Chapter 4 ( elbow, humerus) 112

Ap scapula supine

30 degrees

Tangential (Fisk)

Hand supinated and holding ir against anterior surface of forearm, elbow fixed , patient leaning forward to place posterior forearm on tabletop, humerus 10 to 15 degree vertical cr, cr enter at superior surface of humerus

Lateral scapula

45 to 60 anterior oblique affected scapula in contact and centered to grid, part position to demonstrate acromion and coracoid, flex elbow and place back of hand on posterior thorax(chest) . To demonstrate body extend arm upward and rest forearm on head, cr to mid medial border of scapula

Essiential views for elbow

AP( partial flexion position to demonstrate distal humerus and partial flexion position to demonstrate proximal forearm) lateral, ap oblique( medial rotation and lateral rotation), axiolateral (coyle method). 3 inches proximal and distal to the elbow joint and one inch on sides.

Ap scapula

Abduct arm to right angle flex elbow , CR to point 2 inch inferior to coracoid process

Shoulder girdle

Consists of scapula and clavicle, shoulder girdle articulates with head of humerus and manubrium of sternum(stemoclavicle (sc) joint ), functions connects the upper limb to the trunk of body,

Essiental projections proximal humerus (tangential projection ) (Fisk modification )

Demonstrates inyertubercular groove, supine, ir against shoulder superior surface supinate hand, cr 10 to 15 downward angle enters superior surface of humeral head(tangential projection) 4x4 collimation.

Pa axial clavicle

15 to 30 caudal to aupraclavicular fossa and midshaft clavicle

Ap oblique (grashey)

35 to 45 degree posterior oblique , affected shoulder close to IR, rotation should place scapula parallel to IR, head humerus will be contact with IR, abduct arm and slightly internally rotate, place palm of hand on abdomen, CR perpendicular to glenoid cavity and enter 2 inch(5cm) medial and inferior to superplastic border of shoulder, collimation is 8x10(18x24)

Essential projections shoulder

Ap projections are internal rotation and external rotation and neutral rotation, ap oblique (grashey method), transthoracic lateral ( Lawrence method), pa oblique (scapula Y), superior to interior projection middle of clavicle visible .

Essential projections humerus

Ap, lateral ( lateral is usually images using the bucky of possible, lateral projection for a fracture does not use Bucky) 2 inch distal to the elbow joint and superior to the shoulder and 1 in sides .

Scapula

Ap, lateral , adjust 10x12 , suspended respiration

Clavicle projection essentials

Ap, pa, ap axial, pa axial , pa used because reduce oid, 8x12, adjust light 2 inches superior from the upper shadow and 1 in from lateral shadow, suspended respiration

Shoulder

Articulation of the upper limb with the girdle, humerus is not considered part of the shoulder girdle, the upper portion articulates with the shoulder girdle, proximal humeral anatomy is considered in evaluation of radiographs of the shoulder joint. Diarthrodial classification by function and synovial classification by anatomy and ball and socket type and capable of all motions.

Ap elbow distal humerus partial flexion position

Can be used in place of ap projection of elbow when patient cannot completely extend the joint, requires distal humerus and proximal forearm to be imaged separately. Humerus in same plane with posterior surface resting on IR, elevated forearm supported, supinate hand and center IR to condyles of humerus. CR perpendicular to humerus passing through elbow joint.

Scapula

Classified as flat bone , forms the posterior portion of the shoulder girdle, triangular in shape,

Clavicle

Classified as long bone, lies just above first rib, acromial extremity( lateral end) articulates with acromion on scapula(av joint), sternly extremity (medial end) articulates with manubrium of sternum (sc joint), double curve to body, curve more pronounced in males than in females.

Lateral humerus

Cr for recumbent (supine) horizontal and perpendicular to midportion of humerus and centered IR, for lateral recumbent position perpendicular to midportion of humerus and centered to IR, Include as much of proximal humerus as possible below the elbow joint during collimation.

Pa clavicle

Cr middle clavicle ,

Superior to inferior projection ( patient sitting down

Elbow 90 degree , IR over shoulder joint angle 5 to 15 degree toward elbow

ap projection in neutral position

For trauma cases leave arm neutral position, palm of hand on thigh And epicondyles at 45 degree angle to IR, 10x12, cr one inch inferior to coracoid process,

AP elbow proximal forearm partial flexion position

Leaving elbow flexed place dorsal surface of forearm on IR, supinate hand and center IR to condyles of humerus, CR perpendicular to elbow joint and long axis of forearm.

