HAND RADIOGRAPHY
BY – ANUPAM DAS
(DEPARTMENT OF RADIOLOGY)
Anatomy –
The five digits are described by numbers and names; however,
description by number is the more correct practice. Beginning at the
lateral, or thumb, side of the hand, the numbers and names are as
follows:
• First digit (thumb)
• Second digit (index finger)
• Third digit (middle finger)
• Fourth digit (ring finger)
• Fifth digit (small finger)
The digits contain 14 phalanges (phalanx, singular), which are long
bones that consist of a cylindrical body and articular ends. Nine
phalanges have two articular ends. The first digit has two phalanges—
proximal and distal. The other digits have three phalanges—proximal,
middle, and distal. The proximal phalanges are the closest to the palm,
and the distal phalanges are the farthest from the palm. The distal
phalanges are small and flattened, with a roughened rim around their
distal anterior end; this gives them a spatulalike appearance. Each
phalanx has a head, body, and base.
A, Anterior aspect of right hand and wrist.
B, Second metacarpal and phalanges showing head, neck, body, and base on second digit.
Indication –
o Pain, tenderness, or swelling in the finger.
o Deformity in the finger.
o Suspected dislocated joint.
o Suspected inflammation or arthritis.
o Suspected tumors.
Projections –
o PA
o Lateral (Lateromedial or mediolateral)
o Oblique (PA Oblique/Lateral rotation)
o Oblique (AP Oblique/Medial rotation)
PA Projection –
Position -
o Seat the patient at the end of the radiographic table.
o Place the extended digit with the palmar surface down on the
unmasked portion of the IR.
o Separate the digits slightly, and central the digit under examination to
the midline portion of the IR.
Central -
o Perpendicular to the PIP joint of the affected digit
Collimation -
o 1 inch (2.5 cm) on all sides of the digit, including 1 inch (2.5 cm)
proximal to the MCP joint
Structures shown -
o B, PA hand showing closed, displaced,
transverse fracture of third proximal phalanx
with dislocation of MCP joint. Overall hand was
o A, PA hand. placed in correct position despite trauma.
Lateral Projection(Lateromedial or mediolateral) –
Position -
o Seat the patient at the end of the radiographic table with the forearm in
contact with the table and the hand in the lateral position with the ulnar
aspect down.
o Extend the patient’s digits and adjust the first digit at a right angle to the
palm.
o Place the palmar surface perpendicular to the IR. Center the IR to the MCP
joints, and adjust the midline to be parallel with the long axis of the hand and
forearm. If the hand is resting on the ulnar surface, immobilization of the
thumb may be necessary.
o The two extended digit positions result in superimposition of the phalanges.
A modification of the lateral hand is the fan lateral position, which eliminates
superimposition of all but the proximal phalanges.
Central -
o Perpendicular to the second digit MCP joint.
Collimation -
o 1 inch (2.5 cm) on all sides of the shadow of the hand and thumb,
including 1 inch (2.5 cm) proximal to the ulnar styloid.
Lateral hand with ulnar Lateral hand with radial surface Fan lateral hand.
surface to IR: lateromedial. to IR: mediolateral.
Structures shown -
o B, PA hand showing closed, displaced,
transverse fracture of third proximal phalanx
with dislocation of MCP joint. Overall hand was
o A, PA hand. placed in correct position despite trauma.
Oblique (PA Oblique/Lateral rotation) –
Position -
o Adjust the patient's height to rest the forearm on the table.
o Rest the patient's forearm on the table with the hand pronated and the palm
resting on the IR .
o Adjust the obliquity of the hand so that the MCP joints form an angle of
o approximately 45 degrees with the IR plane.
o Use a 45-degree foam wedge to support the fingers in the extended po ition to
demonstrate the interphalangeal joints.
Central -
o Perpendicular to the third MCP joint.
Collimation -
o 1 inch (2.5 cm) on all sides of the shadow of the hand and thumb,
including 1 inch (2.5 cm) proximal to the ulnar styloid.
PA oblique hand for PA oblique hand for
PA oblique hand for demonstration of joint
demonstration of demonstration of joint spaces.
metacarpals. spaces.
Structures shown -
o The resulting image shows a
PA oblique projection of the
bones and soft tissues of the
hand. This supplemental
position is used for
investigating fractures and
pathologic conditions.
Oblique (AP Oblique/Medial rotation)
/ NORGAARD METHOD/ Ball-catcher View –
Position -
o Seat the patient at the end of the radiographic table. Norgaard recommended
that both hands be radiographed in the half-supinate position for compari on.
o Have the patient place the palms of both hands together. Center the MCP
joints on the medial aspect of both hand to the I R . Both hands should be in
the lateral position.
o Place two 45-degree radiolucent sponges against the posterior aspect of each
hand.
Central -
o Perpendicular to a point midway between both hands at the level
of the MCP joints for either of the two patient positions.
Collimation -
o 1 inch (2.5 cm) on all sides of the shadow of the hand and thumb,
including 1 inch (2.5 cm) proximal to the ulnar styloid.
AP oblique hands, semi-supinated position. Ball-catcher's position
Structures shown -
o The resulting image shows an AP 45- degree oblique projection of both
hands The early radiologic change significant in making the diagnosis
of rheumatoid arthritis is a symmetric, very light, indistinct outline of
the bone corresponding to the insertion of the joint capsule dorsoradial
on the proximal end of the fir t phalanx of the four finger . I n addition,
associated demineralization of the bone structure is always present in
the area directly below the contour defect.
Exposure Factors -
kVp mA mAs Grid FFD Casstte
40-45 160 4-6 No 100 cm 8’’×10”
THANK YOU