Elbow and Distal Humerus Chapter 5

Trauma Humerus Positions

AP Neutral Transthoracic lateral for the proximal humerus Lateral for mid to distal humerus

Humerus Routine

AP and lateral

What does the lateral elbow (lateromedial) best visualize?

Elevated or displaced fat pads & Olecranon in profile

What do you do palpate to make sure your elbow is parallel to the IR?

Epicondyles are parallel on both sides

Fat Pads in elbow

Seen on the lateral view, indicates a radial head fracture

First radial head lateral (radial tuberosity up)

hand supinated maximum external rotation

*In the lateral external oblique rotation you see the radial _________ and ___________ free of superimposition?

head and neck

The radial notch fits the

head of ulna

What type of synovial joint is the elbow?

hinge (ginglymus)

Distal humerus A?

lateral epicondyle

Distal humerus D?

medial epicondyle

Distal Humerus #3?

olecranon fossa

Radial head laterals-(hand with maximum internal rotation

radial tuberosity is pointing all the way down

Radial head laterals (hand pronated)

radial tuberosity is pointing down

Radial head laterals (hand lateral)

radial tuberosity is pointing outward

What is the difference in the four radial head laterals?

rotation of the hand and wrist

Elbow: routine

AP, oblique (lateral and/or medial), & lateral

Where do you center for AP Projection: Elbow?

Mid-Elbow

Does it matter that the hand is not straight in an AP Projection Elbow?

NO, elbow should be straight even if the hand isn't

Does the Ulna have a neck?

No

Lateral Elbow- (Lateromedial) projection

-Flex elbow 90 degrees and drop shoulder so that humerus and forearm are on the same horizontal plane -CR mid elbow -Best visualized elevated or displaced fat pads

Acute Flexion Projection Elbow Jones Method (Distal Humerus)

-For DISTAL HUMERUS: CR perpendicular to IR and humerus, directed to a point midway between epicondyles -seat patient at end of table with acutely flexed arm resting on cassette

Acute Flexion Projection: Elbow Jones Method (Proximal Forearm)

-For PROXIMAL FOREARM: CR perpendicular to forearm (angle as needed), directed to a point approximately 2 inches proximal or superior to olecranon process -seat patient at end of table, with acutely flexed arm resting on cassette

Trauma axial lateromedial projections (coyle method) (80 degrees)

-elbow flexed 80 degrees

Trauma Axial Lateral Elbow (Coyle Method) (90 degrees)

-elbow flexed 90 degrees -CR 45 degrees TOWARD the shoulder, center to radial head -best demonstrates the joint space between radial head and capitulum -radial head, neck, and tuberosity are in profile and free of superimposition except for a small part of the coronoid process

Ap Projection- Elbow

-fully extend and supinate hand -palpate the epicondyles to ensure they are parallel to the IR (pt may need to lean laterally) -CR to mid-elbow joint

AP Humerus

-fully extend elbow and supinate -palpate the epicondyles till parallel to IR -Suspend respiration During exposure -Both joints must be visualized on the radiograph

Alternate AP projections of the elbow should include how many projections?

2

How many projections do you take for radial head laterals?

4

For a true lateral projection of the elbow, the patient is positioned so that: A. the humeral epicondyle plane is perpendicular to the IR B. a line connecting the humeral epicondyles is parallel to the IR C. the arm is extended with the hand in a lateral position D. the elbow is flexed 90 degrees with the hand pronated

A. the humeral epicondyle plane is perpendicular to the IR For the lateral elbow, the epicondyles are superimposed over top of each other so that they are perpendicular to the receptor. This position places the olecranon process in profile.

A young boy comes to radiology with an elbow injury. The basic elbow projections demonstrate a possible non displaced fracture of the coronoid process. Beyond the oblique projection, what additional projection(s) can be performed to demonstrate the coronoid free of superimposition? A. Coyle method with 45-degree CR angle toward shoulder B. Radial head lateral projections C. Coyle method with 45-degree CR angle away from shoulder D. Acute flexion projection

C. Coyle method with 45-degree CR angle away from shoulder

On which of the following projections of the elbow are the radial head, neck and tuberosity demonstrated without superimposition by the ulna? A. AP elbow B. medial oblique elbow C. lateral oblique elbow D. lateral elbow

C. lateral oblique elbow

Where do you center for an AP projection of the elbow?

