Hand Anatomy Quiz

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Questions and Answers

How many phalanges does each thumb (1st digit) consist of?

2 (correct)

What is the total number of bones in each hand?

27 (correct)

Which joint is located between the proximal and distal phalanges of the thumb?

Interphalangeal Joint (correct)

Carpometacarpal Joint

Metacarpophalangeal Joint

Distal Interphalangeal Joint

What is the correct term for the individual bones of the fingers and thumb?

Phalanges Signup and view all the answers

How many metacarpals are there in each hand?

5 Signup and view all the answers

Which part of the phalanx is referred to as the 'shaft'?

Body Signup and view all the answers

What are the three parts of a metacarpal bone?

Head, Body, Base Signup and view all the answers

How many carpals are present in each wrist?

8 Signup and view all the answers

What is the recommended height for the tabletop during positioning considerations?

Near shoulder height Signup and view all the answers

What should be utilized to assist pediatric patients during imaging procedures?

Parents and soothing language Signup and view all the answers

Which of the following is a common clinical indication for an imaging procedure?

Dislocation Signup and view all the answers

What type of fracture is described as a fracture through the base of the first metacarpal with posterior displacement?

Bennett fracture Signup and view all the answers

Which imaging exposure factor setting is most appropriate for upper limb imaging?

Medium kVp (60-80) Signup and view all the answers

What is an important detail regarding collimation during imaging?

Select the smallest IR for the part being imaged Signup and view all the answers

For geriatric patients, what should be considered in imaging procedures?

Clear and complete instructions Signup and view all the answers

Osteoporosis is characterized by which of the following?

Reduction in bone quantity Signup and view all the answers

Which condition is known as degenerative joint disease?

Osteoarthritis Signup and view all the answers

What type of fracture is commonly seen in the 5th metacarpal?

Boxer fracture Signup and view all the answers

Which joint is located between the distal and middle phalanges?

Distal Interphalangeal (DIP) Joint Signup and view all the answers

What must be included when x-raying the thumb?

1st Metacarpal and Trapezium Signup and view all the answers

Which joint connects the proximal phalanx and the distal metacarpal?

Metacarpophalangeal (MCP) Joint Signup and view all the answers

What is the main purpose of an X-ray of the 2nd to 5th digits?

To include only through the MCP joint Signup and view all the answers

Which of the following is NOT a joint in the hand?

Intercarpal Joint Signup and view all the answers

The PIP Joint is located between which two phalanges?

Middle and Proximal Phalanges Signup and view all the answers

Which anatomical structure articulates with the 1st metacarpal?

Trapezium Signup and view all the answers

Which digit is typically included when x-raying to visualize the MCP joint?

2nd to 5th digits Signup and view all the answers

What is the role of the carpometacarpal (CMC) joint?

Facilitates thumb opposition Signup and view all the answers

What is the anatomical order of joints from distal to proximal in the fingers?

DIP, PIP, MCP Signup and view all the answers

What is the correct positioning for a lateral projection of the 2nd digit?

Hand with thumb side up and digit fully extended Signup and view all the answers

In a PA projection of the hand, which factor is essential to ensure proper imaging?

Centering the field at the 3rd MCP Joint Signup and view all the answers

What must be true for the evaluation criteria of a lateral projection of the 4th digit?

The entire phalanx and MCP joint must be demonstrated Signup and view all the answers

What is the advised degree of rotation for a PA Oblique projection of the hand?

45 degrees laterally Signup and view all the answers

In the lateral projection of the 3rd to 5th digits, which positioning aspect is critical?

Keeping the digit parallel to the IR Signup and view all the answers

What is the primary positioning requirement for the AP projection of the 1st digit?

Arm extended in front, thumb aligned with IR Signup and view all the answers

What is the consequence of using a PA projection for the first digit?

Loss of definition due to increased OID Signup and view all the answers

In a PA oblique projection of the 1st digit, how is the thumb positioned?

Abducted slightly with palm on IR Signup and view all the answers

Which criterion is essential for evaluating a lateral projection of the 1st digit?

No rotation of phalanges is evident Signup and view all the answers

When performing a PA projection for fingers 2-5, what is the direction of the CR?

Perpendicular to the IR at the PIP joint Signup and view all the answers

What should be done to separate fingers during a PA oblique projection for digits 3-5?

Rotate the hand laterally 45˚ Signup and view all the answers

What is the minimum requirement for collimation when performing a PA projection for fingers?

Collimate on four sides to the affected area Signup and view all the answers

What must be ensured to obtain a properly evaluated PA oblique projection of the 1st digit?

The entire finger should be demonstrated with joints partially open Signup and view all the answers

What should be done to the fingers during the lateral projection for the 1st digit?