Ap oblique elbow lateral rotation

Limb in same plane with elbow extended , elbow centered to unmasked pArt of IR, supinate hand and laterally, or externally, rotate elbow to place anterior surface 45 degrees from IR plane, first and second digits with touch table when elbow is sufficiently rotated, CR perpendicular to elbow joint.

AP oblique elbow medial rotation

Limb in same plane with elbow extended, elbow centered to unmasked part of IR, pronate hand and medically, or internally , rotate elbow to place anterior surface 45 degree from IR plane, cr perpendicular to elbow joint.

Lateral elbow

Limb in same plane with long axis parallel to IR. elbow flexed 90 degrees and placed in center of unmasked part of IR. forearm resting on ulnar surface, wrist in true lateral, CR perpendicular to elbow joint.

Pa oblique (scapula y)

Named because when properly positioned the acromion and coracoid process form a Y shape, position is particular useful to diagnose shoulder dislocation, in the normal shoulder the humeral head is directly superimposed over the junction of the Y( acromion and coracoid), patient upright 45 to 60 anterior oblique position affected shoulder closer to ir, arm position not important . CR to scapula humeral joint 12 in in length 1 in from lateral shadow.

Lateral humerus

Place top border of ir 1 and half inch above humeral head, internally rotate humerus flex elbow 90 degree and rest palm of hand on hip, coronal plane passing through epicondyles should be perpendicular to plane of IR . Cr perpendicular to midportion of humerus and centered to IR.

Ap humerus

Place top border of ir 1 and half inch above humeral head, slightly abduct humerus from body and supinate hand, coronal plane passing through humeral epicondyles should be placed parallel to IR plane, CR perpendicular to mid portion of humerus and centered to IR . Suspended respiration pause breathing .

Ap projection internal rotation ahoulder

Rotate patient slightly toward affected shoulder, place body of scapula Patel with plane of IR, important for patients with extreme kyphosis(humpback curvature spine), flex elbow slightly, rotate arm internally and rest back of hand on hip, place humeral epicondyles perpendicular to IR. cr enters one in inferior to corCoid process, 10x12 (24x30 cm)

Ap projection in external rotation

Rotate patient toward affected shoulder, place body of scapula parallel with plane of IR, flex elbow slightly , rotate arm externally and supinate hand, place humeral epicondyles parallel to IR, cr enters patient 1 in inferior to coracoid process, 10x12 (24x30)

Inferosuperior axial projection Lawrence method

Supine head and shoulder elevated 3 in radiolucent support, abduct arm to right angle, place arm external rotation, 12 inch in length and 1 in(2.5cm) above Anterior shadow of shoulder. Cr horizontal , medial angulation of 15 to 30, enters axilla passes through ac joint,

Ap elbow

Upper limb in same plane with posterior surface in contact with IR, elbow extended and hand supinated, elbow centered to middle of unmAsked portion of IR. hi metal epicondyles parallel with IR. CR perpendicular to elbow joint.

Ap ac joint (Pearson)

Upright because supine position will reduce dislocation , arms hanging side unsupported , desperate exposures made unweighted and weighted. 6x8 single, 6x17 double collimation, 72 sid

Ap axial clavicle

Upright lordotic position of possible, lordotic position not available supine with shoulders in same plane, center clavicle to ir, lordotic 0-15 cephalon, supine 15 to 30 cephalic, enter misshaft clavicle ,

Ap clavicle

Upright or supine , clavicle centered to ir , arms at side, cr perpendicular to miss haft of clavicle , want full humerus and clavicle joints show.

Transthoracic lateral (Lawrence)

Used for trauma who can't abduct arm, affected limb closer to IR unaffected limb elevated over head, don't move trauma arm center surgical neck of humerus to IR, cr enters mid coronal plane at surgical neck? If shoulders same plane cr angled 10 to 14 degree cephalad, 10x12

Axiolateral ( coyle)

Useful in trauma to demonstrate radial head and coronoid process, part position for radial head elbow 90 degree and hand pronated, cr angled 45 degree toward shoulder , part position for corpnoid process elbow flexed 90 degree and hand pronated cr angles 45 degree away from shoulder.