When performing a PA hand radiographic examination the central ray CR should be centered to the ____

The Hand PA view is part of a two view series metacarpals, phalanges, carpal bones and distal radial ulnar joint.

The PA hand view is requested for diagnosing a variety of clinical indications such as rheumatoid arthritis, osteoarthritis, suspected fracture or dislocation and localizing foreign bodies.

This view complements the ball-catcher view as it is particularly useful for diagnosing early signs of rheumatoid arthritis and osteoarthritis in the metacarpals, carpal bones and distal radio ulnar joint.

patient is seated alongside the table
the affected arm if possible is flexed at 90° so the arm and hand can rest on the table
the affected hand is placed, palm down on the image receptor
shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to the central beam
the hand and elbow should be at shoulder height which makes radius and ulna parallel (lowering the arm makes radius cross the ulna and thus relative shortening of radius)

posteroanterior projection
centering point
collimation
- laterally to the skin margins
- proximal to include distal radioulnar joint
- distal to the tips of the distal phalanges
orientation
detector size
exposure
SID
grid

5th finger is positioned PA, with no rotation as evidenced by the symmetric appearance of the concavities of the phalanges. Interphalangeal and metacarpophalangeal joint spaces of digits 2 to 5 appear open.

The concavity of the metacarpal shafts is equal 1.

The hand is not a technically challenging radiograph, always ensure the fingers are equal distance apart and the detector is high enough to avoid overlap at the wrist.

Always include the wrist joint on your PA radiograph, patients may have referred pain from pathology other than the hand.

The PA wrist view is part of a three view series of the wrist and carpal bones. Although performed PA the view can often be referred to an AP view.

The PA wrist radiograph is requested for myriad reasons including but not limited to trauma, suspected infective processes, injuries the distal radius and ulna, suspected arthropathy or even suspected foreign bodies.

What is probably more useful is remembering that a PA wrist radiograph will not rule out a forearm fracture given the limited coverage (for this, one would request a forearm series).

patient is seated alongside the table
the affected arm if possible is flexed at 90° so the arm and wrist can rest on the table
the affected hand is placed, palm down on the image receptor
shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to the central beam
the wrist and elbow should be at shoulder height which makes radius and ulna parallel (lowering the arm makes radius cross the ulna and thus relative shortening of radius)

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posteroanterior projection
centering point
collimation
- laterally to the skin margins
- distal to the midway up the metacarpals
- proximal to the include one-quarter of the distal radius and ulna
orientation
detector size
exposure
SID
grid

there is only minor superimposition of the metacarpal bases
the articulation between the distal radius and the ulna is open or has little superimposition.
the concavity of the metacarpal shafts is equal 1.

Wrist radiographs are very common in emergency departments; they are often associated with FOOSH injuries and be quite painful.

Due to the non-urgent nature of a "?fractured wrist", patients will often be triaged to a lower category and left waiting for longer than multi-trauma patients; an understandable reality of emergency departments.

It is important to remember this when examining your patient, and it is easy to forget that simply lifting your hand up and placing it on an image receptor could result in substantial pain. More often than not, the pain has not been addressed yet. Offer to move things around to assist in positioning, simple things like lowering/raising the table can go a long way and result in a better experience for the patient.

It is also possible to achieve the PA wrist with the patient supine in bed, by simply following the basic positioning principles, the image receptor can be placed next to the patient on the bed under the affected wrist.

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