FIRST DIGIT (THUMB)

Frontal, Lateral, and Oblique

1. THUMB AP PROJECTION

o Film: 8x10 in. (18x24 cm) crosswise

o Hand extreme internal rotation with finger extended.
o CR is perpendicular to 1st metacarpophalangeal joint.
o Best demonstrates BASE OF 1ST METACARPAL for ruling
out BENNET’S TYPE FRACTURES.

Structure shown:
a. Distal Phalanx
b. Proximal Phalanx
c. 1st metacarpal joint
d. Carpometacarpal joint

2. THUMB LATERAL

o Film: 8x10 in. (18x24 cm) crosswise

o Pronate hand
o Have patient arch (cup) hand and abduct thumb until thumb
lies in a lateral position.
o CR is perpendicular to 1st metacarpophalangeal joint.

Structure shown:
a. Distal Phalanx
b. Proximal Phalanx
c. 1st metacarpal joint
d. Carpometacarpal joint

3. THUMB PA OBLIQUE

o Film: 8x10 in. (18x24 cm) crosswise

o Pronate hand
o Abduct thumb, and place on cassette in 45 degrees
oblique position.

Structure shown:
e. Distal Phalanx
f. Proximal Phalanx
g. 1st metacarpal joint
h. Carpometacarpal joint
 4. LATERAL PROJECTION

o Film: 8x10 in. (18x24 cm) crosswise

o Pronate hand
o Patient is seated alongside the table
o The forearm is placed on table
o The wrist is kept in ulnar deviation and thumb abducted
o Lateral aspect of thumb is brought into contact with the
cassette by curling fingers
o Demonstrates anterior and posterior displacements of the
bony structures and to localized foreign bodies.

Structure shown:
i. Distal Phalanx
j. Proximal Phalanx
k. 1st metacarpal joint
l. Carpometacarpal joint

DIGITS (2ND to 5TH digit)

1. PA PROJECTION

o FILM: 8 X 10 in. (18 x 24 cm) crosswise

o Hand and forearm in same horizontal plane
o Hand pronated with fingers extended
o CR is to the PIP joint of the affected digit
o It is recommended when there is a suspected joint injury.

2.

LATERAL PROJECTION
Structure shown:
o FILM: 8 X 10 in. ( 18 X 24cm ) crosswise a. Distal Phalanx
o Hand and forearm in same horizontal direction as film. b. Distal IP joint
o Seat patient at end of table, with elbow flexed about 90degrees. c. Middle Phalanx
d. Proximal IP joint
e. Proximal Phalanx
f. MCP joint
g. Head of metacarpal
 o Hand in Lateral position.
o Ulnar/medial side down for 4th and digit 5th digit
o Radial/lateral side down for 2nd and 3rd digit
o CR is to the PIP joint of the affected digit.

4th Digit 5th Digit

BURMAN METHOD
AP Projection for Carpometacarpal joint

o FILM: 8 X 10 in. (18 x 24 cm) crosswise

o Rotate the hand internally and abduct the thumb.
o Hyperextend the hand.
o CR is at 45 degrees towards the elbow at the 1st
CMC joint.
o SID: 18 inches to produce a magnified image that
creates a greater field of view concavoconvex
aspect of the joint.
o Best demonstrate a clearer image of the 1st CMC
joint than the standard AP Projection.

Structure showed:
o TRAPEZIUM in concave profile
o Base of the 1st MC in convex profile
o Magnified concavoconvex outline of the 1st CMC joint
FOLIO METHOD
Skiers Thumb Projection

o FILM: 8 X 10 in. (18 x 24 cm) crosswise

o Hand rotated laterally into 45 degree oblique
position; resulting in true PA projection of the
thumb.
o Place round spacer, such as a roll of medical tape,
between proximal thumb regions; wrap rubber
bands around distal thumbs as shown.
o CR is to level of the MCP joints.
o Minimum SID of 40 inches (100cm)
o Collimate on four sides to include second
metacarpals and entire thumbs, from CMC joints
proximally to distal phalanges distally.

Structure shown:
a. Entire thumbs from second metacarpals to distal phalanges. Demonstrates
metacarpophalangeal angles and joint spaces at MCP joints.

