3 View Standard Hand Radiology Tutorial
Summary
TLDRDr. Jamie Motley's tutorial covers the standard radiographic examination of the hand, detailing the anatomical structures visible in various projections such as PA, medial oblique, and lateral. Key points include identifying the carpal bones, the common scaphoid fractures due to FOOSH injuries, and the unique appearance of the lunate in lateral views. The tutorial also emphasizes the importance of recognizing carpal-metacarpal joints, phalanges, and potential fractures, providing a comprehensive guide for medical professionals.
Takeaways
- 📚 The script covers a standard radiographic examination of the hand, highlighting the importance of different projections such as PA, medial oblique, and lateral for evaluating hand anatomy and pathology.
- 🔍 The anatomical structures of the wrist, including the ulna, radius, and carpal bones, are essential to understand for accurate radiographic interpretation.
- 💡 The scaphoid bone is the most commonly fractured carpal bone, often due to 'FOOSH' injuries, which occur when a person falls on an outstretched hand.
- 🌙 The lunate bone's crescent shape is particularly visible in lateral projections and is crucial for identifying certain conditions and fractures.
- 👀 The script emphasizes the importance of careful observation of the wrist anatomy, especially the scaphoid's waist, which is the most common site for fractures.
- 👈 The metacarpal bones articulate with the carpals and phalanges, forming the carpometacarpal and metacarpophalangeal joints, which are significant for hand function.
- 🤞 The thumb has a unique anatomy with only two phalanges, the proximal and distal, and no middle phalanx, unlike the other four fingers.
- 👉 The lateral projection is particularly useful for identifying fractures, such as those of the triquetrum, and for evaluating the direction of fractures or displacements.
- 👁 The distal phalanx's tuft is a notable feature that can be important in certain conditions causing bone resorption under the fingertips.
- 🛡 The triangular fibrocartilage complex in the wrist is not visible on radiographs but is important for cushioning the space between the ulna and carpals.
- 🔑 The script provides a comprehensive guide to understanding hand anatomy in radiographic examinations, which is key for medical professionals in diagnosing and treating hand-related conditions.
Q & A
What is the purpose of the video tutorial by Dr. Jamie Motley?
-The purpose of the video tutorial is to cover a standard radiographic examination of the hand, including standard projections and normal anatomy.
What are the standard projections of the hand mentioned in the script?
-The standard projections of the hand include PA (posteroanterior), lateral, and oblique hand projections.
Why are accessory projections useful in radiographic examinations?
-Accessory projections are useful for evaluating anatomy that is not well seen or for further evaluation of pathology that needs more detailed assessment.
What is the most common carpal bone to fracture, and what type of injury typically causes this?
-The scaphoid is the most common carpal bone to fracture, and it usually occurs due to FOOSH injuries, which are falls on an outstretched hand.
What is the significance of the lunar shape in the lateral projection of the hand?
-The lunar shape in the lateral projection refers to the lunate bone, which is easily identifiable due to its crescent moon-like appearance.
What is the role of the triangular fibrocartilage in the wrist?
-The triangular fibrocartilage cushions the space between the ulna and the carpals, playing a crucial role in the stability and flexibility of the wrist joint.
How many bones are in the proximal row of the carpal bones, and what are they?
-There are four bones in the proximal row of the carpal bones: the scaphoid, lunate, triquetrum, and pisiform.
What are the three main parts of a metacarpal bone?
-The three main parts of a metacarpal bone are the base (near the carpal metacarpal joint), the shaft (the thinner midsection), and the head (the slightly rounded end).
How many phalanges are there in the fingers, and what are the differences between the thumb and the other digits?
-There are 14 phalanges in the fingers, with three phalanges (proximal, middle, and distal) in each of the second through fifth digits, and two phalanges (proximal and distal) in the thumb.
What is the significance of the distal tuft of the distal phalanx?
-The distal tuft of the distal phalanx is a semi-bulbous feature that can be important in certain conditions causing resorption of bone directly under the fingertips.
Why is the lateral projection useful for identifying certain fractures?
-The lateral projection is useful for identifying certain fractures, such as triquetral fractures, due to the different orientation that reduces overlap of bones and allows for better visualization of the fracture site.
Outlines
📚 Introduction to Hand Radiography
Dr. Jamie Motley introduces a tutorial on standard radiographic examination of the hand. The standard projections discussed include PA hand, medial oblique hand, and lateral hand. Accessory projections are mentioned but not covered in the tutorial. The focus is on normal anatomy, starting with the wrist, identifying the ulna, radius, and carpal bones, including the scaphoid, lunate, triquetrum, pisiform, and the distal row of carpals. Special attention is given to the scaphoid due to its susceptibility to fractures from 'FOOSH' injuries. The tutorial outlines the carpal-metacarpal joints and the structure of the metacarpals and phalanges, including the unique anatomy of the thumb with only two phalanges.
