Hand and Fingers Imaging

Question 1

Hand exposure factors and rationale

Answer 1

50 kV - high contrast image (large attentuation difference), thin anatomical area
100mA - requires fine focus for image detail
0.02 s - minimal movement risk, combined to give 2 mAS which is appropriate image density
No grid - no scatter radiation (matter=scatter)

Question 2

Imaging techniques for hand projections

Answer 2

PA bilateral:
- centre midway btw hands, level 5th metacarpals
- collimate wrist joint, all phalanges, fingers separated

PA One Hand
- centre over 3rd metacarpal

Ball catcher:
- hands palm upwards, slight medial rotation
- centre midway btw hands, level 5th metacarpals
- collimate both hands and wrist joint

Lateral
- fingers superimposed, thumb adducted
- centre over 2nd metacarpal
- collimate hand, wrist joint

**Oblique **
- 45 degree external rotation, use sponge, fingers separated
- centre over 2nd metacarpal
- collimate hand, wrist joint

Question 3

Rheumatoid arthritis

Answer 3

systemic autoimmune disease that causes inflammation of the joints

Question 4

What projections for rheumatoid Arthritis? Explain rationale for each

Answer 4

PA Bilateral - allows comparison between hands, soft tissue swelling
Ball catcher - to better see joint space narrowing and erosion
Lateral - to see if any anteroposterior displacement
Oblique - joint narrowing, bony deformities on areas that are not visible in PA

Question 5

Radiographic appearance of rheumatoid arthritis

Answer 5

• Distorted metacarpophalangeal joints
• Fingers deviated medially

Question 6

Osteoarthritis

Answer 6

Caused by wear and tear, deformities in joints

Question 7

What projections for osteoarthritis? Explain rationale for each

Answer 7

PA Bilateral - to see if pathology present in both hands
Lateral - to observe bony growths, alignment issues, joint space narrowing
Oblique - better see joint interphalangeal joint spaces, bony growths, deformities

Question 8

Radiographic appearance of osteoarthritis

Answer 8

• Extreme deformities in proximal interphalangeal joints
• Slight deformities in distal interphalangeal joints
• Osteopathic lipping - little bony growths forming along the interphalangeal joints due to bone erosion
• cartilage erosion

Question 9

Boxer’s Fracture

Answer 9

5th metacarpal takes force of impact and fractures at neck of palm creating a dorsal bump

Question 10

What projections for Boxer’s fracture? Explain rationale for each

Answer 10

PA - visualisation of metacarpals, fractures
AP Internal Oblique - visualisation of 5th metacarpal (external cant see that well)
Lateral - to see anterior displacement

Question 11

Radiographic appearance of Boxer’s Fracture

Answer 11

• Head of 5th metacarpal is displaced anterior

Question 12

Crush Fracture

Answer 12

proximal phalanges have comminuted fractures

Question 13

What projections for crush fracture? Explain rationale for each

Answer 13

PA - visualise fractures in phalanges
Oblique - fractures
Lateral (If possible) - fractures
Thumb AP - see any fractures in thumb
Thumb Lateral - see any fractures in thumb

Question 14

Radiographic appearance of Crush Fracture

Answer 14

Proximal phalanges have comminuted fractures (more than 3 bony fragments)

Question 15

Traumatic Amputation

Answer 15

phalanges/s amputated

Question 16

What projections for traumatic amputation? Explain rationale for each

Answer 16

PA - to see whole hand
Lateral (if possible) - limited movement but to visualise side of hand

Question 17

Radiographic appearance of traumatic amputation

Answer 17

• lots of artefact (dressings)
• soft tissue swelling
• amputation, missing bones

Question 18

Bony Tumour

Answer 18

reduced bone density

Question 19

What projections for Bony tumour? Explain rationale for each

Answer 19

PA - see whole hand, where erosion occurs
Oblique - visualisation of joint spaces, to see if superimposed
Lateral - alignment, degree of reduced bone density, see how much growth, whether or not it is bony/soft tissue/other

Question 20

Radiographic appearance of Bony Tumour

Answer 20

• Metacarpals and carpals may appear underexposed due to exposure factor compensation for reduced bone density
• bone erosion

Question 21

Dislocation

Answer 21

bone in hand or fingers is moved out of normal position of joint

Question 22

What projections for hand/finger dislocation? Explain rationale for each

Answer 22

PA - standard view, where dislocation is
Oblique - visualisation of joint spaces
Lateral - degree of anteroposterior dislocation, see superimposition

Question 23

Radiographic appearance of hand/finger dislocation

Answer 23

• bone clearly anterior or posterior dislocation
• lack of superimposition of fingers

Question 24

Post operative

Answer 24

after surgery

Question 25

What projections for post operative hand? Explain rationale for each

Answer 25

**PA** - see how hand looks after surgery, ensure correct positioning **Lateral** - correct positioning

Question 26

Radiographic appearance of post operative hand

Answer 26

- unremoveable artefacts- nails, screws to hold bone in place

Question 27

Salter-Harris Fracture

Answer 27

only occurs in children, fractures to epiphyses (growth plate of cartilage)

Question 28

What projections for Salter-Harris fracture? Explain rationale for each

Answer 28

**PA** - where fracture is **Oblique** - standard projection, ensure no other fractures that wasnt visible in PA **Lateral** - to see fracture, standard projection

Question 29

Radiographic appearance of Salter-Harris Fracture

Answer 29

- fracture through epiphysis