Radiology - Upper Extremity Positioning - Ian

AP Shoulder Trauma Projection Neutral Rotation

40" Rotate thorax slightly as needed to place posterior shoulder against IR *CR to 1" inferior to coracoid process *No breathing

PA Oblique Thumb

40" Thumb will be at 45 degree oblique *CR is centered to 1st MP Joint *Include entire 1st metacarpal extending to carpals.

AP and AP Axial Clavicle

40" Upright or recumbent, center clavicle to IR and CR. CR to midclavicle *AP CR is to midclavicle *AP Axial CR is 15-30 degrees cephald (thin shoulders requite 5-10 degree more angle than thick shoulders) *PA Axial DR is 15-30 degrees caudad *Expose upon expiration *Entire clavicle and it's articulation

Posterior Oblique AP Oblique Projection (Grashey Method) Shoulder

40" Upright with coronal plane of body aligned 35-45 degrees to IR. Posteriolateral aspect of shoulder in contact with upright bucky or table. *CR Perpendiculat through glenohumeral joint at a point 2" medial and 2" interior to superolateral border of shoulder. *Glenohumeral joint

AP Elbow

40" Elbow extended with hand supinated. (axilla at level of table) *CR centered to mid elbow joint *Elbow joint with portions of distal and proximal forearm

Transthoracic Lateral Shoulder (Lawrence Method)

40" - Acute injury to shoulder Coronal plane of body is perpendicular to IR with affected side against upright bucky. Unaffected arm is raised above head. *CR Perpendicular to center of IR with top of IR 1 1/2-2" above top of shoulder. (through thorax to surgical neck) *Demonstrates proximal half of humerus and portions of scapula and clavicle.

PA Axial Projection (Stecher Method) Wrist

40" - When ulnar deviation is too painful. *Arm is extended and parallel to long axis of table for correct alignment with angled x-ray beam. Wrist is positioned with anterior aspect on IR as for PA *CR is 20 degree angle in direction of elbow and centered to scaphoid *Structures seen is the distal portion of radius and ulna, carpal bones and proximal metacarpals.

Tangential Projection (Gaynor - Hart Method) Wrist - Carpal Canal

40" - used to demonstrate the carpal canal. Arm is extended and parallel to long axis of table for correct alignment with angled beam. *CR angled 25-30 degrees in direction of elbow and centered to middle of palm of hand. *Carpal canal - anterior arch of carpal bones

Lateral Elbow

40" Elbow is flexed 90 degrees with medial surface in contact wtih IR. (wrist in lateral position) *CR centered to mid elbow joint Elbow joint with portions of distal and proximal forearm.

PA Projection Ulnar Deviation Wrist (scaphoid)

40" PA projection with ulnar deviation is performed when fracture of the scaphoid is suspecred. It reduces foreshortening of the scaphoid. Hand is deviated in the direction of ulna. *CR is perpendicular and cented to scaphoid. *Scaphoid is seen with minimal foreshortening

Inferosuperior Axial Shoulder (West Point Method)

40" *Affected arm abducted 90 degress hanging down over table edge. *Place IR on edge as far medially as possible against pt's neck. *CR angled medially 25 degrees down,25 degrees from horizontal, centered to pass through mid scapulohumeral joint. *stop breathing

Intertubercular (bicipital) Groove Tangential Projection (Fisk Method)

40" *Supine or erect - palpate anterior humeral head to locate groove. Abduct arm slightly, supinate hand *CR 10-15 degrees down from horizontal, centered groove *Don't breathe

AP Humerus

40" Abduct arm slightly, supinate hand *CR to mid humerus *Stop breathing *Entire humerus, shoulder joint, and elbow joint

Lateral Thumb

40" Align thumb to long axis of IR. Hand pronated and slightly arched, rotate hand medially until thumb is in a tru lateral position. *CR is centered to 1st MP Joint. *Entire thumg and first metacarpal with all joint spaces open and clearly visualized.

PA Wrist

40" Anterior surface of wrist is in contact with IR fingers are flexed to form a loose fist. *CR centered to midcarpals *Proximal 2/3 of metacarpals and the distal 1/4 forearm.

AC Joints

40" Bilateral AP Projection w/ or w/o weights 1- No weights 2- With weights *Cr is Midline at level of acromion process. *Stop Breathing *Both Ac Joints for Compatison to evaluate ligament integrity.