Fingers must be slightly arched Signup and view all the answers

How should the arm be positioned for the PA projection of the 1st digit?

Arm extended in front with thumb aligned Signup and view all the answers

What is the shape of the pisiform carpal bone?

Pea-shaped Signup and view all the answers

Which carpal bone is located anterior to the triquetrum?

Pisiform Signup and view all the answers

Which of these carpal bones is the largest?

Capitate Signup and view all the answers

Which carpal bone is described as the smallest in the distal row?

Trapezoid Signup and view all the answers

What is the anatomical classification of the trapezium carpal bone?

Proximal to the first metacarpal Signup and view all the answers

Which wrist fracture involves a fracture and dislocation of the posterior lip of the distal radius?

Barton fracture Signup and view all the answers

What is the correct positioning of the hand for a PA projection of the wrist?

Hand pronated with fingers curled Signup and view all the answers

For which type of cast is an increase of 8-10 kVp recommended?

Large plaster cast Signup and view all the answers

Which carpal bone is best demonstrated during radial deviation?

Hamate Signup and view all the answers

What is the clinical indication for the PA oblique wrist projection?

Evaluating fractures of distal radius or ulna Signup and view all the answers

What is the proper central ray (CR) location for a lateral wrist projection?

At the midcarpal area Signup and view all the answers

In a lateral wrist position, which evaluation criteria should be met regarding the ulnar head?

The ulnar head should be superimposed over the distal radius Signup and view all the answers

Which of the following conditions is indicated for imaging using a lateral wrist projection?

Barton fracture Signup and view all the answers

What is the correct way to position the hand for the lateral projection?

In a true lateral position with a karate chop stance Signup and view all the answers

What degree should the hand/wrist be rotated laterally during the projection?

45 degrees Signup and view all the answers

What is the purpose of using the Gaynor Hart method for imaging?

Evaluating the carpal tunnel for abnormalities Signup and view all the answers

Which angle is used for the CR when performing the Gaynor Hart projection?

25-30 degrees Signup and view all the answers

During the Gaynor Hart projection, how should the wrist be positioned?

Hyperextended as far as possible Signup and view all the answers

Which anatomical structure is important in separating and visualizing during the Gaynor Hart projection?

Pisiform and hamulus process Signup and view all the answers

Where is the CR directed in relation to the base of the third metacarpal?

1 inch distal Signup and view all the answers

Which of the following is located on the lateral aspect of the proximal ulna?

Radial notch Signup and view all the answers

What structure fits into the ulnar notch to form the distal radioulnar joint?

Head of ulna Signup and view all the answers

What is the main clinical indication for performing a sonography in relation to the carpal tunnel?

Assessment of median nerve impingement Signup and view all the answers

Which clinical indication would require a PA and PA Axial Scaphoid projection?

Potential scaphoid fracture Signup and view all the answers

What is the correct CR angle for a PA Axial projection to visualize the scaphoid?

10-15 degrees proximally Signup and view all the answers

For a PA Projection with Radial Deviation, which structure is primarily assessed?

Fractures of the carpals on the ulnar side Signup and view all the answers

In the Modified Stecher Method, which specific positioning detail is emphasized?

The hand must be elevated on a 20-degree sponge Signup and view all the answers

What is the main purpose of using ulnar deviation in hand imaging?

To better visualize the scaphoid bone Signup and view all the answers

Which view is likely required if a scaphoid fracture is not clearly visible after standard projections?

Four-projection series with varying CR angles Signup and view all the answers

What should be ensured before proceeding with imaging if a patient has possible wrist trauma?

A routine series must be completed to rule out fractures Signup and view all the answers

When the hand is positioned for a PA Scaphoid projection, how should the hand be oriented?

Palm down and elevated on a sponge Signup and view all the answers

Study Notes

Hand Anatomy

27 Bones: Each hand has 27 bones:
- Phalanges (Fingers & Thumb): 14
- Metacarpals (Palm): 5
- Carpals (Wrist): 8

Phalanges: Fingers & Thumb

Digits: Each finger and thumb is a digit.
Phalanges: Each digit has 2 or 3 phalanges (bones):
- Proximal: Closest to the palm
- Middle: Middle bone in fingers 2-5
- Distal: Farthest from the palm
- Thumb: Has only proximal & distal phalanges

Metacarpals

Palm: Form the palm of the hand.
Numbered 1-5: Corresponds to digits.
3 Parts:
- Head: Distal end that connects to phalanges.
- Body: Curved middle part.
- Base: Proximal end that connects to carpals.

Carpals

Wrist: Form the wrist bones .
8 Total: Each wrist has 8 carpals, each with a specific name.

