Upper Extremities

• Bones of the upper limb

  • Hand and wrist
  • Forearm
  • Arm
  • Shoulder girdle

  
• The shape and structure of each of the bones and the articulations, or joints, of the upper limb must be thoroughly understood by technologist so that each part can be identified and demonstrated on radiographs

  
• Bones of the hand and wrist

  • Phalanges
  • Metacarpal
  • Carpals

  
• Phalanges


  The most distal bones of the hand which comprise the digits

  
• Metacarpals


  The bones that comprise the palm of each hand

  
• Carpals


  The bones of the wrist

  
• Radius


  The bone on the lateral or thumb side of the forearm

  
• Ulna


  The bone on the medial side of the forearm

  
• Proximal radioulnar joint


  One of the joints where the radius and ulna articulate, allowing rotational movement of the wrist and hand
• Distal radioulnar joint


  One of the joints where the radius and ulna articulate, allowing rotational movement of the wrist and hand

  
• Radiographic projections of the upper extremities

  • Fingers (PA, PA Oblique, Lateral)
  • Thumb (AP, PA Oblique, Lateral)
  • Hand (PA, PA Oblique)
  • Wrist (PA, Lateral)
  • Forearm (AP, Lateral)
  • Elbow Joint (AP, Lateral)
  • Humerus (AP, Lateral)

  
• PA projection of fingers

  • Demonstrates fractures and dislocations of the distal, middle and proximal phalanges, distal metacarpal, and associated joints
  • Pathologic processes like osteoporosis and osteoarthritis may also be demonstrated

  
• PA projection technical factors

  IR size 18x24 cm crosswise, detail screen, tabletop, 45-50 kVp
• PA projection patient position

  Seat patient at end of table with elbow flexed about 90° with hand and forearm resting on table
• PA projection part position

  Pronate hand with fingers extended, center and align long axis of affected finger to long axis of portion of IR being exposed, separate adjoining fingers from affected finger
• PA projection central ray


  CR perpendicular to IR, directed to PIP joint, minimum SID of 100 cm
• PA projection collimation


  Collimate on four sides to area of affected finger
• PA projection radiographic criteria

  • Distal, middle and proximal phalanges, distal metacarpal and associated joints shown
  • No rotation, fingers separated with no overlapping of soft tissues, interphalangeal joints open indicating full pronation
  • Collimation visible on four sides, CR and midpoint of collimation field to PIP joint
  • Optimal density and contrast with no motion, clear soft-tissue margins and bony trabecular markings

  
• PA oblique projection of fingers

  • Demonstrates fractures and dislocations of the distal, middle and proximal phalanges, distal metacarpal, and associated joints
  • Pathologic processes like osteoporosis and osteoarthritis may also be demonstrated

  
• PA oblique projection technical factors

  IR size 18x24 cm crosswise, detail screen, tabletop, 45-50 kVp
• PA oblique projection patient position


  Seat patient at end of table with elbow flexed about 90° with hand and wrist resting on cassette and fingers extended
• PA oblique projection part position

  Place hand with fingers extended against 45° foam wedge block, placing hand in a 45° lateral oblique (thumb side up), align long axis of finger to long axis of one third of IR being exposed, separate fingers and carefully place finger being examined against block so it is supported in 45° oblique and parallel to IR

  
• PA oblique projection central ray


  CR perpendicular to IR, directed to PIP joint, minimum SID of 100 cm
• PA oblique projection collimation


  Collimate on four sides to area of affected finger
• PA oblique projection radiographic criteria

  • 45° oblique view of the distal, middle, and proximal phalanges, distal metacarpal and associated joints
  • Interphalangeal and metacarpophalangeal joint spaces open, long axis of finger aligned to side border of IR, proximal and middle phalanges curved on one side and straight on other, no superimposition of adjacent fingers
  • Collimation visible on four sides, CR and center of collimation field to PIP joint
  • Optimal density and contrast with no motion, clear soft-tissue margins and bony trabecular markings

  
• Lateral projection of fingers

  • Demonstrates fractures and dislocations of the distal, middle and proximal phalanges, distal metacarpal, and associated joints
  • Pathologic processes like osteoporosis and osteoarthritis may also be demonstrated

  
• Lateral projection technical factors

  IR size 18x24 cm crosswise, detail screen, tabletop, 45-50 kVp
• Lateral projection patient position


  Seat patient at end of table with elbow flexed about 90° with hand and wrist resting on cassette and fingers extended
• Lateral projection part position


  Place hand in lateral position (thumb side up) with finger to be examined fully extended and centered to portion of IR being exposed, align and center finger to long axis of portion of IR, use support to prevent motion

  
• Lateral projection central ray


  CR perpendicular to IR, directed to PIP joint, minimum SID of 100 cm

  
• Lateral projection collimation


  Collimate on four sides to area of affected finger

  
• Lateral projection radiographic criteria

  • Lateral view of the distal, middle, and proximal phalanges, distal metacarpal and associated joints
  • Interphalangeal and metacarpophalangeal joint spaces open, long axis of finger aligned to side border of IR, finger in true lateral position with concave anterior and straight posterior aspects
  • Collimation visible on four sides, CR and center of collimation field to PIP joint
  • Optimal density and contrast with no motion, clear soft-tissue margins and bony trabecular markings

  
• AP projection of thumb

  • Demonstrates fractures or dislocations of the distal and proximal phalanges, distal metacarpal and associated joints
  • Pathologic processes like osteoporosis and osteoarthritis may also be demonstrated

  
• AP projection technical factors

  IR size 18x24 cm, division in third crosswise, 45-50 kVp
• AP projection patient position

  Seat patient facing table, arms extended in front with hand rotated internally to supinate thumb
• AP projection part position

  Internally rotate hand with fingers extended until posterior surface of thumb is in contact with IR, align thumb with long axis of portion of IR being exposed, center first MCP joint to CR and center of IR
• AP projection central ray


  CR perpendicular to IR to first MCP joint
• AP projection collimation


  Collimate four sides to area of thumb, including entire first metacarpal
• AP projection radiographic criteria

  • Distal and proximal phalanges, first metacarpal, trapezium, and associated joints visible
  • Interphalangeal and metacarpophalangeal joints appear open, long axis of thumb aligned with side border of IR, no rotation

  
• Part position - AP

  1. First, position this awkward position on yourself so the patient can see how is it done and better understand what is expected

  2. Internally rotate hand with fingers extended until posterior surface of thumb is in contact with IR

  3. Align thumb with long axis of portion of IR being exposed

  4. Center first MCP joint to CR and to center of portion of IR being exposed