Special Positioning- Upper Extremities

Carpal Bridge: Tangetial

* Show fractures of the dorsal carpal bones* * CR directed 45 degree caudally, skimming the dorsal wrist*

PA Axial Oblique Wrist (Trapezium): Clements- Nakayama

* Shows trapezium and its articulations with adjacent carpal bones* - Thumb on 45 degree sponge

AP Oblique Wrist: medial rotation

* allows visualization of the pisiform in it's entirety* - 45 degree CR @ midcarpal

Axiolateral Elbow: Coyle

* done in cases where routine oblique elbow images are not possible* * requires CR angles of 45 degrees toward and away from the shoulder*

Scaphoid series: Rafert-Long

* gradually elongates the scaphoid in 4 different images* - Patient in ulnar deviation for all of images - (1) 0 degree CR, (2) CR 10 degree cephalic, (3) CR 20 degree cephalic, (4) CR 30 degree cephalic

PA axial proximal forearm ( Olecranon Process)

* requires arm be placed in a 45 degree flexion with the hand supinated* - CR 20 degrees toward elbow an 1" or 2"

Radial Head Series

* requires the hand to be in 4 different positions* - all in a lateral elbow and CR perp. - (1) hand supinated, (2) hand lateral, (3) hand flat and pronated, (4) internal rotation

1st MCP joint: Folio

* shows MCP joints and MCP angles bilaterally* *Requires a tension device* - stress view-

PA Axial Humerus (Ulnar Sulcus)

* shows the ulnar sulcus; used for tennis elbow* - CR perp, elbow at 75 degree flexion

AP Oblique hand: Norgaard

* used in the diagnosis of rheumatoid arthritis* - hands @ 45 angle; can use sponge

1st MCP Joint: Robert

*first carpometacarpal joint* - Place finger in AP projection - CR perp but can angle 15 degrees proximally

AP Wrist

*shows carpal interspaces well* - CR in mid carpal area, don't want too much flexion

Tangential Carpal Tunnel (Gaynor-Hart Method)

- CR 25-30 degrees toward palm *Allows visualization of pisiform in it's entirety*

PA wrist: Radial Deviation

- deviate towards radius *opens the interspaces between the carpals on the medial side of wrist

PA wrist: Ulnar Deviation

- deviate towards the ulna - looking at radial side * corrects foreshortening of the scaphoid*a

Navicular: Stetcher

- use sponge to elevate hand 20 degrees or angle CR 20 degrees proximal - scaphoid sits at a downward angle so this will *correct foreshortening of scaphoid* - *scaphoid w/o s.i.*

First carpometacarpal joint: Burman

- visualizes the first carpometcarpal joint - requires a tension device - 45 degree on CR - thumb parallel to IR (so tilt hand medial)

Acute Flexion: Jones

-if patient can't extend elbow * acute flexion of elbow* * S.I. the bones of the humerus and forearm*