hand and wrist

• The standard views of the hand and wrist are PA and lateral. Oblique may also be requeste.d
• A standard hand PA is used to determine skeletal age.
• The central ray of a PA hand is the 3rd MCP joint.
• A hand PA is a oblique view of the thumb.
• A lateral hand is a PA thumb.
• A lateral view of the hand is best for viewing the displacement of a fracture fragment.
• The central ray of the lateral view of the hand is the 2nd MCP joint.
• The CR of the oblique view is the 3rd MCP jont.
• A PA view of the wrist allows visualization of the ulnar variance, radial articular angle, and the arcuate lines of the carpals.
• The central ray of all wrist imaging is the midcarpal joint.
• Normal radial articular angle is 15-25 degrees.
• Optional views of the hand include radial deviation, ulnar deviation, and carpal tunnel view.
• Ulnar deviation imaging is best for subtle scaphoid fractures.
• Carpal tunnel view is best for seeing fractures of the hook of the hamate.
• A Bennett fracture is a fracture dislocation resulting from an axial blow to the partially flexed 1st metacarpal at the CMC joint.
• Gamekeeper's thumb is the disruption of the UCL at the thumb's MCP joint. It may result in the avulsion of the base of the proximal phalanx.
• A common complication of a fracture to the proximal pole is avascular necrosis.
• Lunate fractures are often not recognized until avascular necrosis occurs. This is known as Kienbock's disease.
• Stage one lunate fractures will have negative radiographs, but MRI will confirm vascular changes.
• Stage two lunate fractures will have sclerosis, fractures, and cystic changes on radiographs.
• Stage three lunate fractures will have advanced bone density changes on radiographs.
• Stage four lunate fractures will demonstrate complete collapse and fragmentation of the lunate on radiographs.
• Colles fractures, or dinner fork deformity, have a volar apex and dorsal angulation.
• Smith fractures have dorsal apex and volar angulation.
• Barton fractures are fracture-dislocations of the radius. The dorsal rim is fractured and radiocarpal joint is dislocated.
• Galeazzi fractures are fractures at the junction of the middle and distal thirds of the radius with a distal radioulnar dislocation.
• Essex-Lopresti fractures occur at the radial head with a dislocation of the distal radioulnar joint. It typically involves the disruption of the interosseous membrane.
• Scapholunate instability is the malignment of the scaphoid and lunate.
• Predynamic scapholunate instability is a normal x-ray but positive clinical signs.
• Dynamic scapholunate instability is when the carpals are normal at rest but collapse under load on radiographs.
• Static scapholunate instability is present on routine PA radiograph.
• Heberden's nodes at deformities on the DIP joint.
• Bouchard's Nodes are deformities at the PIP joint.
• The radiographic characteristics of OA are decreased joint space, sclerosis, and osteophytosis.
• The radiographic characteristics of rheumatoid arthritis are periarticular refraction, articular erosions, and synovial cysts.