RADIOGRAPHY OF THE WRIST

Transcription

1 RADIOGRAPHY OF THE WRIST

2 Patient Position: WRIST PA Projection, elbow in same plane Part Position: Hand ; fingers centered to IR

3 Central Ray: Structures Shown:

4 NOTE: Optional AP projection best demonstrates the.

5 PA Wrist Criteria for Evaluation The long axis of the hand and wrist are aligned with the. The radius and ulna are, the distal radioulnar joint is The is demonstrated There is equal on each side of the The navicular is The trapezoid is

6 Fat Stripe

7 PA Wrist Error: the hand and wrist are not, the distal radioulnar joint, the metacarpals are. Correction:

8 PA Wrist Error: fingers, centered. Correction: phalanges, don t, center to.

9 WRIST PA Oblique Projection Patient Position:, elbow Hand and forearm resting Shoulder, elbow and wrist are Part Position: From pronated position, rotate wrist to form º angle with IR Wrist in

10 Central Ray: to Structures Shown:

11 PA Oblique Wrist Criteria for Evaluation The trapezium and should be demonstrated The of the scaphoid should be demonstrated. The medial carpals are. The ulnar styloid should be in The long axes of the 3 rd metacarpal and midforearm should be aligned with the long axis of the collimated field.

12 Oblique wrist Error: Wrist is To correct: oblique wrist by rotating it until it forms a degree angle with IR.

13 Oblique wrist Error: Wrist is. To correct: oblique wrist by rotating it until it forms a degree angle with IR.

14 Oblique wrist Error: The long axes of the are not aligned. To correct; The forearm and metacarpals and carpals need to be.

15 WRIST AP Oblique Projection Patient Position: Forearm in position Part Position: From supine position, rotate wrist to form a º angle with IR Wrist in

16 Central Ray: to midcarpal area Structures Shown:

17 Patient Position: WRIST Lateral Projection, elbow Entire plane Part Position: The aspect of arm is adjacent to the IR Wrist (distal radius and ulna ) centered to IR

18 Central Ray: to midcarpal area Structures Shown:

19 Lateral Wrist Criteria for Evaluation The distal end of the scaphoid and the should be. The radius and ulna should be superimposed. The anterior (pronator) fat stripe should be seen.

20 Fat Stripe

21 There of the wrist. The long axis of the first metacarpal should be The ulnar styloid should be demonstrated in. The joint space between the trapezium and the base of the 1 st metacapral should be

22 Lateral wrist Error: if the wrist is rotated internally, the distal scaphoid is visible to the and the radius is to the ulna. Correction need to rotate wrist. Good image

23 Lateral wrist Error the of the first metacarpal is not with the. To correct: Align the long axis of the 1 st metacarpal parallel with the midforearm

24 Lateral wrist Error The joint space between the is. To correct place the on the same level as the

25 WRIST PA and PA Axial Projections for Scaphoid in Ulnar Deviation/Ulnar Flexion Patient Position: in same plane Part Position: Hand hand (turn ), flexed toward Note: With severe pain,.

26 Central Ray: Centered to PA: PA Axial: Proximally -, ( to scaphoid)

27 Structures Shown: Scaphoid ; carpal interspaces on ( ) side of wrist. of scaphoid demonstrated. PA Projection PA Ulnar deviation

28 PA Axial for Scaphoid Modified Stecher Methods Wrist positioned as for a Variations: 1. Hand in flexion; elevated on sponge; CR º ( ) to IR

29 2. Wrist ( ); CR angled proximally º (toward the ) projection

30 3. Power Grip ; hand and in a ; CR is º ( ) to IR

31 WRIST PA Projection in Radial Flexion/Radial Deviation Patient Position:, elbow in same plane Part Position: Hand hand (turn ), flexed toward

32 Central Ray: area Structures Shown:

33 CARPAL CANAL (TUNNEL) Method Tangential Projection Inferosuperior Projection: Wrist is ( ) with long axis of hand as ; rotate hand ; forearm ; central ray angled º- º to long axis of hand

34 Superoinferior Projection: Wrist is dorsiflexed with ; patient leans forward to place in ; CR is º to IR

35 Structures Shown:

36 CARPAL BRIDGE Tangential Projection Original Method: Hand lies palm on IR; hand forms. Central Ray: CR angled º to long axis of forearm ; proximal to wrist joint

37 Modified Method: Forearm on support device; wrist to right angle; IR placed against Central Ray: CR angled º to long axis of forearm ; proximal to wrist joint

38 Structures Shown:

39 Patient Position: FOREARM AP Projection in same plane Part Position: Hand in ; patient Centered to Humeral epicondyles

40 Central Ray: to midpoint of forearm Structures Shown:

41 AP Forearm Criteria for Evaluation The radial head should be superimposed over the. Epicondyles of the should be seen in. The radius and ulna. The radial styloid process should be.

42 AP forearm Error; rotation. To correct: Place in position. hand so humeral epicondyles and to IR

43 AP forearm Error: Distal forearm is the bones are and the humeral epicondyles are. To correct:

44 FOREARM Lateral Projection Patient in same plane Part Position: Elbow º; centered to IR Hand and wrist in position Distal radius and ulna Humeral epicondyles

45 Central Ray: Structures Shown:

46 Lateral Forearm Criteria for Evaluation The radius and ulna should be. The elbow joint space should be, and the head of the radius should be over the. Humeral epicondyles should be and to the IR. Distal humerus is in a

47 Lateral forearm Error: Incorrect alignment of. To correct: rotate the until they are in the true lateral position.

48 Lateral forearm Error: incorrect alignment of. To correct; the proximal humerus until epicondyles are of the humerus are with the IR. Flex the elbow degrees. Enlarged view

49 Situation: A radiograph of a tangential, inferosuperior projection of the carpal canal reveal that the hamate is superimposed over the pisiform. Solution: Repeat the exposure rotating the.

50 Situation: A patient enters the ER with a possible scaphoid fracture. The patient is unable to assume the ulnar flexion position. Solution: A position with the CR angled 20 toward the elbow could be performed to confirm a scaphoid fracture.

51 Situation: A patient with a history of carpal tunnel syndrome comes to radiology. The physician wants to rule out abnormal calcifications in the carpal canal. Solution: The method would best demonstrate this region.

52 Situation: A radiograph of the PA scaphoid projection in ulnar flexion reveals extensive superimposition of the scaphoid and adjacent carpals. Solution: Insufficient ulnar can lead to this problem.