HAND Flashcards
PP: Hand palmar surface down; spread finger slightly
RP: 3rd MCP joint
CR: ┴
SS: PA oblique projection of the thumb
AP Projection:
Hand cannot be extended because of injury and pathologic conditions
For metacarpal bones and MCP joints
PA PROJECTION
PP: Hand pronated; palmar surface down; MCP joints 45o to IR; 45o foam wedge
RP: 3rd MCP joint
CR: ┴
SS: PA oblique projection of the hand
ER: To investigate fractures and pathologic conditions
Foam Wedge: For interphalangeal joints
Fingertips Touching The Cassette: For metacarpal bones
Index Finger Elevation:
Use of radiolucent material
Opens joint spaces
Reduces the degree of foreshortening of phalanges
PA OBLIQUE PROJECTION
PP: Hand rotated 45o internally
RP: 3rd MCP joint
CR: ┴
ER: To demonstrate severe metacarpal deformities fractures
REVERSE OBLIQUE PROJECTION
Lane-Kennedy-Kuschner Recommendations
PP: Hand in PA position; hand rotated 40-45o toward ulnar surface & 40-45oforward; MCP joints flexed 75-80o; hand dorsum resting on IR
RP: MCP joint of interest
CR: ┴
ER: To demonstrate metacarpal head fractures
TANGENTIAL OBLIQUE PROJECTION
Kallen Recommendation
PP: Hand in lateral position; digits extended; ulnar aspect down (lateromedial projection); radial aspect down (mediolateral projection; more difficult to assume); thumb 90o to palm
RP: 2nd MCP joint
CR: ┴
SS: Lateral projection of the hand in extension
ER: To localize foreign bodies and metacarpal fracture displacement
Fan Lateral Position: Eliminates superimposition of all phalanges (except proximal phalanges)
LATERAL PROJECTION
In Extension
PP: Hand rotated 5o posteriorly from true lateral position (removes superimposition of 2nd-4th metacarpals); thumb extended;
RP: Midshaft of 5th metacarpal
CR: ┴
ER: To better demonstrate fractures of 5th metacarpal
LEWIS METHOD
PP: Hand in natural arch position; digits relaxed
RP: 2nd MCP joint
CR: ┴
SS: Lateral projection of the hand in flexion
ER: To demonstrate anterior or posterior displacement in fractures of metacarpals
LATERAL PROJECTION
In Flexion
PP: Hand supinated; medial aspect against IR; 45o sponge support
RP: b/n level of 5th MCP joints of both hands
CR: ┴
SS: AP oblique projection of both hands
ER: To diagnose rheumatoid arthritis
NORGAARD METHOD
AP OBLIQUE PROJECTION
PP: Hand slightly arch (places wrist in close contact with IR)
RP: Midcarpal area
CR: ┴
SS: Slightly oblique rotation of ulna (AP should be taken if ulna is under examination)
PA PROJECTION
PP: Hand slightly arch (places wrist in close contact with IR)
RP: Midcarpal area
CR: 30o toward the elbow; 30o toward the fingertips
SS: Elongated scaphoid & capitate (toward the elbow); elongated capitate only (toward the fingertips)
ER: To better demonstrate the scaphoid & capitate
Daffner-Emmerling-Buterbaugh Recommendation
PP: Hand supinated; digits elevated (places wrist in close contact with IR)
RP: Midcarpal area
CR: ┴
SS: Carpal interspaces better demonstrated; no rotation of ulna
AP PROJECTION
PP: Elbow flexed 90o; hand & forearm in lateral position; ulnar surface against IR; radial surface against IR (for comparison)
RP: Midcarpal area
CR: ┴
SS: Proximal metacarpals & distal radius & ulna; trapezium & scaphoid (more anterior)
ER: To demonstrate anterior or posterior displacement in fractures
LATERAL PROJECTION
Lateromedial
PP: Wrist in palmar flexion (rotates the scaphoid in dorsovolar position)
RP: Scaphoid
CR: ┴
SS: Lateral position of the scaphoid
Burman & et al. Suggestions
-First to describe carpe bossu (carpal boss), a small bony growth occurring on the dorsal surface of the 3rd CMC joint
-Best demonstrated in a lateral position of wrist in palmar flexion
Foille
PP: Palmar surface against IR; hand pronated & rotated 45olaterally; wrist ulnar deviation (for scaphoid only)
RP: Midcarpal area
CR: ┴
SS: Carpals on the lateral side (Scaphoid & Trapezium)
PA OBLIQUE PROJECTION
Lateral Rotation