RTE 121 Forearm and elbow

radiocarpal joint

Formed by the scaphoid, lunate, triquetrum, and radius Synovial, ellipsoidal type

Lateral Forearm

Part position: Forearm in the same plane as the shoulder Elbow is flexed 90 degrees Ulnar and radial styloid processes superimposed Long axis of forearm is aligned with the long axis of the IR CR directed perpendicular to the IR (lateromedial projection) and enters patient at midpoint of forearm Include from proximal row of carpals to distal humerus and all surrounding soft tissue

Lateral Elbow

Part position: From the AP elbow postion flex the elbow 90 degrees Place the wrist in a true lateral position Forearm resting on the ulnar surface Center the IR to the elbow joint: On patients with muscular forearms elevate the wrist so that the forearm is parallel to the IR CR is perpendicular to the elbow joint Include from distal humerus to proximal forearm, proximal radioulnar joint and all surrounding soft tissue Humeral epicondyles will be perpendiuclar to the IR

AP Oblique medial or internal rotation elbow

Part position: Rotate the arm medially 45 degrees-pronate the hand. This will prevent over-rotation of the elbow. The anterior surface of the elbow and distal humerus should be 45 degrees to the IR Elbow center to the IR CR is perpendicular to the elbow joint

Radius

Shorter of the two bones of the forearm Primarily involved in the formation of the wrist joint

Ulna

Distal portion is smaller, articulates with the radius at ulnar notch round, rounded process on lateral side, articular disk separates head from lunate & triquetrum carpals, Ulnar styloid process projection on postero-medial side *Proximal end is larger and articulates with humerus Olecranon process is proximal and posterior Coronoid process is distal and anterior, radial notch on lateral aspect Trochlear notch, large anterior depression in proximal ulna

AP Distal Humerus Partial Flexion Position film Critique

Evidence of proper collimation Distal humerus without rotation or distortion Proximal radius superimposed over the ulna Closed elbow joint Greatly foreshortened proximal forearm Trabecular detail on the distal humerus Soft tissue and bony trabecular detail

AP Oblique Elbow Lateral Rotation Critique

Evidence of proper collimation Elbow joint open and centered to the central ray 45-degree lateral rotation of elbow Radial head, neck and tuberosity projected free of the ulna Elongated lateral humeral epicondyle Capitulum Soft tissue and bony trabecular detail

AP Oblique Elbow Medial Rotation Critique

Evidence of proper collimation Elbow joint open and centered to the central ray 45-degree medial rotation of elbow Coronoid process in profile Elongated medial humeral epicondyle Ulna superimposed by the radial head and neck Trochlea Olecranon process with the olecranon fossa Soft tissue and bony trabecular detail

Lateral elbow film critique

Evidence of proper collimation Elbow joint open and centered to the central ray Elbow in a true lateral position Superimposed humeral epicondyles Radial tuberosity facing anteriorly Radial head partially superimposing the coronoid process Olecranon process in profile

Axiolateral (Coyle ) radial head film critique

Evidence of proper collimation Open joint space between radial head and capitulum Radial head, neck and tuberosity in profile and free from superimpositon with the exception of a small protion of the coronoid process Humeral epicondyles distorted as a result of central ray angulation Radial tuberosity facing posteriorly Soft tissue and bony trabecular detail

AP Proximal forearm partial flexion critique

Evidence of proper collimation Proximal radius and ulna without rotation or distortion Radial head, neck, and tuberosity slightly superimposed over proximal ulna Partially open elbow joint Forshortened distal humerus Soft tissue and bony trabecular detail

AP Elbow film critique

Evidence of proper collimation Radial head, neck, and tuberosity slightly superimposed over the proximal ulna Elbow joint open and centered to the central ray No rotation of humeral epicondyles ( Coronoid and olecranon fossae approximately equidistant to epicondyles Soft tissue and bony trabecular detail

radial tuberosity

Is located below the neck of the radius on the medial side of the body

radial head

Located at the proximal end of the radius near the elbow joint Just below this is the radial neck

Axiolateral (Coyle) Coronoid process film critique

Open joint space between the coronoid process and trochlea Coronoid process in profile and elongated Radial head and neck superimposed by ulna Elbow flexed 80 degree Soft tissue and bony trabecular detail

