Forearm, Elbow, and Humerus Positioning and Film Critique
Positioning for the circumference of the radial head
1.) lateral elbow, hand supinated as much as possible 2.) lateral elbow, lateral hand with thumb up 3.) lateral elbow, hand pronated 4.) lateral elbow, hand internally rotated in a reverse lateral
Objective for an internal (medial) oblique elbow
1/3 of proximal forearm and 1/3 of distal humerus (1 1/2 inches of collimation on either side)
Objective for external (lateral) oblique elbow
1/3 of proximal forearm and 1/3 of distal humerus (1 1/2 inches of collimation on either side)
Objective for lateral elbow
1/3 of proximal forearm and 1/3 of distal humerus (1 1/2 inches of collimation on either side)
Objective for partial flexion of the elbow
1/3 of proximal forearm and 1/3 of distal humerus (1 1/2 inches of collimation on either side)
AP Acute Flexion (Jones Method)
What projection is this?
AP Forearm
What projection is this?
AP Humerus
What projection is this?
AP elbow
What projection is this?
Internal (medial) oblique elbow
What projection is this?
Lateral elbow
What projection is this?
Lateral forearm
What projection is this?
Lateral humerus
What projection is this?
PA Acute Flexion (Jones Method)
What projection is this?
Partial flexion of the elbow (distal humerus)
What projection is this?
Partial flexion of the elbow (proximal forearm)
What projection is this?
Transthoracic Lateral Humerus (Lawrence Method)
What projection is this?
What is 6 on this lateral elbow?
coronoid process
What is 8 on this AP elbow?
coronoid process
Structure shown for an internal (medial) oblique elbow
coronoid process in profile, trochlea, longer medial epicondyle in profile. Ulna superimposed by the radial head and neck
Objective for lateral forearm
entire carpals through distal humerus (joint to joint)
Objective for AP forearm
entire carpals through distal humerus (joint-to-joint)
Structure shown for AP humerus
greater tubercle in profile
Technique for transthoracic lateral humerus (Lawrence Method)
80 kVp @ 10-20 mAs
Technique for AP humerus (bucky/grid)
80 kVp @ 6-10 mAs
Technique for lateral humerus (bucky/grid)
80 kVp @ 6-10 mAs
Film size for AP elbow
8x10 preferred
Film size for an internal (medial) oblique elbow
8x10 preferred
Film size for external (lateral) oblique elbow
8x10 preferred
Film size for lateral elbow
8x10 preferred
Which projection of the elbow demonstrates the olecranon in profile? A.) Lateral B.) AP C.) AP oblique, medial rotation D.) AP oblique, lateral rotation
A
Which of the following require the humeral epicondyles to be positioned parallel with the IR? (1) AP forearm (2) AP elbow (3) PA wrist A.) 1 and 2 only B.) 1 and 3 only C.) 2 and 3 only D.) 1, 2, and 3
A Pronation of the hand causes medial (internal) rotation of the humeral epicondyles
PAC-MAN
PAC MAN (it look like pac-man lol)
Structure shown for transthoracic lateral humerus (Lawrence Method)
lateral view of proximal humerus
What is 2 on this lateral elbow?
superimposed humeral epicondyles
Which of the two structures primarily form the hingelike structures of the elbow joint?
trochlea and olecranon process
What is 5 on this lateral elbow?
trochlear sulcus
What composes the three concentric arcs of a lateral elbow?
trochlear sulcus, outer ridges of the capitulum and trochlea, trochlear notch of ulna
What bone is on the medial side of the forearm?
ulna
Positioning for AP forearm
upper limb extended, hand supinated. Shoulder and humerus in same plane as forearm. Humeral epicondyles parallel to IR, distal radioulnar joint open, slight superimposition of the radial head, neck, and tuberosity over the proximal ulna.
Positioning for lateral forearm
upper limb flexed 90* in true lateral position. Shoulder and humerus in same plane as forearm, epicondyles perpendicular to IR w/ slight wrist elevation.
Positioning for a lateral elbow
upper limb flexed 90*, shoulder in same plane as forearm, epicondyles perpendicular to IR, lateral hand w/ thumb up and wrist slightly elevated
External (lateral) oblique elbow
what projection is this?
CR for lateral elbow
perpendicular to elbow joint
CR for partial flexion of the elbow
perpendicular to elbow joint
Positioning for lateral humerus
shoulder in same plane as elbow, flexed 90*. Epicondyles perpendicular to IR, hand on hip with thumb anterior. Respiration suspended.
