
Hand - Lateral Extension Projection
- similar to fan projection, but fingers are superimposed as well
- thumb demonstrated with PA projection
Hand - Norgaard Method/ “Ballcatchers” Projection
- Bilateral AP oblique
- Both hands supinated at 45 degrees
- CR - perpendicular to IR
- CP - between hands at the level of MCPs
- include tips of fingers to distal forearm
Hand - Norgaard Method/ “Ballcatchers” Evaluation Criteria
- both hands fro tip of fingers to distal forearm
- metacarpal heads free of superimposition
- pisiform seen free of superimposition
Wrist - PA Projection
- Hand pronated, slightly curl fingers to bring wrist into contact with IR
- CR - perpendicular to IR
- CP - through the middle of carpals
- Include distal forearm and half of metacarpals
Wrist - PA Evaluation Criteria
- proximal half of metacarpals to distal forearm
- no rotation
- open radioulnar joint space
- good visualization of the styloid processes
- can do AP for better visualization of the spaces between carpals
Wrist - Lateral Projection
- Same position as lateral hand: but no abduction of thumb
- CR - perpendicular to IR
- CP - through the middle of the carpals
- include distal forearm and half of metacarpals
Wrist - Lateral Projection Evaluation Criteria
- proximal half of metacarpals to distal forearm
- superimposed radius and ulna
- superimposed carpal bones
- lunate in profile
Wrist - PA and AP Oblique Projections
- Hand semi-pronated 45 degrees or semi-supinated 45 degrees
- CR - perpendicular to IR
- CP - through the middle of the carpals
- Include distal forearm and half of metacarpals
Wrist - PA Oblique Evaluation Criteria
- lateral and carpal bones: scafoid and trapezium
- STT complex
Wrist - AP Oblique Evaluation Criteria
- medial carpal bones
- Hamate, triquetrum and pisiformW
What is the PACEMAN approach?
Positioning
Area/Anatomy
Collimation/CR/CP
Exposure criteria
Markers
Aesthetics
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