1st week (thu)+2nd week(sun).ppt

8/12/2019 1st week (THU)+2nd week(SUN).ppt

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Upper LimbsForearm, elbow, humerus,shoulder


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PLEASE TURN ALL CELL PHONES TO

SILENT MODE


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By the end of this Lecture the student will be able to:

List and identify the different bones related to shoulder joints

List the basic and Optional projections for radiographing the shoulder

Discus the correct body position, part position, central ray, and center point for

specific positions of shoulder

Critique and evaluate radiographs of shoulder based on (position, collimation and

central ray, exposure, and structure best shown)

Learning Objectives


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4

Basic

Text book of radiographic positioning and related anatomy; Kenneth

L.Bontrager,5th, 6thedition

Optional

Merrills Atlas of Radiographic Positions and Radiologic Procedures,

P.W. Ballinger, E.D. Frank

Positioning in Radiography: By k.C.Clarke.

Websites

References
http://www.e-radiography.net/http://www.e-radiography.net/http://www.e-radiography.net/http://www.e-radiography.net/


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Forearm Anatomy

Anterior Posterior


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Patient sits at end of couch, shoulder at couch level,forearm/palm supinated, elbow extended, both the

elbow and the wrist joint to be included.

AP forearm (Basic)

Film: 30x35 cm (35x43 cm for large patients).

CR: 90to film center.

CP: Midshaft (between the wrist and elbow joints).

For #s and dislocations, osteoarthritis (OA), and osteomyelitis (OM).Shows the entire radius and ulna,proximal row of the carpals, and distal end o the humerus.

Body and Part position


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WhyAP forearm NOTPA

Where is the radius after Pronation?

Lateral Medial

Where is the radius after Supination?

MedialLateral


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1. Scaphoid

2. Lunate

3. Styloid process of radius

4. Styloid process of ulna

5. Head of ulna

6. Radius

7. Ulna

8. Tuberosity of radius9. Neck of radius

10. Head of radius

11. Proximal radioulnar joint

L

RADIOGRAPHIC ANATOMY

AP Forearm


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Patient sits at end of couch, shoulder at level with

couch, wrist and elbow in true lateral and included

on the film.

Lateral forearm (Basic)

Same indication as the AP forearm.


Film: 30x35 cm (35x40 cm for the large patients).


CP: Midshaft (between the wrist and elbow)


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1. Scaphoid

2. Lunate

3. Distal end of radius4. Styloid process of ulna

5. Head of ulna

6. Ulna

7. Radius

8. Olecranon

9. Tuberosity of radius10. Neck of radius

11. Head of radius

12. Trochlea


Lateral Forearm


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12

Elbow Joint (Anatomy)


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Elbow Joint (Anatomy)


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Patient sits at end of couch, shoulder at couch level,

forearm supinated, elbow extended on the film, patient

then leans laterally to make a true AP position.

AP elbow (full extension) (Basic)

For #s, dislocations, and pathology (OA, OP) of elbow joint. Also shows distal humerus, elbow joint

space, and proximal radius and ulna.

Film: 24x30 cm.

CR: 90to film center

CP: Mid elbow joint (0.75 inches ( 2 cm) distal to

midpoint of a line joining the epicondyles)



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1. Lateral supracondylar ridge

2. Medial supracondylar ridge

3. Olecranon fossa

4. Medial epicondyle

5. Lateral epicondyle

6. Capitulum

7. Olecranon

8. Trochlea

9. Coronoid process of ulna

10. Proximal radioulnar joint11. Head of radius

12. Neck of radius

13. Tuberosity of radius

14. Ulna


AP ElbowR


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Two projections obtained with:

(a) Forearm parallel to the film.(b) Humerus parallel to the film (with support under the

wrist).

Film: 24x30 cm (two films)


CP: Mid elbow (2 cm distal to midpoint of a line joining

the epicondyles )

NB/ kV increased to (6075) because of increased

part thickness.

AP elbow (partial flexion)trauma case (Basic)

For patients who cannot fully extend the elbow (e.g., trauma or in plaster).



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Patient sits sideways alongside the couch, elbow

flexed 90, hand then rotated laterally by 90.

Lateral elbow (Basic)

For pathology, #s, and dislocations. Clearly shows lateral projection of distal humerus and proximal forearm,

and the Olecranon process with the epicondyles superimposed (overlapping).

Film: 18x24 cm.


CP: Mid elbow joint 1.5 inch ( 4cm) medial to

posterior surface of the Olecranon process.



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1. Supracondylar ridge

2. Trochlea

3. Olecranon

4. Trochlear notch

5. Coronoid process of ulna

6. Head of radius

7. Neck of radius

8. Tuberosity of radius

9. Ulna


Lateral Elbow


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Arm fully extended on the film, shoulder at elbow level withshoulder lowered to couch level, hand facing outwards, armrotated externally (laterally) so that entire elbow is 45to thefilm (interepicondylar line 20 degrees to the couch).

APO elbow (lateral/external rotation) (Basic)

For #s, dislocations, and pathology of elbow and mainly the radial head and neck and Radioulnar joint.

Film: 24x30 cm.


CP: Mid elbow joint (0.75 inch distal to the midpoint

between the epicondyles).

NB/ External (lateral) oblique best shows radial head and neck, and Capitulum.



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APand lateral oblique

External (lateral) oblique best

shows radial head and neck, and

Capitulum.


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Arm fully extended on the film, shoulder at elbow level with

shoulder lowered to couch level, palm in contact with the

couch (facing the couch).

APO elbow (medial/internal)rotation (Basic)

For #s, dislocations, and pathology of elbow, mainly radial head and neck, and pathology of the

Radioulnar joint.

