WRIST POSITIONS

CARPAL CANAL

TANGENTIAL PROJECTION:

GAYNOR-HART METHOD

CARPAL BRIDGE
TANGENTIAL PROJECTION
LENTINO

TRAPEZIUM
PA AXIAL OBLIQUE PROJECTION
CLEMENTS-NAKAYAMA METHOD

*alignment WITH ulnar deviation

TRAPEZIUM
PA AXIAL OBLIQUE PROJECTION
CLEMENTS-NAKAYAMA METHOD

*alignment WITHOUT ulnar deviation

SCAPHOID SERIES

PA AND PA AXIAL PROJECTIONS
RAFERT-LONG METHOD- ULNAR DEVIATION

PERPENDICULAR to midcarpal area

STRUCTURE SHOWN

• Carpal spaces are better demonstrated compared with PA projection.

• Distal radius

• Distal ulna

• Radiocarpal joint (the scaphoid, lunate, and triquetrum)

• Ulnocarpal joint (lunate and triquetrum)

• Carpal bones

• Bases of the 1st–5th metacarpals

CR & SS

AP PROJECTION
PATIENT POSITION

• Seat the patient at the end of the radiographic table.

POSITION OF PART

• Arm and hand supinated

• Elevate digits to place the carpals in close contact with the IR.

• Have the patient lean laterally to prevent rotation of the wrist

CR: 

• PERPENDICULAR to midcarpal area
  

• STRUCTURES SHOWN 

  • SLIGHT OBLIQUE PROJECTION OF THE ULNA.

  • SCAPHOID with self-superimposition.

  • Distal radius

  • Distal ulna

  • Radiocarpal joint

  • Ulnocarpal joint

  • Eight carpal bones

  • Bases of the metacarpals

  • Soft tissue of the wrist

CR & SS

PA PROJECION
PATIENT POSITION

Seat the patient low enough. This position places the shoulder, elbow, and wrist joints in the same plane to permit right-angle rotation of the ulna and radius for the lateral position.

POSITION OF PART

• Flex the digits to place the wrist in close contact with the film.

The CR is angled 30° cephalad (toward the elbow), elongating the scaphoid and capitate.

The CR is angled 30° caudad (toward the fingertips), elongating the capitate only.

CR AND SS

PA PROJECION

DAFFNER, EMMERLING, AND BUTERBAUGH METHOD

Purpose: Better demonstrate the scaphoid and capitate.

CR

PERPENDICULAR TO THE WRIST JOINT 

STRUCTURES SHOWN

A LATERAL PROJECTION OF THE: 

• PROXIMAL AND DISTAL CARPALS

• PROXIMAL METACARPALS

• DISTAL RADIUS AND ULNA

• RADIOCARPAL JOINT

LATERAL POSITION (EXTENSION) LATEROMEDIAL PROJECTION

POSITION OF PART

• Have the patient flex the elbow 90 degrees to rotate the ulna to the lateral position.

• Center the IR to the wrist (radiocarpal) joint.

• Adjust the forearm and hand, placing the humeral epicondyles and styloid processes superimposed and perpendicular to the IR, so that the wrist is in a true lateral position

CR

PERPENDICULAR TO THE WRIST JOINT 

STRUCTURE SEEN

• Specifically demonstrates: Carpal boss (3rd CMC joint). 

Distal radius and ulna

Radiocarpal joint

Carpal bones in lateral profile

Proximal metacarpals

CR AND SS

PALMAR FLEXION (LATERAL POSITION)FIOLE METHOD
Position:

•  Wrist in palmar flexion.

Purpose: 

• Best demonstrates the carpal boss (carpe bossu).

CR

PERPENDICULAR to wrist joint 

STRUCTURE SHOWN

• Specifically demonstrates: Scaphoid in lateral profile. 

Distal radius and ulna

Radiocarpal joint

Carpal bones in lateral profile

Proximal metacarpals

Scaphoid in lateral profile, achieved by rotating it anteriorly into a dorsovolar position.

PALMAR FLEXION (LATERAL POSITION)

Burman et al. Method

Position:

 Wrist in palmar flexion.

Purpose: 

Obtains a lateral view of the scaphoid.

Part position: 

• Palmar flexion rotates the scaphoid anteriorly into a dorsovolar position, producing a lateral profile.

CR

Perpendicular to the midcarpal area (center of the wrist). 

STUCTURE SHOWN

*BEST FOR PISIFORM

*Demonstrates the carpals on the MEDIAL SIDE OF THE WRIST

*TRIQUETRIUM, HAMATE and PISIFORM free of superimposition and in profile.

Best demonstrates the pisiform and the medial-sided carpals of the wrist, with the triquetrum, hamate, and pisiform shown in profile and free of superimposition.

AP OBLIQUE PROJECTIONMEDIAL ROTATION

Thumb goes IN = Internal (Medial) Rotation

POSITION 

Rotate the wrist medially (internally) until it forms semisupinated position of approx. 45 degrees to the IR.