CR to mid-elbow joint

Which structure is not on the ulna A.styloid process B.head C.olecranon process D.capitulum

D. capitulum

Which structure is not on the radius A.head B.styloid process C.tuberosity D.lateral epicondyle

D. lateral epicondyle

When a patient has a cast, should you increase or decrease exposure?

Increase

AP Oblique projection: Lateral (External ) Rotation is best to visualize the

Radial head, Neck, and Capitulum of Humerus

*The proximal radioulnar joint (considered part of the elbow joint) is what type of joint

Trochoidal (pivot)

Which out of the ulna and radius is the medial bone?

Ulna

With no rotation, the proximal radius is superimposed only slightly by the

Ulna

Trauma axial lateromedial projections x-ray (90 degrees)

best visualizes radial head, neck ,and capitulum

Distal humerus B?

capitulum

The head of the radius articulates with the

capitulum of humerus

What bone of the distal humerus is highlighted?

coronoid fossa

In the Internal rotation the ________ is free of superimposition?

coronoid process

What does the coyle method demonstrate (90 degrees)?

joint space between the radial head and capitulum

The appearance of the PROXIMAL radius and ulna changes as the

elbow and distal humerus is rotated or obliqued

Distal humerus C?

trochlea

When are Alternate AP projections of the elbows done?

when the elbow cannot be fully extended

AP Projection: Elbow (when the elbow cannot be fully extended)

-Obtain (2) projections -ONE with the forearm parallel to the IR and ONE with the humerus parallel to the IR -Use a support sponge to prevent motion -CR to Mid-Elbow joint

Lateral Humerus (lateromedial)

-position pt with back to IR and elbow partially flexed. Body may be rotated toward affected side as needed to bring humerus and shoulder in contact with cassette -Epicondyles perpendicular to IR -Suspend respiration during exposure

AP Oblique Projection- Medial (Internal) Rotation

-pronate hand and rotate the entire arm until as needed until the distal humerus and anterior surface of the elbow are medial obliqued 45 degrees

Trauma Horizontal Beam-Humerus

-pt is recumbent, take image as a horizontal beam lateral -flex elbow if possible , DO NOT rotate -IR between thorax and arm -CR to midpoint of distal two-thirds of humerus

AP Oblique projection- Lateral (External) Rotation

-supinate hand and rotate the entire arm laterally (45) degrees (pt must lean laterally for sufficient rotation) -CR to Mid-Elbow joint -Best Visualizations radial head and neck and capitulum of humerus

On an AP elbow projection, the central ray is directed to the elbow joint, which is located: A. at the level of the humeral epicondyles B. approximately 2 cm distal to the humeral epicondyles C. approximately 2 cm proximal to the humeral epicondyles D. approximately 2 cm distal to the humeral condyles

B. approximately 2 cm distal to the humeral epicondyles The epicondyles are structures on the distal humerus, and are located approximately 2 cm above the actual elbow joint, meaning the joint is distal to them.

Which projection of the elbow demonstrates both the olecranon and coronoid processes of the ulna in profile? A. AP elbow B. medial oblique elbow C. lateral oblique elbow D. lateral elbow

D. lateral elbow The lateral projection of the elbow is the only one that demonstrates the olecranon process in profile, as well as the coronoid process in profile. The olecranon is posterior to the humerus and the coronoid is anterior.

Why is a sponge used ?

for support and to prevent motion

The elbow is considered (synovial) diarthrodial, meaning it is

freely moveable

The ulna does not have a

neck

Which out of the ulna and radius is the lateral bone?

radius

Trauma axial lateromedial projection Coyle Method (80 degrees)

second picture - coronoid appears elongated but in profile