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Citation, DOI & article dataCitation: Grant, K., Murphy, A. Wrist (oblique view). Reference article, Radiopaedia.org. (accessed on 04 Nov 2022) https://doi.org/10.53347/rID-40372 The oblique wrist view is part of a three view series of the wrist and carpal bones. It is not generally performed in follow-up studies unless specifically requested. On this page:The oblique wrist radiograph is requested for myriad reasons including but not limited to trauma, suspected infective processes, injuries the distal radius and ulna, suspected arthropathy or even suspected foreign bodies. It is also a handy projection to better assess the scaphoid and subtle distal radial fractures. What is probably more useful is remembering that an oblique wrist radiograph will not rule out a forearm fracture given the limited coverage (for this, one would request a forearm series).
The ulna head and distal radius are slight superimposed. The proximal metacarpals 3 to 5 also being partly superimposed. Wrist radiographs are very common in emergency departments; they are often associated with FOOSH injuries and be quite painful. Due to the non-urgent nature of a "? fractured wrist", patients will often be triaged to a lower category and left waiting for longer than multi-trauma patients; an understandable factor in emergency hospitals. It is important to remember this when examining your patient; it is easy to forget that just lifting your hand up and placing it on an image receptor could result in substantial pain and 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 go a long way and result in a better experience for the patient. It is also possible to achieve the oblique wrist with the patient supine in bed, by simply following the basic positioning principles, the image receptor can be placed next to the patient on the bed under the affected wrist. Related articles: Imaging in practicePromoted articles (advertising)Citation, DOI & article dataCitation: Murphy, A., Fahrenhorst-Jones, T. Scaphoid (PA axial view). Reference article, Radiopaedia.org. (accessed on 04 Nov 2022) https://doi.org/10.53347/rID-47225 The scaphoid posteroanterior axial view is part of a four view series of the scaphoid, wrist and surrounding carpal bones. This view is a complementary projection to the PA view. On this page:This view aims to show the scaphoid in its true anatomical appearance without any superimposition or foreshortening. As the scaphoid sits in a slight volar tilt, the angle of the axial view ensures there is no superimposition hence allowing the visualization of any subtle distal, middle or proximal fractures 1 of the scaphoid.
The scaphoid does not sit 100% flush with the image receptor when the hand is resting (see Figure 1), the scaphoid has a natural palmar tilt, therefore angling to that tilt will result in a 'truer' PA radiograph. It is important to remember why you are angling the central ray. Some patients will have little tolerance to the ulnar deviation, and too much angle will only distort the scaphoid via superimposition. More often than not, if the scaphoid is profoundly elongated with overlaying anatomy, you have angled too much. 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. However, 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 only lifting your hand up and placing it on an image receptor could result in substantial pain. ReferencesRelated articles: Imaging in practicePromoted articles (advertising)How many degrees is the central ray angle for a PA oblique projection of the wrist?Central ray: Tangential to carpal canal and directed at midcarpal area and perpendicular to the image receptor or angulated towards the hand approximately 20-35 degrees from the forearm's long axis.
Where is the central ray centered for a PA projection of the hand?Position of part: Hand centered palm down flat, fingers separated. The central ray should be perpendicular to the image receptor at 3rd MCP joint. Central ray: Perpendicular to the image receptor at 3rd MCP joint.
What is the proper angle of the wrist for oblique position?The oblique view is obtained with the wrist rotated 45 degrees so that the ulnar aspect of the wrist is resting on the image receptor while the radial side is elevated.
How much obliquity is required for a PA oblique projection of the hand?Positioning for PA oblique projection
Adjust the obliquity of the hand so that the MCP joints form an angle of approximately 45° with the cassette plane. Use a 45° foam wedge to support the fingers in the extended position to demonstrate the interphalangeal joints.
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How many degrees is the central ray angles for a PA oblique projection of the wrist?
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