FOREARM, ELBOW, & HUMERUS

HUMERUS FOR FRACTURE OF PROXIMAL 1/2-1/3 TRANSTHORACIC LATERAL LAWRENCE METHOD

place patient in seated or upright lateral postion w/EFFECTED arm adjacent to IR.(may also be done supine). place top of IR 1 1/2" above top of shoulder. place the unaffected arm above head to de-superimpose shoulders. CR: mid-humerus Breathing Instructions: use low mA and long exposure time(min 3 sec) and have patient take slow deep breaths. QC: lateral image humerus is projected thru ribs & lung field.

HUMERUS LATERAL - UPRIGHT

place patient in upright position facing x-ray tube. place top of IR 1 1/2" superior to top of shoulder. place arm in lateral postion by placing the palmar surface of hand against lower hip(epicondyles perpendicular to IR). CR: perpendicular to midpoint of humerus (center of IR). QC: lesser tubercle in profile(medially)

FOREARM LATERAL PROJECTION

place the entire extremity in same horizontal plane. flex the elbow 90 degrees so epicondylar line is perpendicular to IR. place the hand in lateral extension position. CR: perpendicular to midpoint of forearm.

HUMERUS AP PROJECTION UPRIGHT(for patient comfort)

place the patient in upright postion facing the x-ray tube. place the top of IR 1 1/2" superior to head of humerus(1 1/2" above top of shoulder). supinate hand to place humeral epicondyles parallel to IR. CR: perpendicular to midpoint of humerus(center of IR). QC: humeral head & greater tuberosity seen in profile(laterally).

FOREARM LATERAL PROJECTION QUALITY CHECKS

Anatomical inclusions: from distal end of humerus to carpal bones. radius and ulna to be directly superimposed at distal ends only.

FOREARM AP PROJECTION QUALITY CHECKS

Anatomical inclusions: from distal end of humerus to carpal bones.. radial head, neck, & tuberosity slightly superimposed over proximal ulna. radius and ulna should be parallel to each other if hand in proper position.

ELBOW LATERAL PROJECTION QUALITY CHECKS

Anatomical inclusions: from distal humerus to proximal forearm. OLECRANON PROCESS should be in profile & free of bony superimposition. proximal region of forearm should not be crossed if hand was in correct position. radial tuberosity facing anteriorly.

ELBOW AP PROJECTION QUALITY CHECKS

Anatomical inclusions: from lower shaft of humerus to proximal forearm. radial head, neck, & tuberosity slightly superimposed over proximal ulna.

ELBOW AXIOLATERAL TRAUMA (COYLE) RADIAL HEAD & CORONOID PROCESS

FOR PATIENT WHO CAN'T FULLY EXTEND ELBOW. Seated position. pronate hand and flex elbow 90 degrees to demonstrate radial head. CR: radial head demonstration- directed TOWARD shoulder at 45 degree angle. cr enters joint at mid-elbow. coronoid process demonstration- directed AWAY from shoulder at 45 degree angle. cr enters joint at mid-elbow.

ELBOW LATERAL PROJECTION

extend the entire extremity and place in one horizontal plane. flex the elbow 90 degrees - epicondylar line should be perpendicular to IR. 2 reasons for importance:(1) olecranon process will be seen in profile, (2) elbow fat pads ar least compressed. hand should be in lateral extension position. CR: perpendicular to elbow joint regardless of location on IR.

FOREARM AP PROJECTION

extend the entire extremity to have the humerus & forearm in the same horizontal plane. supinate the hand to prevent rotation of radius and ulna. line btw epicondyles of humerus should be parallel to IR. CR: perpendicular to midpoint of forearm.

ELBOW AP PROJECTION

have the patient extend the entire extremity so it lies in one plane. epicondylar line shoul be parallel to IR. supinate the hand to prevent rotation of radius & ulna. CR: perpendicular to elbow joint.

ELBOW AP OBLIQUE PROJECTION LATERAL(EXTERNAL) ROTATION

position as for an AP projection of elbow. rotate the extremity laterally to place the posterior surface of elbow at 45 degree angle. CR: perpendicular to elbow joint. QC: RADIAL HEAD, NECK & TUBEROSITY should be free of any bony superimposition.

ELBOW AP OBLIQUE PROJECTION MEDIAL (INTERNAL) ROTATION

position patient as for an AP projection of elbow. pronate hand and adjust elbow to place its anterior surface at an angle 45 degrees. CR: perpendicular to elbow joint. QC: CORONOID PROCESS should be free of any bony superimposition.

AP PROJECTION PARTIAL FLEXION DISTAL HUMERUS

seat patient low enough to place humerous in one plane on IR. elevate the forearm w/hand supinated and supported. CR: perpendicular to elbow joint QC: distal humerus should be demonstrated w/out rotation or distortion.

AP PROJECTION PARTIAL FLEXION PROXIMAL FOREARM

seat the patient high enough for dorsal surface of forearm to rest on IR. humerus WILL NOT touch IR. CR: perpendicular to elbow joint. QC: proximal forearm should be seen w/out rotation or distortion. distal humerus will be foreshortened.