elbow, forearm, and humerus

AP elbow

-10*12 cassette -extend elbow -center IR to the elbow joint -should, humerus, and elbow in same plane -lean laterally until humeral epicondyle and anterior surface of el bow are parallel with plane of IR -supinate hand to prevent rotation of bones of forearm Central ray- perpendicular to elbow joint shield gonads Collimation- 3 inch proximal and distal to elbow joint and 1 inch on all sides *shows AP projection of elbow joint, proximal radius and ulna and distal humerus

AP neutral- humerus

-USED FOR INJURY -supine on table or standing upright against upright bucky. -position top of IR 1 1/2 above the humeral head -adjust patients humerus to get truest AP Central ray- perpendicular to midpoint o humerus and center IR shield gonads suspend respiration collimtion- 2 inches distal to elbow joint and superior to shoulder and 1 inch on all sides *shows AP entire humerus epicondyles without rotation humeral head and greater tubercle in profile

Proximal forearm AP projection-partial flexion

-dorsal surface of forearm on table -center IR to elbow joint Central ray- perpendicular to elbow joint shield gonads collimation- 3 inches proximal and distal to elbow joint and 1 inch on all sides *shows proximal forearm when elbow cannt be full extended

AP oblique- medial rotation

-extend limb in position for AP and center IR to elbow joint -medially (internal) rotate or pronate the hand -adjust elbow to place anterior surface at 45 degree angle Central ray- perpendicular to elbow joint Shield gonads Collimation- 3 inches proximal and distal to elbow joint and 1 inch on all sides *Shows coronoid process free of superimposition

Lateral Elbow (lateromedial)

-flex elbow 90 degrees -place humerus and forearm in contact with table in the same plane -center IR to elbow joint -adjust hand in lateral position -humeral epicondyle perpendicular to IR Central ray-perpendicular to elbow joint Shield gonads Collimation 3 inches proximal and distal to elbow joint *shows elbow joint, distal humerus and proximal radius and ulna, Superimposition humeral epicondyles -olecranon in profile -soft tissue and bony trabecular detail

AP oblique-lateral rotation

-forearm extended to AP position -center IR to the elbow joint -rotate hand laterally (externally)to place posterior surface of elbow at 45 degree angle -first and second digit in contact with table Central ray- perpendicular to elbow joint Shield gonads Collimation- 3 inches proximal and distal to elbow joint and 1 inch on all sides *structure shows radial head and neck free of superimposition of the ulna

Distal humerus- partial flexion

-place IR under the elbow and center it to the condyloid area of the humerus -place humerus in the same place and the shoulder -support elevated forearm Central ray- perpendicular to humerus, midway between humeral epidocondyles-depending on the degree of flexion angle central ray distally to the joint Shield gonads Collimation-3 inches proximal and distal to elbow joint and 1 inch on all sides. *shows distal humerus without rotation when elbow cannot be extended, forearm foreshortened

Lateral humerus

-supine on table or standing upright against upright bucky -body positioned not as important as arm -top of IR 1 1/2 above humeral head -internally rotate arm unless contraindicated by possible fracture -flex elbow at 90 degrees -place palm of hand on hip -coronal plane passing through epicondyle should be perpendicular to IR Central ray- perpendicular to midpoint of humerus and center of IR shield gonads collimation- 2 inches distal to elbow joint and superior to the shoulder and 1 inch on sides *shows lateral of entire humerus, should joint to elbow joint superimposed epicondyles lesser tubercle in profile

AP humerus- recumbent

-supine on table or standing upright against upright bucky -painful nature of shoulder injuries suggest upright positioning whenever possible -14*`7 cassette -top of IR 1 1/2 above the humeral head- -abduct arm slightly and supinate hand -coronal plane passing between epicondyles should be parallel to IR Central ray-perpendicular to midpoint of humerus and center of IR shield gonads suspend respiration collimation- 2 inches distal to elbow joint and superior to shoulder and 1 inch on all sides *shows entire humerus, epicondyles without rotation, humeral head and greater tubercle in profile.

Transthoracic lateral (Lawrence view)

-use when trauma exists and arm cannot be rotate or abducted -position patient updated or supine- upright more comfortable-affected side against bucky in lateral position -for supine use decubitus sponge to elevate head and shoulders -raise unaffected arm and rest on head -prevents superimposition DO NOT move or rotate affected arm -MCP perpendicular to IR center IR to surgical neck of affected humerus Breathing INstructions: Full inspiration- air filled lungs will improve contrast, reduces the amount of exposure necessary to penetrate the body breathing technique blues out ribs and lung markings Central ray- perpendicular to IR enter MCP at the level of the surgical neck -if shoulders are superimposed angle CR 10-15 degrees cephalad shield gonads Collimation- adjust 10*12 lengthwise in collimator *shows proximal humerus, scapula, clavicle through lung field - unaffected clavicle and humerus projected abover affected shoulder.

Coyle Method(anxiolateral trauma)

patient seated at the end of table, low enough to place humerus, elbow, and wrist joints in same place - patient can be supine for imaging traumatized elbow -pronate hand and flex elbow 90 degrees to show radial head or 80 degrees to show coronoid process -center IR to elbow joint In trauma if patient is lying supine: elevate distal humerus on radiolucent sponge place IR in vertical position centered to elbow joint epidocondyles should be apprx perpendicular to IR flex elbow 90 degrees to show radial or 80 degrees to show coronoid process IF patient is seated by table: CR directed toward should at angle of 45 degrees to radial head, entering at the mid elbow joint CR directed away from shoulder at angle of 45 degrees to coronoid process, entering at mid elbow joint. Collimation- 3 inches proximal and distal to elbow joint