Procedure III: Upper Extremity -Elbow, Humerus, Shoulder

The degree of CR angulation for the lateral elbow, radial head series is -----------.

0 degrees (perpendicular)

The CR angulation for the Stryker-Notch method is -------.

10 degrees cephalad

The pt positioning for an AP oblique shoulder, Apple method, is similar to the positioning of what other method?

Grayshey

For the Coyle method with the pt seated, how should the CR be directed if the radial head is of interest?

45 degrees toward the shoulder

For the axiolateral elbow, Coyle method, what is the degree of flexion if the coronoid process is the area of interest?

80 degrees

For the axiolateral elbow, Coyle method, what is the degree if elbow flexion if the radial head is the area if interest?

90 degrees

What is the degree of flexion of the elbow for a lateral elbow, radial head series?

90 degrees

The Fisk modification, performed to demonstrate the bicipital groove, is an example of a --------- projection.

Tangential

Which pathology is the PA Axial projection of the distal humerus useful in diagnosing?

Tennis elbow

For the transthoracic projection of the shoulder, Lawrence method, it is possible the pt either upright or supine. T/F

True

When performing the AP proximal forearm with elbow in partial flexion, if its impossible to position the patient seated with the dorsal surface of the forearm resting on the table , you can elevate the limb on a support in a lateral position and use a vertical IR behind the upper end of the forearm and direct the CR horizontally.

True

What determines if you will need to angle the CR distally into the elbow joint when performing an AP distal humerus with the elbow in partial flexion>

Degree of flexion of the elbow

Which part should be parallel to the IR when positioning for an AP distal humerus with the elbow in acute flexion?

Humerus

Describe how you can determine that the pt has been positioned with the correct degree if rotation for a Scapular Y projection (AP or PA).

-mzAlign the medial boarder if the scapula with the humeral head and make that line perpendicular to the IR - Place a finer on the humeral head and medial border of scapula and rotate the pt until horizontal line is firmed between fingers and is perpendicular to IR

Name the 4 positions of the hand in a lateral elbow, radial head series:

1. Supinated 2. Lateral w/thumb up 3. Pronated 4. Extreme internal rotation (so thumb is in AP postion)

For the PA Axial elbow performed for the olecranon process, the CR should be angled ------- degrees toward the wrist.

20

How many degrees is the body rotated toward the affected side fit an AP oblique shoulder, Apple method?

35-45

For the Coyle method with the pt supine for trauma, how should the horizontal CR be directed if the radial head is of interest?

45 degrees cephalad

In a tangential projection of the scapular spine, Laquerrire-Pierquin, the CR should be directed through the posteriorsuperior region of the shoulder at angle of ------degrees caudal.

45

The AP axial oblique shoulder, Garth Method should be performed with a -------degree caudal CR angulation passing through the glenohumeral joint.

45

For the Coyle method with the pt seated, how should the CR be directed if the coronoid process is of interest?

45 degrees away from the shoulder

For the Coyle method with the pt supine for trauma, how should the horizontal CR be directed if the coronoid process is of interest?

45 degrees caudad

For the transthoracic projection of the shoulder, Lawrence method, what should you do if the pt is unable to elevated the unaffected shoulder?

Angle the CR 10-15 degrees cephalad

When performing a lateral projection of the humerus when a fracture is suspected, the patient should be positioned recumbent with the IR-------.

Between the humerus and the pt's torso, as close to the axilla as possible

When performing a PA proximal forearm with the elbow in acute flexion, the CR should be perpendicular to the -----.

Forearm

The Stryker-Notch method is often used to demonstrate ----------.

Hills-Sachs defect

What is the disadvantage if performing the Fisk modification to demonstrate the bicipital groove, with the pt standing at the end of the x-ray table as compared to having the pt supine?

Increased OID

What other projection would you perform in addition to the transthoracic projection if the shoulder, Lawrence method, if a lateral humerus was ordered and a fracture was suspected?

Lateral recumbent and recumbent if the distal humerus

For an AP distal humerus with the elbow in acute flexion how would the CR be directed?

Perpendicular to the humerus, entering 2'' superior to the olecranon proccess

For the PA Axial elbow performed for the distal humerus, the hand should be--------- to prevent rotation if the humerus and ulna.

Supinated

How should the hand be positioned for an Ap distal humerus with the elbow in partial flexion?

Supinated

What is the disadvantage of performing the AP proximal forearm and distal humerus with elbow in partial flexion instead of an AP elbow?

The elbow joint is not as well demonstrated

What determines the degree of angulation for the AO axial projection of the coracoid process?

The shape if the pt's back/shoulders

For the transthoracic projection of the shoulder, Lawrence method, what is the purpose of raising the non-injured arm and elevating the non-injured shoulder?

To prevent superimposition of the shoulders

What is the purpose of angling the CR 15-45 degrees cephalic for the AP axial projection of the coracoid process?

To project the coracoid process with minimal self-superimposition

What is the purpose if using weighted abduction for the AP oblique shoulder, Apple method?

To show the loss if articular cartilage in the scapulohumeral joint

The----------- method is used when chronic instability if the shoulder is suspected and to show bony abnormalities of the anterior inferior glenoid rim. Associated Hill-Sachs defect of the lateral aspect if the humeral head is also shown. The pt is prone, IR is vertical in contact with superior shoulder, and CR is directed 25 degrees anteriorly from horizontal and 25 degrees medially. The pt's arm is abducted 90 degrees with the forearm resting over the edge if the table.

West Point

When are the AP distal humerus and AP proximal forearm with the elbow in partial flexion performed instead of an AP elbow?

When the pt cannot completely extend the elbow

If the pt is supine for a lateral projection of the distal humerus, and a fracture is suspected, the CR will be-------- to the mid-portion of the humerus.

horizontal and perpendicular

Which structure's position will change in the images for lateral elbow, radial head series, by changing the position of the hand for each image?

radial tuberosity