Radiographic Anatomy and

Positioning of the Upper

Extremity
 Intended Learning Outcomes
• The student should be able to recognize
clinical radiographic technical principles
of the upper limb
Upper extremity consists of:

• Phalanges
• Metacarpals
• Carpals
• Radius
• Ulna
• Humerus
 The hand & wrist consists of :

• 27 Bones
– Phalanges - 14
– Metacarpals - 5
– Carpals -8
Phalanges
• Fingers & thumb

• 3 separate bones
Digits 2-5
– Proximal
– Middle
– Distal
• Tuft
• Thumb
– Proximal
– Distal
 Naming of Digits
• 1 • Thumb
• 2 • Index
• 3 • Middle
• 4 • Ring
• 5 • Little
 Joints
• Interphalangeal

• Metacarpophalangeal

• Distal Interphalangeal

• Proximal
Interphalangeal
 Metacarpals
• Palm
• Numbering Head
• Three parts
– Head
– Shaft
– Base Shaft Base

• Joints
– MP
– Carpometacarpal
 Carpals (Wrist)
• 8 bones

• Proximal row d
a Scaphoid
c
b Lunate a b
c Triquetrum
d Pisiform
 Carpals (continued)
• Distal row
a Trapezium
b Trapezoid
c Capitate
d Hamate

b c d
a
 Carpal Joints
• Radiocarpal

• Intercarpal
 Distal Radius & Ulna
• Radial Styloid Process
• Ulnar Styloid Process
• Distal Radioulnar Jt.
Radiographic
Anatomy
Tuft

2nd DIP Jt.

2nd PIP Jt.

2nd MP Jt.
IP Jt.

1st MP Jt.

CM Jt.

Radiocarpal Jt.
Trapezium

Trapezoid Pisiform

Scaphoid
 Hamate
Capitate
Triquitral
Lunate
Motions of the Hand & Wrist

• Ulnar Flexion (Radial

• Radial Flexion Deviation)
(Ulnar Deviation)
Positioning of the Hand & Wrist
Finger
• Routine projections
– PA
– Medial Oblique
– Lateral Oblique
– Lateral
• Film size
• SID
• CR
PA
Lateral
Medial oblique
Lateral oblique
 Prevention of
• Immobilize
– Sandbags
– Tape

• Short exposure time

 Thumb
• Routine projections
– AP
– PA Oblique
– AP Oblique
– Lateral
• Film size
• SID
• CR
AP
Lateral
PA Oblique
AP Oblique
Structures shown
 Hand
• Routine projections • Non-routine projections
– PA – Lateral for Foreign Body
– PA Oblique-Lateral
Rotation
– Fan Lateral
Routine Hand
Projections
• Routine projections
– PA
– PA Oblique-Lateral
Rotation
– Fan Lateral
• Film size
• SID
• CR
PA
PA Oblique-Lateral
Rotation
Fan Lateral
Structures Shown
Non-routine projections of the
Hand
Lateral for Foreign Body
 Wrist
• Routine projections • Non-routine projections
– PA (Ulnar Flexion) – PA-no flexion
– PA Oblique-Lateral – Stetcher
Rotation – Carpal Canal (Gaynor-
– Lateral Hart)
 Routine Wrist Projections

• Routine projections
– PA (Ulnar Flexion)
– PA Oblique-Lateral
Rotation
– Lateral
• Film size
• SID
• CR
PA (Ulnar Flexion)
PA Oblique-Lateral Rotation
Lateral
Structures shown
Non-routine projections of the
Wrist
PA-no flexion
Scaphoid views (Stetcher)
 Carpal Canal
(Gaynor -Hart)
Anatomy of
the Forearm
& Elbow
 Radius
• Distal
– Styloid Process
– Ulnar Notch

• Proximal
– Head
– Neck
– Tuberosity

• Shaft
Ulna
• Distal
– Head
– Styloid Process

• Proximal
– Olecranon process
– Coronoid process
– Trochlear notch
– Radial notch

• Shaft
Effects of
pronation
on the
forearm
Distal Humerus

• Humeral Condyle
– Trochlea (Medial condyle)
– Capitulum (Lateral condyle)
• Lateral epicondyle
• Medial epicondyle
• Depressions
– Coronoid fossa
– Radial fossa
– Olecranon fossa
 Classification of Joints
• Radioulnar
– Proximal
– Distal

• Elbow
Radiographic
Anatomy
Medial Epicondyle Lateral
Epicondyle
Coronoid Process
Radial Head
Shaft (Ulna)
Radial
Tuberosity

Shaft (Radius)

Distal
Ulnar Head Radioulnar Jt.
Ulnar Styloid Radial Styloid
Process Process
Lateral epicondyle
Olecranon fossa
Capitulum
Medial
Proximal radioulnar epicondyle
jt.
Radial head Trochlea

Radial neck Coronoid

process
Radial tuberosity
 Coronoid Process
Radial head
Radial neck

Condyles

Trochlear notch

Olecranon
process

Radial notch
Positioning of the Forearm &
Elbow
 Forearm

• Routine projections
– AP
– Lateral
• Film size
• SID
• CR
AP
Lateral
Structures shown
 Elbow

• Routine projections
– AP
– Lateral
– Coyle
Routine Elbow
• Routine projections
– AP
– Lateral
– Coyle
• Film size
• SID
• CR
AP
Lateral
Coyle
Structures shown
ASSIGNMENT
 Question

Mention routine radiographic

positioning of the wrist joint
 Suggested Readings

Clark’s radiographic positioning and

techniques
Thank You