Transcript
PLAIN RADIOGRAPHY OF HAND AND WRIST
Dr.Bhaskaranand KumarProfessor & Head,
Hand & Microvascular Surgery,Department of Orthopaedics,Kasturba Medical College &
HospitalManipal - 576 104.
HISTORYHistory of imaging of hand and wrist is the history of radiology
William Conrad Roentgen (Dec 1895) x- ray of human hand
William Conrad Roentgen(1845-1923)
The first radiograph was of his wife's hand given to her as a Christmas present
William Conrad Roentgen(1845-1923)
What was
20mins
exposure
then, has been reduced to
milliseconds now
HISTORY
Few months later in Feb. 1896 first clinical
application of x-ray in USA to diagnose
Colles’ fracture
A good orthopedist needs to be “his own radiologist”
-Prof. V.
Chacko
A good radiologist must aim at becoming a good orthopaedic radiologist
-Dr. Jaganmohan Reddy
It is a common mistake to ask for wrong or insufficient views
Common mistakes
Exposing two hands in single film
Common mistakes
To include entire hand, wrist
and forearm in a single film
Common mistakes
Breaking the rule of minimum two views
Common mistakes
Breaking the rule of minimum two views
Common mistakes
Writing for AP view in hand and wrist
X ray of hand and wrist in a single film is a
false sense of economy
Standard views of the hand differ from those of the wrist
Similarly when fingers are to be studied properly they need separate X-ray
BASIC VIEWS•Wrist- PA, lateral,•Hand - PA, Lateral, oblique
•Fingers- PA, lateral, oblique
WRIST•PA and Lateral view•Centre point-head of capitate
•Exact positioning is most important
WRIST PA VIEW
Position: (sitting)•Shoulder: 900 abduction•Elbow: 900 flexion•Forearm: pronated•Wrist: neutral •Fingers: extended
WRIST PA VIEW
Long axis of 3rd metacarpal,capitate and radius in a straight line
WRIST PA VIEW
WRIST PA VIEW
What is a good PA view?
• CMC joints must be seen without foreshortening
• If wrist is dorsiflexed these are not seen
WRIST PA VIEW
What is a good PA view?
WRIST PA VIEW
What is a good PA view?• Ulnar styloid arises from ulnar
border of head of ulna• In AP view it arises from the
center of distal end of ulna
WRIST PA VIEW
What is a good PA view?• Fovea is seen just lateral to the
base of ulnar styloid process• Triangular fibro cartilage is
attached here
WRIST PA VIEW
What is a good PA view?• ECU groove is at or radial to the
fovea, at the base of the ulnar styloid.
WRIST PA VIEW
What is a good PA view?
• If ECU groove overlaps ulnar styloid it means that elbow is kept at a lower level than shoulder
• More the groove overlaps, lower the elbow
-Gilula and Yin
WRIST PA VIEW
What is a good PA view?
• Ulna becomes more positive if shoulder abduction is reduced
WRIST PA VIEW
What is a good PA view?
WRIST lateral view
• Patient – sitting • Shoulder - adducted against the
trunk• Elbow – 900 flexion • Forearm – midprone• Wrist – neutral flexion• Fingers - full extension
WRIST lateral view
A good lateral view
• Long axis of the radius, capitate and metacarpal should be in the same line
WRIST lateral view
A good lateral view
• ‘‘ Line of sight ” - SPC• Ideal lat. View – palmar margin
of pisiform should project midway between the palmar margins of distal pole of scaphoid and head of capitate
WRIST lateral view
A good lateral view
SPC
WRIST lateral view
• The more supinated the wrist , the pisiform will project more anterior to the scaphoid
WRIST oblique view
Position-
• Wrist - pronation 450 from the lateral position
Step wedge can be used
WRIST oblique view
Advantages
Evaluation of • Base of the thumb• Scaphotrepezio-trepezoid
joint• Additional view of scaphoid
WRIST ulnar deviation PA
Position- • Like for PA view but wrist in
ulnar deviation
WRIST ulnar deviation PA
Position- • Like for PA view but wrist in
ulnar deviation
• Scaphoid looks elongated
WRIST AP view
Position-
• Forearm in full supination
• Best for evaluation of scapholunate and lunotriquetral interspace
CLENCH FIST VIEW AP
This increases the gap between the carpal bones
PA AP
Scapholuno diastases
Compare the gap with opposite wrist
Normal Compare the width with the
adjacent capitolunate joint
Radial inclination
16-28 (22)
Radial length
11 – 12 mm
Palmar tilt
90 deg
Palmar tilt
0-22 deg (11)
HANDPA, lateral & oblique views
Centre point head of the metacarpal
Exact positioning is important
HAND PA VIEW
Position- sitting
•Hand kept with entire palm touching the cassette
•Fingers and thumb slightly opened up
HAND PA VIEW
HAND PA VIEW
Metacarpals and proximal phalanges are best exposed
Distal phalanges are over exposed
Carpal bones are under exposed
HAND PA VIEW
HAND LATERAL
Position- Sitting•Wrist neutral •Hand kept with its ulnar
border of fingers and hypothenar touching the cassette
•Fingers with MCP flexion at varying degrees of flexion and thumb abducted
HAND LATERAL
There should be no digital overlapping
Centre point:head of 3rd metacarpal
HAND LATERAL
HAND OBLIQUE
Position- Sitting Hand is kept at 450 of pronation
with hypothenar eminence touching the cassette
A step wedge with steps to accommodate the fingers, could be used
HAND OBLIQUE
Good for visualizing metacarpals which tend to overlap in a true lateral view
Fingers PA, lateral and oblique
Center point over the point of interest
( may be PIP or DIP )
Finger PA Position – Sitting
Finger – volar side touching the cassette
All digits abducted from the center
Finger lateral
Index, Middle & Little – respective MCP extended, remaining fingers flexed
Finger lateral Ring – others extended and
ring flexed
Finger oblique
Helpful in the assessment of joint injuries
top related