Chapter 4 Hand and Wrist

Hand Digits (fingers) –____ bones __________ –Phalanx Metacarpals (Hand) –_____ bones

Digits Identified by number 1.__________ 2.Pointer 3.___________ 4.Ring 5.________

Digits Digits ______have 3 phalanges –Distal –Middle –_________ 1 st digit has _______ phalanges –________ –Proximal

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

Metacarpals Bones of the Hand 3 segments –___________ –____________ –Base (Proximal)

1 st Digit Joints _____________________joint – Between proximal and distal phalanx. –Ginglymus (Hinge) 1 st __________________________joint – Between the base of proximal phalanx and head of metacarpal –Ellipsoidal 1 st _______________________joint – Between the base of metacarpal and trapezium –Sellar joint

2 nd – 5 th 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 Digits 2 nd – 5 th 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

1 st Digit Imaging Thumb Routine 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 2 nd -5 th 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 ___________

Wrist 8 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 3 rd metacarpal