19/08/2019

XRAY WRIST
SV/LP
Moderator : NO
Supervisor :
dr. Andi Dhedie P. Sam, M. Kes, Sp.OT

Source:
1. Thompson JC. Netter’s Concise Orthopaedic Anatomy 2nd ed. Philadelphia: Saunders Elsevier
; 2010.
2. McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis
Company.
 INTRODUCTION
• The wrist is a complex joint comprising 3 main
articulations:
1. Radiocarpal (distal radius/TFCC to proximal
row)
2. Distal radioulnar joint (DRUJ)
3. Midcarpal (between carpal rows)
4. Other articulations: pisotriquetral and
multiple intercarpal (between 2 adjacent
bones in the same row

Thompson JC. Netter’s Concise Orthopaedic Anatomy 2nd ed. Philadelphia: Saunders Elsevier ; 2010.
Thompson JC. Netter’s Concise Orthopaedic Anatomy 2nd ed. Philadelphia: Saunders Elsevier ; 2010.
 BASIC PROJECTIONS
• ● Posteroanterior
• ● Lateral
• ● Oblique

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.

 POSTEROANTERIOR – what we can see
1. Metacarpals (trace and number each one)
2. Carpals (trace and identify each carpal)
3. Three arcuate lines formed by the carpals
Distal radius and ulna
4. Ulnar variance
5. Radial articular angle

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.

 POSTEROANTERIOR
• This view demonstrates the middle and
proximal portions of the metacarpals,the
carpals, the distal radius and ulna,and all
related joints.

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.
McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.
 Oblique - what we can see
• Metacarpals
• Trapezium, trapezoid, and scaphoid
• Triquetrum and hamate
• Distal radius and ulna

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.

 Oblique
• This view demonstrates the middle and
proximal metacarpals, the carpals, and the
distal radius and ulna in an oblique view.
• Structures best shown are the trapezium,the
scaphoid,and the first carpometacarpal joint of
the thumb.

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.
 Lateral - what we can see
• First metacarpal and trapezium
• Distal radius and ulna
• Volar tilt of the radius measurement
• Scapholunate angle measurement
• Capitolunate angle measurement
• Stacked arrangement of the radius–lunate–
capitate relationship

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.

 Lateral
• This view demonstrates superimposed
proximal metacarpals, carpals, distal radius,
and ulna as seen from a lateral perspective

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.
McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.
 Optional Projections
• ● Ulnar deviation PA view
• ● Radial deviation PA view
• ● Carpal tunnel view

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.

 Ulnar deviation PA view

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.

 Radial deviation PA view

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.

 Carpal tunnel view

McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging. Philadelphia: F.A. Davis Company.