PA View of Hand (Radiography)_20250817_120156_0000.pdf

PA view of hand which are helpful in positioning during perform x ray and enhance radiographic imaging

1. Posterior_anterior(PA) views of hand
Presentation by _ uzma zafar and sabreen
In short: PA view of the hand means the palm is placed flat on the cassette, X-rays enter from the
posterior (back of hand) side and exit from the anterior (palm) side. It is the routine standard view for
hand X-rays
purpose
To study the bones, joints, and soft tissues of the hand.
Commonly used for detecting fractures, dislocations, bone lesions, infections, arthritis, congenital
deformities etc.
Standard projection for routine hand X-rays
Patient preparation
Explain the procedure to the patient.
Remove any jewelry, rings, or watches from the hand.
1. Patient position:
Patient can be seated sideways at the X-ray table.

2. 2. Part position:
Hand is placed palmar (anterior) surface down on the cassette / detector.
Fingers are naturally extended and separated slightly.
Forearm rests on the table for support.
Hand and wrist should lie flat with no rotation.
3. Centering (CR):
Central Ray perpendicular to the 3rd metacarpophalangeal (MCP) joint.
4. Film / Detector placement:
Under the hand, parallel to the long axis of the hand and forearm.
5. SID (Source to Image Distance):
100cm (40 inches).
Technical factors
Exposure: 50–60 kVp, 2–4 mAs (varies by patient build and machine).
Collimation: Include fingertips to distal radius and ulna.
Radiographic appearance
All bones of the hand are seen:
Phalanges (distal, middle, proximal)
Metacarpals (1st to 5th)
Carpals (wrist bones)
Distal radius and ulna (partially included).
Joint spaces between MCP, PIP, DIP, and carpal-metacarpal joints must be visible.
Soft tissues should be seen (for swelling, foreign bodies, or soft tissue abnormalities).
Evaluation criteria

3. Entire hand from fingertips to distal radius & ulna included.
Fingers slightly separated (no overlapping).
Equal concavity on both sides of phalanges and metacarpals (shows no rotation).
Open joint spaces at MCP and IP joints.
Good density and contrast (bony trabeculae visible)
Different Types of PA Views in Hand, Fingers, Wrist, and Special Cases
1. PA View of Hand (Routine / Palmar View)
Palm flat on cassette.
Shows phalanges, metacarpals, carpals.
Used for fractures, arthritis, general survey.
2. PA Dosri Palmar View (Both Hands PA)
Both hands palmar surface down, side by side.
Used for comparison (e.g., congenital deformities, bone age study, metabolic bone disease).

4. 3. PA View of Fingers
Individual finger placed palm-down on cassette, CR to PIP joint.
Used for finger fracture, dislocation, arthritis, nail-bed injury.
Oblique & lateral usually taken additionally

5. 4. PA View of Thumb (Foreign Body)
Normally thumb is taken in AP, but for foreign body localization → PA can also be used.
Palm flat, thumb spread laterally.
Detects foreign bodies, fractures, dislocations

6. 5. PA Scaphoid (Ulnar Deviation View)
Hand placed in PA, wrist deviated towards ulnar side.
Purpose: Elongates scaphoid bone → best for scaphoid fracture detection.

7. 6. PA View of Wrist
Palm flat, wrist in neutral.
Shows carpal bones, distal radius & ulna.
Used for fractures, arthritis, dislocation, infections.

8. 7. Nørgaard’s (Ball-Catcher’s) View [PA Oblique Both Hands]
Both hands semi-supinated at 45° obliquity, dorsal side on cassette.
Used for early rheumatoid arthritis.

9. 8.PA Clenched Fist View (Wrist)
Same as PA wrist, but patient is asked to make a tight fist during exposure.
Palm down on cassette, fingers curled firmly.
To demonstrate scapholunate ligament injury.
Making a fist increases pressure between the scaphoid & lunate → separation (widening) can be
seen if ligament is torn.