Finger and Hand RAD 101 PDF

Finger/Hand Rad 101 References: Bontrager 10th Edition & Positioning and Related Anatomy 11th Edition  Phalanges (Fingers & Thumb) – 14 Hand/Wrist Metacarpals (Palm) – 5 Total Bones Carpals (Wrist) – 8 Total : 27 bones in each hand Phalanges: Fingers &...

Finger/Hand Rad 101 References: Bontrager 10th Edition & Positioning and Related Anatomy 11th Edition  Phalanges (Fingers & Thumb) – 14 Hand/Wrist Metacarpals (Palm) – 5 Total Bones Carpals (Wrist) – 8 Total : 27 bones in each hand Phalanges: Fingers & Thumb (Digits) Each finger and thumb is known as a – Digit Each digit consists of 2 or 3 separate bones called phalanges (Singular - phalanx) Numbered 1-5 Thumb = 1 Little finger = 5 Digits 2, 3, 4, & 5 Composed of 3 phalanges Proximal Middle Distal Hmm… What does proximal and distal mean?  Special name for thumb? Digit 1 (Thumb) Made of 2 phalanges Proximal Distal Phalanx 3 parts Head Body (shaft) Base Metacarpals Make up the palm of the hand 5 Metacarpals in each hand Number the same as the digits 3 parts Head – Distal round portion Body (Shaft) – Long curved portion Anterior has concave shape Posterior is convex Base – Expanded proximal end articulates with carpals Carpals Make up the wrist 8 total carpals in each wrist All have specific names D A Practice Labeling Anatomy on X-ray A - ________________ B B - ________________ C - ________________ C https://www.healthpages.org/wp-content/uploads/hand-x-ray.jpg D – Sesamoid bone(s) 1st Digit - Joints Interphalangeal (IP) Joint: Located between the proximal and distal phalanges 1st metacarpophalangeal (MCP) Joint: Located between the proximal phalanx and 1st metacarpal 1st Carpometacarpal (CMC) Joint: Located between the proximal metacarpal and the associated carpal *When x-raying the Thumb, you must include the 1st Metacarpal & Trapezium (carpal articulating with 1st metacarpal) 2nd – 5th Digits - Joints Distal Interphalangeal (DIP) Joint: Located between the distal and middle phalanges Proximal interphalangeal (PIP) Joint: Located between the middle and proximal phalanges Metacarpophalangeal (MCP) Joint: Located between the proximal phalanx and the distal metacarpal *When x-raying the 2-5th digit you only need to include through the MCP joint F Practice labeling anatomy on X-ray A -________________ B -_________________ C -_________________ D -_________________ E -_________________ F -_________________  Practice labeling anatomy on X-ray G -______________________ H -______________________ I -_______________________ J -_______________________ K -_______________________ L -_______________________  Practice labeling anatomy on X-ray (Parts of the Phalanx) A A - ________________ B B - ________________ C - ________________ C  Typically performed with patient seated sideways at end of table General Height of tabletop should be near Positioning shoulder height, so arm is fully Considerations supported 40 SID Trauma Patients X-rays can be completed with patient on stretcher Pediatric Patients Patient motion Immobilization needed to help assist children Sponges and tape are useful Utilize parents Speak in soothing manner in a language a child can understand Geriatric Applications Provide Clear and Complete instructions May have difficulty holding strenuous potions Reduce techniques - osteoporosis Exposure Factors Lower to medium kVp (60-80) Short exposure time Small focal spot Correctly exposed images of the upper limbs should reveal soft tissue margins for fat pad visualization and fine trabecular markings of all bones being radiographed Grids not used unless body part is greater than 10cm  Collimate down – without cutting off essential anatomy Collimation, Positioning, General rule regarding IR size – select smallest and Markers IR for the part being imaged Positioning rule: always place the long axis of the part being imaged parallel to the long axis of the portion of the IR being exposed Correct marker should be demonstrated on each image  Clinical Indications Dislocation: displacement from joint Fractures: Bennett fx: fracture through base of the first metacarpal bone, extending into the CMC joint with subluxation w/ posterior displacement Boxer fx: Transverse fx that extends through the metacarpal neck – most commonly seen on 5th metacarpal Skier’s thumb: sprain or tear of the ulnar collateral ligament of the thumb near the MCP joint of the hyperextended thumb Occurs from falling on outstretched arm and hand – thumb bends back toward hand Osteoarthritis: AKA degenerative joint disease Most common type of arthritis