Forearm, Elbow, and Humerus Positioning and Film Critique

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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


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