A. HAND
PA, PA OBLIQUE, LATERAL, NORGAARD, BREWERTON

ROUTINE: PA-OBLIQUE-LATERAL

1. HAND PA
o FILM: 8 X 10 in. (18 x 24cm)
o The patient sit at end of table, with elbow flexed about 70
degrees and place the hand on the cassette with the
palmar surface down.
o 1 inch or 2.5 cm. of the distal forearm should be included
in the radiograph.
o CR is to the 3rd MCP joint.
o Demonstrates a frontal image of the carpals, metacarpals
and phalanges; the interarticulations of the hand and the distal radius and ulna.
Also demonstrates an oblique image of the first digit.

Structure shown:
a. Metacarpals
b. Phalanges
c. Carpal bones
 d. Distal radial ulnar joint.

2. HAND PA OBLIQUE
o FILM: 8 X 10 in. (18 x 24 cm)
o The patient sit at end of table, with elbow flexed about
90degrees and place the hand on the cassette in the
lateral position, ulnar side down.
o Oblique hand towards the lateral so that the MCP joint
form a 45 degree angle with plane of film.
o 1 inch or 2.5 cm. of the distal forearm should be
included in the radiograph.
o CR is to the 3rd MCP joint.

Structure shown:
a. Metacarpals
b. Phalanges
c. Carpal bones
d. Distal radial ulnar joint

B. HAND LATERAL
Extension, Flexion, Fan Lateral

1. HAND LATERAL IN EXTENSION

o FILM: 8 X 10 in. (15 x 24 cm)

o Seated sideways at the end of the table.
o Flex elbow 10 Hand in lateral position with the
ulnar aspect down (lateromedial) against the IR.
o Palmar surface perpendicular to IR
o CR to superimpose 2nd-5th MCP joints.
o The lateral in extension is use for localization of
foreign bodies and fractures of metacarpals.

Structure shown:

a. Phalanges
b. Metacarpals
c. Carpals
d. Distal Phalanx
e. Proximal Phalanx
f. 1st metacarpal

2. HAND LATERAL IN FLEXION

 o FILM: 8X 10 in. (18 x 24 cm)
o Seated sideways of the end of the table
o Hex elbow 90°
o Flex fingers into a natural fixed position with thumb slightly touching the 1st
finger.
o Thumb should be parallel firm
o Fingers are superimposed with the enfire hand in a true lateral position
o CR to superimpose 2-5 MCP joints.
o Useful for diagnosing possible trauma to the digits. It is also the preferred lateral
position for the hand.

Structure shown: Carpal Bones

a. 1st distal phalanx a. Capitate

b. 1st metacarpal b. Lunate
c. 1st proximal phalanx c. Pisiform
d. radius d. Scaphoid
e. ulna e. Trapezium
f. ulnar styloid f. Trapezoid
g. Triquetrium

3. HAND IN FAN LATERAL

o FILM: 8 X 10 in. (18 x 24 cm)

o Seated sideways at the end of the able.
o Align long axis of hand a long axis of film
o Rotate hand and wrist into a lateral position with the
thumb side up (ulnar side down).
o Spread fingers and thumb into a fan position.
o Thumb should be projecting away from the palm and
parallel to the film
o CR perpendicular to 2nd MCP joint

Structure shown:

a. Phalanges
b. MCP joint
c. Metacarpals
d. Carpals
e. Radius
 4. NORGAARD METHOD (BALL CATCHERS
POSITION)

o FILM: 8 X 10 in. (18 x 24 cm)

o Semi-or half supinated both hand at 45
degrees
o Cupped as if the patient were going to catch
a ball
o CR perpendicular to level of the 5th MCP
joint.
o Best demonstrate fractures at the base of
the 5th metacarpal
o Best demonstrate early evidence of rheumatoid arthritis.

Structure shown:

a. Phalanges
b. Metacarpals
c. Carpals
d. Distal radial ulnar joint

5. HAND AP AXIAL BREWERTON’S METHOD

o FILM: 8 X 10 in. (18 x 24 cm)

o Patient position: STANDING
o Hand supinated with fingers flexed
o Flex the 2nd to 5th MCP joint so that shaft of the
MC joint 45 degrees with IR
o CR-entering at 3rd CMC joint.
o Used to demonstrate bony erosion of MC heads
& phalangeal bases of finger.

