Hand, Wrist, Forearm Flashcards
First thing (s) you look for when viewing any image for Evaluation Criteria?
- Is all the anatomy there?
- is there evidence of proper collimation and presence of marker, placed clear of anatomy of interest?
PA hand, Evaluation Criteria
- Anatomy from Fingertips to Distal Radius and Ulna
- Slightly separate digits, with no soft tissue overlap
No rotation of Hand:
- Equal concavity of the metacarpal and phalangeal bodies on both sides
- Equal amount of soft tissue on both sides of the phalanges
- Fingernails, if visualized, in the center of each distal phalanx
- Equal distance between the metacarpal heads
- Open MCP and IP joints, this indicates that the hand is placed flat on the IR
- Bony trabecular detail and surrounding soft tissue
PA Oblique, Evaluation Criteria
- Anatomy from fingertips to distal radius, and ulna
- Digit separated slightly with no overlap of their soft tissues
45° of rotation of anatomy:
- Decreasing amounts of separation between metacarpal bodies, two through five, with the second and third having the greatest separation
- Partial superimposition of the third fourth and fifth metacarpal bases and heads
- Open MCP joints
- Open IP joints, when digits are positioned parallel to the IR
- Bony trabecular detail and surrounding side tissues
Hand Lateral, Elevation Criteria
- Anatomy from fingertips to distal radius and ulna
- Extended digits
Hand in true lateral position:
- Superimposed phalanges (individuals seen on a fan lateral)
- Superimposed metacarpals
- Superimposed distal radius and ulna
- Thumb free of motion and superimposed
- Bony trabecular detail and surrounding soft tissue
What does superimposed mean?
When structures overlap in an x ray image; making them appear to be on top of each other
PA Wrist Evaluation Criteria
- Distal radius and ulna, carpals, and proximal half of metacarpals
- No excessive flexion of digits overlap and obscure metacarpals
- No rotation in carpals, metacarpals, radius, and ulna
- Open radio ulnar joint space
Lateral Wrist Evaluation Criteria
- Distal radius and ulna, carpals, and proximal half of the metacarpals
- Superimposed distal radius and ulna
- Superimposed Proximal end of Metacarpals
- Bony Trabecular detail and surrounding soft tissues
PA Oblique Wrist Lateral Projection Evaluation Criteria
- Anatomy: Distal radius and ulna, carpals, and proximal half of metacarpals
45 Degree rotation of anatomy:
- slight interosseous space between the third, fourth, and fifth metacarpal bodies
- Slight overlap of the distal radius and ulna
- carpals on lateral side of wrist
- trapezium and distal half of the scaphoid without superimposition
- open trapeziotrapezoid and scaphotrapezial joint space
- bony trabecular detail and surrounding soft tissue
AP Forearm Evaluation Criteria
Central Ray- Midpoint of forearm
Collimation- 2 inches distal to the wrist joint and proximal to the elbow joint, 1 inches on sides
- Entire forearm, including wrist and distal humerus
- Slight superimposition of the radial head, neck, and tuberosity over the proximal ulna
- no elongation or foreshortening of the humeral epicondyles
Lateral Forearm Evaluation Criteria
Central Ray- Midpoint of forearm
Collimation- 2 inches distal to the wrist joint and proximal to the elbow joint, 1 inches on sides
Entire forearm, including wrist and distal humerus in a true lateral position:
- Superimposition of the radius and ulna at their distal ends
- Superimposition of the radial head over the coronoid process
- Radial tuberosity facing anteriorly
- superimposed humeral epicondyles
- Elbow flexed 90 degrees
PA & Lateral hand central ray and collimation?
Perpendicular to the third MCP Joint
Collimation: 1 inch on all sides of the hand, including 1 inch proximal to the ulnar styloid
PA & Lateral Wrist central ray and collimation
Central Ray- Perpendicular to the mid carpal area
Collimation- 2.5 inches proximal and distal to the wrist joint, and 1 inch on both sides
