Radiography and Arthrography
The main emphasis of this chapter is a description of basic radiography of the wrist and hand with detailed description of radiographic technique and evaluation of the different projections. Static and dynamic carpal instability evaluation is vital for th
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Contents
Abstract
1
Introduction..............................................................
1
2 2.1 2.2 2.3 2.4 2.5
Radiographic Projections........................................ Radiographic Projections of the Wrist ..................... Radiographic Projections of the Scaphoid Carpus... Radiographic Projections of the Hand...................... Radiographic Projections of the Phalanges .............. Radiographic Evaluation of the Thumb ...................
2 2 4 5 7 8
3 Radiographic Technique ......................................... 3.1 Computed Radiography (CR) ................................... 3.2 Direct Radiography (DR) ..........................................
11 12 13
4 Additional Projections and Fluoroscopy .............. 4.1 Carpal Instability Series—Static Evaluation ............ 4.2 Dynamic Evaluation—Fluoroscopy ..........................
13 14 14
5 5.1 5.2 5.3 5.4 5.5 5.6 5.7
Measurements .......................................................... Ulna Variance ............................................................ Radial Inclination ...................................................... Radial Length (Radial Height).................................. Palmar Tilt (Volar Tilt or Volar Inclination)........... Scapholunate Angle................................................... Capitate–Lunate Angle.............................................. Carpal height .............................................................
15 15 16 16 17 17 17 17
6
Arthrography ...........................................................
18
References..........................................................................
20
The main emphasis of this chapter is a description of basic radiography of the wrist and hand with detailed description of radiographic technique and evaluation of the different projections. Static and dynamic carpal instability evaluation is vital for the assessment of ligamentous disruption. These techniques are covered in this chapter. There are a whole variety of measurement techniques which can be used in the assessment of wrist pathology. Following distal radial fracture, radial inclination, radial length and palmar tilt are important. Ulna variance is also assessed following distal radial fracture and in the context of ulnarsided wrist pain. The scapholunate angle and capitate lunate angle are assessed when intercalated instability is suspected. Finally, the carpal height is a measurement which is applied when there is evidence of carpal collapse or loss of joint space. Arthrography still has a place in the modern assessment of the wrist. Radiocarpal and to a lesser extent midcarpal injection techniques may be employed.
1
S. G. Davies (&) Consultant Radiologist, Radiology Department, Royal Glamorgan Hospital, Rhondda Cynon Taf, Llantrisant, CF72 8XR, UK e-mail: [email protected]
Introduction
Plain film radiography has a fundamental role in the evaluation of the hand and wrist following trauma, in cases of suspected arthropathy, as part of an evaluat
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