PA Oblique Hand

40" Elbow flexed Rotate entire hand and wrist laterally 45 degrees, support with wedge. All digits slightly separated *CR centered to 3rd MP joints *Entire hand andrist, most distal aspects of radius and ulna.

Lateral Humerus

40" Elbox flexed 45 degrees and plam of hand against hip so that fingertips point down. *CR to midhumerus *Stop Breathing Entire Humerus, shoulder, and elbow joint

AP Scapula

40" Erect or supine Abduct arm 90 degree *CR midscapula (2" interior to coracoid process and 1" medial to lateral border) Elbow flex 90 degrees *Stop breathing * Entire scapula

Lateral Finger

40" Hand in lateral position, thumb side up for 3rd to 5th digits, thumb side down for 2nd digit. *CR centered to PIP joing *Entire digit and idstal portion of metacarpal with IP and MCP joint spaces open and clearly visualized.

PA Hand

40" Hand on table - digits slightly separated *CR centered to 3rd MP joint *Entire hand and wrist, distal aspects of radius and ulna

PA Oblique Finger

40" Hand on table, elbow flexed 90 degrees, align finger to IR. Rotate hand 45 degrees, resting against support block Separate fingers *CR centered to PIP joint. *Entire digit and distal portion of metacarpal with IP and MCP joint spaces open and clearly visualized.

Oblique Elbow External or Internal

40" Internal - elbow extended, hand pronated. Palpate epicondyles to check for 45 degree internal rotation. External - supinate hand and rotate elbow 40-45 degrees externally. *CR centered to mid elbow joint. Internal visualizes coronoid process. External visualizeds radial head and neck.

Lateral Wrist

40" Medial surface of wrist in contact with IR *CR centered to midcarpals *Distal portion of radius and ulna, carpal bones, and proximal halves of metacarpals.

Lateral Scapula (LAO, LPO)

40" Oblique body position with affected side to the IR, body rotation 45-60 degrees Patient's forearm is positioned behind back with elbow flexed 90 degrees. *CR to mid- medial (vertebral)border *Stop breathing *Entire scapula

AP Shoulder External and Internal Rotation

40" Patient Upright External - arm slightly abducted with palm of hand supinated - humeral epicondyles parallel to IR Internal - humerus and arm rotated internally until back of hand is against thigh. Humeral epicondules perpendicular to IR. *Stop breathing *CR is perpendicular to a point 1" medial and inferior ot coracoid process. *External- Greater tuberosity Internal-Lesser tuberosity

Lateral Forearm

40" Patient seated at end of table. Elbow flexed 90 degrees Hand and wrist must be in a true lateral position (distal radius and ulna should be directly superimposed) *CR centered to midpoint to forearm. &Include a 1" beyond both wrist and elbow joints

AP Thumb

40" Patients hand is rotated internally with palm out to bring the posterior surgace of thumb in direct contact with IR. *CR centered to 1st MP joint. *Entire thumb and first metacarpal with all joint spaces open and clearly visualized.

AP Forearm

40" Pt seated at end of table with arm extended and hand supinated. Include both wrist and elbow joints *CR centered to midpoint of forearm *Include a minimum of 1" beyond both wrist and elbow joints.

PA Finger

40" Pt seated with elbow flexed 90 degrees, pronate hand and separate fingers. *CR centered to PIP joints *Entire digit and distal portion of metacarpal with IP and MCP Joint spaces open and clearly visualized.

Lateral Hand

40" Pt seated, hand on table, elbow flexed. Hand in lateral position, thumb side up, digits separated and spread into "fan" position and supported by step. *CR centered to 2nd MP Joint *Entire hand, most distal aspects of radius and ulna

Axiolateral Elbow (Coyle Trauma Method)

40" Radial head and neck -elbow flexed 90degrees with hand pronated. *CR angeld 45 degrees toward thorax, centered to radial head and neck, CR to enter at mid elbow joint. Coronoid Process-elbow flesed only 80 degrees with hand pronated *CR angled 45 degrees away from thorax, centered to coronoid processc CR to enter at midelbow joint. Demonstrates radial head and coronoid process.

PA Oblique Wrist

40" Rotate hand and wrist into 45 degree oblique angle *CR centered to midcarpals *Proximal 2/3 of metacarpals and the distal 1/4 of forearm

Lateral Shoulder Scapular y Lateral (Neer Method)

40" Rotate pt into a 45-60 degree anterior oblique as for a lateral scapula. Unaffected arm up in front of pt - affected arm down. *Cr to scapulohumeral joing *No breathing