RADIOGRAPHY OF THE ELBOW & HUMERUS

Transcription

1 RADIOGRAPHY OF THE ELBOW & HUMERUS

2 Patient Position: ELBOW AP Projection in same plane Part Position: Hand in ; patient Centered to Humeral epicondyles

3 Central Ray: Structures Shown:

4 AP Elbow Criteria for Evaluation The humeral epicondyles are seen. The is superimposed over the lateral aspect of the The coronoid process is

5 AP Elbow Criteria for Evaluation The capitulum-radius joint should. The radial tuberosity should be seen. The humerus and forearm should other.

6 AP elbow Error; rotation of elbow. of head of radius is superimposed on and the humerus and forearm are. To correct: Rotate the elbow until the humeral epicondyles are to the IR. Align Good image

7 AP elbow Error: rotation of elbow. Correction: overlap of head of radius on ulna. To correct: Rotate the elbow until the humeral epicondyles are with the IR Good image

8 AP elbow Error: Elbow not, and humerus & forearm. To correct: elbow if patient is able. If patient is unable of the AP. Humerus and forearm should. Good image

9 ELBOW Partial Flexion Views AP Projections (2) NOTE: Used when the patient is Distal Humerus: Entire humerus to IR Forearm is

10 Central Ray: Structures shown

11 Proximal Forearm: Entire to IR Hand is Central Ray Structures Shown

12 ELBOW AP Oblique Projection Patient Position: Lateral Rotation Arm for AP projection Part Position: Rotate hand ( ) to place elbow at º to IR Center to

13 Central Ray: Structures Shown:

14 ELBOW Method Demonstrates the radial,, & (same as in projection)

15 ELBOW AP Oblique Projection Patient Position: Medial Rotation Arm projection Part Position: hand Rotate elbow ( ) - º Center to

16 Central Ray: Structures Shown:

17 ELBOW Lateral (lateromedial) Projection Patient in same plane Part Position: Elbow º; Hand Center to Humeral epicondyles

18 Central Ray: Structures Shown:

19 Elbow only flexed º if soft tissue structures are in question

20 Lateral Elbow Criteria for Evaluation The epicondyles should. Arm should be The elbow joint should be and the radial head should. fat pads seen.

21 Lateral elbow Error: Elbow. To correct degrees. Good image

22 Lateral elbow Error: humerus. Hand. To correct: degrees. Good image

23 Error: Humerus is Correct image Trochlea Capitulum

24 ELBOW Acute Flexion Method NOTE: Used when that radiographs are made with Distal Humerus: projection CR to humerus Shows

25 Proximal Forearm: Projection CR Shows

26 METHOD Trauma Axial Lateral NOTE: Used when patient cannot projections Patient Position:

27 Part Position and CR for radial head : Elbow flexed ; hand CR angled shoulder

28 Part Position and CR for coronoid process: Elbow flexed ; hand CR angled from shoulder

29 ELBOW Radial Head Views (4) Patient Position: in same plane Part Position: Elbow

30 Make separate exposures with the following changes in hand positions:

31 Central Ray: Structures Shown: Eversion Lateral Pronation Inversion

32 HUMERUS AP Projection Patient Position: Part Position: Arm ; position Hand in ( rotation) Top of IR Humeral epicondyles to IR

33 Central Ray: Structures Shown:

34 Patient Position: HUMERUS Lateral Projection Part Position: Arm rotated to position hand in rotation Rotate patient - affected side Humeral epicondyles Elbow if possible

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37 Central Ray: Structures Shown:

38 TRAUMA VIEWS of HUMERUS AP Proximal humerus: AP in

39 PA distal humerus - Patient is, but arm is. CR is, so that it is to the plane.

40 TRAUMA VIEWS of HUMERUS Lateral Proximal humerus: lateral (erect in rotation)

41 TRAUMA VIEWS of the HUMERUS Lateral Proximal humerus: Transthoracic lateral (in rotation; with beam)

42 TRAUMA VIEWS of HUMERUS Lateral Distal humerus projection with beam

43 Situation: An AP radiograph of the elbow demonstrates the radius directly superimposed over the ulna and the coronoid process in profile. Solution: This indicates that the projection of the elbow has been performed.

44 Situation: A radiograph of an AP oblique elbow with medial rotation reveals that theradial head is superimposed over part of the coronoid process. Solution: This indicates that the elbow is has excessive rotation.

45 Situation: A radiograph of an AP projection of the elbow reveals that there is complete separation of the proximal radius and ulna. What positioning error has been committed? Solution: The elbow is in excessive rotation (humeral epicondyles not parallel to IR).

46 Situation: A patient enters the ER in severe pain with a possible dislocation of the elbow. The patient has the elbow flexed more than 90. Solution: The projections to be performed to confirm the diagnosis are and limited.

47 Situation: A patient enters the ER with an elbow injury. The partially flexed AP and lateral positions reveal a possible fracture of the coronoid process. The patient s elbow is partially flexed and he refuses to extend it further. Solution: The method should be performed to confirm the coronoid process fracture. The elbow is flexed degrees and the CR is angled 45 the shoulder.

48 Situation: A young child comes to radiology with an elbow injury. The basic elbowprojections demonstrate a possible nondisplaced fracture of the radial head. The patient s elbow is partially flexed and he is unable to extend it. Solution: The method should be performed to confirm the radial head fracture. The elbow is flexed degrees and the CR is angled 45 the shoulder.

49 Situation: A radiograph of a transthoracic lateral projection reveals that it is difficult to visualize the proximal humerus due to the ribs and lung markings. The exposure was made on suspended respiration. Solution: Using a technique would improve the quality of the image.

50 Situation: A radiograph for an AP projection with external rotation of the proximal humerus reveals that the greater tubercle is profiled laterally. Is a repeat exposure necessary? Solution:

51 Situation: A patient enters the ER with a midshaft humeral fracture. The AP projection taken on the stretcher demonstrates another fracture near the surgical neck of the humerus. The patient is unable to stand or rotate the humerus due to the extent of the trauma. What other projection should be taken for this patient? Solution: A lateral projection of the humerus with a horizontal beam should be taken on this patient.