Joints

Interphalangeal (IP) Joint: Between phalanges.
Metacarpophalangeal (MCP) Joint: Between phalanges and metacarpals.
Carpometacarpal (CMC) Joint: Between metacarpals and carpals.

General Positioning Considerations

Sideways: Patient seated sideways at the end of the table.
Shoulder Height: Table height should be near shoulder height for support.
SID (Source to Image Distance): 40 inches.

Trauma Patients

Stretcher: X-rays can be done on a stretcher.

Pediatric Patients

Motion: Immobilization is key for children.
Sponges & Tape: Use sponges and tape to help.
Parents: Involve parents for assistance.
Child Language: Speak clearly and in a language a child can understand.

Geriatric Patients

Clear Instructions: Provide clear and complete instructions.
Strenuous Positions: Patients may have difficulty holding strenuous positions.
Reduce Techniques: Reduce technique due to potential osteoporosis.

Exposure Factors

kVp: 60-80 kVp (lower to medium).
Short Exposure Time: To minimize motion blur.
Small Focal Spot: For sharper images.
Soft Tissue Margins & Trabecular Markings: Images should show these details.
Grids: Not used unless the body part is greater than 10 cm.

Collimation, Positioning & Markers

Collimation: Collimate down to the area of interest.
IR Size: Use the smallest IR size possible.
Long Axis: Align the long axis of the part being imaged parallel to the long axis of the IR.
Markers: Use correct markers on each image.

Clinical Indications

Dislocation: Displacement of a bone from its joint.
Fractures: Broken bones.
- Bennett's Fracture: Fracture of the base of the first metacarpal.
- Boxer's Fracture: Transverse fracture of the metacarpal neck.
- Skier's Thumb: Sprain or tear of the thumb ligament.
Osteoarthritis: Degenerative joint disease.
Rheumatoid Arthritis: Chronic inflammatory disease affecting connective tissues.
Osteoporosis: Reduced bone density.
Foreign Objects: Presence of foreign objects in the hand.

Positioning: 1st Digit (Thumb)

Routine Views: AP, PA Oblique, Lateral.

AP Projection - 1st Digit

SID: 40 inches.
Grid: No grid.
IR: Smallest IR available.
Position: Arm extended and thumb aligned with the IR.
CR: 1st MCP joint.

PA Projection - 1st Digit

Alternate View: When AP is not possible.
SID: 40 inches.
Position: Hand in near-lateral position, thumb resting on a sponge support block.
CR: 1st MCP joint.

PA Oblique Projection - 1st Digit

SID: 40 inches.
Grid: No grid.
IR: Smallest IR size available.
Position: Thumb abducted slightly and resting on the IR.
CR: 1st MCP joint.

Lateral Projection - 1st Digit

SID: 40 inches.
Grid: No grid.
IR: Smallest IR size available.
Position: Hand pronated and thumb abducted, then rotated into a true lateral position.
CR: 1st MCP joint.

Positioning: Fingers 2-5

Routine Views: PA, PA Oblique, Lateral.

PA Projection - Fingers 2-5

SID: 40 inches.
Grid: No grid.
IR: Smallest IR available.
Position: Hand pronated, fingers extended, affected finger aligned with IR long axis.
CR: PIP joint.

PA Oblique Projection - Fingers 2-5

SID: 40 inches.
Grid: No grid.
Position:
- Fingers 3-5: Rotate hand laterally 45 degrees.
- Finger 2: Rotate hand medially 45 degrees.
CR: PIP joint

Lateral Projection - Fingers 2-5

SID: 40 inches.
Grid: No grid.
Position: Hand in lateral position (thumb up) for fingers 3-5. Hand rotated medially (thumb down) for finger 2.
CR: PIP joint

Positioning: Hand

Routine Views: PA, PA Oblique, Lateral “Fan”.

PA Projection - Hand

SID: 40 inches.
Grid: No grid.
Position: Hand pronated, fingers slightly spread.
CR: 3rd MCP joint.

PA Oblique Projection - Hand

SID: 40 inches.
Grid: No grid.
Position: Rotate hand laterally 45 degrees, fingers parallel to IR.
CR: 3rd MCP joint.

Radial Deviation

Less common than ulnar deviation
Best for visualizing the hamate, pisiform, triquetrum, and lunate bones

Common Wrist Fractures

Barton: fracture and dislocation of the posterior lip of the distal radius involving the wrist joint.
Colles: transverse fracture of the distal radius with the distal fragment displaced posteriorly.
Smith: a reverse Colles fracture, transverse fracture of the distal radius with the distal fragment displaced anteriorly.