Structure shown:

a. Phalanges
b. Metacarpals
c. Carpals
d. Distal radial ulnar joint

WRIST
Routine: PA, Oblique, Lateral
1. WRIST PA

o FILM X10 (18 x 24 cm)

o SID: 40
o PP: Seated sideways at the end of the table.
o Flex elbow 90°
o Pronate hand
o Place entire upper extremity in same horizontal
plane as film.
o Arch (cup) hand by flexing fingers at middle
phalangeal joints to place carpals in contact with
cassette.
o CR to mid carpals.

Structure shown:
a. 1st- 2nd metacarpals
b. 8 carpal bones
c. Ulnar styloid process
d. Radial styloid process

2. WRIST AP
o FILM X10 (18 x 24 cm)
o Have the patient rest the forearm on the table,
with the arm and hand supinated.
o An AP wrist may be taken, with hands slightly
arched to place wrist and carpals in close contact
with cassette.
o This wrist projection is good for visualizing the
carpals.
o CR to mid carpal

Structure shown:
a. 1st Metacarpal
b. Trapezium and Trapezoid
c. Capitate and Hamate
d. Triquetrum and Scaphoid
e. Pisiform and Lunate
f. Radius and Ulna

3. WRIST PA OBLIQUE

o FILM 8 X10 (18 x 24 cm)

o PP: Patient is sitting sideways at the end of the
table.
o Flex elbow (about 90") with wrist and hand
 laterally (externally) rotated 45 from the prone position.
o *fingers in "C" or use 45 sponge
o Best demonstrate the carpals on the lateral side of the wrist (scaphoid and
trapezium)
o Best demonstrate the anatomic snuff box.

Structure shown:

a. 1st metacarpal
b. Trapezoid
c. Trapezium
d. Scaphoid
e. Lunate
f. Radius
g. Ulna

4. WRIST AP OBLIQUE
o FILM 8X 10 inch (18X24 cm)
o PP: standing/sitting in the side of the table
o Rotate the wrist medially approximately 45 to the
image receptor.
o This position separates the pisiform from adjacent
carpal bones.
o Best demonstration including trauma, suspected
infections, injuries, arthropathy, foreign bodies, and
scaphoid and subtle fractures.
o CR to carpal region

Structure shown:
a. Hamate
b. Pisiform
c. Triquetrium
d. Lunate

5. WRIST LATERAL
o FILM 8 x 10 in. (18 x 24 cm), SID: 40
o PP: Seated sideways at the end of the table.
o Flex elbow 90. Place the wrist and hand on IR in thumb-up
lateral position.
o CR to IR, directed to mid carpal
o Good projection to assess the relationship of capitate,
lunate and distal radius
o Best demonstrate the pronator fat stripe and widening of the
wrist joint due to fracture or dislocation.
 Structure shown:
a. 1st metacarpal
b. Trapezium
c. Scaphoid
d. Capitate
e. Lunate
f. Radius
g. Ulna

6. PA WRIST RADIAL DEVIATION

o FILM 8 X10in (18 x 24 cm) SID: 40
o PP: Seated sideways at the end of the table.
Flex elbow 90
o Pronate hand
o Have patient invert (turn inward) hand as far
as can be rolated.
o CR-IR directed to midcarpal area
o Best demonstrate the lunate, triquetrum,
pisiform and hamate.

Structure shown:

a. 1st metacarpal
b. 8 carpal bones
c. Ulna
d. Radius
e. Ulnar styloid process
f. Radial styloid process

7. PA WRIST ULNAR DEVIATION

o FILM 8 X10in (18 x 24 cm) SID: 40
o Seated sideways at the end of the fable. Flex
elbow 90°
o Pronate hand
o Have patient exert (turn outward hand as far as
can be rotated.
o No CR
o This projection opens the spaces between
adjacent carpals on the lateral side
o Best demonstrate fractures of the scaphoid.
WALA PAKOY KATUNG TAAS2 UG NAMES SA WRIST KAY
NALIBOG KO DIMAKLARO ANG PICTURE.

FOREARM
AP, Lateral