Wrist (radial deviation view)

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The wrist PA radial deviation view is specialized projection employed to better demonstrate the carpal bones that lay on the ulnar aspect of the wrist.

Indications

Suspected abnormality at the ulnar aspect of the wrist, or in conjunction with a PA and ulnar deviation view to assess carpal movement.

Patient position

  • 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 radial 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)

Technical factors

  • posteroanterior projection
  • centering point
    • central carpal zone
  • 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

Image technical evaluation

  • hand is in radial deviation
  • minor superimposition of the metacarpal bases

Practical points

Patients with fractured carpal bones will be in a lot of pain so deviating their hand to the radial side can be quite a task; only deviate the hand as much as the patient can bear it.

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

Imaging in practice
Radiographic views