For the pa projection of the wrist in ulnar deviation, the central ray is directed to the:

In the PA projection of the second digit, the CR is directed to the

In a lateral projection of the second through fifth digits, the central ray is directed?

The most common oblique projection of the second through fifth digits is a

For a PA oblique projection of the first digit the is in what position?

How many degrees should the CR be angled for the PA projection of the hand?

For a PA projection of the hand, the central ray is directed what joint?

For a lateral projection of the hand, the central ray is directed to what joint?

What projection is best to demonstate the carpal interspaces?

What is the degree of angulation used for a lateral projection of the wrist?

For a lateral projection of the wrist how many degrees must the elbow be flexed?

What is the primary projection used to demonstrate anterior or posterior placement of fractures of the hand and wrist?

PA oblique projection of the wrist in lateral rotation requires a wrist angulation of ?

The central ray angulation for a PA oblique projection of the wrist is how many degrees?

What two bones of the wrist are well demonstrated on a PA oblique projection of the wrist?

The PA projection of the wrist in ulnar deviation clearly demonstrates what carpal bone?

What projection of the wrist foreshortens the scaphoid?

How many degrees should the CR be angles for a PA projection of the wrist in ulnar deviation?

For the PA projection of the wrist in ulnar deviation, the CR is directed what carpal bone?

How many degrees must the IR be elevated for the PA axial (Stecher method) ?

Citation, DOI & article data

Citation:

Shetty, A., Worsley, C. Scaphoid (PA ulnar deviation view). Reference article, Radiopaedia.org. (accessed on 09 Oct 2022) https://doi.org/10.53347/rID-30341

The posteroanterior ulnar deviation scaphoid view is part of a four view series of the scaphoid, wrist and surrounding carpal bones. Although performed PA, the view can often be referred to as an AP view. The view is performed with the wrist in ulnar deviation to free the scaphoid from bony superimposition. 

On this page:

This view aims to show the scaphoid in its anatomical position, hence allowing the visualization of any subtle distal, middle or proximal fractures 1 of the scaphoid.

• 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 with hand in ulnar deviation (see practical points)
• 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)

• posteroanterior projection
• centering point
  • anatomical snuffbox 
• 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  
  • portrait
• detector size
  • 18 cm x 24 cm
• exposure
  • 50-60 kVp
  • 3-5 mAs
• SID
  • 100 cm
• grid
  • no

• hand is in ulnar deviation with little superimposition over the scaphoid bone
• minor superimposition of the metacarpal bases
• articulation between the distal radius and the ulna is open or has little superimposition
• concavity of the metacarpal shafts is equal 2

As scaphoid fractures are associated with FOOSH injuries, it is desirable in the acute setting to collimate to include the wrist in the PA view, covering all areas around the scaphoid that could be the source of pain. In a follow-up radiograph, coning down to the scaphoid is favored.

Ulnar deviation is necessary as it moves the scaphoid away from the radius and rotates it in the palmer aspect, minimizing superimposition and achieving a pure PA projection 1-3. Patients with a fractured scaphoid will be in a lot of pain so deviating their hand to the ulna can be quite a task; only deviate the hand as much as the patient can bear it. 

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 important to remember this when examining your patient, as it is easy to forget that simply lifting your hand up and placing it on an image receptor could result in substantial pain. 

References

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