AP Elbow-Proximal Forearm Partial flexion Position -Trama view

Part Position: Leaving elbow flexed, place dorsal surface of forearm to IR Supinate hand, if possible, and center IR to condyles of humerus CR is perpendicular to elbow joint and long axis of forearm

AP Elbow-Distal humerus partial flexion position-Trama view

Part position: Drop the shoulder so that it is in the same horizontal plane as the distal humerus. Have the humerus rest on the IR Elevated forearm may need to be supported Supinate hand (if possible) and center the IR to the condyles of the humerus CR perpendicular to the humerus and passing through the elbow joint Include the distal humerus, proximal radius and ulna and radioulnar articulation and surrounding soft tissue

AP Oblique lateral or external rotation elbow

Part position: Limb in same plane with elbow extended Elbow centered to IR AP elbow position rotate the arm 45 degrees laterally CR is perpendicular to elbow joint Include from distal humerus to proximal radius radius and ulna and surrounding soft tissue First and second digits will touch table when elbow is sufficiently rotated laterally

AP Elbow

Part position: Same as with AP forearm Supinate the hand, extend the elbox and have the patient lean laterally until the forearm is supinated Drop the should so that it is in the same horizontal plane as the forearm and hand Humeral epicondyles equidistant (or parallel ) with the IR Long axis of the forearm is aligned with the long axis of the IR Elbow centered to middle of IR CR is perpendicular to the elbow joint Include the distal humerus to proximal radius and ulna and surrounding soft tissue

AP Forearm

Part postion: Supinate the hand, extend the elbow Drop the shoulder so that it is in the same horizontal plane as the forearm and hand Humeral epicondyles equidistant or paralled with the IR Long axis of forearm is aligned with the long axis of the IR CR is perpendicular to the IR and enters the patient at midpoint of forearm Include from proximal row of carpals to distal humerus and all surrounding soft tissue

Right AP elbow looking at elbow joint

Projection? Anatomy

Left AP oblique in lateral rotation of elbow. 45 degree oblique looking at radial head

Projection? Anatomy?

Left AP oblique in medial rotation of elbow. 45 degree oblique looking at coronoid process

Projection? Anatomy?

Left AP partial flexion for distal humerus. Looking at distal humerus

Projection? Anatomy?

Right axiolateral- Coyle method-80 degree elbow flexion with 45 degree tube angle away form shoulder (caudad)-looking at coronoid process

Projection? Anatomy?

Right axiolateral-Coyle method-90 degree elbow flexion with 45 degree tube angle towards the shoulder (Cephalad-looking at radial head

Projection? Anatomy?

Ap forearm critique

Proper collimation Entire forearm including wrist to distal humerus Slight superimposition of the radial head and tuberosity over the the proximal ulna No elongation or foreshortening of the humeral epicondyles Partially open elbow joint if the shoulder was place in the same plane as forearm open radioulnar space Good bightness and contrast to demonstrate soft tissue

Lateral forearm critique

Proper collimation Entire forearm to include wrist and distal humerus in true lateral Superimposition of the radius and ulna at their distal end Superimposition of the radial head over the coronoid process Radial tuberosity facing anteriorly Superimposition of humaral epicondyles Elbow Flexed 90 degrees Soft tissue entire length of image

radioulnar joint

Proximal: head of radius with radial notch of ulna Distal: Distal ulna with ulnar notch of radius Synovial, pivot joint

fat pads

These are seen only on the lateral view: Anterior fat pad: Seen just anterior to the distal humerus and resembles a teardrop in a negative exam. If it resembles a "Sail" then a fracture is likely Supinator fat pad: Located anterior to and parallel with the proximal radius Posterior fat pad: Located deep with the olecranon fossa

Axiolateral coyle method for coronoid process

Useful in trama to demonstrate conornoid process. Part position: Elbow flexed 80 degrees hand pronated CR angled 45 degrees away from shoulder

Axiolateral coyle method for radial head

Useful in trauma to demonstrate radial head Part position: Elbow flexed 90 degrees hand pronated CR angled 45 degrees toward shoulder

radial styloid process

the pointed structure at the distal end of the radius Extends more distally that does the ulnar syloid process can be palpated on the thumb side of the wrist