Radiographic Positioning

Patient's arm and shoulder should be on the same plane.
Remove jewelry.
Use 40 SID.
Increase kVp for plaster casts: 5-7 kVp for small to medium; 8-10 kVp for large.
Increase kVp for fiberglass casts: 3-4 kVp.

Routine Projections:

PA
Lateral
Oblique

PA - Wrist

Clinical Indications:
- Fractures of the distal radius or ulna.
- Isolated fractures of radial or ulnar styloid processes.
- Fractures of individual carpal bones.
40 SID
Align the long axis of the hand and wrist to the IR.
Pronate the hand.
Curl fingers to place wrist and carpal area in close contact with the IR.
CR at the midcarpal area.

Alternative AP - Wrist

Clinical Indications:
- Fractures of the distal radius or ulna.
- Isolated fractures of radial or ulnar styloid processes.
- Fractures of individual carpal bones.
40 SID
Align the long axis of the hand and wrist to the IR.
Hand supinated, fingers curled to place wrist and carpals close to the IR.
Best demonstrates intercarpal spaces and carpals.
CR at the midcarpal area.

PA Oblique - Wrist

Clinical Indications:
- Fractures of the distal radius or ulna
- Isolated fractures of radial or ulnar styloid processes
- Fractures of individual carpal bones.
- 40 SID
Pronate the hand then rotate hand/ wrist laterally 45˚
CR at the midcarpal area.

Distal Row Carpal Bones

Trapezium: Located medial and distal to the scaphoid, proximal to the first metacarpal
Trapezoid: Smallest bone in the distal row
Capitate: Largest of all the carpal bones.

Lateral - Wrist

40 SID
Hand and wrist placed in true lateral position (karate chop)
CR – Midcarpal area
Evaluation Criteria: the ulnar head should be superimposed over the distal radius, proximal second through fifth metacarpals should be superimposed.

Scaphoid Projections

CR angle with ulnar deviation
Modified Stecher Method
Radial Deviation
Gaynor Hart

PA and PA Axial Scaphoid – With Ulnar Deviation- Wrist

Clinical Indication: Possible scaphoid fracture
40 SID
Position for a PA wrist
Without moving forearm gently evert hand toward ulnar side as far as patient can tolerate.
PA – CR @ scaphoid (3/4 in distal and medial to radial styloid process)
PA Axial – CR angled 10-15˚ proximally (toward elbow), directed at scaphoid

Evaluation Criteria – PA Axial Scaphoid

Scaphoid clearly seen without superimposition
Scaphoid not foreshortened

PA Scaphoid – Hand elevated and ulnar deviation (Modified Stecher Method)

Clinical Indication: Possible scaphoid fracture
40 SID
Place hand and wrist palm down on IR with hand elevated on a 20˚ sponge.
Ensure wrist is in direct contact with IR.
Gently evert or turn hand outward (toward ulnar side)
CR perpendicular to IR and directed to the scaphoid.

PA Projection - Radial Deviation - Wrist

Clinical Indications: possible fractures of the carpals on the ulnar side (lunate, triquetrum, pisiform, and hamate)
40 SID
Position for a PA wrist.
Gently invert hand toward thumb side.
CR perpendicular to IR, directed to the midcarpal area.

Carpal Canal (tunnel) Tangential, Inferosuperior Projection (Gaynor Hart Method)

Clinical Indications: Rule out abnormal calcification & bony changes in the carpal sulcus that may impinge on the median nerve, as with carpal tunnel syndrome. Possible fractures of the hamulus process of the hamate, pisiform, and trapezium.
40 SID
Ask patient to hyperextend wrist (dorsiflex) as far as possible.
Internally rotate the hand & wrist 10 degrees.
CR angled 25-30˚ proximally, directed to 1in distal to base of third metacarpal (center of palm).

Evaluation Criteria – Gaynor Hart

Carpals are demonstrated in a tunnel-like, arched arrangement
Pisiform and hamulus process should be separated and visible

Forearm Anatomy

Styloid process: Located on both distal ends of the radius and ulna.
Ulnar notch: Small depression on the medial aspect of the distal radius.
Head of Ulna: Located on the distal end of the ulna, fits in the ulnar notch to form the distal radioulnar joint.
Radius: Body (shaft)
Ulna: Body (shaft)
Radius: Head, Neck, Radial tuberosity
Ulna: Olecranon process, Coronoid tubercle, Trochlear notch (semilunar notch), Radial notch

Forearm Rotational Movements

The forearm is routinely positioned AP with the hand supinated.

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Description

Test your knowledge on the anatomy of the hand, including the bones of the fingers, palm, and wrist. This quiz covers the 27 bones that make up each hand and the structure and function of the joints. Challenge yourself to recall the names and functions of the phalanges, metacarpals, and carpals.