Rad 141-Elbow and Distal Humerus

External rotation vs. Internal rotation

External see the head of radius the best Internally pronating hand you see coronoid process

What type of fracture?

Transverse fracture

Radial Head Laterals-Hand lateral

Shadow of bone

Which basic projection of the elbow best demonstrates the olecranon process in profile and the fat pads of the elbow? A. lateral B. AP C. Medial rotation oblique D. Lateral rotation oblique

A. lateral

Which of the following is not true about the elbow joint? A. The elbow joint is synarthrodial B. The elbow joint is synovial C. The elbow joint is a ginglymus type of joint D. The elbow joint includes the radius, ulna and humerus

A. The elbow joint is synarthrodial

What two bony landmarks are palpated for positioning of the elbow? A. Radial and ulnar styloid processes B. Humeral epicondyles C. Coronoid process and coronoid fossa D. Trochlea and capitulum

B. Humeral epicondyles

How should the humeral epicondyles be positioned for a lateral projection of the elbow? A. Parallel to image receptor B. Perpendicular to image receptor C. 45 degrees to image receptor D. 30 degrees to image receptor

B. Perpendicular to image receptor

Which one of the following statements is NOT true about a lateral projection of the humerus for an adult? A. You can use a 14x17 inch (35x43 cm) image receptor B. Place epicondyles parallel to image receptor C. Use a minimum 40 inch(102 cm) SID D. Internally rotate the arm to get into the lateral position

B. Place epicondyles parallel to image receptor

Which two structures form the proximal radioulnar joint? A. Ulnar notch and head of ulna B. Radial notch and radial head C. Radial tuberosity and ulnar notch D. Coronoid tubercle and radial notch

B. Radial notch and radial head

Situation: 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

Which of the following best demonstrates the radial head using the trauma lateral Coyle method routine? A. Elbow flexed 90 degrees, CR perpendicular to image receptor B. Elbow flexed 90 degrees, CR angled 30 degrees toward shoulder C. Elbow flexed 90 degrees, CR angled 45 degrees toward shoulder D. Elbow flexed 80 degrees, CR angled 45 degrees away from the shoulder

C. Elbow flexed 90 degrees, CR angled 45 degrees toward shoulder

Which routine projection of the elbow best demonstrates the radial head and neck free of superimposition? A. AP B. Lateral C. External oblique D. Internal oblique

C. External oblique

With the radial head projections, what is the only difference between the four projections? A. The amount of flexion of elbow B. The CR angulation C. The position of the hand/wrist D. The SID used for each projection

C. The position of the hand/wrist

What is the purpose of performing the partially flexed projections of the elbow? A. To provide a view of the radial head and capitulum B. To separate the radial head from the ulna C. To provide an AP perspective if patient cannot fully extend elbow D. To demonstrate any possible elevated fat pads

C. To provide an AP perspective if patient cannot fully extend elbow

Which one of the following structures is NOT part of the ulna? A. Styloid process B. Radial notch C. Ulnar neck D. Coronoid process

C. Ulnar neck

What is the position? A. AP-Partial flexion B. Jones-Acute Flexion C. External rotation D. Internal rotation

D. Internal rotation

Which of the following structures is considered to be most distal? A. Radial head B. Olecranon process C. Radial tuberosity D. Ulnar head

D. Ulnar head

Trauma Axial Laterals: Coyle Method

-10x12 - Elbow flexed 80 degrees -Pronate hand -Part position 2- CR directed 45 degrees from the shoulder, centered to the radial head. *Best demonstrates the joint space between the coronoid process and the trochlea -The distal portion of the coronoid appears elongated but in profile

Trauma Axial Lateral: Coyle Method

-10x12 -Elbow flexed 90 degrees -Pronate hand -Part position 1: CR directed 45 degrees toward the shoulder, centered to the radial head *best demonstrates the joint space between radial rad and capitulum. -Radial head, neck and tuberosity are in profile and free of superimposition except for a small part of the coronoid process

Radial Head Laterals

-10x12 -Flex elbow 90 degrees and drop shoulder so that humerus and forearm are on the same horizontal plane -CR all to radial head region -Take four projections: The only difference among the four being the rotation of the hand and wrist

Lateral elbow(lateromedial projection)

-10x12 -Flex elbow 90 degrees and drop shoulder so that humerus and forearm are on the same horizontal plane -CR mid-elbow joint *Best visualizes elevated or displaced fat pads

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

-10x12 -Obtain two 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

AP Oblique Projection-Medial (Internal) Rotation

-10x12 -Pronate hand and rotate the entire arm as needed until the distal humerus and anterior surface of the elbow are medial obliques 45 degrees. -CR mid-elbow joint *Best visualizes coronoid process of the ulna

Acute Flexion Projection Elbow Jones Method

-10x12 -Seat patient at end of table with acutely flexed arm resting on cassette -Align and center humerus to long axis of IR -Ensure no rotation *For proximal forearmL CR perpendicular to forearm (angle as needed), directed to a point approximately 2 inches proximal or superior to olecranon process

Acute Flexion Projection Elbow Jones Method

-10x12 -Seat patient at end of table, with acutely flexed arm resting on cassette -Align and center humerus to long axis of IR -Ensure no rotation *For distal humerus: CR perpendicular to IR and humerus directed to a point midway between epicondyles

AP oblique projection elbow (external) Rotation

-10x12 -Supinate hand and rotate the entire arm laterally 45 degrees(patients must lean laterally for sufficient rotation) -CR mid-elbow joint *Best visualizes radial head and neck and capitulum of humerus

AP projection: Elbow

-10x12 -fully extend elbow and supinate hand -palpate the epicondyles to ensure they are parallel to the IR(the pt. may need to lean laterally) -CR to mid-elbow joint

AP Humerus

-14x17 -Fully extend elbow and supinate hand -palpate the epicondyles to ensure they are parallel(equidistant) to the IR (the pt. may need to learn laterally) -CR to mid-humerus -Suspend respiration during exposure -Both joints must be visualized on radiograph

Lateral Humerus- Lateromedial

-14x17 -Position patient with back to IR and elbow partially fixed. Body may be rotated toward affected side as needed to bring humerus and should in contact with cassette. -Palpate the epicondyles to ensure they are perpendicular to the IR. -CR to mid-humerus -Suspend respiration during exposure -Both joints must be visualized on radiograph

Elbow Joint

-Synovial Joint -Freely movable or diathrodial -considered a ginglymus (hinge) type of joint -The proximal radioulnar joint (considered part of the elbow joint) joint is trochoidal (pivot-type)

Elbow rotational movements

-The appearance of the proximal radius and ulnar changes as the elbow and distal humerus is rotated or obliqued -With no rotation, the proximal radius is superimposed only slightly by the ulna

Trauma Horizontal Beam

-With patient recumbent, take image as a horizontal beam lateral -Flex elbow if possible but do not attempt to rotate arm -Gently placed IR between arm and thorax -Cr to midpoint of distal two-thirds of humerus

Exposure Factors

-lower to medium kVp(50-70) -short exposure time -small focal spot -adequate mAs for sufficient density -increase exposure w/cast -40" SID

Radial Head Laterals- Hand with maximum internal rotation

Bump all the way down

Radial Head Laterals- Hand pronated

Normal, bump in middle

Radial Head Laterals-Hand supinated(maximum external rotation)

Tuberosity up

Proper positioning of the forearm for an AP projection requires that hand to be a. lateral b. flexed c. supinated d. prontated

c. supinated