Hand & Digits

• A. Projection:

  AP Thumb 1st digitB. Patient positioning:Seated at the end of the table. (Shield Gonads)C. IR placement:Centered on long Axis of the thumb. Hand in extreme medial rotation. Digits held back with tape or unaffected hand.D. CR angulation and location:Perpendicular to the MCP & Collimated to 1 inch on all sides and 1 inch proximal to the CMC joint.

  
• A. Projection:

  Lateral Hand projectionB. Patient positioning:Seated at the end of the table. (Shield Gonads)C. IR placement.Centered to MCP Joints. Ulnar side of wrist against IR. Extended Digits. First digit (thumb) at a right angle to palm.Ca. "Fan Lateral": separate digits and abduct thumb. Use foam wedge if available.D.CR angulation and location:Perpendicular to the 2nd MCP joint. Collimate 1 inch on all sides. 1 inch proximal ulnar styloid.

  
• A. Projection

  : Lateral First Digit (Thumb)B. Patient positioning:Seated at the end of the table (Gonads Shielded)C. IR placement:Centered to the MCP. Palmar surface naturally against IR. Arch the hand until the thumb is in true lateral.D. CR angulation and location: Perpendicular to the MCP Joint and collimated 1inch on all sided; 1 inch proximal to the CMC joint.

  
• A. Projection:

  Lateromedial Projection 4th digit.B. Patient positioning:Seated at the end of the table (Shielded Gonads)C. IR placement:centered on the PIP joint. 4th & 5th digits resting on medial surface. Affected digit extended and immobilized. Adjust hand rotation for true lateral.D. CR angulation and location:Perpendicular to PIP joint of affected digit. Collimate to 1 inch on all sides.

  
• A. Projection:

  Mediolateral Projection of the 2nd digitB. Patient positioning:Seated at the end of the table (Shielded Gonads)C. IR placement:centered on the PIP joint. 1st & 2nd digit resting on the lateral surface.D. CR angulation and location:Perpendicular to the PIP joint of affected digit. Collimated to 1 inch on all sides.

  
• A. Projection:

  PA Oblique HandB. Patient Positioning:Seated at the end of the table. (Gonads Shielded)C. IR placement:Centered to the MCP joints. Forearm resting on table. Elevate index finger & thumb to open joint spaces. *Fingertips touch IR for metacarpal images. *Elevate first and second digits for phalanges. Use foam if available.D. CR angulation and location:Perpendicular to the 3rd MCP joint. Collimate to 1inch on all sides; 1 inch proximal to ulnar styloid.

  
• A. Projection:

  PA Oblique Third FingerB. Patient positioning:Seated at the end of table (Gonads shielded)C. IR placement:Digit rotated lateral 45 degrees. IR centered to the PIP joint. forearm on table. Hand rotated laterally from pronation. Use foam if available.D. CR angulation and location:Perpendicular to the PIP joint of affected digit and collimated to 1 inch on all sides.

  
• A. Distal Interphalangeal (DIP)

  B. Proximal Interphalangeal (PIP)

  C. Metacarpophalangeal (MCP)

  D. Intercarpals

  E. Distal radioulnar

  F. Radiocarpal

  G. Carpometacarpals

  H. Metacarpophalangeal (MCP)

  J. Interphalangeal (IP)

  
• A. Phalanges

  B. Metacarpals

  C. Distal Phalanx

  D. Middle Phalanx

  E. Proximal Phalanx

  F. Distal Phalanx

  G. Proximal Phalanx

  H. Sesamoids

  J. Trapezium

  
• A. Head

  B. Body

  C. Base

  D. Head

  E. Neck

  F. Body

  G. Base

  
• Bennett Fracture

  Fracture at the base of the 1st Metacarpal (Thumb)
• Boxer Fracture


  Fracture at metacarpal neck (usually the pinky or 5th metacarpal)
• Rheumatoid Arthritis


  Chronic, systemic, inflammatory collagen disease.
• Exposure Techniques

  Digits: 63 @ 0.6

  PA Hand: 66 @ 0.71

  OB Hand: 66 @ 0.8

  Lateral Hand: 70 @ 1.25
• PA Projection for 2nd - 5th Digits Eval Criteria

  -Proper collimation

  Entire digit; tip to distal portion of metacarpal

  - No soft tissue overlap

  - No rotation shown by equal concavity on both sides of the phalangeal bodies

  - Equal amount of soft tissue on both sides of phalanges

  - Centered Fingernail

  - Open IP and MCP joint spaces

  - Bony Trabecular detail
• PA Oblique 2nd - 5ht Digits Eval Criteria

  -Proper collimation

  -Entire digit distal to adjoining metacarpal

  rotated 45 degrees shown by concavity of elevated side of phalangeal bodies

  - No super imposition of proximal phalanx or MCP joint by adjacent digits.

  - Open IP and MCP joint spaces

  - Bony trabecular detail
• Lateral 2nd - 5th digits Eval Criteria

  -Proper collimation

  -Entire digit from fingertip to distal portion of adjoining metacarpal.

  - No rotation

  - Fingernail in profile

  - Concave, anterior surfaces of phalanges

  - No superimposition of the proximal phalanx or MCP joint by adjacent digits

  - Open IP joint spaces

  - Bony trabecular detail
• AP First Digit Eval Criteria


  -Proper collimation

  - Area from distal tip to thumb trapezium.

  - No rotation

  - Concavity of phalangeal and metacarpal bodies.

  - Equal amount of soft tissue on both sides of phalanges.

  - Thumbnail in center of distal thumb

  - Overlap of soft tissue profile of palm over midshaft of first metacarpal

  - Open IP and MCP joint spaces with no bone overlap

  - Bony trabecular detail
• PA OBL First Digit Eval Criteria

  - Proper collimation

  - Area from distal tip of thumb to trapezium

  - Proper rotation 45 degrees

  - Concave surface of elevated of proximal phalanx and metacarpal.

  - Open IP and MCP joint spaces

  - Bony trabecular detail
• Lateral First Digit Eval Criteria


  - Proper Collimation

  - Area from distal tip of thumb to trapezium

  - No rotation

  - Concave anterior surface of proximal phalanx and metacarpal.

  - Thumb in profile

  - Open IP and MCP joint spaces

  - Bony trabecular detail
• PA Hand Eval Criteria

  - Proper collimation

  - Anatomy from fingertips to distal radius and ulna

  - Slightly separate digits with no soft tissue overlap

  - No rotation of hand

  - Equal concavity of metacarpal and phalangeal bodies

  - Equal amount of soft tissue on both sides of phalanges

  - Fingernails in center of distal phalanx

  - Equal distant between metacarpal heads

  - Open MCP and IP joints

  - Bondy trabecular detail.
• PA OBL Hand Eval Criteria

  - Proper collimation

  - Anatomy from fingertips to distal Radius and Ulna

  - Digits separated slightly with no soft tissue overlap

  - 45 degrees of rotation

  - Decreased amount of metacarpal seperation between 2nd, 3rd, 4th, & 5th bodies.

  - Partial superimposition of 3rd, 4th, & 5th, metacarpal bases and heads

  - Open MCP Joints

  - Open IP joints when digits are Parallel to IR*

  - Bony Trabecular
• Lateral Hand Eval Criteria

  - Proper Collimation

  - Anatomy of fingertips to distal Radius and Ulna

  - Extended digits

  - Hand in true lateral position

  - Superimposed phalanges

  - Superimposed metacarpals

  - Superimposed distal Radius and Ulna

  - Thumb free of motion and superimposition

  - Bony Trabecular