Hand Projections PDF

# Hand Projections ## **Hand Projection** - Hand Palmar surface down; - spread finger slightly ## **AP Projection** - cannot do PA; due to pathologic condition and injury ## **Clements-Nakayama** - Detecting early Rheumatoid Arthritis ## **PA Oblique Projection (Lateral Rotation)** - Hand Pron...

# Hand Projections ## **Hand Projection** - Hand Palmar surface down; - spread finger slightly ## **AP Projection** - cannot do PA; due to pathologic condition and injury ## **Clements-Nakayama** - Detecting early Rheumatoid Arthritis ## **PA Oblique Projection (Lateral Rotation)** - Hand Pronated, rotated laterally; - Palmar surface down; - MCP jt 45° to IR (nakaangat ang Knuckles) ## **PA of:** - Carpals - Metacarpals - 2nd-5th Phalanges ## **Thumb - PA Oblique** ## **Interphalangeal Joint** - For Metacarpal bones - Opens Joints spaces - Reduces the degree of Foreshortening of phalanges ## **45º Foam wedge** - Fingertips touching the cassette - Index Finger Elevation ## **PA ProT Hand** - 2nd–5th PA projection ## **Metacarpal Bones** - MCP Jt. ## **To Investigate Fracture and Pathologic Condition** ## **Reverse oblique projection (Lane, kennedy & Kushner)** - Medial Rotation ## **Tangential Oblique Projection (Ikällen Recommendation)** - From hand PA position, - MCP Jt 75-80; dorsum of digits rest on IR - Hand rotated 40-45° toward the ulnar surface ## **Hand Rotate 45° medially (internally)** ## **MCP Jt of interest** - For severe metacarpal deformities ## **To Demonstrate Metacarpal head Fractures (Knuckles)** ## **Lateral Projection** - Extension, lateromedial, Fan Lateral, Lewis recommendation - Flexion, mediolateral ### **(In Extension)** - Hand in Lat position digits extended - Thumb 90° to the palm - Ulnar aspect down ### **(Lateromedial)** - Radial aspect down; (difficult to do) ### **(Medio lateral)** ## **2nd MCP Jt** ### **Lateral Proj of the hand in extension** - Cons: superimposition of Phalanges - Pros: Localize Foreign bodies Metacarpal FX displacement ### **5th MCP jt** ## **In extension, latero-medial** - Medio attral - Fig 4-60 Lateral hand with radial surface to IR: mediolateral ## **Fan Lateral (modification of the lateral hand)** ## **In Flexion (Latero Medial)** - Hand in natural arch; digits relaxed - C shaped hand ## **2nd MCP Jt** - Lateral proj of hand in Flexion (superimposed) ## **Eliminates superimposition of all phalanges (except proximal) Phalanges** ## **Demonstrate anterior or posterior displacement in Fractures of Metacarpals** ## **LEWIS Recommendation** - Hand From true Lateral position; - Rotate hand 5° Posteriorly to remove superimposition of 2nd-4th metacarpals - Thumb extended ## **Midshaft of 5th metacarpal** ## **To Better Demonstrate Fracture of 5th metacarpal** ## **Fx: Boxer's Fx (Bar Room)** ## **Norgaard Method AP oblique Projection (Medial rotation) Ball catcher's position** - Both hands supinated? medially rotated; medial aspect against the IR; - 45° sponge support ## **b/n level 1 of 5th MCP Jt of both hands** ## **AP oblique 45° projection of both hands** ## **Stapczynski Recommended** - AP oblique projection demonstrate fractures of the base of the 5th metacarpal ## **Brewerton - Unilateral of ball catcher; evaluate erosive changes** - AP axial - Base 1 head metacarpal - 60° Relation ship hand to IR ## **Rheumatoid Arthritis** ## **GReulich & Pyle** - Bone aging method - PA proj of Left hand w/ a computer software - Calculate the age of bone (Langerhans Cells - hystiocytosis) # **PROJECTION FOR Rheumatoid Arthritis** 1. Norgaard Method 2. Ball catchers 3. Brewerton 4. Clements nakayama (AP Pros) # **PROJECTION FOR 5th (pinky) metacarpal FX** 1. Lewis recommendation - 5° rotation (Lateral) 2. Stapczynitski (AP oblig.) <br> # **Lateral Projection** - demo: - Foreign bodies - displacement FX ## **Fig. 4-61 Fan lateral hand.** ## **Fig. 4-64 Lateral hand in flexion.** ## **Fig. 4-65 Lateral hand in flexion** ## **Early detect and diagnose of Rheumatoid Arthritis** ## **Fig. 4-66 AP oblique hands, semi-supinated position** ## **Fig. 4-67 Ball-catcher's position** ## **Fig. 4-68 A, AP oblique hands, ball-catcher's position, showing where indistinct area occurs (arrows); B, ball-catcher position**