Special Positioning- Upper Extremities
Carpal Bridge: Tangetial
* Show fractures of the dorsal carpal bones* * CR directed 45 degree caudally, skimming the dorsal wrist*
PA Axial Oblique Wrist (Trapezium): Clements- Nakayama
* Shows trapezium and its articulations with adjacent carpal bones* - Thumb on 45 degree sponge
AP Oblique Wrist: medial rotation
* allows visualization of the pisiform in it's entirety* - 45 degree CR @ midcarpal
Axiolateral Elbow: Coyle
* done in cases where routine oblique elbow images are not possible* * requires CR angles of 45 degrees toward and away from the shoulder*
Scaphoid series: Rafert-Long
* gradually elongates the scaphoid in 4 different images* - Patient in ulnar deviation for all of images - (1) 0 degree CR, (2) CR 10 degree cephalic, (3) CR 20 degree cephalic, (4) CR 30 degree cephalic
PA axial proximal forearm ( Olecranon Process)
* requires arm be placed in a 45 degree flexion with the hand supinated* - CR 20 degrees toward elbow an 1" or 2"
Radial Head Series
* requires the hand to be in 4 different positions* - all in a lateral elbow and CR perp. - (1) hand supinated, (2) hand lateral, (3) hand flat and pronated, (4) internal rotation
1st MCP joint: Folio
* shows MCP joints and MCP angles bilaterally* *Requires a tension device* - stress view-
PA Axial Humerus (Ulnar Sulcus)
* shows the ulnar sulcus; used for tennis elbow* - CR perp, elbow at 75 degree flexion
AP Oblique hand: Norgaard
* used in the diagnosis of rheumatoid arthritis* - hands @ 45 angle; can use sponge
1st MCP Joint: Robert
*first carpometacarpal joint* - Place finger in AP projection - CR perp but can angle 15 degrees proximally
AP Wrist
*shows carpal interspaces well* - CR in mid carpal area, don't want too much flexion
Tangential Carpal Tunnel (Gaynor-Hart Method)
- CR 25-30 degrees toward palm *Allows visualization of pisiform in it's entirety*
PA wrist: Radial Deviation
- deviate towards radius *opens the interspaces between the carpals on the medial side of wrist
PA wrist: Ulnar Deviation
- deviate towards the ulna - looking at radial side * corrects foreshortening of the scaphoid*a
Navicular: Stetcher
- use sponge to elevate hand 20 degrees or angle CR 20 degrees proximal - scaphoid sits at a downward angle so this will *correct foreshortening of scaphoid* - *scaphoid w/o s.i.*
First carpometacarpal joint: Burman
- visualizes the first carpometcarpal joint - requires a tension device - 45 degree on CR - thumb parallel to IR (so tilt hand medial)
Acute Flexion: Jones
-if patient can't extend elbow * acute flexion of elbow* * S.I. the bones of the humerus and forearm*