Upper Extremities
15 Hand
Anatomy
Digits, Head, Base, Body or shaft, Phalanges, Metacarpals, Carpals: scaphoid, Lunate, Triquetrium, Pisiform, Trapezium, Trapezoid, Capitate, Hamate; Radius, Ulna. Interphalangeal joints, Metacarpophalangeal joints, Carpometacarpal joints, Intercarpal joints, Radiocarpal joints.
Projections
Hand, PA
CR Location
Hand, PA – CR perpendicular to IR, directed to third MCP joint
Evaluation Criteria
Hand, PA – Entire hand, wrist and 1 inch of the forearm should be included. Equal concavity of the shafts of the phalanges and metacarpals shows us that there is no rotation. Fingers should be spread apart and joint spaces should be open (indicating correct CR placement).
Hand, Lateral Oblique
CR Location
Hand, Lateral Oblique – CR perpendicular to IR, directed to third MCP joint
Evaluation Criteria
Hand, Lateral Oblique – Entire hand, wrist and 1 inch of the forearm should be included. Fingers should be spread apart. Joint spaces should be open (indicating correct CR placement and that the phalanges are parallel to the image). The heads of the 3rd, 4th, and 5th metacarpals should overlap slightly. The heads of the 2nd and 3rd metacarpals should NOT overlap. (This indicates a proper 45º oblique.)
Hand, Lateral
CR Location
Hand, Lateral – CR perpendicular to IR, directed to second MCP joint
Evaluation Criteria
Hand, Lateral – Entire hand, wrist and 1 inch of the forearm should be included. Fingers should be spread apart. Joint spaces should be open (indicating correct CR placement and that the phalanges are parallel to the image). Distal radius and ulna should be directly superimposed. Metacarpals should be superimposed. (Indicates true lateral position.)
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Hows & Whys of Hand Radiography
- How can you tell that a PA hand is not rotated?
- Equal concavity of the shafts of the phalanxes and metacarpals.
- How can you tell that the hand was flat on the image?
- The joint spaces are open
- How can you tell if the degree of obliquity is correct for an oblique hand?
- Minimal overlap of 3rd, 4th and 5th metacarpals
- Why should the fingers be kept parallel to the image receptor?
- To prevent foreshortening of the phalanges and to open the joint spaces.