Wrist Projections PDF

# Wrist Projection ## RP: Midcarpal (or) Wrist Projection (between 2 Styloid Processes) * PA Projection * Hand slightly arched * Places wrist in close contact with IR * Midcarpal area - PA projection of carpals * Slightly oblique projection of Ulna * Open Radio-ulnar joint spac...

# Wrist Projection ## RP: Midcarpal (or) Wrist Projection (between 2 Styloid Processes) * PA Projection * Hand slightly arched * Places wrist in close contact with IR * Midcarpal area - PA projection of carpals * Slightly oblique projection of Ulna * Open Radio-ulnar joint space * Elongate scaphoid and capitate * AP projection for ulnar examination * Better demonstrate scaphoid and capitate. * Daffner, Emmerling & Buterbaugh recommended PA projection * 30 degrees toward the elbow * DEB 30 degrees EIF-fingers cap * 30 degrees toward the fingertips * Elbow 30 degrees * Scap * Cap * AP Projection * Hand supinated and digits elevated * Place wrist in close contact with IR * Midcarpal area * Better demonstration of carpal interspaces * Better for ulnar examination * No rotation of Ulna * Lateral Projection * Elbow flexed 90 degrees to rotate ulna (laterally) * Hand and forearm in lateral position * Ulnar surface (pinky) against IR * Wrist joint (midcarpal area) * Lateral metacarpals * Distal radius and ulna * Scaphoid and Trapezium (more anterior) * To demonstrate anterior or posterior displacement in fracture * Colle's Fx (Bayonet) (DinnerFork) * Smith Fx (Reverse Colles) * Barton's Fx * Hutchinsion's Fx (Chauffer) * Burman et al. suggested Lateral Position Palmar flexion * Additional structure shown * Wrist in palmar flexion * Rotates the scaphoid into a dorsovolar position * Lateral position of scaphoid * Foille 1st to describe CARPE BOSSU (carpal boss) * Bony growth occurring (dorsal) at the 3rd CMC joint # PA Oblique Projection * Lateral rotation * Ap near wrist * Palmar surface of wrist on IR * Hand pronated and rotated 45 degrees laterally * Midcarpal area * Carpals on lateral side * Thumb * Trapezium * Scaphoid * Inakaangat na side ang kita) * For Scaphoid only * Ulnar deviation # PA Oblique Projection * Medial rotation * Wrist dorsal surface against IR * Hand supinated and rotated 45 degrees medially * Midcarpal area (pinky) * Carpals on the medial side * Hamate * Pisiform * Triquetrum * Inakadikit na side) # PA projection (ulnar deviation) * Scaphoid projection * Hand pronated * Wrist in extreme ulnar deviation * Scaphoid * Clear delineation 10-15 degrees * No foreshortening of scaphoid * Corrects the foreshortening of scaphoid * Open joint spaces on lateral side # PA Projection (radial deviation) * Hand pronated * Wrist in radial deviation * Midcarpal area * Opens carpal interspaces on medial side # SCAPHOID (and) Cephalad * Original method: Stecher Method (PA axial projection) * IR elevated 20 degrees * Scaphoid, no foreshortening * Scaphoid with 20 degrees angulation IR * Scaphoid for no self-superimposition * Scap right angle to CR (1) * Scap // to IR * Other variations (but same result as original) * Alternative methods: * CR 20 degrees toward the elbow * CR 20 degrees toward digits * Demonstrate a fracture line that angles superoinferiorly (from up to down) * Close/clenched the fist (PA projection) * Bridgman method is stecher method with ulnar deviation * Open joint interspace at lateral side * Scaphoid * Bridgman suggested PA axial projection with ulnar deviation * Position the wrist in ulnar deviation # SCAPHOID Series * Rafert-Long method (PA axial projection) * Hand pronated, wrist in extreme ulnar deviation * 10 degrees cephalad * 20 degrees cephalad * 30 degrees cephalad * Scaphoid * Scaphoid with minimal superimposition * To diagnose scaphoid fractures * PA axial projection (ulnar deviation) * Four-image, multiple angle central ray series * Difficult to see if the wrist is pronated or supinated after taking a routine wrist radiograph # TRAPEZIUM (or) Greater Multangular MSP CR * Clements-Nakayama method PA axial oblique method * Palmar surface against 45 degrees foam wedge (hand in ulnar deviation) * 45 degrees distally * Anatomical snuffbox * Trapezium * Demonstrate trapezium fractures * Evaluation of trapezium articular surface * Can be used to treat osteoarthritic patient * If unable to do ulnar deviation: * Rotate elbow end of IR and arm 20 degrees away from CR (move the IR with the arm) * Proximal first MC bone base * Trapezium * Variations of clements * Holly - Hand on recommended sponge. # Carpal Bridge * Lentino Method (tangential projection) * Hand palm upward, hand 90 degrees to forearm, (wrist in 90 degrees flexion) * 45 degrees CR * 1.5 inches proximal to wrist * Carpal bridge * Demonstrate: * Fx of scaphoid * Lunate dislocation * Calcificaiton of wrist dorsum * Foreign bodies * Chip Fx dorsal aspect carpal bones * Alternative Method: Modified tangential prog. (if wrist too painful to do the original method) * Elevate the forearm on sandbags, wrist flexed 90 degrees IR vertical. # Carpal Canal * Gaynor-Hart Method (tangential projection) * Inferosuperior * Wrist hyperextended, rotate hand slightly toward radial side to prevent superimposition of hamate & pisiform shadows * 25-30 degrees to long axis of the hand * Palm of hand, approx. 1 inch distal to 3rd MCP base * Demo: * Carpal canal tunnel syndrome (CTS) * Fx hook of hamate (Colfer's wrist) * Triquetrum * Pisiform * Templeton & Zim * Superoinferior * Dorsiflex the wrist, lean forward to place carpal canal tangent to IR * 20-35 degrees from the long of the forearm * Midpoint of the wrist * CTS: * Carpal sulcus + flexor retinaculum * Compression of median nerve * (M3) Mequillen-Martensen suggested * Wrist can't extend to within 15 degrees of vertical * CR // palmar surface * Marshall suggested dorsiflexion limit * Place 45 degrees angle sponge under palmar surface * Slight degree of magnification carpal canal (increased oid) # Carpal canal projections * Gaynor-Hart * Zim & Templeton