Considered normal in the aging process Rheumatoid Arthritis: Chronic systemic disease with inflammatory changes throughout connective tissues 3x more common in women than men Osteoporosis: reduction in the quantity of bone or atrophy of skeletal tissue Occurs in postmenopausal women and elderly men Results in bone trabeculae that are scanty and thin Foreign Objects  Routine Views: Positioning 1st Digit AP PA oblique Lateral AP projection – 1st digit 40 SID No Grid Smallest IR available Arm extended in front Rotate arm internally to supinate thumb Align thumb with long axis of IR CR – 1st MCP joint Exception - PA Projection If patient is unable to be positioned for AP 40 SID Place hand in near-lateral position Rest thumb on sponge support block that is high enough to keep thumb from rotating CR- 1st MCP joint *PA is not advisable b/c of loss of definition caused by increased OID  AP Projection 1st Digit Evaluation Criteria Entire thumb demonstrated (including first CMC joint) Center field at first MCP joint No rotation of phalanges Exposure factors PA oblique projection – 1st digit 40 SID Smallest IR size available No Grid Abduct thumb slightly with palmar surface of hand in contact with IR This naturally places thumb in 45˚ oblique CR – 1st MCP joint PA Oblique 1st Digit Evaluation Criteria Entire thumb demonstrated Joints partially open as in 45° oblique Center of field at first MCP joint Exposure factors Lateral Projection – 1st digit 40 SID Smallest IR Size No Grid Start with hand pronated and thumb abducted Fingers slightly arched Medial rotate hand slightly till thumb is in true lateral position CR – 1st MCP joint Lateral 1st digit Evaluation Criteria Entire thumb demonstrated Center of field at first MCP joint No rotation from lateral evident Exposure factors Positioning Fingers/Digits 2-5 Routine Views: PA PA oblique Lateral PA Projection – Fingers 2-5 40 SID No Grid Smallest IR available Pronate hand with fingers extended Center and align long axis of affected finger with long axis of IR CR perpendicular to IR directed at PIP joint Recommended collimation: Collimate on four sides to area of affected finger and distal aspect of metacarpal PA 4th Digit Evaluation Criteria Entire finger and minimum ⅓ of MCP demonstrated Center field at PIP joint No rotation of phalanges Exposure factors PA Oblique Projection – 2-5th digits 40 SID No Grid With fingers extended rotate hand laterally 45˚ - 3rd – 5th digit Separate fingers and carefully finger that is being examined against block CR – PIP Joint *2nd digit – Rotate medially 45˚- other fingers flexed to prevent superimposition PA Oblique 4th digit Evaluation Criteria Entire phalanx and MCP joint demonstrated IP and MCP joints open Center field at PIP Exposure factors Lateral Projections – 2-5th Digits 40 SID No Grid CR – PIP Joint Lateromedial: 3-5th digit Place hand in lateral position (thumb side up) with finger to be examined fully extended Flex unaffected fingers Finger is parallel to IR Mediolateral: 2nd digit Rotate hand medially till thumb side is down and second digit is touching IR Flex unaffected fingers Lateral 4th digit Evaluation Criteria Entire phalanx and MCP joint demonstrated Center field at PIP True lateral position Digit parallel to IR Exposure factors  Routine Views Positioning PA Hand PA Oblique Lateral “Fan” PA Projection - Hand 40 SID No grid Pronate hand with palmar surface on IR Spread fingers slightly CR – 3rd MCP Joint PA Hand Evaluation Criteria Entire hand and carpals demonstrated Center of field at third MCP joint No rotation of phalanges or metacarpals Exposure factors PA Oblique Projection - Hand 40 SID No Grid Pronate hand on IR Rotate entire hand and wrist laterally 45˚ with digits parallel to IR (support with radiolucent sponge if necessary) Separate all digits CR – 3rd MCP Joint *Only allow thumb & fingertips to touch IR if digits are not of interest -Why? How was the patient positioned? Evaluation Criteria Entire hand and carpals demonstrated Center of field at third MCP joint Joints open Adequate separation of phalanges and metacarpals Exposure factors “Fan” Lateral Projection - Hand 40 SID No Grid Rotate hand and wrist into lateral position with thumb side up Spread fingers and thumb into a “fan” position You can use a radiolucent sponge to support fingers Ensure all digits are parallel to IR CR – 2nd MCP Joint *Preferred lateral if phalanges are of interest  “Fan” Lateral - Hand Evaluation Criteria Entire hand and carpals demonstrated Center of field at second MCP joint Fingers equally separated Exposure factors