Scaphoid (oblique view)

The oblique scaphoid view is part of a four view series of the scaphoid, wrist and surrounding carpal bones. The positioning is similar if not identical to the oblique wrist. 

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
• shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to the central beam
• 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)
• from the positioning of the PA projection, the wrist is externally rotated 40°; a sponge can be placed under the wrist to aid stability
• if possible maintain some ulnar deviation 

Technical factors

• posteroanterior projection
• centring point
  • mid carpal region
• 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

The ulna head and distal radius are slight superimposed. The proximal metacarpals 3 to 5 also being partly superimposed.

Practical points

As scaphoid fractures are associated with FOOSH injuries, it is desirable in the acute setting to collimate to include the wrist in the oblique view, covering all areas around the scaphoid that could be the source of pain. In a follow-up radiograph, coning down to the scaphoid is favoured.

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.