Upper Extremity fingers digits hand RTEC 123 1

Upper Extremity fingers (digits) & hand RTEC 123 # 1 A LECTURE Contributions by: MOSBY – MERRILLS & BONTAGER XRAY 2000. CO. UK rev 10/10/11 1

ANATOMY REVIEW UPPER EXT : FINGERS/ HAND 2

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POSITIONING Upper Limb Anatomy &Positioning Review 8

RE: LATERALS PG 80 PROJECTION VS POSITION • CHEST / ABDOMEN / SKULL • The lateral is referred to the POSTION – which is the SIDE TOUCHING THE IR • SO LEFT LATERAL (position ) in referred to as a LATERAL PROJECTION • LIMBS : Pos/Pro – side entered by IR • MEDIOLATERAL OR LATERALMEDIAL 9

LEFT LATERAL POSITION – LT LATERAL PROJECTION RIGHT LATERAL POSITION – RT LATERAL PROJECTION 10

Lateromedial mediolateral 11

FINGERS “series” • PA FINGER (PA HAND) • OBLIQUE * • LATERAL • *OBLIQUE (med or lat rot) depending on which digit 12

FINGER “series” PA OBL LATERAL 13

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DO NOT PLACE PATIENT’S LEGS UNDER THE TABLE 15

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WHICH DIGIT? 17

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LATERAL MEDIAL ROTATION 19

? Which rotation is this? PA oblique - medial rotation 20

YES NO Keep fingers // to IR 21

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ST THUMB (1 DIGIT) • PA / AP • PA OBLIQUE • LATERAL 26

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AP PA 29

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OBLIQUE 31

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LATERAL 33

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HAND Series (3 vw or 4*vw) • PA OBLIQUE (lat rotation) • LATERAL (FAN) ------------------ • *AP OBLIQUE (med rotation) or PA OBLIQUE (med rotation) 35

HAND Series • Re: LATERAL • MEDIOLATERAL OR • LATEROMEDIAL • FAN /TRUE LATERAL/ FLEXION 36

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Note: Incorrect position of hand forearm Forearm should be parallel with end of the table – elbow flexed 40

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HAND Series • Re: LATERAL • MEDIOLATERAL OR • LATEROMEDIAL P 128 • FAN /TRUE LATERAL/ FLEXION 48

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Projection ? 52

Alternate lateral (FB) 53

Additional projection of hand AP OBLIQUE OPENS SPACES BETWEEN 4 & 5 mc TH 54 TH

AP OBLIQUE HAND (medial rotation) • • • May be required as the 4 th “routine view” Hand supinated (AP) then rotated medially 45º (keep fingers straight) PA OBLIQUE Medial rotation another -alternate method – Radiographically image will look the same 55

PA OBLIQUE another -Alternate method keep hand PA then rotate hand 45º PA lateral medial 56

Compare : OBLIQUE OF RT HAND PA & AP What anatomy is seen specific to each position? 57

BILATERAL AP OBLIQUES ? 58

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For Arthritis “ballcatchers” 60

Keep arm level and elbow flexed 90º (not like this!) 61 Legs should be at the side of the table – and where is the shield!

FILM CRITIQUE & Pathology Reduce OID, magnification 62

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PATHOLOGY FOR UPPER EXTREMITY 1 SEE CHART PG 109 Bone cyst Bursitis Fractures /Dislocations Joint effusion Osteoporosis Rheumatoid Arthritis 66

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What abnormality do you see? 73

Alternate method if you can’t get the fingers straight!!!! Do 2 projections – 1 for hand, 1 for fingers in this position 74

OSTEOSARCOMA 75

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Bennett’s FX fx at base of 1 st MC 78

Mutilating rheumatoid arthritis. 79

RHEUMATOID ARTHRITIS 80

Rheumatoid arthritis RA - inflammatory disease 3 x more common in females 81

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Osteoarthritis of fingers. Note narrowing of interphalangeal joints with spurring and erosions OA - Non inflammatory joint disease involves the articular cartilage – Aging /erosion 83

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BOXER’S FX 87

88 Bennett's fracture • is caused by forced abduction of the thumb • there is a dislocation of the base of the first metacarpal <> although a fragment continues to articulate with the trapezium. 88

CONGENTIAL ABNORMALITIES 89

What abnormality do you see? 90

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G S W 92

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www. rad. washington. edu 96

QUESTIONS ? End of Upper Extremity #1 Wrist will be covered if there is time … 97