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Introduc)on

to X rays

When X rays are passed through a body area
onto a detector, an image called a radiograph is
produced, as dierent 8ssues absorb/ transmit
the X rays to dierent extents.
The denser the area, the whiter it appears on
radiographs as more X rays are absorbed.
Therefore, bone appears whiter than the
surrounding so@ 8ssue.

Benets and drawbacks of X-rays

J Diagnoses fractures, tumours, arthri8s, and
disloca8ons
J Cheap
J Low radia8on
J Good bone to so@ 8ssue contrast
L Poor so@ 8ssue contrast, and so can be
dicult to determine so@ 8ssue damage
L 2D image of 3D structure, so can be dicult
to interpret (see [5])

[5]: PA view of thumb
metacarpal base
fracture is easily
overlooked as another
bone is superimposed
over the fragmented
bone. Fracture much
clearer in oblique X ray.

By Danning Li Student ID: 13000215

[5]

The radial and ulna ends


come together to form
the carpus at the base of
the hand

Anatomy of the Hand



The bones comprising the nger
are numbered 1 to 5, with the
thumb being 1 and the liPle
nger 5.
Each nger is composed of
three bones: the proximal (PP),
middle (MP) and distal
phalanges (DP). These are
separated by the joints:
metacarpophalangeal (MCPJ) ,
proximal interphalangeal
(PIPJ)and distal interphalangeal
(DIPJ) joints respec8vely. The
hand and wrist bones allow a
high degree of movement,
enabling us to carry out
complex ac8vi8es.
For instance: PIPJ and DIPJ are
hinge joints, allowing exion
and extension
MCPJ allows circumduc8on,
abduc8on, adduc8on, exion
and extension

Metacarpal bones are the
largest in the hand and form
the palm

Wrist bones join onto
metacarpal bones

Clinical Applica)ons
The hand is prone to high impact collisions e.g. hand is used to break a fall, which can lead to fractures and disloca8ons. X rays
can be used to diagnose the extent of these injuries, and are also useful in char8ng the progression of diseases and injuries.

Above: Dislocated 4th middle


phalanx at the PIPJ with so@ 8ssue
swelling (note how the grey area
surrounding the 4th PIPJ is
signicantly larger than the other
ngers). Disloca8ons are generally
quite evident clinically, but X rays
are used to check for underlying
bone injuries.

Above: rheumatoid arthri8s. X rays


(alongside other medical tests such as
blood tests) can be used to determine
the type of arthri8s in the hand, and
several X rays spaced over a period of
8me can track the progression of
rheumatoid arthri8s in the joints of
the hand.
This X ray shows the disorganiza8on
and erosion of the MCPJ typical of
rheumatoid arthri8s

Hand fractures are


par8cularly prone to
displacement due to
tendons pulling on
them. Therefore hand
fractures generally
require a follow up X
ray to ascertain
correct healing and
alignment.
Top le@: fracture of
middle phalanx
shortly a@er injury
occurred
BoPom le@: further
displacement of the
bone a week a@er
injury due to forces
ac8ng on the bone.

Sources
1.
hPp://mrmackenzie.co.uk/wp-content/uploads/2010/11/Hand.jpg
2.
hPp://2.bp.blogspot.com/_JAR7UvJP0gc/TO_Zc-W5ySI/AAAAAAAABkA/0uI5YL2GP-4/s1600/spi-dislocate%2Bnger%2Bxray.jpg
3.
hPp://www.racgp.org.au/afp/2012/april/hands,-ngers,-thumbs/
4.
hPp://www.webmd.com/rheumatoid-arthri8s/ss/slideshow-ra-overview
5.
hPp://radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_upper_limb/hand_nger_trauma_x-ray.html