Hand - Lateral

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Radiographic Positioning

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Name of projection Hand - Lateral
Area Covered Hand, wrist and 2.5cm of distal forearm
Pathology shown Displacement of fractures, location of foreign bodies.
Radiographic Anatomy Hand Radiographic Anatomy
IR Size & Orientation 18 x 24cm
Film / Screen Combination Detail
(CR and DR as recommended by manufacturer)
Bucky / Grid No
Filter No
Exposure 54 kVp
3.2 mAs
FFD / SID 100cm
Central Ray Directed to the 2nd metacarpophalangeal joint
Perpendicular to the IR
Collimation Centre: 2nd metacarpophalangeal joint
Shutter A: Distal phalanges to 2.5cm of distal radius and ulna
Shutter B: To include soft tissues
Markers Distal and Lateral
Marker orientation AP
Shielding Gonadal (check your department's policy guidelines)
Respiration Not applicable
  • Patient seated at end of table
  • Elbow flexed at 90°
  • Hand and forearm resting on table
  • Rotate hand and wrist into lateral position with thumb on up side
    • For the "Fan" lateral, digits are spread out
      • a step block may be used
    • For a "Flexion" lateral, digits 2 through to 5 are superimposed and held in extension with the thumb held clear
    • For an "Extension" lateral, digits 2 through to 5 are superimposed and held in flexion with the thumb held clear

  • The hand is in the lateral position, shown by
    • The metacarpal midshafts are superimposed
    • The ulna is slightly posterior to the radius
(Note: the wrist is not necessarily lateral when the hand is. In a lateral wrist the radius and ulna are superimposed)
  • The interphalangeal joints are open
  • Phalanges are not foreshortened

"Fan lateral"
  • 2nd through to 5th digits are separated with little superimposition of bony and soft tissue structures
  • 2nd through to 5th metacarpals are superimposed
  • Thumb has no superimposition
  • Thumb position varies from PA to slightly oblique

"Extension lateral"
  • 2nd through to 5th digits fully extended and superimposed

"Flexion lateral"
  • 2nd through to 5th digits are flexed and superimposed
Area Covered
  • Phalanges, metacarpals, carpals and 2.5cm of distal radius and ulna
  • Include the distal phalanges to the distal forearm and soft tissue
  • Bony trabecular patterns and cortical outlines are sharply defined
  • Soft tissues are visualised
Special Notes
  • The extension lateral is sometimes preffered in cases of suspected foreign bodies
  • Metacarpals are used in assessing how lateral the hand is
  • To identify metacarpals, the 2nd metacarpal is the longest and the 5th metacarpal is the shortest