Hand (PA view)

The Hand PA view is part of a two view series metacarpals, phalanges, carpal bones and distal radial ulnar joint.

Indications

The PA hand view is requested for diagnosing a variety of clinical indications such as rheumatoid arthritis, osteoarthritis, suspected fracture or dislocation and localizing foreign bodies.

This view complements the ball-catcher view as it is particularly useful for diagnosing early signs of rheumatoid arthritis and osteoarthritis in the metacarpals, carpal bones and distal radio ulnar joint.

Patient position

• patient is seated alongside the table
• the affected arm if possible is flexed at 90° so the arm and hand can rest on the table
• the affected hand is placed, palm down on the image receptor
• shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to the central beam
• the hand 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)

Technical factors

• posteroanterior projection
• centering point
  • third metacarpal head
• collimation
  • laterally to the skin margins
  • proximal  to include distal radioulnar joint 
  • distal to the tips of the distal phalanges 
• orientation  
  • portrait
• detector size
  • 18 cm x 24 cm
• exposure
  • 50-60 kVp
  • 1-5 mAs
• SID
  • 100 cm
• grid
  • no

Image technical evaluation

5th finger is positioned PA, with no rotation as evidenced by the symmetric appearance of the concavities of the phalanges. Interphalangeal and metacarpophalangeal joint spaces of digits 2 to 5 appear open.

The concavity of the metacarpal shafts is equal .

Practical points

The hand is not a technically challenging radiograph, always ensure the fingers are equal distance apart and the detector is high enough to avoid overlap at the wrist.

Always include the wrist joint on your PA radiograph, patients may have referred pain from pathology other than the hand.