Upper Extremityfingers (digits) & hand

RTEC 123 # 1 A LECTURE

Contributions by:MOSBY – MERRILLS & BONTAGER

XRAY2000.CO.UK rev 10/10/11

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ANATOMY REVIEWUPPER EXT : FINGERS/ HAND

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Anatomy &Positioning Review

Upper Limb

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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

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LEFT LATERAL POSITION – LT LATERAL PROJECTION

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RIGHT LATERAL POSITION – RT LATERAL PROJECTION

Lateromedial mediolateral

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FINGERS “series”

• PA FINGER (PA HAND)

• OBLIQUE *

• LATERAL

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

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FINGER “series”

PA OBL LATERAL 13

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DO NOT PLACE PATIENT’S LEGS UNDER THE TABLE 15

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WHICH DIGIT?

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LATERAL MEDIAL ROTATION 19

? Which rotation is this?

20PA oblique - medial rotation

YES NOKeep fingers // to IR

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THUMB (1ST DIGIT)

• PA / AP

• PA OBLIQUE

• LATERAL

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PA

AP

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OBLIQUE

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LATERAL

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HAND Series (3vw or 4*vw)

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

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HAND Series

• Re: LATERAL • MEDIOLATERAL OR

• LATEROMEDIAL

• FAN /TRUE LATERAL/ FLEXION

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

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HAND Series

• Re: LATERAL • MEDIOLATERAL OR

• LATEROMEDIAL P 128

• FAN /TRUE LATERAL/ FLEXION

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Projection ?

Alternate lateral (FB)

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AP OBLIQUE OPENS SPACES BETWEEN

4TH & 5TH mc

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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)

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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

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Compare :OBLIQUE OF RT HANDPA & AP

What anatomy is seen specific to each position?

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BILATERAL AP OBLIQUES

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For Arthritis “ballcatchers”

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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

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Reduce OID, magnification

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PATHOLOGYFOR UPPER EXTREMITY 1

SEE CHART PG 109

Bone cyst

Bursitis

Fractures /Dislocations

Joint effusion

Osteoporosis

Rheumatoid Arthritis66

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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

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OSTEOSARCOMA

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Bennett’s FX

fx at base of 1st MC

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Mutilating rheumatoid arthritis.

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RHEUMATOID ARTHRITIS

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Rheumatoid arthritis

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RA - inflammatory disease

3x more common in females

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Osteoarthritis of fingers. Note narrowing of

interphalangeal joints with spurring and erosions

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OA - Non inflammatory joint disease involves the articular cartilage – Aging /erosion

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BOXER’S FX

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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

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What abnormality do you see?

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G S W

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www.rad.washington.edu

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QUESTIONS ?

End of Upper Extremity #1

Wrist will be covered if there is time …

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