2. HAND ANATOMY
THE HUMAN HAND CONSISTS OF A BROAD PALM (METACARPUS) WITH 5 DIGITS, ATTACHED TO
THE FOREARM BY A JOINT CALLED THE WRIST (CARPUS). THE BACK OF THE HAND IS FORMALLY
CALLED THE DORSUM OF THE HAND.
Digits
• Each finger, starting with the one
closest to the thumb, has a colloquial
name to distinguish it from the
others:
• index finger : pointer finger, or forefinger
• middle finger: digitus medius
• ring finger: Annulus
• little finger: 'pinky' - minimus
• The thumb (connected to the trapezium) is
located on one of the sides, parallel to the
arm. The thumb can be easily rotated 90°,
on a level perpendicular to the palm, unlike
the other fingers which can only be rotated
approximately 45.
6. BONES
• The human hand has 27 bones: the carpus or wrist account for 8; the metacarpus or
palm contains five; the remaining fourteen are digital bones; fingers and thumb.
• The eight bones of the wrist are arranged in two rows of four. These bones fit into a
shallow socket formed by the bones of the forearm. The bones of proximal row are (from
lateral to medial): scaphoid, lunate, triquetral and pisiform. The bones of the distal row
are (from lateral to medial): trapezium, trapezoid, capitate and hamate.
• The palm has five bones known as metacarpal bones, one to each of the 5 digits. These
metacarpals have a head, a shaft, and a base.
• Human hands contain fourteen digital bones, also called phalanges, or phalanx bones:
two in the thumb (the thumb has no middle phalanx) and three in each of the four
fingers. These are the distal phalanx, carrying the nail, the middle phalanx, and the
proximal phalanx.
• Sesamoid bones are small ossified nodes embedded in the tendons to provide extra
leverage and reduce pressure on the underlying tissue. Many exist around the palm at
the bases of the digits; the exact number varies between different people.
7. ARTICULATIONS
• Also of note is that the articulation of the human
hand is more complex and delicate than that of
comparable organs in any other animals. Without
this extra articulation, we would not be able to
operate a wide variety of tools and devices.
– The articulations are:
– interphalangeal articulations of hand (IP)
– metacarpophalangeal joints (MCP)
– intercarpal articulations
– wrist (may also be viewed as belonging to the forearm.)
8. GENERAL PROCEDURE
• Remove rings, watches, and other radiopaque objects, and
place them in secure storge during the procedure.
• Seat the patient at the side or end of the table.
• Place the cassette at a location
• Radiograph each side separately when performing a bilateral
examination of the hand or wrist.
• Shield gonads
• Use close collimation
• Placing multiple exposures one one cassette is a common
practise
• Use right or left markers and all others vital identification
markers when apropiate.
10. PA PROJECTIONS (DIGITS 2-5)
For all
• Indications for imaging projections
• Injury, Rheumatoid arthritis, Bone pain.
• IR: 8 x 10 crosswise for two or more images on one cassette
• SID: 40 inches
• Position of the patient: seat the patient at the end of the radiographic
table.
• Position of the part: When radiographing individual digits (except the
first), take the following steps:
– Place the extended digit with the palmar surface down on the
unmasked portion of the cassette.
– Separate the digits slightly, and center the digit under
examination to the midline portion of the cassette.
– Center the PIP joint to the cassette
14. EVALUATION CRITERIA
• No rotation of the digit
• Entire digit from fingertip
to distal portion of the
adjoining metacarpal
• No soft tissue overlap
from adjacent digits
• Open interphalangeal
and MCP joint spaces
without overlap of bones
• Soft tissue and bony
trabeculation
15. LATERAL PROJECTIONS (2-5 DIGITS)
• IR: 8 x 10 crosswise for two or more images on
one cassette
• Basic position: Place the patient hand in true
lateral position, the fingers are then flexed and the
finger in question extended parallel to the film. A
radiolucent pointer may aid maintenance of the
extension. For fingers other than the middle, the
hand is rotated to the lateral position bringing the
finger in question nearest the film or in contact
with it for the 2nd and 5th.
19. EVALUATION CRITERIA
• Entire digit in a true
lateral position
• No obstruction of the
proximal phalanx or MCP
joint by adjacent digits
• Open interphalangeal
and MCP joint spaces
without overlap of bones
• Soft tissue and bony
Is it correct
trabeculation this image?
21. PA OBLIQUE PROJECTION
• IR: 8 x 10 crosswise for two or more images on
one cassette
• Position of the patient: seat the patient at the
end of the radiographic table.
Position of part:
Place the patient’s forearm on the table with the hand
pronated and the palm resting on the cassette.
Center the cassette at the level of the PIP joint.
Rotate the hand externally until the digits are separated and
supported on a 45- degree foam wedge.
25. EVALUATION CRITERIA
Entire digit rotated at 45-
degree angle, including the
distal portion of the
adjoinig metacarpal
No superimposition of the
adjacent digits over the
proximal phalanx or MCP
joint
Open interphalangeal and
MCP joint spaces
Soft tissue and bony
trabeculation
26. FIRST DIGIT (THUMB): AP/PA PROJETION
• Indications for imaging
• Trauma, congenital abnormalities, and rheumatology.
IR: 8 x 10 crosswise for two or more images on one cassette
Basic Position
The PA position is easiest for the patient however the AP
projection produces less magnification and better detail as the
thumb is in contact with the cassette.
PA Position, The patient sits alongside the end of the table elbow flexed
palm downwards, or at the end of the table with he elbow flexed at 90
degrees, the hand is rotated into the true later position projecting the thumb
clear of superimposition with the fifth metacarpal.
