IMAGE ANALYSIS CHAPTER 4: UPPER EXTREMITY
Image 4:19- The wrist was rotated more than 45 degrees medially. The posterior radial margin superimposes more than one fourth of the lunate. The proximal forearm was elevated. The ulnar styloid is not in profile.
Correction: Decrease medial wrist obliquity to 45 degrees, depress the proximal forearm to bring it parallel with IR, and position the humeral epicondyles perpendicular to the IR.
Image 4.20- Wrist rotated more than 45 degree
Correction: Decrease the degree of hand flexion until the second MC is at a 10-degree angle with the anterior wrist plane, depress the proximal forearm to bring it parallel with IR, and decrease the amount of external rotation.
Image 4.34- The elbow is accurately positioned. The distal radius is anterior to the ulna. The wrist was internally rotated.
Correction: Externally rotate the wrist until it is in a lateral projection.
Image 4.10- The IP and CM joints are closed, and the phalanges and MCs are foreshortened. The thumb demonstrates a lateral projection. The hand and fingers were flexed for this projection.
Correction: Fully extend the hand and fingers, and place them flat against the IR.
Image 4.38: The distal humerus is demonstrated without foreshortening, but the proximal forearm is severely distorted. The humerus was positioned parallel with the IR and the distal forearm was elevated.
Correction: If possible, fully extend the elbow. If the patient is unable to extend the elbow, this is an acceptable projection of the distal humerus. A second AP projection of the elbow should be taken with the forearm positioned parallel with the IR
Image 4.50-(Lateromedial projection) The capitulum is posterior to the medial trochlea, the proximal forearm is distorted, and the lesser tubercle is in only partial profile. The arm was not internally rotated enough to position the humeral epicondyles perpendicular to the IR.
Correction: If the distal forearm is situated on the abdomen, rest it on the IR. Internally rotate the arm until the humeral epicondyles are positioned perpendicular to the IR.
Image 4.12: The midshaft of the fourth and fifth MCs are superimposed. The hand was placed at more than 45 degrees of obliquity. The phalanges are foreshortened, and the IP joint spaces are closed. The fingers were flexed toward the IR.
Correction: Internally rotate the hand until the MCs and IR form a 45-degree angle and extend the fingers, placing them parallel with the IR.
Image 4.25- The anterior aspect of the pisiform is demonstrated anterior to the anterior aspect of the distal scaphoid. The wrist was externally rotated.
Correction: Internally rotate the wrist until the wrist is in a lateral projection.
Image 4.25: The anterior aspect of the pisiform is demonstrated anterior to the anterior aspect of the distal scaphoid. The wrist was externally rotated.
Correction: Internally rotate the wrist until the wrist is in a lateral projection.
Image 4.36- The humeral epicondyles are not in profile and more than one eighth of the radial head is superimposed over the ulna. The elbow was internally rotated.
Correction: Rotate the elbow externally until the humeral epicondyles are parallel with the IR.
Image 4.37- The humeral epicondyles are not in profile and less than one eighth of the radial head is superimposing the ulna. The elbow was externally rotated.
Correction: Rotate the elbow internally until the humeral epicondyles are parallel with the IR.
Image 4:33- The elbow was externally rotated. The proximal and distal aspects of the forearm do not demonstrate even brightness. The proximal forearm was positioned at the anode end of the tube.
Correction: Rotate the wrist and hand externally until they are in an AP projection, and rotate the elbow internally until the humeral epicondyles are parallel with the IR. Position the distal forearm at the anode end of the tube to take advantage of anode heel effect.
PA Hand
FIGURE 4.44 - PA hand projection taken in external rotation.