Wrist Flashcards by Eun Woo

PA projection of Wrist

Pt position

Conventional lateral seating/comfort position-edge RT

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PA projection of Wrist

PART

Affected limb-top RT-flex elbow 90 degrees-hand pronated

Arch hand-MCPJ-place wrist-in contact-IR

RP: mid carpal area

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PA projection of Wrist

IR & CRD

IR: 8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp-36-40”-SID-RP-MP-IR

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(1) gives a slightly oblique rotation to the ulna - if ulna is under examination, (2) should be taken.

PA projection
AP projection

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To demonstrate
▪ Distal radius and ulna, carpals, and proximal half of metacarpals
▪ No rotation in carpals, metacarpals, or radius
▪ Soft tissue and bony trabeculation
▪ No excessive flexion to overlap and obscure metacarpals with digits

PA projection of Wrist

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PA projection of Wrist modification

Daffner, Emmerling, and Buterbaugh

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Daffner, Emmerling, and Buterbaugh all the same with PA of Wrist-EXCEPT

CRD: 30 deg towards elbow
Obj: elongates the scaphoid and capitate

CRD: 30 deg towards fingertips
Obj: elongates only the capitate

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Added: AP projection of Wrist

PART

Affected limb-top -hand and arm supinated

Elevate digits – support – wrist - IR

RP: mid carpal area

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Added: AP projection of Wrist

IR & CRD

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp-36-40”-SID-RP-MP-IR

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Carpal interspaces are better demonstrated

Added: AP projection of Wrist

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To demonstrate
▪ Distal radius and ulna, carpals, and proximal half of the metacarpals
▪ No rotation of the carpals, metacarpals, radius, and ulna
▪ Well-demonstrated soft tissue and bony trabeculation
▪ No overlapping or obscuring of the metacarpals as a result of excessive flexion

Added: AP projection of Wrist

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Lat projection (Lateromedial) of Wrist

PART

Affected limb-top RT-flex elbow 90 degrees-hand lateral and wrist in true lateral

RP: mid carpal area

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Lat projection (Lateromedial) of Wrist

IR & CRD

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp-36-40”-SID-RP-MP-IR

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This position can also be used to demonstrate anterior or posterior displacement in fractures.

Lat projection (Lateromedial) of Wrist

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To demonstrate
▪ Distal radius and ulna, carpals, and proximal half of metacarpals
▪ Superimposed distal radius and ulna
▪ Superimposed metacarpals
▪ Radiographic density similar to PA or AP and oblique radiographs, which requires increased exposure factors to compensate for greater part thickness

Lat projection (Lateromedial) of Wrist

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Lateral projection of Wrist

Radiographic density similar to PA or AP and oblique radiographs, which requires (1) to compensate for (2)

increased exposure factors
greater part thickness

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Added: Lateral projection
(Mediolateral) of Wrist

Radial surgace against IR

Pt should lean forward to assume the position

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Lateral projection of Wrist modification

Burman et. al.
Fiolle

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If the lateral position of the scaphoid should be obtained, wrist should be in palmar flexion

Burman et. al.

(Lateral projection modification)

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This action rotates the bone anteriorly into a dorso-volar position.

Wrist in palmar flexion

Burman et. al.
(Lateral projection modification)

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This is valuable only when sufficient flexion is permitted.

Burman et. al.

(Lateral projection modification)

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First to describe a small bony growth occurring on the dorsal surface of the 3rd CMCJ ‘carpe bossu’ (carpal boss) and found that it is demonstrated best in a lateral position with the wrist in palmar flexion

Fiolle

(Lateral projection modification)

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Added: PA Oblique projection: Lateral rotation (Wrist)

PART

Affected limb-top RT-flex elbow 90 degrees-axilla in contact – RT –place wrist-in contact-IR

Prone – rotate laterally – 45 deg with IR plane

Note: use foam wedge – If ff-up will be done

RP: scaphoid

If POI is scaphoid, with ulnar deviation

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Added: PA Oblique projection: Lateral rotation (Wrist)

IR & CRD

8x10/10x12-top-RT-longitudinal/CW-MP-RP

CRD: Perp midcarpal-36-40”-SID-just distal to radius

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Demonstrates the carpals on the lateral side of the wrist, particularly the trapezium and the scaphoid.

Added: PA Oblique projection: Lateral rotation (Wrist)

To demonstrate ▪ A well demonstrated scaphoid and trapezium ▪ Distal radius and ulna, carpal and proximal half of metacarpals ▪ Usually, adequate amount of obliquity in the following circumstances: ✓ Slight interosseus space between the 3rd-4th and 4th-5th metacarpal shafts ✓ Slight overlap of the distal radius and ulna ▪ Soft tissue and bony trabeculation

Added: PA Oblique projection: Lateral rotation (Wrist)

Added: AP Oblique projection: Medial rotation (Wrist) PART

Affected limb-top RT- FA rest on RT - place wrist-in contact-IR Supine – rotate medially –semi-supinated - 450 with IR plane Note: use foam wedge – If ff-up will be done RP: midway medial and lateral borders – midcarpal area

Added: AP Oblique projection: Medial rotation (Wrist) IR & CRD

8x10/10x12-top-RT-longitudinal/CW-MP-RP CRD: Perp midcarpal-36-40”-SID-RP

Separates the pisiform from the adjacent carpal bones.

