3 View Standard Hand Radiology Tutorial

Summary

Dr. 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

00:00

📚 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.

05:02

🔍 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.

10:03

👁️ 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.

Keywords

💡Radiographic examination

Radiographic examination refers to the process of using X-rays to examine the internal structures of the body, such as bones and joints. In the context of this video, it specifically pertains to examining the hand. The script discusses various standard projections used in hand radiography, which are essential for visualizing different aspects of the hand's anatomy and for diagnosing potential injuries or conditions.

💡Projections

In radiography, projections refer to the specific angles and positions from which X-rays are taken to capture images of the body part in question. The script mentions several standard projections of the hand, including PA (posteroanterior), lateral, and oblique views, each providing a unique perspective on the hand's anatomy and aiding in comprehensive evaluation.

💡Anatomy

Anatomy is the study of the structure and parts of living organisms, including the human body. In this video, the term is used to describe the bones and joints of the hand, which are the focus of the radiographic examination. The script provides a detailed overview of the hand's bones, such as the carpals, metacarpals, and phalanges, and their respective roles and positions.

💡Carpal bones

The carpal bones are a group of eight small bones in the wrist that form the transition from the forearm to the hand. They are crucial for wrist movement and provide attachment points for the tendons and ligaments. The script identifies and describes the specific carpal bones, such as the scaphoid, lunate, triquetrum, and pisiform, and their significance in hand radiography.

💡Metacarpals

Metacarpals are the long bones that form the middle part of the hand, connecting the wrist (carpal bones) to the fingers. There are five metacarpals, each corresponding to a finger. The script discusses the metacarpals' structure, including the base, shaft, and head, and their articulation with the carpal bones and phalanges.

💡Phalanges

Phalanges are the bones that make up the fingers and thumb. The human hand typically has 14 phalanges, with each finger having three (proximal, middle, and distal) and the thumb having two (proximal and distal). The script explains the structure of the phalanges and their role in the hand's anatomy, particularly in the context of fractures and joint evaluation.

💡Fracture

A fracture is a break or crack in a bone. The script emphasizes the scaphoid bone as the most common carpal bone to fracture, often due to 'FOOSH' injuries (Falling on an Outstretched Hand). Understanding fractures is essential in radiographic examination for proper diagnosis and treatment planning.

💡Sesamoid bones

Sesamoid bones are small, round bones that are embedded within tendons and are often found near joints. The pisiform bone, mentioned in the script, is an example of a sesamoid bone in the hand. These bones can be important in radiographic evaluations, especially when assessing for fractures or other conditions.

💡Triangular fibrocartilage

The triangular fibrocartilage is a type of fibrocartilage that is located in the wrist, cushioning the space between the ulna and the carpals. Although it is not visible on X-rays, the script mentions its importance in understanding wrist anatomy and the potential for injury or degeneration in this area.

💡Ligamentous or tendonous calcifications

Ligamentous or tendonous calcifications refer to the abnormal deposits of calcium in ligaments or tendons, respectively. The script advises to check for these calcifications during radiographic examination, as they can indicate certain conditions or injuries, affecting the soft tissues of the hand.

💡Volar plate

The volar plate is a fibrocartilaginous structure on the palmar side of the fingers that helps stabilize the joints. The script mentions the volar plate in the context of lateral projections, which can be useful for evaluating potential fractures or injuries involving this structure.

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