🔍 Anatomy and Injuries in Oblique and Lateral Projections
This section delves into the anatomy visualized in the medial oblique and lateral projections of the hand. It emphasizes the different orientation of bones in these views, allowing for a more ventral perspective of the metacarpals and phalanges. The tutorial highlights the importance of identifying the carpal bones, such as the scaphoid, lunate, and triquetrum, and their potential fractures. The lateral projection is particularly useful for detecting triquetral fractures and evaluating finger displacement or angulation. The tutorial also mentions the presence of sesamoid bones and the triangular fibrocartilage, a structure not visible on radiographs but important for understanding wrist anatomy.
👁️ Lateral Projection Details and Tutorial Conclusion
The final paragraph focuses on the details of the lateral projection, providing insights into the alignment of the wrist bones and the visibility of individual digits. It discusses the challenges of identifying certain structures, such as the trapezium, trapezoid, and capitate, in this view and the benefits of using different radiographic projections for a comprehensive assessment. The paragraph also touches on the importance of examining for ligamentous or tendinous calcifications in the wrist area. The tutorial concludes with a reminder to join for future educational content.
Mindmap
Keywords
💡Radiographic examination
💡Projections
💡Anatomy
💡Carpal bones
💡Metacarpals
💡Phalanges
💡Fracture
💡Sesamoid bones
💡Triangular fibrocartilage
💡Ligamentous or tendonous calcifications
💡Volar plate
Highlights
Introduction to a standard radiographic examination of the hand by Dr. Jamie Motley.
Explanation of standard projections including PA hand, media oblique hand, and lateral hand.
Mention of accessory projections useful for further evaluation of anatomy and pathology.
Identification of the ulnar and radial styloid regions in the wrist.
Importance of the distal radial ulnar joint and radial carpal joint in hand projections.
Description of the carpal bones, including the scaphoid, lunate, triquetrum, pisiform, and their respective roles.
Emphasis on the scaphoid as the most common carpal bone to fracture, especially in FOOSH injuries.
Discussion on the lunate's appearance in lateral projections, resembling a crescent moon.
Clarification of the carpal metacarpal joint and its significance in hand anatomy.
Overview of the metacarpals, including their base, shaft, and head, and their articulation with the phalanges.
Differentiation between the thumb, having only two phalanges, and the other digits with three.
Explanation of the interphalangeal and metacarpophalangeal joints in the fingers.
Importance of the distal phalanx's tuft in certain bone resorption conditions.
Identification of sesamoid bones in the hand and their typical locations.
Discussion on the triangular fibrocartilage's role and its invisibility in radiographic projections.
Analysis of the medial oblique projection for a different orientation of hand anatomy.
Utilization of the lateral projection to evaluate fractures, displacement, and angulation.
Instructions on how to identify and evaluate the thumb's unique anatomy in radiographic projections.
Advice on checking for ligamentous or tendonous calcifications in the wrist region.
Conclusion and invitation to future tutorials for further learning.
Transcripts
welcome back this is dr jamie motley and
i will be covering a standard
radiographic examination of the hand
standard projections of the hand include
pa hand media oblique hand and lateral
hand there are multiple accessory
projections that we will not discuss in
this tutorial however they are very
useful for evaluating anatomy that is
not well seen or even pathology that
needs further evaluation let's begin
with some normal anatomy beginning in
the wrist this is the oma i'm just going
to change my color here i don't know how
well black is going to show up here is
the ulnar styloid this is this stylus
like region and again the rest of the
ulna now remember in hand projections we
are only going to get a variable amount
of the radius and ulna typically the
first inch or two of the ulna and radius
will be included in hand projections
simply to evaluate the radial carpal
joint
and the distal radial ulnar joint here's
the radius here is the radial styloid
this styloid-like region here next the
joint made between the radius and ulna
that you see in the wrist is the distal
radial ulnar joint it's important to say
distal because there is a proximal
radial on our joint here is the radial
carpal articulation between the distal
radius and the carpal bones they call
this shared radiocarpal joint space
these are the carpals now the proximal
row of the carpools is here this is the
proximal row proximal row has four bones
distal row here which articulates with
the metacarpals has four bones as well
let's start with the proximal row here
is the scaphoid now the scaphoid is a
very important bone and should be
paid close attention to because this is
the most common carpol to fracture
typically the fractures in this location
will occur by what we call foosh
injuries
also known as falling on an outstretched
hand so any type of activities in which
a person may fall and want to break
their fall using their hand
this particular bone is very susceptible
to fracture in those types of mechanisms
of injury now we want to pay very close
attention to the waste because the waste
is the most common location or the
midsection of the scaphoid this is the
most common location where fractures
will occur in the scaphoid now moving on
to the next carpel is going to be the
lunate now this name will become
important in just a moment when we get
to the lateral projection because on
lateral projections it does look very
much like a crescent moon hence the name
lunar or lunate so scaphoid lunate now
these two bones here are going to be
sitting on top of each other the bigger
of which is going to be the
triquetrum and the smaller rounder one
of which is the piezoform now the
piezoform is technically a sesamoid bone
and does live in a tendon overlap of the
piso form and the triquetrum is very
very common on bpa radiographs
now we come to the distal row the first
bone which articulates with the first
metacarpal is going to be the trapezium
trapezium second bone which is trapped
