Radiographic Positions and Projections Upper Limb

Transthoracic Lateral Shoulder

CR entering the mid coronal plane at the surgical neck W/O ability to elevate arm, angle CR 10-15 degrees cephalic Full inspiration Proximal humerus is projected in the thorax

Axial Trauma (Coyle)

CR horizontal directed 45degrees cephalad to the visualize the radial head CR horizontal directed 45 degrees caudad to visualize the coronoid process

Inferosuperior Axial Shoulder

CR horizontally through the axilla Degree of medial angulation 15-30 degrees Humerus externally rotated Exaggerated external rotation (Rafert Method) Lesser tubercle in profile and coracoid process directed anteriorly

AP Clavicle

CR midshaft of clavicle Suspend respiration at the end of exhalation

Lateral Thumb

CR perpendicular to 1st MCP Concave, anterior surface of proximal phalanx

Oblique Thumb

CR perpendicular to 1st MCP Proper rotation of phalanges

AP Thumb

CR perpendicular to 1st MCP joint Patient's hand in extreme medial rotation

Lateral Hand

CR perpendicular to 2nd MCP

Oblique Hand

CR perpendicular to 3rd MCP

PA Hand

CR perpendicular to 3rd MCP

AP Neutral Shoulder

CR perpendicular to a point 1 inch inferior to the coracoid process Palm of hand placed against hip Epicondyles at a 45degree angle Posterior part of the supraspinatus insertion is visualized

AP Internal Shoulder

CR perpendicular to a point 1 inch inferior to the coracoid process Rotate arm internally Rest back of hand on hip Epicondyles perpendicular Suspend respiration

AP External Shoulder

CR perpendicular to a point 1 inch inferior to the coracoid process Supinate the hand Humeral head in profile Greater tubercle and site of insertion of the supraspinatus tendon are visualized

Internal Oblique Elbow

CR perpendicular to elbow joint Coronoid process in profile Hand Pronated

External Oblique Elbow

CR perpendicular to elbow joint Radial head, neck and tuberosity projected free of ulna Hand supinated

Lateral Elbow

CR perpendicular to elbow joint Superimposed humeral condyles Olecranon process in profile

AP Partial Flexion

CR perpendicular to elbow joint and proximal forearm

AP Humerus

CR perpendicular to mid portion of humerus Top of IR 1 1/2 inches above the head of humerus Humeral head and greater tubercle in profile

PA Wrist

CR perpendicular to midcarpal area

Oblique Wrist

CR perpendicular to midcarpal area; enters just distal to radius Well shown trapezium and distal half of scaphoid

Lateral Forearm

CR perpendicular to midpoint of forearm

AP Forearm

CR perpendicular to midpoint of forearm Well shown wrist and distal humerus Hand supinated

PA for Scaphoid

CR perpendicular to scaphoid Well shown scaphoid with adjacent articulations

PA Finger

CR perpendicular to the PIP joint

Finger lateral

CR perpendicular to the PIP of the affected digit

Oblique Finger

CR perpendicular to the PIP of the affected digit Rotate hand laterally on a 45degree foam wedge

AP Elbow

CR perpendicular to the elbow joint

Lateral PO Scapula

CR perpendicular to the lateral border of the rib cage at the mid scapular area Patient turns away from affected side rotating the shoulder 15-20degrees Suspend respiration

Lateral AO Scapula

CR perpendicular to the mid-medial border of protruding scapula 45-60degree rotation from the plane of the IR

Scapular Y Shoulder

CR perpendicular to the scapulohumeral joint Unaffected side 45-60degrees Suspend Respiration Humeral shaft and scapular body superimposed Acromion projected laterally

Lateral Wrist

CR perpendicular to wrist joint Well shown distal radius & ulna , carpals & proximal half of metacarpals

Scaphoid Stecher (PA Axial)

CR directed to enter scaphoid IR angled 20degrees

Carpal Canal (Gaynor Hart Method)

CR directed to palm of the hand 1" distal to the 3rd MC CR angled 25-30degrees Shows all carpals with pisiform in profile Hamulus of hamate

Tangential Shoulder

CR 10-15 degrees caudad entering superior aspect of humeral head Suspend Respiration Humeral head projected below the AC joint

Transthoracic Lateral Humerus

CR 10-15 degrees cephalad Opposite arm and shoulder raised Affected arm dropped

AP Scapula

CR 2inches inferior to the coracoid process Exposure made during slow breathing

Posterior Oblique Shoulder Grashey

CR 2inches medial and 2inches inferior to the superolater border of the shoulder Rotate body 35-45 degrees toward affected side Suspend respiration Scapulohumeral joint shown

PA Axial Clavicle

CR angled 15-30degrees caudad

AP Axial Clavicle

CR angled 15-30degrees cephalad (supine) CR angled 0-15 degrees cephalad (standing lordotic)

Acromioclavicular Joints -AP Biateral w/&w/o weights

CR at level of AC joints Suspend Respiration

AP Neutral Humerus

Seated or standing Humeral head and greater tubercle in profile

Lateral Humerus

Superimposed epicondyles Lesser tubercle in profile