1. Film Critique
1st year class 4th class
Fingers-Wrist

2. PA

3. Bony Landmarks
The most readily identifiable bony structures are the posterior aspects of the metacarpophalangeal (MCP) joints. Also know as the "knuckles".
Note that there are two interphalangeal (IP) joints in each finger (proximal and distal, abbreviated to "PIP" and "DIP"), but only one interphalangeal (IP) joint in the thumb. This reflects the number of phalanges in each.

4. Distal interphalangeal joint
Distal phalanx IP
DIP
Proximal interphalangeal joint
PIP
Middle phalanx
Proximal phalanx
Metacarpophalangeal joint
MCP
Carpometacarpals joint
CMC
Trapezium
PA Rt Hand

5. In the posteroanterior (PA) view of the hand and wrist, since the human thumb is "rotated" 90° with respect to the fingers, this radiograph gives an oblique view of the thumb, (In some people it’s a lateral) but a PA view of all the other structures.

6. Thumb/1st digit
Standard views
* AP (PA)
* PA Oblique
*Lateral

7. PA Lt 1st Finger
* AP Lt 1st Finger

8. Oblique Rt 1st finger

9. Oblique vs Lateral
Oblique right 1st finger
Lateral right 1st finger

10. Lateral
Lateral Rt 1st Finger
Lateral Rt 1st finger

11. Structures shown
All projections demonstrates the 1st carpometacarpal (CMC) joint free of superimposition of the soft tissues of the hand
Check rotation
* Must have the area from the distal tip of the 1st phalanx to the Trapezium on the film
Open interphalangeal (IP) and metacarpophalangeal (MCP) joint spaces (we center to the MCP)
All soft tissue and bony trabeculation

12. Open joint spaces
Open
Closed

13. 2nd-5th fingers
Standard views
*PA (AP)
*PA 45 DEGREE OBLIQUE
*LATERAL

14. PA Left 5th finger PA

15. Oblique left 5th finger

16. Lateral Left 5th finger LT

17. Do you know your collimator?

18. Structures Shown
*All projections of the 2nd-5th fingers: entire digit from tip (distal phalanx)to distal portion of the adjoining metacarpal (some sites like the whole metacarpal or even some carpals !!!)
Check rotation (can you see the finger nail) is there equal soft tissue on both sides of the finger
No soft tissue overlap from adjacent digits
Open IP and MCP joint spaces (we center to the PIP

19. Standard views of Hand *posteroanterior (PA) *PA 45 degree oblique
*lateral (with fingers fanned)

20.                             
HOME | LEARNING MODULE HOME | RADIOLOGY MODULE HOME
Home Wrist and hand module   Self-tests  Radiographs
previous | 1 of 8 | next RT
PA RT Hand

21. RT

22. PA RT Hand

23. Structure shown:
PA hand: No rotation of hand
Open MCP and IP joints
Slightly separate digits with no soft tissue overlap
*The area from the distal phalanges, metacarpals, carpals to the distal radius and ulna
Soft tissue and bony trabeculation

24. Oblique with sponge To much rotation R Too much Overlap
Oblique Right hand

25. Posteroanterior oblique (oblique)
Either with or without the aid of a foam (radiolucent) support, the patient holds the hand at about 45° with respect to the cassette, and fans the fingers so there is minimal overlap in the final radiograph.
Note that in this view , the all-important scaphoid bone is not well isolated from the other carpal bones

26. Oblique Rt Hand RT
(Navicular)

27. Obliques
To much R
To much
Oblique Right Hand

28. Oblique Rt Hand
The 5th
Boxer’s FX

29. Structures Shown
PA oblique projection of the bones and soft tissue of the hand
Minimal overlap of the 3-4 and 4-5 metacarpal shafts
Slight overlap of the metacarpal bases and heads
(but separation of the second and third metacarpals)
Open interphalangeal and MCP joints
Digits separated slightly with no overlap of soft tissues
All anatomy distal to the distal radius and ulna
Soft tissue and bony trabeculation

30. Lateral Left Hand
Poor positioning

31. Superimposed distal radius and ulna
Structure shown:
Lateral hand: Hand is in a true lateral position (superimposed metacarpals)
Superimposed distal radius and ulna
Thumb free of motion and superimposition

32. Wrist views
*PA
*45 degree oblique
*Lateral
*PA Axial-Stecher method

33. (Navicular)

34. Structures shown:
PA wrist :PA projection of the carpals, distal radius and slightly oblique rotation of ulna, and proximal metacarpals *The area from the proximal metacarpals, carpals to the distal ulna and radius on the film No rotation in the carpals, metacarpals or radius Open radioulnar joint space Soft tissue and bony trabeculation No excessive flexion of hand to overlap and obscure metacarpals with digits No clenched fist unless order that way!!!

35. Not for a PA wrist!!!!
A method recommended by Stecher is to have the patient clench the fist. This elevates the distal end of the scaphoid so that it lies parallel with the IR; it also widens the fracture line. The wrist is positioned as for the PA projection, and no central ray angulation is used.
NO!

36. RT PA
Bridgeman’s view

37. Structures shown:
Oblique wrist: The carpals on the lateral side of the wrist, particularly the trapezium and the scaphoid (**the most common fracture and dislocated bones of the wrist)
*Distal radius and ulna, carpals and proximal half of metacarpals on the film
Open trapeziotrapezoid and scaphotrapezial joints spaces
Rotation: slight overlap of distal radius and ulna
Soft tissue and bony trabeculation

38. Oblique Lt Wrist
Lateral Lt wrist

39. ▪ Distal radius and ulna, carpals, and proximal half of metacarpals
Structures shown:
The lateral image shows a lateral projection of the proximal metacarpals, carpals, and distal radius and ulna.
This position can also be used to demonstrate anterior or posterior displacement in fractures.
The following should be clearly demonstrated:
▪ Distal radius and ulna, carpals, and proximal half of metacarpals
▪ Superimposed distal radius and ulna
▪ Superimposed metacarpals
▪ Radiographic density similar to PA and oblique radiographs, which requires increased exposure factors to compensate for greater part thickness

40. Stecher Method
PA wrist (no deviation) with a CR or film angled 20 degrees toward the elbow
Stecher Lt wrist

41. Modified Stecher method (Bridgman)
Wrist is PA in ulnar deviation
With CR angled 20 degrees toward the elbow entering at the scaphoid
CR 20 degrees