Film: 24x30 cm.


CP: Mid elbow joint 2cm distal to the midpoint

between the epicondyles.

NB/ * Internal (medial) rotation best shows the coronoid process of the ulna and Trochlea in profile.



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The medial oblique will demonstrate

the coronoid process.

The Olecranon process and fossa

The radial head will be overlie the

ulna.


Medial Oblique Elbow


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Patient seated ,standing or in supine position

for radial head Elbow flexed 90if possible

For coronoid process elbow flexed only 80because

flexion more than 80may obscure coronoid process

Axial Lateral (Coyle Method) (TRAUMA) (Special)

Film: 24x30 cm.

Radial head

CR: 45 towards shoulder to film center.

CP: Mid elbow joint (1 inch distal to the midpoint



Coyle Trauma View if the elbow is very useful when a fracture of the radial head or

neck is suspected. It is helpful when patient can not straighten elbow after significant

trauma.

Coronoid process

CR: 45 from shoulder to film center.

CP: Mid elbow joint (1 inch distal to the midpoint



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Coyle Trauma View of the elbow (useful when a fracture of the radial head

or neck is suspected. It is helpful when patient can not straighten elbow

after significant trauma.


Coyle Trauma View


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Arm acutely flexed and placed on film, fingertips resting on the

shoulder. Two projections are taken:

Acute flexion elbow(Axial)ulnar groove (Special )

For #s and dislocations of the elbow joint, distal humerus and proximal elbow. Also shows the ulnar groove

and a good view of Olecranon process in profile.


CR(a) CR 90to the humerus

(b) CR 90to the forearm.

CP: (a) Midway between epicondyles

(b) A point 5 cm superior to the Olecranon process


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Patient erect or supine. Affected side in contactwith film, other side raised, arms abducted, handsupinated, humerus rests on the film with shoulderand elbow included.

AP humerus (Basic)

To show #s, pathology, and dislocations.


Film:35x43 cm.

CR:90to film center.

CP:Midshaft (between elbow and shoulder joints).

NB/ Exposure on arrested expiration to reduce movement.

L t l h (B i )


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From the AP, elbow is partially flexed, body rotated toward

the affected side, arm internally rotated to give a lateral

view so that epicondyles are 90to the couch.

Lateral humerus (Basic)

To show #s, pathology, and dislocations.

NB/ Exposure on arrested expiration to reduce movement


Film: 35x43 cm.


CP: Midshaft (between elbow and shoulder).


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Lateral humerus

Lateral humerus


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Lateral humerus


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Shoulder Anatomy


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Shoulder Anatomy

B


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AP Shoulder(external rotation) B

This is a non-trauma case to show #s, dislocations, and pathology(osteo- porosis, osteoarthritis, etc..) of shoulder joint and proximalHumerus.

Patient erect or supine, body rotated slightly toward affected side toplace shoulder in contact with the film, arm extended and slightlyabducted and then externally rotated (hand supinated with palm up).

Film: HD 24x30 cmCP: To mid scapulohumeral joint (1 inch inferior to coracoid

process).

CR: 90vertically on the film center.

Lateral Shoulder (i t l t ti ) B


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Lateral Shoulder (internal rotation) B

This is a non-trauma case for the same indications.Same position as in AP shoulder with arm internally rotated (handprone with palm facing down).

Film: HD 24x30 cm

CP: To mid scapulohumeral joint (1 inch inferior

to coracoid process).

CR: 90vertically on the film center.

NB/ A neutral rotation is also done, with same CP and CR direction.

Inferosuperior axial Shoulder S


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Inferosuperior axial Shoulder S

Non-trauma case with same indication as for AP and lateral.Also shows Hill-Sachs Defect with exggerated rotation of thelimb. Exposure on arrested respiration.

Patient supine, shoulder raised 5 cm from tabletop (pillowunder shoulder and arm), head rotated toward opposite side, avertical cassette placed close to the neck, arm abducted 90deg. With external rotation (palm up).

Film: HD 18x24 cm (crosswise).

CP: Humeral head (axilla).CR: Horiz. 25- 30medially to film center.

NB/ Exaggerated external rotation is an alternative position toshow the Hill-Sachs Defect (anterior dislocation and

possible compression fracture of the humeral headarticular surface).

APO (Glenoid Cavity) B


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APO (Glenoid Cavity) B

For #s and dislocations of the glenoid, and for Bankartfracture and state of scaulo-humeral joint.

Patient erect or supine, body rotated 35to 45towardaffected side with support under shulder and hip (in thesupine), top of the cassette 5 cm above shoulder, armabducted slightly in a neutral position.

.Film: HD 18x24 cm

CP: Scapulohumeral joint.

CR: 90to film center

Transthoracic Lateral (LawrenceMethod)B


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For #s and dislocations of proximal humerus andshoulder.Patient erect or supine in lateral position with sideof interest against cassette, affected arm atpatients side in neutral rotation, opposite armraised and placed over top of head, thorax must bein true lateral to minimize superimposition

Film: HD 24x30 cmCP: Surgical neck (through thorax).CR: 90to film center.

NB/ Patient gently breathe short shallowbreaths without moving affected arm.


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AP shoulder Joint

1. Clavicle

2. Acromioclavicular joint

3. Acromion

4. Greater tubercle of Humerus

5. Head of Humerus

6. Lesser tubercle of humerus

7. Surgical neck of humerus

8. Coracoid process

9. Glenoid fossa

10. Shoulder joint

11. Lateral border of scapula


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1st week (thu)+2nd week(sun).ppt

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