Chapter 4

Hand and Wrist

Hand

• Digits (fingers)– ____ bones

• __________– Phalanx

• Metacarpals (Hand)– _____ bones

Digits

• Identified by number1. __________

2. Pointer

3. ___________

4. Ring

5. ________

Digits

• Digits ______have 3 phalanges– Distal– Middle– _________

• 1st digit has _______ phalanges– ________– Proximal

Phalanx

• 3 segments to each– Head (Distal)– _____________– _____________

Metacarpals

• Bones of the Hand• 3 segments

– ___________

– ____________

– Base (Proximal)

1st Digit Joints

• _____________________joint – Between proximal and distal phalanx.– Ginglymus (Hinge)

• 1st __________________________joint – Between the base of proximal phalanx and head of metacarpal– Ellipsoidal

• 1st _______________________joint – Between the base of metacarpal and trapezium– Sellar joint

2nd – 5th Digit Joints

• Interphalangeal– Distal (DIP) Between _____________phalanx

• Hinge

– Proximal (PIP) Between _____________phalanx• Hinge

• ______________________(MCP)– Between proximal phalanx and head of metacarpal

• Ellipsoid (Condyloid)

Imaging the Digits2nd – 5th Routine

• PA Hand• PA affected digit• Oblique affected digit• Lateral affected digit• ___________• ___________

PA Hand

• Remove rings/bracelets/watch/etc..

• ______ hand with digits slightly _______

• Center at __________Joint

• Collimate on four sides to hand and wrist

PA Affected Digit

• Pronate hand with digits extended and abducted

• Center at the ____________

• Collimate on four sides to include _______ metacarpal

Oblique Digit

• PA Oblique• Use ____________sponge • Usually ___________ Oblique• Center at _______• Collimate down to affected digit

Lateral Digit

• Lateromedial/Mediolateral site dependent• Usually ______________• Use block sponge• ________ affected finger in lateral position• Center at __________• Collimate down to affected digit

1st Digit ImagingThumbRoutine

• PA Hand (Gives ________ of thumb)• AP Thumb• Lateral Thumb• 40” SID• __________

PA Hand

• Remove rings/bracelets/watch/etc..• Pronate Hand with digits slightly

_____________• Center at ____________ Joint• Collimate on four sides to hand and wrist

AP Thumb

• ___________ rotate hand so _______ aspect of thumb is down

• Have pt hold back 2nd-5th digits• Center to ________• Collimate to thumb

Lateral Thumb

• Pronate hand• Rotate ____________ slightly until thumb

is in true lateral• A small sponge under _________ can help• Center to ________• Collimate down to thumb

Hand Imaging

Routine• PA • Oblique• Lateral• 40” SID• ____________

PA Hand

• Remove rings/bracelets/watch/etc..• ____________ Hand with digits slightly

____________• Center at _________Joint• Collimate on four sides to hand and wrist

Oblique Hand

• Pronate hand• Rotate hand laterally ______________• A sponge is helpful• Center to ___________• Collimate to include entire hand

Lateral Hand

• Place Hand laterally with thumb side up• Form the __________• Fan remaining digits• A sponge can be helpful placed under

__________• Center at ___________

Wrist8 Carpals

• Proximal row from Lateral to Medial– _________ (Navicular)– Lunate (Semilunar)– ____________ (Triangular)– Pisiform

• Distal row from Lateral to Medial– Trapezium (Greater Multangular)– __________ (Lesser Multangular)– Capitate (Os Magnum)– __________ (Unciform)

Wrist Imaging

Routine• PA• Lateral• Oblique• Ulnar Deviation• __________• 60 kVp

PA Wrist

• Pronate hand• Align _______________parallel to film• Center to mid-carpal • Just distal to ______________• Collimate to skin laterally and to cassette

proximal/distal

Lateral Wrist

• _____________ Projection• Place ___________aspect on cassette• Align ____________ perpendicular to film• Center to mid-carpal just distal to styloids• Collimate to skin

Oblique Wrist

• Pronate Hand• Rotate wrist _______________Rotation• A __________ can help• Center to mid-carpal• Collimate to skin

Ulnar Deviation (Flexion)

• Pronate Hand• _______ hand toward _______ as much

as patient can tolerate• _______________tube angle• Center at ______________• Collimate down to carpal area• Done for ______________

Carpal Canal (Tunnel)

• Have patient ___________the hand 90°

• Rotate hand _____________(radial side)

• Angle ______________toward the hand

• Center _____________to base of the 3rd metacarpal