Evaluation Criteria Hand, Wrist and Fingers

PA Hand

Side marker present

Bony trabecular detail and surrounding soft tissue

Anatomy from distal phalanx to distal radius and ulna

Slightly separate digits with no soft tissue overlap

No rotation of the hand shown by

• equal concavity of the metacarpal and phalangeal bodies on both sides

• equal amount of soft tissue on both sides of the phalanges

• equal distance between metacarpal head

• fingernails in the center of each distal phalanx

Open MCP joints

Open IP joints indicating the hand is placed flat on IR

PA Oblique Hand

Side marker present

Bony trabecular detail and surrounding soft tissue

Anatomy from distal phalanx to distal radius and ulna

Digits separated slightly with no overlap of their soft tissue

45 degrees of rotation of anatomy shown by

-decreasing amounts of separation between metacarpal bodies 2-5, with the 2nd and the 3rd having the greatest separation.

-partial superimposition of 3rd, 4th and 5th metacarpal bases and heads.

Open metacarpophalangeal joints

Open interphalangeal joints when digits are positioned parallel to IR

Lateral Hand

Side Marker

Bony trabecular detail

Anatomy from distal phalanx to distal radius and ulna

Extended digits

Hand in true lateral position shown by

-superimposed phalanges, metacarpals

-superimposed distal radius and ulna

Thumb free of motion and superimposition

PA Wrist

Side Marker

Bony trabecular detail

Distal radius and ulna, carpals and metacarpals visible

No excessive flexion of digits to overlap and obscure metacarpals

No rotation in carpals, metacarpals, radius and ulna

Open radioulnar joint space

PA Oblique Wrist

Side marker present

Bony trabecular detail

Distal radius and ulna, carpals and metacarpals visible

45 degree rotation of anatomy shown by

-slight interosseous space between 3rd, 4th and 5th metacarpal bodies

(over-rotated)

-slight overlap of the distal radius and ulna

Carpals on lateral side of the wrist

Trapezium and distal half of scaphoid without superimposition

Open trapeziotrapezoid and scaphotrapezial joint spaces

Lateral Wrist

Side Marker

Bony trabecular detail

Distal radius and ulna, carpals and metacarpals visible

Superimposed distal radius and ulna

Superimposed metacarpals

Oblique Thumb

Side Marker

Bony trabecular detail and surrounding soft tissue

Area from distal tip of the thumb to the trapezium

Proper rotation, demonstrated by concave surface of elevated side of the proximal phalanx and metacarpal

Open IP and MCP joint spaces

AP Thumb

Side marker

Bony trabecular detail and surrounding soft tissue

Area from the distal phalanx to the trapezium

No rotation shown by

-concavity of the phalangeal and metacarpal bodies

-Equal amount of soft tissue on both sides of the phalanges

-thumbnail in the center of the distal thumb

Overlap of soft tissue profile of the palm over the midshaft of the first metacarpal

Open IP and MCP joint spaces without the overlap of bones

Lateral Thumb

Side Marker

Bony trabecular detail and surrounding soft tissue

Area from the distal phalanx to the trapezium

No rotation shown by

-concave anterior surface of the proximal phalanx and metacarpal

Open IP and MCP joint spaces

PA Digit (2-5)

Side Marker

Bony trabecular detail and surrounding soft tissue

Entire digit from distal phalanx to associated carpal

No soft tissue overlap from adjacent digits

No rotation shown by

-equal concavity on both sides of phalangeal bodies

-equal amount of soft tissue on both sides of phalanges

Fingernail centered over distal phalanx if visible

Open IP and MCP joint spaces

PA Oblique Digit (2-5)

Side marker

Bony trabecular detail and surrounding soft tissue.

Entire digit, including the associated carpal

Digit rotated at 45 degrees shown by concavity of elevated side of the phalangeal bodies

No superimposition of the proximal phalanx or MCP joint by adjacent digits

Open IP and MCP joint spaces

Lateral Digit (2-5)

Side Marker

Bony trabecular detail and surrounding soft tissue

Entire digit to associated carpal

No rotation shown by

-concave, anterior surfaces of the phalanges

No superimposition of the proximal phalanx or MCP joint by adjacent digits.

Open IP joint spaces