Added: AP Oblique projection: Medial rotation (Wrist)

Gives a more distinct radiograph of the triquetrum and hamate

Added: AP Oblique projection: Medial rotation (Wrist)

To demonstrate ▪ Carpals on medial side of wrist ▪ Triquetrum, hamate, and pisiform free of superimposition and in profile ▪ Distal radius and ulna, carpals and proximal half of metacarpals ▪ Radiographic quality soft tissue and bony trabeculation

Added: AP Oblique projection: Medial rotation (Wrist)

Added: PA PROJECTION: Ulnar deviation (Wrist) PART

Affected limb-top RT- FA rest on RT - place wrist-in contact-IR PA proj pos’n – wrist in extreme ulnar deviation RP: scaphoid

Added: PA PROJECTION: Ulnar deviation (Wrist) IR & CRD

8x10/10x12-top-RT-longitudinal/CW-MP-RP CRD: Perp – scaphoid - 36-40”-SID-RP Note: Clear delineation sometimes requires a CR angulation of 10 to 15 degrees proximally or distally

Corrects foreshortening of the scaphoid, which occurs with a perpendicular central ray.

Added: PA PROJECTION: Ulnar deviation (Wrist)

It also opens the spaces between the adjacent carpals

Added: PA PROJECTION: Ulnar deviation (Wrist)

To demonstrate ▪ Scaphoid with adjacent articulation open ▪ No rotation of wrist ▪ Extreme ulnar deviation, as revealed by the angle formed between longitudinal axes of the forearm compared with the longitudinal axes of the metacarpals ▪ Soft tissue and bony trabeculation

Added: PA PROJECTION: Ulnar deviation (Wrist)

Added: PA PROJECTION: Radial deviation (Wrist) PART

Affected limb-top RT- FA rest on RT - place wrist-in contact-IR PA proj pos’n – wrist in extreme radial deviation RP: midcarpal

Added: PA PROJECTION: Radial deviation (Wrist) IR & CRD

8x10/10x12-top-RT-longitudinal/CW-MP-RP CRD: Perp – midcarpal - 36-40”-SID-RP

Opens the interspaces between the carpals on the medial side of the wrist

Added: PA PROJECTION: Radial deviation (Wrist)

To demonstrate ▪ Carpal and their articulations on the medial side of the wrist ▪ No rotation of wrist ▪ Extreme radial deviation, as revealed by the angle formed between longitudinal axes of forearm compared to the longitudinal axes of the metacarpals ▪ Soft tissue and bony trabeculation

Added: PA PROJECTION: Radial deviation (Wrist)

Projection for Scaphoid

PA AXIAL PROJECTION: STECHER METHOD

PA AXIAL PROJECTION: STECHER METHOD PART

Affected limb-top RT- FA rest on RT – axilla on RT - wrist-centered and in contact-IR PA proj pos’n – one end of IR – support – 20 deg elevated (phalangeal end) RP: scaphoid

PA AXIAL PROJECTION: STECHER METHOD IR & CRD

8x10/10x12-top-RT-longitudinal/CW-MP-RP CRD: Perp – RT - scaphoid - 36-40”-SID-RP

Places the scaphoid at right angles to the CR so that it is projected without self-superimposition

PA AXIAL PROJECTION: STECHER METHOD

To demonstrate ▪ Scaphoid ▪ No rotation of carpals, metacarpals, radius, or ulna ▪ Distal radius and ulna, carpals, and proximal half of the metacarpals ▪ Soft tissue and bony trabeculation

PA AXIAL PROJECTION: STECHER METHOD

PA AXIAL PROJECTION: BRIDGMAN METHOD All the same as Stecher method EXCEPT:

With ulnar deviation

PA AXIAL PROJECTION: STECHER METHOD Variations

▪ IR and wrist - horizontal – CR 20 deg toward elbow ▪ SUPEROINFERIOR fx line demo: wrist angled inferiorly or CR angled towards the digits ▪ Clench fist: elevates distal end of scaphoid (parallel with IR) & widens fracture line – (PA wrist; no CR angulation)

The series is performed after routine wrist radiographs do not identify a fracture

Scaphoid series

PA and PA AXIAL PROJECTION: Ulnar deviation RAFERT-LONG METHOD PART

Affected limb-top RT- FA rest on RT –- wrist-centered and in contact-IR PA proj pos’n of wrist – extreme ulnar deviation RP: scaphoid

PA and PA AXIAL PROJECTION: Ulnar deviation RAFERT-LONG METHOD IR & CRD

8x10/10x12-top-RT-longitudinal/CW-MP-RP CRD: SERIES: Perp (0°), 10°, 20°, and 30° cephalad

Scaphoid is demonstrated with minimal superimposition

PA and PA AXIAL PROJECTION: Ulnar deviation RAFERT-LONG METHOD

To demonstrate * No rotation of the wrist * Scaphoid with adjacent articular areas open * Extreme ulnar deviation

