Projections

Wrist, PA

CR Location

Wrist, PA – CR perpendicular to IR, directed to midcarpal area

Evaluation Criteria

Wrist, PA – Proximal 1/2 of the metacarpals and distal 1/3 of the radius and ulna are included. Equal concavity of the shafts of the metacarpals and separation of the distal radius and ulna shows us that there is no rotation. near-equal distances exist among the proximal metacarpals; separation of the distal radius and ulna is present except for possible minimal superimposition at the distal radioulnar joint

Wrist, Lateral Oblique

CR Location

Wrist, Lateral Oblique – CR perpendicular to IR, directed to midcarpal area

Evaluation Criteria

Wrist, Lateral Oblique – Proximal 1/2 of the metacarpals and distal 1/3 of the radius and ulna are included. Ulnar head partially superimposed by distal radius; proximal third through fifth metacarpals (metacarpal bases) should appear mostly superimposed (correct obliquity). Trapezium and Scaphoid should be visualized with very little superimposition.

Wrist, Lateral

CR Location

Wrist, Lateral – CR perpendicular to IR, directed to midcarpal area

Evaluation Criteria

Wrist, Lateral – Proximal 1/2 of the metacarpals and distal 1/3 of the radius and ulna are included. Distal radius and ulna should be directly superimposed. Metacarpals 2-5 should be superimposed. (Indicates true lateral position.)

Wrist, PA-Ulnar Deviation

Indication – Possible scaphoid fracture

CR Location

Wrist, PA-Ulnar Deviation – Angle CR 10° to 15° proximally, along long axis of forearm and toward elbow. Center CR to scaphoid at a point 2 cm [34 inch] distal and medial to radial styloid process.

Evaluation Criteria

Wrist, PA-Ulnar Deviation – Proximal 1/2 of the metacarpals and distal 1/3 of the radius and ulna are included. Scaphoid should be demonstrated clearly without foreshortening, with adjacent carpal interspaces open (correct CR angle). Ulnar deviation should be evident by the angle of the long axis of the metacarpals to that of the radius and ulna.

Wrist, PA Axial (Stetcher)

Indication – Possible scaphoid fracture

CR Location

Wrist, PA Axial (Stetcher) – Center CR to scaphoid at a point 2 cm [34 inch] distal and medial to radial styloid process.

Evaluation Criteria

Wrist, PA Axial (Stetcher) – Proximal 1/2 of the metacarpals and distal 1/3 of the radius and ulna are included. Scaphoid should be demonstrated clearly without foreshortening, with adjacent carpal interspaces open (correct CR angle).  Ulnar deviation is evidenced by only minimal, if any, superimposition of distal scaphoid.

Wrist, Tangential Carpal Canal (Gaynor-Hart)

Indication – Possible impingement on the median nerve, Possible fractures of the hamulus process of the hamate, pisiform, and trapezium

CR Location

Wrist, Tangential Carpal Canal (Gaynor-Hart) – Angle CR 25° to 30° to the long axis of the hand. Direct CR to a point 2 to 3 cm (1inch) distal to the base of third metacarpal (center of palm of hand).

Evaluation Criteria

Wrist, Tangential Carpal Canal (Gaynor-Hart) – The pisiform and the hamulus process should be separated and visible in profile without superimposition. • The rounded palmar aspects of the capitate and the scaphoid should be visualized in profile.