Uppers: Lesson 9 (Positioning Obl Elbow & Routine Humerus)

To achieve an AP Humerus, the patient will have to (Internally/Externally) rotate their arm.

Externally rotate until line connecting epicondyles is parallel to IR

In an AP Humerus with Ext rotation, the (greater/lesser) tubercle is in profile (medially/laterally).

Greater tubercle is in profile Laterally

Lateral Humerus (Internal Rotation): -IP -CR -Marker

IP: 14x17" LW CR: Mid-Humerus to include shoulder and elbow joints Marker: upper lateral corner & INT marker ***If the patient's arm is too long you may place the arm diagonally to include more anatomy

AP Humerus (External Rotaion): -IP -CR -Marker

IP: 14x17" LW (BUCKY) CR: Mid-Humerus to include shoulder and elbow joints Marker: upper lateral corner & EXT marker ***If the patient's arm is too long you may place the arm diagonally to include more anatomy

AP Oblique Elbow with Internal Rotation: -IP -CR -Marker

IP: 8x10" LW CR: Elbow Joint Marker: upper lateral side (remember that the humerus will be at the top of the image)

AP Oblique Elbow with External Rotation: -IP -CR -Marker

IP: 8x10" LW or CW CR: Elbow Joint Marker: upper lateral side (remember that the humerus will be at the top of the image)

When the arm is in neutral rotation, the humerus will have a slight (internal/external) rotation.

Internal -our arm naturally sits with a slight internal rotation making the int rotation (lat humerus) easier to achieve.

Structures shown on Lateral Humerus (Interanl Rotation):

Must include: -Humerus -Elbow joint -Shoulder joint -Lesser tubercle in profile medially = true lateral -Epicondyles perpendicular to IR (superimposing)

Structures shown on AP Humerus (External Rotation):

Must include: -Humerus -Elbow joint -Shoulder joint -No rotation of epicondyles -Greater Tubercle in profile laterally -Humeral Head in profile medially -Elbow joint partially open (radial head and capitulum)

For an Oblique Elbow with External Rotation, the (ulnar/radial) side is down closest to IR.

Radial side down

For an Oblique Elbow with Internal Rotation, the (ulnar/radial) side is down closest to IR.

Ulnar side down

Routine Humerus:

2 Views: -AP (External Rotation) -Lateral (Internal Rotation)

What structures should be shown on an AP Oblique Elbow with Internal Rotation?

-Coronoid process is free from superimposition with the radial head -Elongated medial epicondyle -Radial head/neck superimpose the ulna -Olecranon process in olecranon fossa

Structures shown on AP Oblique Elbow with External Rotation (LATERAL ELBOW):

-Elongated Lateral Epicondyle -Radial head/neck NOT superimposed with Ulna -Radial tuberosity facing anterior (medial) with no superimposition on Ulna

AP Oblique Elbow with External Rotation (LATERAL ELBOW) - Patient Position

-From AP, externally (laterally) rotate 45 degrees -Arm extended Same Plane: -Shoulder -humerus -elbow -wrist

AP Oblique Elbow with Internal Rotation - Patient Positioning

-From AP, internally (medially) rotate the epicondyles 45 degrees -Elbow extended Same plane: -Shoulder -Humerus -Elbow -Wrist

AP Humerus (External Rotation) - Patient Position

-Patient Supine on table -BUCKY exam -To achieve External Rotation, supinate the hand to place epicondyles parallel with the IR ***At MAYO: roll patient 15 degrees towards affected side to lower shoulder, thus, positioning the humerus parallel with the table

Lateral Humerus (Internal Rotation) - Patient Position

-Patient Supine on table -BUCKY exam -To achieve Internal Rotation, medially rotate the hand to the place epicondyles perpendicular with the IR ***At MAYO: roll patient 15 degrees towards affected side to lower shoulder, thus, positioning the humerus parallel with the table

For an Oblique Elbow with Internal Rotation and/or External Rotation, the line between epicondyles is at

45 degrees

To achieve a Lateral Humerus, the patient will have to (Internally/Externally) rotate their arm.

Internally rotate until line connecting epicondyles is perpendicular to IR

In a Lateral Humerus with Int rotation, the (greater/lesser) tubercle is in profile (medially/laterally)

Lesser tubercle is in profile medially

In an AP Humerus, the line connecting the epicondyles are (parallel/perpendicular) to the IR.

Parallel

In a Lateral Humerus, the line connecting epicondyles is (parallel/perpendicular) to the IR.

Perpendicular

CR for all elbow projections are at

the Elbow Joint