PA and PA AXIAL PROJECTION: Ulnar deviation RAFERT-LONG METHOD

Projection for Trapezium

PA AXIAL OBLIQUE PROJECTION CLEMENTS-NAKAYAMA METHOD

PA AXIAL OBLIQUE PROJECTION CLEMENTS-NAKAYAMA METHOD PART

Affected limb-top RT- FA rest on RT –- hand in contact- IR – lateral – 45° sponge wedge on palmar surf Wrist – lat – resting on ulnar – center of IR – ulnar deviation ***LA of IR and FA & wrist align with CR and rotate 20° away from CR (if ulnar deviation not possible) RP: scaphoid

PA AXIAL OBLIQUE PROJECTION CLEMENTS-NAKAYAMA METHOD IR & CRD

8x10/10x12-top-RT-longitudinal-MP-RP CRD: 45° distal to anatomic snuffbox of wrist

Demonstrates the trapezium and its articulations with the adjacent carpal bones.

PA AXIAL OBLIQUE PROJECTION CLEMENTS-NAKAYAMA METHOD

Eval criteria: Trapezium projected free of the other carpal bones with the exception of the articulation with the scaphoid

PA AXIAL OBLIQUE PROJECTION CLEMENTS-NAKAYAMA METHOD

Projection for Carpal Bridge

TANGENTIAL PROJECTION

TANGENTIAL PROJECTION (Carpal Bridge) Pt position

Conventional lateral seating/stand -edge RT – allow manipulation of arm / XRT

TANGENTIAL PROJECTION (Carpal Bridge) PART

Affected limb-top RT- hand – palm upward on IR – hand at right angle to FA or elevate FA on sandbags – wrist flexed at right angle - IR in vertical position RP: anatomic snuffbox – pass through trapezium

TANGENTIAL PROJECTION (Carpal Bridge) IR & CRD

8x10-top-RT-longitudinal-MP-RP CRD: 1 1⁄2 inch prox to wrist - 450 caudal

For demonstration of fractures of the scaphoid, lunate dislocations, calcifications and foreign bodies in the dorsum of the wrist, and chip fractures of the dorsal aspect of the carpal bones.

TANGENTIAL PROJECTION (Carpal Bridge)

Eval criteria: * Dorsal aspect of the wrist * Carpals * Dorsal surface of the carpals free of superimposition by the metacarpal bases

TANGENTIAL PROJECTION (Carpal Bridge)

Projection for Carpal Canal

TANGENTIAL PROJECTION GAYNOR-HART METHOD: inferosuperior

TANGENTIAL PROJECTION GAYNOR-HART METHOD: inferosuperior Pt position

Conventional lateral seating-edge RT – FA parallel with LA of RT

TANGENTIAL PROJECTION GAYNOR-HART METHOD: inferosuperior PART

Affected limb-top RT- hand – hyperextend wrist – level of radial styloid process Radiolucent pad – 3⁄4 inch – under lower FA – rotate hand slightly toward radial side (prevent superimpo of shadows of hamate and pisiform) Pt – grasp digits w/ opp hand or use a suitable device to hold wrist in extended pos’n RP: 1 in distal to bass of 3rd MC

TANGENTIAL PROJECTION GAYNOR-HART METHOD: inferosuperior IR & CRD

8x10-top-RT- LW -MP-RP CRD: 25 to 30 degrees - towards palm of hand – LA of hand -RP

Shows the palmar aspect of the trapezium, the tubercle of the trapezium, and the scaphoid, capitate, hook of hamate, triquetrum, and entire pisiform

TANGENTIAL PROJECTION GAYNOR-HART METHOD: inferosuperior

TANGENTIAL PROJECTION GAYNOR-HART METHOD: superoinferior (modification) Pt pos'n

Stand -edge RT – allow manipulation of arm

TANGENTIAL PROJECTION GAYNOR-HART METHOD: superoinferior (modification) PART

Affected limb-top RT- hand – dorsiflex wrist as much as tolerable – lean forward level – carpal canal tangent to IR RP: midpoint of wrist

TANGENTIAL PROJECTION GAYNOR-HART METHOD: superoinferior (modification) IR & CRD

8x10-top-RT- LW -MP-RP CRD: tangential to carpal canal – midpoint of wrist or angled toward the hand 20 – 35 degree from LA of FA

Shows the palmar aspect of the trapezium, the tubercle of the trapezium, and the scaphoid, capitate, hook of hamate, triquetrum, and entire pisiform

TANGENTIAL PROJECTION GAYNOR-HART METHOD: superoinferior (modification)

TANGENTIAL PROJECTION GAYNOR-HART METHOD: superoinferior (modification) When dorsiflexion of the wrist is limited, (1) suggested placing a 45-degree angle sponge under the (2) of the hand. This slightly elevates the wrist to place the (3). A slight degree of magnification exists because of the (4)

1. Marshall I 2. palmar surface 3. carpal canal tangent to the central ray 4. increased OID

Wrist Flashcards

(73 cards)