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

Upper Extremityfingers (digits) & hand

RTEC 123 # 1 A LECTURE

Contributions by:MOSBY – MERRILLS & BONTAGER

XRAY2000.CO.UK rev 10/10/11

1

ANATOMY REVIEWUPPER EXT : FINGERS/ HAND

2

3

4

5

?

6

7

Anatomy &Positioning Review

Upper Limb

8

POSITIONING

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

LEFT LATERAL POSITION – LT LATERAL PROJECTION

10

RIGHT LATERAL POSITION – RT LATERAL PROJECTION

Lateromedial mediolateral

11

FINGERS “series”

• PA FINGER (PA HAND)

• OBLIQUE *

• LATERAL

• *OBLIQUE (med or lat rot) depending on which digit

12

FINGER “series”

PA OBL LATERAL 13

14

DO NOT PLACE PATIENT’S LEGS UNDER THE TABLE 15

16

WHICH DIGIT?

17

18

LATERAL MEDIAL ROTATION 19

? Which rotation is this?

20PA oblique - medial rotation

YES NOKeep fingers // to IR

21

22

23

24

25

THUMB (1ST DIGIT)

• PA / AP

• PA OBLIQUE

• LATERAL

26

27

28

PA

AP

29

30

OBLIQUE

31

32

LATERAL

33

34

HAND Series (3vw or 4*vw)

• PA• PA OBLIQUE (lat rotation)• LATERAL (FAN)-------------------------------------• *AP OBLIQUE (med rotation) or PA OBLIQUE (med rotation)

35

HAND Series

• Re: LATERAL • MEDIOLATERAL OR

• LATEROMEDIAL

• FAN /TRUE LATERAL/ FLEXION

36

37

38

39

Note: Incorrect position of hand and forearmForearm should be parallel with end of the table – elbow flexed

40

41

42

43

44

45

46

47

HAND Series

• Re: LATERAL • MEDIOLATERAL OR

• LATEROMEDIAL P 128

• FAN /TRUE LATERAL/ FLEXION

48

49

50

51

52

Projection ?

Alternate lateral (FB)

53

AP OBLIQUE OPENS SPACES BETWEEN

4TH & 5TH mc

54

Additional projection of hand

AP OBLIQUE HAND(medial rotation)

• May be required as the • 4th “routine view”• Hand supinated (AP) • then rotated medially 45º• (keep fingers straight)

55

PA OBLIQUEMedial rotation

another -alternate method – Radiographically image

will look the same

PA OBLIQUEanother -Alternate method

keep hand PA then rotate hand 45º PA lateral medial

56

Compare :OBLIQUE OF RT HANDPA & AP

What anatomy is seen specific to each position?

57

BILATERAL AP OBLIQUES

58

?

59

For Arthritis “ballcatchers”

60

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

FILM CRITIQUE& Pathology

62

Reduce OID, magnification

63

64

65

PATHOLOGYFOR UPPER EXTREMITY 1

SEE CHART PG 109

Bone cyst

Bursitis

Fractures /Dislocations

Joint effusion

Osteoporosis

Rheumatoid Arthritis66

67

68

69

70

71

72

73

What abnormality do you see?

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

74

OSTEOSARCOMA

75

76

77

Bennett’s FX

fx at base of 1st MC

78

Mutilating rheumatoid arthritis.

79

RHEUMATOID ARTHRITIS

80

Rheumatoid arthritis

81

RA - inflammatory disease

3x more common in females

82

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

85

86

BOXER’S FX

87

88

                                          <>

88Bennett'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.

CONGENTIAL ABNORMALITIES

89

What abnormality do you see?

90

91

G S W

92

93

94

95

www.rad.washington.edu

96

QUESTIONS ?

End of Upper Extremity #1

Wrist will be covered if there is time …

97