Elbow positioning and Projections

How should the hand be positioned for an axiolateral projection of the elbow?

Hand should be pronated

How can you get the humeral epicondyles and anterior surface of elbow parallel with plane of the IR for an AP elbow projection? What does doing this signify?

Have the patient lean laterally; True AP position

To view the crooned process, how should the elbow be flexed for an axiolateral projection of the elbow?

80 degrees

To view the radial head, how should the elbow be flexed for an axiolateral projection of the elbow?

90 degrees

What 2 AP projections of the elbow are required when the patient cannot extend their elbow in addition to the lateral projection?

AP Projection of Distal Humerus AP Projection of Proximal Forearm

In what projection of the elbow is the elbow joint open between the coronoid process and trochlea?

An axiolateral projection of the elbow (viewing the coronoid process)

How do you center the IR for an AP elbow projection?

Center the IR to the elbow joint longitudinally and transversely.

What should be clearly shown in an AP Oblique Projection of the Elbow with external/ lateral rotation?

Radial head, neck, and tuberosity projected free of ulna

Where do you center the IR for a lateral projection of the elbow?

Center to the elbow joint longitudinally and transversely

Where is the elbow joint centered for an AP elbow projection?

Centered to the CR

Where is the IR centered for an AP projection of the distal humerus?

Centered to the condyloid area

T or F: The elbow joint is open between the radial head and capitulum in an axiolateral projection of the elbow when viewing the radial head.

True

T or F: The humeral epicondyles should be superimposed in a lateral elbow projection

True

Where is the IR placed for an AP projection of the distal humerus?

Under the elbow

Name the four positions the hand must be placed in for the lateral projection of the elbow to view the entire circumference of the radial head.

1) Hand supinated 2) Hand Lateral w/ Thumb Up 3) Hand pronated 4) Hand internally rotated w/ Thumb Down

What are two reasons that it is important to flex the elbow 90 degrees for a lateral projection of the elbow?

1) To see the profile of the olecranon process 2) The elbow fat pads are least compressed

At what degree angle should the anterior surface of the elbow be at for an AP Oblique Projection of the Elbow with internal/medial rotation?

45 degrees

In what projection of the elbow are the radial head and neck free of superimposition of the ulna?

AP Oblique Projection of the Elbow with external/ lateral rotation

What projection of the elbow shows the coronoid process in profile?

AP Oblique Projection of the Elbow with internal/medial rotation

Describe the oblique projection of the elbow that will demonstrate the separation of the radius from the ulna.

AP Oblique with Lateral rotation

Describe the oblique projection of the elbow that will demonstrate the coronoid process.

AP Oblique with Medial rotation

Is the radial tuberosity facing anteriorly or posteriorly in a lateral projection of the elbow?

Anteriorly

What projection should be used when the patient cannot fully extend their elbow for medial and lateral oblique projections of the elbow? What images can be obtained?

Axiolateral aka Coyle Method; images of the radial head and coronoid process

Is the elbow joint open or closed in AP projection of the distal humerus?

Closed

How is the CR directed for an AP Projection of the proximal forearm?

Direct CR perpendicular to elbow joint and long axis of forearm ......

How is the CR directed for an AP projection of the distal humerus?

Direct CR perpendicular to the humerus, traversing the elbow joint

How should the CR be directed when viewing the coronoid process in an axiolateral projection of the elbow?

Direct the CR AWAY FROM the shoulder at a 45 degree angle to the radial head.....to center of IR.....

How should the CR be directed when viewing the radial head in an axiolateral projection of the elbow?

Direct the CR TOWARD the shoulder at a 45 degree angle to the radial head.....to center of IR.....

How is the CR directed for an AP Oblique Projection of the Elbow with internal/medial rotation?

Direct the CR perpendicular to the elbow joint, to the center of the IR, longitudinally and transversely.

How is the CR directed in a lateral elbow projection?

Direct the CR perpendicular to the humeral epicondyles to the center of the IR longitudinally and transversely.

Describe the positioning for an AP elbow projection.

Elbow extended, hand supinated, humeral epicondyles and anterior surface of elbow parallel with plane of the IR

What structures are shown for a lateral elbow projection?

Elbow joint, distal arm, proximal forearm

What are the structures shown in an AP elbow projection?

Elbow joint, distal arm. proximal forearm

What would you do if it is impossible to get a patent in position for an AP projection of the proximal forearm(dorsal surface of forearm on table)?

Elevate limb, put it in lateral position, place IR vertical behind upper end of forearm, direct CR horizontally

What does the degree of obliquity for an AP Oblique Projection of the Elbow with internal/medial rotation make visible?

It clears the coronoid process of the radial head

How can you find the elbow joint?

It is 1 inch below the epicondyles

If an injury to the soft tissue is suspected, at what angle should the joint be flexed? Why? (USING LATERAL ELBOW PROJECTION) What may become visible?

It should only be flexed 30-35 degrees because it does not compress or stretch the soft structures. The posterior fat pad may become visible.

Is the elbow joint open or closed in an AP elbow projection?

Open

Is the elbow joint open or closed for an AP projection of the proximal forearm>

Partially open

What structures are slightly superimposed over the proximal ulna in an AP elbow projection?

Radial head, neck, and tuberosity

How do you position the patient for an AP Oblique Projection of the Elbow with internal/medial rotation?

Patient extends limb as if doing an AP projection, the elbow joint is centered to the midpoint of the IR, patient rotates hand internally (medially)

Where should the humeral epicondyles be in relation to the plane of the IR for a lateral elbow?

Perpendicular to the plane of the IR

How do you obtain an AP projection of the radial head?

Place patient in position for distal humerus projection, elbow is extended as much as possible with the forearm supported. Forearm supinated enough to place horizontal plane of wrist at 30 degree angle from horizontal.

Is the hand supinated or pronated for an AP projection of the distal humerus?

Supinated

How do you know when proper lateral rotation is achieved for an AP Oblique Projection of the Elbow with external/ lateral rotation?

The 1st and 2nd digits are touching the table

What structures should be on the same plane for an axiolateral projection of the elbow?

The humerus, elbow, and wrist joints

What partially superimposes the coronoid process in a lateral elbow projection?

The radial head

Explain the importance of having the patient positioned to place the shoulder and elbow joints in the same plane, then taking a radiograph of the elbow.

To avoid distortion