Wrist

• Wrist

  Eight carpal bones fitted closely together in two horizontal rows
• Distal row of carpal bones (lateral to medial)

  • Trapezium
  • Trapezoid
  • Capitate
  • Hamate
• Proximal row of carpal bones (lateral to medial)

  • Scaphoid
  • Lunate
  • Triquetrum
  • Pisiform
• Scaphoid


  • Largest proximal carpal bone; palpable
• Lunate


  • Crescent shaped
• Triquetrum


  • Pyramidal
• Pisiform


  • Pea shaped; palpable
• Trapezium


  • Under the thumb
• Trapezoid


  • beside the trapezium
• Capitate


  • Largest carpal bone; most centrally located
• Hamate


  • " Hook of hamulus "
• Anatomic Snuff Box


  Triangular depression on posterior surface of wrist; visible when thumb abducted and extended; formed by tendons of two major thumb muscles; overlies scaphoid and radial artery; tenderness suggests scaphoid fracture
• Flexor Retinaculum


  Strong fibrous band attached medially to the pisiform and hook of hamate and attached laterally to the tubercles of the scaphoid and trapezium
• Carpal Canal (Carpal Tunnel)


  Passageway created between the carpal sulcus and flexor retinaculum; contains median nerve and flexor tendons
• Carpal Tunnel Syndrome


  Condition resulting from the compressions of the median nerve inside the carpal tunnel
• Articulations of the wrist

  • Carpometacarpal (CMC)
  • Intercarpal
  • Radiocarpal
  • Radioulnar
  • Distal
  • Proximal
• Colles Fracture


  Fracture of distal radius with posterior displacement
• Smith Fracture


  Fracture of distal radius with anterior displacement
• Torus or Buckle Fracture


  Impacted fracture with bulging of periosteum
• PA Wrist

  Patient position: Seated with shoulder, elbow, and wrist joints in same plane; Position of part: IR - centered to wrist joint, forearm resting and parallel with long axis of IR, slightly arch hand at MCP joints; Central ray: Perpendicular to midcarpal area; Collimation: 2.5 inches proximal and distal to wrist joint, 1 inch on sides
• PA Oblique Wrist

  Patient position: Seated at end of table, 45 degree lateral rotation; Position of part: IR - centered under scaphoid, ulnar deviate if scaphoid is under examination; Central ray: Perpendicular to midcarpal area, entering distal to radius; Collimation: 2.5 inches proximal and distal to wrist joint, 1 inch on sides
• Lateral Wrist

  Patient position: Seated at end of table, elbow flexed 90 degrees to rotate ulna laterally: is centered to wrist joint , wrist in true lateral; Central ray: Perpendicular to wrist joint; Collimation: 2.5 inches proximal and distal to wrist joint, 1 inch on palmar and dorsal surfaces
• Carpe Bossu (Carpal Boss)


  Small bony growth occurring on dorsal surface of third CMC joint; shown in lateral with wrist in palmar flexion
• PA Wrist Ulnar Deviation

  Patient position: Seated at end of table, elbow flexed to 90 degree angle, wrist in PA to start, deviate hand outward toward the ulna , hand remaining pronated; Central ray: Perpendicular to scaphoid; Collimation: 2.5 inches proximal and distal to wrist joint, 1 inch on sides
• PA Axial Scaphoid (Stecher Method)


  Patient position: Seated at end of table, finger end of IR elevated 20 degrees, forearm resting on table; Central ray: Perpendicular to table, entering scaphoid; Collimation: 2.5 inches proximal and distal to wrist joint, 1 inch on sides
• Tangential Carpal Canal (Gaynor-Hart Method)


  Patient position: Seated at end of table, IR - centered to joint at level of radial styloid process, hyperextend wrist, slightly rotate hand toward radial side; Central ray: 25-30 degrees entering 1 inch distal to base of third metacarpal; Collimation: 1 inch on three sides of shadow of wrist
• Pathology term: Colle's


  Fracture of the distal radius with posterior (dorsal) displacement
• Pathology term: Smith's

  Fracture of the distal radius with anterior (palmar) displacement
• Pathology term: Torus or buckle


  Impacted fracture with bulging of periosteum
• Carpal term conversion (proximal): Lunate


  Semiulnar
• Carpal term conversion (proximal): Triquetrum


  Triquetral

  Cuneiform or

  Triangular
• What is the size of the IR for all wrist projections covered?

  8 x 10 inch or 10 x 12 inch lengthwise, depending on availability
• PA projection Wrist: When positioning the patient - Seat the patient low enough to place the BLANK in contact with the table, or elevate the limb to shoulder level on a suitable support.

  
  

  Why?

  - Axilla

  - This position places the shoulder, elbow, and wrist joints in the same plane to permit the right-angle rotation of the ulna and radius for the lateral position.
• 1. PA projection Wrist: When positioning the part - Have the pt rest the forearm on the table, and center the wrist joint to the IR area.

  
  

  Where should the wrist joint be situated?

  The wrist (radoiocarpal) joint is at a level just distal to the ulnar styloid.
• 2. PA projection Wrist: When positioning the part - If you cannot determine location of the radoiocarpal joint due to swelling, what can you do?

  Ask the patient to flex the wrist slightly, and center the IR to the point of the flexion.
• 3. PA projection Wrist: When positioning the part - How do you determine IR centering when the pt is in a cast or splint?


  The exact point of centering can be determined by comparison with the opposite side.
• 4. PA projection Wrist: When positioning the part - How should you adjust the hand and forearm on IR?

  Adjust each to lie parallel with the long axis of the IR.
• 5. PA projection Wrist: When positioning the part - What can you do to ensure the wrist is in close contact with the IR?

  
  

  What may be necessary?

  Slightly arch the hand at the MCP joint by flexing the digits. When necessary, place a support under the digits to immobilize them.

  
  

  AND shield gonads.
• PA projection Wrist: How is the CR positioned?

  Perpendicular to the mid carpal area
• PA projection Wrist: What is the collimation?

  2.5 inches proximal and distal to the wrist joint and 1 inch on both sides.