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Radiographic projection of the first CMC joint.
AP PROJECTION
ROBERT METHOD
Angled 15 degrees proximally along the long axis of the thumb and entering the first CMC joint
Long and Rafert modification
- Angled 10 to 15 degrees proximally along the long axis of the thumb and entering the
first MCP joint.
Lewis modification
Sprain or tearing of ulnar collateral ligament of thumb at MCP joint as a result of acute
hyperextension of thumb;
skier’s thumb
Both hands rotated laterally side by side to place thumbs parallel to IR (cassette) for true PA projection of both thumbs.
PA STRESS THUMB PROJECTION
FOLIO METHOD
- Patient’s forearm on the table with the palmar surface on top of the IR .
- Center the IR to the MCP joints.
- Spread the fingers slightly
CR - Perpendicular to the 3rd MCP joint.
PA PROJECTION
- Patient’s forearm on the table with the hand pronated.
- Oblique the hand Approx. 45 degrees.
- Use a 45-degree foam wedge.
- Center the IR to the MCP joints
CR - Perpendicular to the 3rd MCP joint.
PA OBLIQUE PROJECTION
Lateral rotation
Best demonstrate a
clearer image of the 1st
CMC joint than the
standard AP projection
BURMAN METHOD
- Hand rotated laterally into
45 degree oblique
position; resulting in true
PA projection of the thumb - CR perpendicular to level of
the MCP joints. - Useful for the diagnosis
of the ulnar collateral
ligament (UCL) rupture in
the MCP joint of the
thumb (Skier’s thumb). - Also known as the patient
controlled stress
radiography of the thumb.
FOLIO METHOD
- Hand & forearm in same
horizontal plane - Hand pronated with
fingers extended
PA PROJECTION
Hand and forearm in
same horizontal plane as
film.
* Pronate hand with fingers
extended.
* Oblique hand from prone
towards lateral.
PA OBLIQUE
- Best demonstrate
fractures/dislocations
of the distal, middle and
proximal phalanges and
distal metacarpals. - Hand & forearm in same
horizontal direction as
film - Flex elbow
LATERAL
recommended when
there is a suspected
joint injury.
AP PROJECTION
- CR perpendicular to the
3rd MCP joint - 1 inch or 2.5 cm of distal
forearm should be
included in the
radiograph. - Flex elbow 90°.
HAND PA PROJECTION
- CR perpendicular to 3rd
MCP joint - Flex elbow 90°.
- Pronate hand.
HAND PA OBLIQUE
- Flex elbow 90°
- Hand in lateral position
with the ulnar aspect
down (lateromedial)
against the IR. - Palmar surface
perpendicular to IR
EXTENSION
- demonstrate
anteroposterior
displacements of
fractures of
metacarpals - Flex elbow 90°
- Maintain the natural arch of the hand, arrange the digits so that they are perfectly
superimposed. - Flex fingers into a natural
flexed position with thumb
slightly touching the 1st
finger. - Thumb should be parallel
to film - Fingers are
superimposed with the
entire hand in a true
lateral position.
FLEXION
- useful
for diagnosing possible
trauma to the digits - Align long axis of hand to
long axis of film - Rotate hand and wrist
into a lateral position
with the thumb side up
(ulnar side down). - Spread fingers and thumb
into a fan position. - Thumb should be
projecting away from
the palm and parallel to
the film.
FAN LATERAL
- Best demonstrate
anterior or posterior
displacements of bony
structures.
HAND LATERAL
small bony growth
occurring on dorsal
surface of the 3rd
metacarpocarpal joint
CARPE BOSSU OR CARPAL BOSS
best demonstrate the
carpal boss.
lateral with the
wrist in palmar flexion
- Semi-or half supinated
both hand at 45 degrees - Cupped as if the patient
were going to catch a
ball - Best demonstrate
fractures at the base of
the 5th metacarpal. - Best demonstrate early
evidence of rheumatoid
arthritis.
NORGAARD
BALL CATCHERS POSITION
Used to demonstrate
bony erosion of MC
heads & phalangeal
bases of finger.
HAND AP AXIAL
BREWERTON METHOD