27. CONT…
AP Position, The patient
stand with their back to the
table and the arm is
extended and internally
rotted to bring the palmar
aspect of the thumb facing
upwards, adjust the table
height to a comfortable
position, adjust the rotation
of the arm to bring the
thumb into true AP position
30. EVALUATION CRITERIA
No rotation
Area of the distal tip of
the thumb to the
trapezium
Open PIP and MCP
joints spaces without
overlap of bones
Overlap of soft tissue
profile of the palm over
the midshaft of the first
metacarpal
31. LATERAL PROJECTION
IR: 8 x 10 crosswise for two or more images on one cassette
Basic Patient Position
Place the hand and wrist flat on the cassette, the elbow may
need a small pad to promote contact of the hand with the
cassette. The fingers can be spread slightly. The thumb is
abducted and the hand internally rotated and supported in
position such that the thumb is lateral and in contact with the
cassette.
35. EVALUATION CRITERIA
First digit in a true
lateral projection
Area from the distal tip
of the thumb to
trapezium
Open PIP and MCP joint
spaces
Soft tissue and bony
trabeculation
36. PA OBLIQUE PROJECTION
IR: 8 x 10 crosswise for two or more images on one cassette
Basic Patient Position
The patient sits alongside the end of the table elbow flexed
palm downwards, or at the end of the table with he elbow
flexed at 90 degrees, hand and wrist flat on the cassette the
elbow may need a small pad to promote contact of the hand
with the cassette. With the thumb abducted, place the palmar
surface of the hand in contact with the cassette. Ulnar deviate
the hand slightly. Align the longitudinal axis of the thumb with
the long axis of the cassette. Center the cassette to the MCP
joint
40. EVALUATION CRITERIA
Proper rotation of
phalanges, soft tissue,
and first metacarpal.
Area from the distal tip
of the thumb to the
trapezium
Open PIP and MCP joint
spaces
Soft tissue and bony
trabeculation
43. HAND: PA PROJECTION
Indications for imaging
• Injury, Rheumatoid arthritis, Acromegaly and Bone pain.
IR: 8 x 10 inch for hand of average size or 10 x 12 inch
crosswise for two images.
Basic Position
The patient sits alongside the end of the table elbow
flexed palm downwards, or at the end of the table with
he elbow flexed at 90 degrees, hand and wrist flat on
the cassette the elbow may need a small pad to
promote contact of the hand with the cassette. The
fingers can be spread slightly.
47. EVALUATION CRITERIA
ID and markers must be present and
correct in the appropriate area of the
film
Evidence of collimation on four sides
equally around the centering point.
Limits of the examination, proximally
the radio and ulna carpal joints,
distally the tips of the distal
phalanges, laterally the skin margins
of first and fifth digits.
Metacarpophalangeal joints should be
open and the shafts of the second to
fifth metacarpals should be
symmetrical.
Exposure, adequate penetration to
visualize all bone detail and low
enough contrast to visualize the soft
tissues.
48. PA OBLIQUE PROJECTION
IR: 8 x 10 inch for hand of average size or 10 x 12
inch crosswise for two images.
Basic Position:
The patient sits alongside the end of the table
elbow flexed palm downwards, or at the end of the
table with he elbow flexed at 90 degrees, hand
and wrist flat on the cassette the hand is then
rotated laterally 35 to 45 degrees laterally and
supported so that the fingers are parallel to the
film.
52. EVALUATION CRITERIA
ID and markers must be present and correct in the appropriate
area of the film
Evidence of collimation on four sides equally around the
centering point.
Limits of the examination, proximally the radio and ulna carpal
joints, distally the tips of the distal phalanges, laterally the skin
margins of first and fifth digits.
The center of the 1st to 5th metacarpal shafts should not
overlap, the heads of the 1st and 2nd metacarpals should be
separated.
Exposure, adequate penetration to visualise all bone detail and
low enough contrast to visualise the soft tissues.
53.
54. LATERAL PROJECTION
IR: 8 x 10 inch for hand of average size or 10 x
12 inch crosswise for two images.
Basic Position:
The patient sits alongside the end of the table
elbow flexed palm downwards, or at the end of
the table with he elbow flexed at 90 degrees.
Center the cassette to the MCP joints, and
adjust the midline to be parallel with the long
axis of the hand and forearm.
Abduct the thumb of the patient.
58. EVALUATION CRITERIA
Hand in a true lateral position if
the following are seen:
Superimposed phalanges
Superimposed metacarpals
Superimposed distal radius
and ulna
Extended digits
Thumb free of motion and
superimposition
Each bone outlined through the
superimposed shadows of the
other metacarpals
59. PARA ENTREGAR!!!
Favor de:
Hacer un resumen de las proyecciones de los dígitos del 2 al 5:
PA
Lateral
Oblicua
Hacer resumen de las proyecciones del dígito 1:
PA/AP
Lateral
Oblicua
61. REFERENCES
Frank, Eugene D. (2007). Merrill's atlas of radiographic positioning &
procedures. 11th ed. St. Louis, Missouri: Mosby/Elsevier. Vol 1-3 REF
RC78.4 .B35 2007
Bontrager, Kenneth L. (2005). Textbook of radiographic positioning and
related anatomy. 6th ed. Missouri: Elsevier.
Brant, William E. (2006). Fundamentals of diagnostic radiology.
Philadelphia: Lippincott.
Enrlish, Ruth Ann. (2004). Patient care in radiography: with an introduction
to medical imaging. Philadelphia: Mosby. RC78 .E48 2004
Ward, Robert J. (2007). Pediatric imaging: case review. Philadelphia:
Mosby. RJ51.R3 W37 2007
