1. Upper Extremity fingers (digits) & hand RTEC 123 # 1 A LECTURE Contributions by: MOSBY – MERRILLS & BONTAGER XRAY2000.CO.UK rev 10/10/11 1

2. ANATOMY REVIEW UPPER EXT : FINGERS/ HAND 2

3. 3

4. 4

5. 5

6. ? 6

7. 7

8. Anatomy &Positioning Review Upper Limb 8 POSITIONING

9. RE: LATERALS PG 80 PROJECTION VS POSITION CHEST / ABDOMEN / SKULL The lateral is referred to the POSTION – which is the SIDE TOUCHING THE IR SO LEFT LATERAL (position ) in referred to as a LATERAL PROJECTION LIMBS : Pos/Pro – side entered by IR MEDIOLATERAL OR LATERALMEDIAL 9

10. LEFT LATERAL POSITION – LT LATERAL PROJECTION 10 RIGHT LATERAL POSITION – RT LATERAL PROJECTION

11. Lateromedial mediolateral 11

12. FINGERS “series” PA FINGER (PA HAND) OBLIQUE * LATERAL *OBLIQUE (med or lat rot) depending on which digit 12

13. FINGER “series” PA OBL LATERAL 13

14. 14

15. DO NOT PLACE PATIENT’S LEGS UNDER THE TABLE 15

16. 16

17. WHICH DIGIT? 17

18. 18

19. LATERAL MEDIAL ROTATION 19

20. ? Which rotation is this? 20 PA oblique - medial rotation

21. YES NO Keep fingers // to IR 21

22. 22

23. 23

24. 24

25. 25

26. THUMB (1 ST DIGIT) PA / AP PA OBLIQUE LATERAL 26

27. 27

28. 28

29. PA AP 29

30. 30

31. OBLIQUE 31

32. 32

33. LATERAL 33

34. 34

35. HAND Series (3vw or 4*vw) PA PA OBLIQUE (lat rotation) LATERAL (FAN) ------------------------------------- *AP OBLIQUE (med rotation) or PA OBLIQUE (med rotation) 35

36. HAND Series Re: LATERAL MEDIOLATERAL OR LATEROMEDIAL FAN /TRUE LATERAL/ FLEXION 36

37. 37

38. 38

39. 39

40. Note: Incorrect position of hand and forearm Forearm should be parallel with end of the table – elbow flexed 40

41. 41

42. 42

43. 43

44. 44

45. 45

46. 46

47. 47

48. HAND Series Re: LATERAL MEDIOLATERAL OR LATEROMEDIAL P 128 FAN /TRUE LATERAL/ FLEXION 48

49. 49

50. 50

51. 51

52. 52 Projection ?

53. Alternate lateral (FB) 53

54. AP OBLIQUE OPENS SPACES BETWEEN 4 TH & 5 TH mc 54 Additional projection of hand

55. AP OBLIQUE HAND (medial rotation) May be required as the 4 th “routine view” Hand supinated (AP) then rotated medially 45º (keep fingers straight) 55 PA OBLIQUE Medial rotation another -alternate method – Radiographically image will look the same

56. PA OBLIQUE another -Alternate method keep hand PA then rotate hand 45º PA lateral medial 56

57. Compare :OBLIQUE OF RT HAND PA & AP What anatomy is seen specific to each position? 57

58. BILATERAL AP OBLIQUES 58 ?

59. 59

60. For Arthritis “ballcatchers” 60

61. Keep arm level and elbow flexed 90º (not like this!) Legs should be at the side of the table – and where is the shield! 61

62. FILM CRITIQUE & Pathology 62 Reduce OID, magnification

63. 63

64. 64

65. 65

66. PATHOLOGY FOR UPPER EXTREMITY 1 SEE CHART PG 109 Bone cyst Bursitis Fractures /Dislocations Joint effusion Osteoporosis Rheumatoid Arthritis 66

67. 67

68. 68

69. 69

70. 70

71. 71

72. 72

73. 73 What abnormality do you see?

74. Alternate method if you can’t get the fingers straight!!!! Do 2 projections – 1 for hand, 1 for fingers in this position 74

75. OSTEOSARCOMA 75

76. 76

77. 77

78. Bennett’s FX fx at base of 1 st MC 78

79. Mutilating rheumatoid arthritis. 79

80. RHEUMATOID ARTHRITIS 80

81. Rheumatoid arthritis 81 RA - inflammatory disease 3x more common in females

82. 82

83. Osteoarthritis of fingers. Note narrowing of interphalangeal joints with spurring and erosions 83 OA - Non inflammatory joint disease involves the articular cartilage – Aging /erosion

84. 84

85. 85

86. 86

87. BOXER’S FX 87

88. 88 <> 88 Bennett's fracture is caused by forced abduction of the thumb there is a dislocation of the base of the first metacarpal although a fragment continues to articulate with the trapezium.

89. CONGENTIAL ABNORMALITIES 89

90. What abnormality do you see? 90

91. 91

92. G S W 92

93. 93

94. 94

95. 95

96. www.rad.washington.edu 96

97. QUESTIONS ? End of Upper Extremity #1 Wrist will be covered if there is time … 97