Positioning for AP humerus
shoulder in same plane as elbow, humeral epicondyles parallel to IR and without rotation, arm abducted slightly with a supinated hand, respiration suspended
Positioning for an internal (medial) oblique elbow
shoulder in same plane as forearm, epicondyles medially (internally) rotated 45* via pronation of hand (adjust if needed)
Positioning for AP elbow
shoulder in same plane as forearm, epicondyles parallel to IR (equidistant from olecranon fossa and coronoid), hand supinated. Open humeroradial ("mustache") joint,
Objective for AP humerus
shoulder joint through elbow joint (joint-to-joint)
Objective for lateral humerus
shoulder joint through elbow joint (joint-to-joint)
Positioning for an external (lateral) oblique elbow
shoulder on same plane as forearm, epicondyles laterally (externally) rotated to place the posterior surface of the elbow at a 45* angle such that the first and second digits touch the table.
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Six steps for a lateral elbow film critique
1.) shoulder, elbow, and forearm on the same plane 2.) superimposed humeral epicondyles (teardrop-shape) on the posterior aspect of the humerus 3.) elbow flexed 90* for the olecranon process in profile 4.) radial tuberosity facing anteriorly (thumb up) 5.) radial head partially superimposing the coronoid process (slight wrist elevation) 6.) inferior and anterior joint spaces open
Objective for AP elbow
1/3 of proximal forearm and 1/3 of distal humerus (1 1/2 inches of collimation on either side)
Film size for AP forearm
10x12 or 14x17
Film size for lateral forearm
10x12 or 14x17
Film size for AP humerus
14x17
Technique for AP humerus (bed)
60 kVp @ 6-10 mAs
Technique for lateral humerus (bed)
60 kVp @ 6-10 mAs
Technique for AP elbow
55-60 kVp @ 3-4 mAs
Technique for AP forearm
55-60 kVp @ 3-4 mAs
Technique for an internal (medial) oblique elbow
55-60 kVp @ 3-4 mAs
Technique for external (lateral) oblique elbow
55-60 kVp @ 3-4 mAs
Technique for lateral elbow
55-60 kVp @ 3-4 mAs
Technique for lateral forearm
55-60 kVp @ 3-4 mAs
is the coronoid process more anterior or posterior on the forearm?
Anterior
What structure is in profile on the lateral side of the proximal humerus on the AP projection of the humerus? A.) Lesser tubercle B.) Greater tubercle C.) Medial epicondyle D.) Lateral epicondyle
B
What is the CR angle and direction to demonstrate the radial head with the axiolateral projection (Coyle method)? A.) Perpendicular to the elbow joint B.) Angled 45* away from the shoulder C.) Angled 45* toward the shoulder D.) Angled 25* caudad
B
Coyle Method for Coronoid Process
CR 45* away from the shoulder entering joint at mid-elbow, elbow flexed 80*. Hand pronated.
Coyle Method for Radial Head
CR 45* towards the shoulder entering joint at mid-elbow, elbow flexed 90*. Hand pronated.
Which portion of the humerus articulates with the radial head? A.) Capitulum B.) Trochlea C.) Olecranon D.) Coronoid
Capitulum
Structure shown for partial flexion of the elbow (distal humerus)
Distal humerus without rotation or distortion, proximal radius superimposed over the ulna. Closed elbow joint and greatly foreshortened proximal forearm. Hand supinated if possible.
Structure shown for PA Axial Projection for Distal Humerus
Epicondyles, trochlea, and olecranon process in profile.
Structure shown for acute flexion (Jones method)
Forearm and humerus superimposed without rotation, olecranon process and distal humerus in profile
Structure shown for Coronoid Process Radial Head
Open joint space between coronoid process and trochlea, coronoid process in profile and slightly elongated. Radial head and neck superimposed by ulna, elbow flexed 80*
Structure shown for Radial Head Coyle Method
Open joint space between radial head and capitulum, radial head, neck, and tuberosity free from superimposition with the exception of a small portion of the coronoid process, humeral epicondyles distorted and radial tuberosity facing posteriorly.
is the olecranon process more anterior or posterior on the forearm?
Posterior
Which elbow fat pad indicates pathological change?
Posterior fat pad
Why do we supinate the hand at an AP forearm instead of pronating?