between the trapezium and the capitate
is going to be the
trapezoid next capitate and lastly the
hamate so we have outlined our eight
carpels moving on these articulations
are the carpal metacarpal joints they
are between the carpals which we just
discussed and the metacarpals now the
common joint between them again is
called the carpal metacarpal
joint now the metacarpals there are five
have three distinct areas that we like
to discuss the base which is in the
region of the carpal metacarpal joint
there's also the shaft which is the
midsection or the thinner section of the
metacarpal and we have the metacarpal
head which is slightly rounded it is
normal to have these small indentations
along the metacarpal heads the
metacarpal heads
articulate with the proximal phalanx now
the term phalanx or digit is also used
to describe the whole finger so if you
say the first phalanx or the first digit
or the first finger or which would be
the second in this case second finger or
second digit collectively the three
phalanxes
comprise a single digit now in digits
one through five you have three failing
cities you will have the proximal
you will have the middle
and you will have the distal phalanx
this is true again for the second
through fifth digits if we draw our
attention to the thumb you'll notice
that there is only a distal and proximal
phalanx therefore there will be one less
joint in the thumb notice here there's
an inter phalangeal joint between the
phalanxes this is an interphalangeal
joint if you notice on the second
through fifth digits there are two
joints along the digit
this will be the proximal
interphalangeal joint while this is the
distal interphalangeal joint this is an
important thing to note simply because
the digits two through five haven't
three failing c's and therefore two
joints between them now the distal
phalanx has a very pronounced feature is
semi
bulbous in appearance and this is the
distal tuft
now this region can become important in
certain conditions that can cause
resorption of the bone directly under
the tips of the fingers
the differential diagnosis is quite long
and once we get into differential
possibilities we'll talk a little bit
more about that these are sesamoid bones
these little small
bones that you can see both in the hands
and feet
again sesamoids are
within
tendonous structures and typically are
going to occur at the
fulcrum of a joint there's another
reason that i wanted to talk to you
about in the wrist and this area is
reserved for the triangular fibro
cartilage
and fibrocartilage is not
radiographically visible but is still
present the reason why i'm discussing
this region is because oftentimes
students want to say that there is a
almo carpal joint and that's not
necessarily true this triangular
fibrocartilage lives in this region and
essentially cushions the space between
the ulna and the carpals so the
radiocarpal articulation is the
articulation that we really talk about
as it does have highlighting cartilage
and is a typical normal joint space
here is the medial oblique projection of
the right hand the anatomy that's
visualized on the pa projection is still
visualized on the oblique projection
however we get a slightly different
orientation you'll notice now that we
can see the eventual portions of the
metacarpals and phalanges notice we can
see the more ventral portions of the
metacarpals here's the distal
interphalangeal joint which makes this
the distal phalanx middle phalanx
proximal interphalangeal joint proximal
phalanx metacarpal phalangeal joint
carpal metacarpal articulation of course
the metacarpals interphalangeal joint of
the thumb metacarpal phalangeal joint of
the thumb and again
carpal metacarpal joint again carpals
scaphoid lunate triquetrum and pisa form
distal row trapezium trapezoid capitate
hamate and the handmaid has this nice
little hook here ulna ulnar styloid
radial styloid radiocarpal joint now
we'll move on to the lateral projection
we are now looking at the lateral
projection let's start again with the
bones of the wrist ulnar styloid ulnar
styloid radius radiostyler lunate here's
where we see the very nice lunar shape
of the lunate now the lunate is going to
stand out for you it's going to be the
first bone you see that semilunar in
shape sitting directly on top of the
radius
the rest gets a little more complicated
here's the scaphoid we can only really
see this portion of it without much
overlap from the other carpals what you
see back here is actually the triquetrum
and on lateral projections you
oftentimes with triquetral fractures
we'll see a little flake back here
triglutual fractures also known as
fissures fractures is just a fracture of
the triquetrum and typically you'll see
the fragment in this location so lateral
projections can be very useful for that
we can also see a portion of the
trapezium we don't see much of the
trapezoid and the capitate sits directly
on top of the lunate and that's just
about as good as we're going to get you
don't see the pisa form very well you
don't see the hamate very well and so
you have to use your other radiographic
projections to help you identify those
structures
now as you can see all the digits as
well as all of the metacarpals
are stacked on top of each other so this
is not a great view
to see them individually however with
any type of forward or backward
displacement or angulation of fractures
this view can be very useful to evaluate
direction
also if you're
concerned about volar plate or dorsal
plate fractures or the phalanxes this
also is a use you can also separate the
fingers while taking this view and kind
of fan them out so you can see the
digits individually in a lateral
perspective as well now the thumb since
it kind of lays off to the side we can't
identify those structures this is the
metacarpal here is the proximal phalanx
sorry i'm getting a little messy here
and distal phalanx but
you're familiar with this anatomy now so
you know exactly what i'm pointing to
here is the interphalangeal joint of the
thumb
and the metacarpal phalangeal joint of
the there's a little
sesamoid bone we saw it on the other
projection it's okay we all also want to
make sure that there's no ligamentous or
tendonous calcifications or soft tissue
calcifications within this region i hope
this tutorial was useful and please join
us again for future tutorials
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