Hand , Finger and Thumb

Structures of the upper limb?

1. Shoulder gridle

2. Arm ( Humerus) 

3. Forearm

4. Hand & wrist

Bones of hand (Include digit & R/L)

B.

D.

F.

H.

J.

L.

O.

M.

Q.

R.

B. 1st metacarpal of right hand

D. proximal phalanx of 1st digit of right hand

F. Distal phalanx of 1st digit of right hand

H. Proximal phalanx of 2nd digit of right hand

J. Middle phalanx of 2nd digit of right hand

L. Distal phalanx of 2nd digit of right hand

O. Proximal phalanx of 3rd digit of right hand

M. Middle phalanx of 4th digit of right hand

Q. 4th metacarpal of right hand

R. Carpometacarpal joint of 5th digit of right hand

Joints of Hand (Include digit & R/L)

A.

C.

E.

G.

I.

K.

N.

P.

A. Carpometacarpal joint of 1st digit of right hand 

C. Metacarpo-phalangeal joint of 1st of right hand 

E. Interphalangeal joint of 1st  of right hand 

G. Metacarpo-phalangeal joint of 2nd of right hand 

I. Proximal inter-phalangeal joint of 2nd of right hand 

K. Distal inter-phalangeal joint of 2nd of right hand 

N. Distal inter-phalangeal joint of 5th of right hand 

P.  Metacarpo-phalangeal joint of 5th of right hand 

Wrist bones Left to right : One of them is anterior ! List all names. Learn what is lateral and Proximal . How can you tell? 

A.

B.

C.

D.

A. Scaphoid/Navicular

B. Lunate/semilunar

C. Triquetrum/triangular/ Cuneiform

D. Pisiform

Wrist bones Left to right : One of them is anterior ! List all names. Learn what is lateral and Proximal . How can you tell? 

E.

F.

G.

H.

E. Trapezium/Greater Multangular ( UM as in by the thUMb ) ( think it’s greater cause it’s #1 as in 1st digit)

F. Trapezoid/ Lesser Multangular ( ID as in it’s by its sIDe )

G. Capitate / Os Magnum ( Magnum condoms as it’s XL)

H. Hamate/ Unciform

Lateral aspect of Hand matches with ?

First digit

Trapezoid matches with ?

second digit. always think i before o 

How to remember Capitate and it’s second name? Think of XL magnum condoms. It’s the biggest

How to remember Hamate? I think of a pizza slice

Hook on hamate is called?

Hook of hamulus

Scaphoid articulates with the ____ if it’s near the thumb?

Radius

Triquetrum , how to remember it has three names? It has the word Tri- in it 

On a lateral , if no rotation the scaphoid and pisiform are superimposed 

When you rotate laterally for oblique you see what ?

Anterior portion of the hand has Concavity 

• Side of the hand that is lifting away from the IR has concavity 

What are the margins on a PA 

Equal and even margins 

Heads of metacarpals on PA are ?

nice and even 

Metacarpal spacing on Oblique ? Remember the three bears

Papa bear : Large spacing

Mama bear : medium spacing

baby bear: small spacing

What we want in a lateral hand image

• Fingers spread out

• Radius and ulna superimposed

• Metacarpals superimposed

• No tissue touching though 

Exam considerations for finger exams ( 2-5 digits)

kV: 55-65 

8×10 lw

• Short exposure time ( don’t want patient to move)

• Small focal spot ( small body part/better spatial resolution )

• Non-grid cause extremities

• 40 SID minimum

• Gonadal shielding when appropriate 

•  Marker visible 

What position is the thumb in and what hand ? Pay attention to concavity 

A. 

B.

C.

D.

E.

F.

G.

A. Distal Phalanx 

B. Interphalangeal joint 

C. Proximal Phalanx

D. Metacarpo-Phalangeal joint  

E. Sesamoid bone 

F. 1st metacarpal 

G. 1st Carpometacarpal joint 

Where is CR for Lateral thumb?

Center at the first metacarpo-phalangeal joint

Lateral thumb image analysis : Structures shown

• Distal and proximal phalanges

• 1st metacarpal 

• Trapezium ( superimposed) 

• associated joints 

Lateral thumb image analysis : Position

• Thumb in true lateral 

• concave shaped anterior surface of the proximal phalanx and first MCP

• Straight posterior surfaces

• NO SOFT TISSUE OVERLAP

What is oblique , Lateral and AP thumb?

first image: AP ( equal and even ) 

Second image: Oblique ( thicker with straight posterior side) 

Third image: Lateral ( thinner with more concavity) 

Obliques are what projection?

PA

Hand exam considerations :

kV: 55-65

10X12 LW

Non-Grid

Hand exam considerations : Structures shown

Entire hand/wrist shown and 1 inch (2.5cm) of distal forearm

• PA hand shows oblique thumb 

CR for PA hand 

3rd metacarpo-phalangeal joint 

PA Hand image analysis

• Metacarpo-phalangeal joint and interphalangeal joint open

• correct CR 

• hand pronated

PA Hand image analysis : No rotation

• Symmetrical appearance of both sides of shafts of metacarpals and phalanges of digits 2-5

• equal amounts of tissue on each side of phalanges 

•  Digits slightly separated no soft tissue overlap 

PA 45 degree oblique Hand

• When parallel to IR it opens up joint spaces

CR to 3rd Metacarpo-phalangeal joint

• not a pinpoint but an area

PA 45 degree oblique Hand : Digits NOT parallel

Only done when joints are not of interest

PA oblique hand image analysis criteria

• Midshaft of metacarpals with no overlap 

• some overlap of distal heads of 3-5 metacarpals

• No overlap of distal 2nd and 3rd metacarpals

•  

Excessive overlap of metacarpals indicate? ( for oblique hand )

over rotation

Too much separation indicate? ( for oblique hand)

under rotation

CR for lateral hand?

CR to 2nd metacarpo-phalangeal joint

Lateral Hand image analysis criteria : Position

• Fingers equally seprated 

• phalanges in lateral position

• hand and wrist in true lateral position 

• Distal radius and ulna superimposed

• Metacarpals superimposed