Pronation of the hand crosses the radius over the ulna at its proximal third and rotates the humerus medially, resulting in an oblique projection of the forearm.
is the coronoid process more proximal or distal on the forearm?
Proximal
is the olecranon process more proximal or distal on the forearm?
Proximal
is the radial head proximal or distal on the forearm?
Proximal
is the radial tuberosity proximal or distal on the forearm?
Proximal
Objective for acute flexion (Jones method)
Proximal half of the forearm and olecranon process
Structure shown for partial flexion of the elbow (proximal forearm)
Proximal radius and ulna without rotation or distortion, radial head, neck, and tuberosity over the proximal ulna. Partially open elbow joint and foreshortened distal humerus.
Positioning for acute flexion (Jones method)
Shoulder on same plane as elbow, elbow fully flexed
PA Axial Projection for Distal Humerus
Special view used in radiohumeral bursitis (tennis elbow) to detect calcifications in the ulnar sulcus
PA Axial Projection for Olecranon Process
Special view used to show the articular margin of the olecranon and humerus
How do we ensure that the radial tuberosity is facing anteriorly?
The thumb must be up
Are the radial groove and radial fossa on the radius or ulna?
Ulna
CR for PA acute flexion (Jones method)
angled perpendicular to the flexed forearm, entering approximately 2 inches distal to the olecranon process
Positioning for transthoracic lateral humerus (Lawrence Method)
arm abducted slightly, supination of hand with contralateral arm over head, CR on mid-coronal plane
The most lateral structure on an AP elbow
capitulum
What is 6 on this AP elbow?
capitulum
If the radial head on a lateral elbow is too anterior, the tech must...
elevate the wrist
Circumference of the Radial Head
four-position series of the lateral elbow to view the circumference of the radial head free from superimposition
Structure shown for AP forearm
general overview
Structure shown for AP elbow
general overview; slight superimposition of radial head, neck, and tuberosity over proximal ulna
What view is the semilunar notch best seen?
lateral elbow
What is 1 on this AP elbow?
lateral epicondyle
Structure shown for lateral humerus
lesser tubercle in profile, facing medially. Superimposed humeral epicondyles. Greater tubercle superimposed over humeral head.
If the radial head on a lateral elbow is too posterior, the tech must...
lower the wrist
What is 2 on this AP elbow?
medial epicondyle
What is 4 on this AP elbow?
olecranon fossa
What is 1 on this lateral elbow?
olecranon process
What is 3 on this AP elbow?
olecranon process
Structure shown for lateral elbow
olecranon process in profile, trochlear and semilunar notch visible (three concentric arcs), radial tuberosity facing anteriorly, superimposed humeral epicondyles
CR for an internal (medial) oblique elbow
perpendicular to elbow joint
CR for external (lateral) oblique elbow
perpendicular to elbow joint
CR for AP Forearm
perpendicular to IR at mid-forearm
CR for lateral forearm
perpendicular to IR at mid-forearm
CR for AP elbow
perpendicular to elbow joint
CR for AP humerus
perpendicular to mid-humerus
CR for lateral humerus
perpendicular to mid-humerus
CR for transthoracic lateral humerus (Lawrence Method)
perpendicular to surgical neck (bucky centered first)
CR for AP acute flexion (Jones method)
perpendicular to the humerus, approximately 2 inches superior to the olecranon process
CR for PA Axial Projection for Olecranon Process
perpendicular to the olecranon process
CR for PA Axial Projection for Distal Humerus
perpendicular to the ulnar sulcus, entering at a point just medial to the olecranon process
Objective for transthoracic lateral humerus (Lawrence Method)
proximal humerus, including humeral head and shoulder joint through elbow joint
What is 3 on this lateral elbow?
radial head
What is 5 on this AP elbow?
radial head and neck
Structure shown on an external (lateral) oblique elbow
radial head, neck, and tuberosity free from superimposition. Elongated lateral epicondyle and capitulum
What is 4 on this lateral elbow?
radial neck
What is 9 on this AP elbow?
radial tuberosity
Structure shown for lateral forearm
radial tuberosity facing anteriorly and olecranon in profile, proximal row of superimposed carpal bones and elbow joint
What bone is on the lateral side of the forearm?
radius
The two long bones that make up the forearm
radius and ulna
Partial flexion of the elbow
special AP view obtained for when the patient cannot completely extend the elbow
Coyle Method
special view for patients who cannot fully extend the elbow for oblique projections
What is 7 on this AP elbow?
trochlea