CR

Perpendicular to the midcarpal area

STRUCTURE SHOWN: 

• Demonstrates the carpals on the LATERAL SIDE OF THE WRIST, particularly the trapezium and the scaphoid.

PA OBLIQUE PROJECTIONLateral rotation
POSITION

• From a pronated position, rotate the wrist laterally (externally) 45 degrees

CR

Perpendicular to the midcarpal area

PA OBLIQUE with Ulnar Deviation

- used when the scaphoid is under examination

CR: PERPENDICULAR to the SCAPHOID.

• CR angulation of 10 to 15 degrees proximally or distally is sometimes required for clear delineation. 

STRUCTURE SHOWN

• CORRECTS FORESHORTENING OF THE SCAPHOID

(foreshortening is a type of shape distortion in which an object appears shorter and thicker.)

• opens interspaces between the carpals on the lateral side of the wrist.

PA OBLIQUE with Ulnar Deviation or Flexion

• Move the elbow away from the patient’s body.

• Turn the hand outward until the wrist is in extreme ulnar deviation.

CR:

PERPENDICULAR to the midcarpal area.

STRUCTURE SHOWN

• opens interspaces between the carpals on the medial side of the wrist.

PA OBLIQUE with Radial Deviation

• Move the elbow towards the patient’s body.

• Turn the hand medially

CR: 

PERPENDICULAR to the table and directed to enter the scaphoid 

STRUCTURES SHOWN:

• Places the scaphoid at right angles to the CR and it is projected without self-superimposition.

PA Axial Projection Stecher Method
POSITION OF PART

Remember: 20 - 20

• Finger end elevated 20°. 

• The horizontal or central ray is directed 20° towards the elbow (cephalad)

Note: reverse if the fracture line angles SUPERIORINFERIORLY.

• Hand flat (0° elevation) + 20° cephalad CR 

• Or

• 20° hand elevation + CR perpendicular (0°)

CR: 

PERPENDICULAR to the table and directed to enter the scaphoid 

STRUCTURES SHOWN:

• Places the scaphoid at right angles to the CR and it is projected without self-superimposition.

PA Axial Projection Stecher Method

BRIDGMAN METHOD

- Same position as the Stetcher method but with ULNAR DEVIATION.

CR: 

• PERPENDICULAR and with multiple cephalad angles; with the hand and wrist in the same position for each projection, four separate exposures made at 0, 10, 20, and 30 degrees cephalad

STRUCTURE SHOWN

• The scaphoid is shown with minimal superimposition

PA AND PA AXIAL PROJECTIONS
RAFERT-LONG METHOD- ULNAR DEVIATION
PURPOSE:

• diagnosing scaphoid fractures using a four-image, multiple-angle CR series

POSITION OF PART:

• Position the wrist on the IR for a PA projection.

• Without moving the forearm, turn the hand outward until the wrist is in extreme ulnar deviation

CR: 

• Angled 45 degrees distally to enter the anatomic snuffbox of the wrist and pass through the trapezium

STRUCTURE SHOWN: 

• The trapezium demonstrated free of superimposition by the other carpal bones except at its articulation with the scaphoid

TRAPEZIUM
PA AXIAL OBLIQUE PROJECTION
CLEMENTS-NAKAYAMA METHOD 
POSITION OF PART: 45-45

• Place the wrist in the lateral position, resting on the ulnar surface over the center of the IR.

• Place a 45-degree sponge wedge against the anterior surface, then rotate the hand to come in contact with the sponge.

CR: 

• 1 ½ inches proximal to wrist joint / (superoinferior ) with caudal angle of 45

degrees.

STRUCTURE SHOWN:

• The carpal bridge is shown on the image i

• Show fractures of the scaphoid, lunate dislocations, calcifications, and forei

CARPAL BRIDGE
TANGENTIAL PROJECTION
LENTINO.
POSITION OF PART:

• Lie palm up, forming a right angle to the forearm.

Central Ray (CR)

• Perpendicular to the carpal canal (directed through the carpal tunnel).

Structures Shown (SS)

• Carpal canal (carpal tunnel) in tangential profile.

• Hook of the hamate.

• Pisiform.

• Palmar aspects of the trapezium and tubercles of the scaphoid.

• Useful for detecting fractures, bony abnormalities, or calcifications within the carpal canal.

CARPAL CANAL
TANGENTIAL PROJECTIONGAYNOR-HART METHOD
POSITION OF BODY

• Wrist hyperextended.

• Long axis of the hand is adjusted to vertical as possible

Central Ray (CR)

• Perpendicular to the carpal canal (directed through the carpal tunnel).

Structures Shown (SS)

• Carpal canal (carpal tunnel) in tangential profile.

• Hook of the hamate.

• Pisiform.

• Palmar aspects of the trapezium and tubercles of the scaphoid.

• Useful for detecting fractures, bony abnormalities, or calcifications within the carpal canal.

MARSHALL

• Suggested placing a 45° angle SPONGE under the palmar surface of the hand to slightly elevate the wrist to place the carpal canal tangent to the central ray.