Elbow Flashcards
how are the medial and lateral epicondyles in a an AP elbow
Medial and lateral epicondyles are in profile
how is the radial head in ap projection of the elbow
Radial head is superimposed ¼ inch
are the epicondyles parallel or perp in ap elbow
Epicondyles are parallel, include ¼ of humerus and radius/ulna
what is in medial profile in ap projection of the elbow
Radial tuberosity in medial profile
what is demonstrated on end in an ap elbow
The coronoid process is demonstrated on end
what should be in the same plane for the ap projection of the elbow
humerus, elbow, forearm
what opens up the joint spaces in an ap projection of the elbow
fully extending the arm
how should the hand be in a ap projection of the elbow
hand supinated so that medial and lateral epicondyles are in profile
what should you look at for the rotation of the elbow
look at the radial head and the epicondyles
if you cant get the epicondyles parallel to the IR, what is affecting it
if you cant get the epicondyles parallel to the IR, its the humerus affecting it
if you cant get the hand supinated or pronated, what would be affecting the elbow
if you cant get the hand supinated or pronated correctly, its going to be the hand or wrist thats going to affect the elbow
In the one image, there is too much of the radial head and tuberosity of the ulna, how is the hand and what type of rotation is this
Hand pronated and its internal rotation
In one of the images, there is seperation and a small amount of head and tuberosity touching but not 1/4 inch, how is the hand
externally rotated or turned to the lateral
The lower the CR how is it projecting the radial head?
The lower the CR, its projecting the radial head up into the capitulum, joint space being closed off
The farther the CR is from the joint space, is there more or less superimposition
The farther from the joint space the more the superimposition
if the central ray is proximal to the joint space, how is the capitulum projected
If the central ray is proximal to the joint space, then the capitulum is projected into the joint space
what happens to the capitulum- radial joint when the patients extends arm atleast thirty degrees
Closes capitulum-radial joint
what happens For a patient that can extend at least 30 degrees
Closes capitulum-radial joint
Olecranon process moves away from the fossa
Coronoid process shifts proximally
what happens to the olecranon process when the patients extends arm atleast thirty degrees
Olecranon process moves away from the fossa
what happens to the coronoid process when the patients extends arm atleast thirty degrees
Coronoid process shifts proximally
how should the olecranon process be when arm is extended
olecranon should fill fossa when extended
for an ap elbow, if arm cannot be fully extended how many views should be done
2 views
when arm cannont be extended, and the humerus is in contact with the ir , what does it demonstrate
demonstrates humerus without distortion ( distal humerus ) , keep hand supinated , dont rotate hand bc epicondyles wont be parallel to IR
when pt cant extend for an ap elbow, and the forearm is in contact what is being demonstrated
proximal forearm, joint space is open between radius head and capitulum, humerus is superimposed
degree of obliquity for internal oblique
45 degree of internal obliquity
how should the hand be for a internal oblique of the elbow
epicondyles 45 degrees and hand should be pronated
what is in profile in a internal oblique elbow
Coronoid process, the trochlear notch and the medial aspect of the trochlea are in profile
what articulation is open in a internal oblique of elbow
Trochlear-coronoid process articulation is open
what is superimposed over the ulna in an internal oblique elbow
The radial head and neck are superimposed over the ulna
what are you mainly looking at in an internal oblique elbow
coronoid
what aspect is being demonstrated in an internal oblique of the elbow
medial aspect
what does pronating the hand do to the radial head and ulna
superimposing radial head and ulna by pronating hand bc they are crossing over-> radial head right on top of ulna
does this describe an under or over rotation of the elbow
-the head is demonstrated lateral to the coronoid process
- radial head is not superimposed over the ulna
- hand not fully pronated
not obliqued enough, less than 45 degrees
does this describe an under or over rotation of the elbow
-the radial head is anterior to the coronoid process without complete superimposition of the ulna.
obliquity more than 45 degrees
what do you do for a patinet unable to extend the elbow
Position area of interest parallel to the IR
which fat pad is harder to push out
posterior fat pad is harder to push out than anterior
if the arm is not at a 90 degree angle for a lateral elbow, what are you doing to the anterior fat pad
you are distorting it
what is the hand doing if the capitulum is posterior
hand elevated slightly
if the capitulum is distal, how is the shoulder
elevated
if the capitulum is distal and anterior what happened to the arm and hand
humerus raised, hand down
when the capitulum is anterior , how is the hand
hand went lower
what is the degree for external obliquity of the elbow
45 degree of external obliquity
what is in profile for 45 degree external oblique of the elbow
Capitulum and radial tuberosity are in profile
what articulation is demonstrated in an external oblique of elbow
Radioulnar articulation is demonstrated
what is seen without superimposition in an external oblique of the elbow
The radial head, neck, and tuberosity are seen without superimposition
what do you need to do to hand in external oblique of the elbow
supinate hand and rest on thumb will bring epicondyles 45 degree
what is being demonstrated in an external oblique of the elbow
capitulum
- also the radial head and tuberosity
Does this describe a over or under rotation of an elbow for the obliques
-Radial head and tuberosity are partially superimposed
-not fully extended
-looks more like an AP
-olecranon is not fully filling in fossa
less than 45 degrees of obliquity
Does this describe a over or under rotation of an elbow for the obliques
-The coronoid is partially superimposed over the radial head
- radial head and tuberosity are free of superimposition
- rolled arm over so head is back on ulna
-large amt. of space between radius and ulna
more than 45 degrees of obliquity
how should you position elbow for a lateral elbow
Flexed elbow 90°
Center ¾ inch from lateral epicondyle
how should the epicondyles be in a lateral elbow
Epicondyles are perpendicular
what should be included in a lateral elbow
¼ of distal forearm and humerus
Include soft tissue
Should see the fat pads
Horizontal with IR
why is flexing the elbow in a 90 degree angle so important for lateral elbow
flexing elbow 90 degrees- takes the posterior fat pad and stick it back into joint space
- helps look at anterior fat pad, if not 90 degrees it will not look correct, this could make radiologist suspect fracture of radial head or neck
most common mistake is having proximal humerus elevated (shoulder is up)
how is the capitulum, trochlea, radius and ulna
capitulum- more distal
trochlea- more proximal
radius- more posterior
ulna- more anterior
when the proximal humerus is lower in the later elbow how is the capitulum, trochlea, radius, and ulna
capitulum- more proximal
trochlea- more distal
radius- more anterior
ulna- more posterior
capitulum follows radius
if the wrist (distal forearm) elevated how is the capitulum, radius, trochlea, coronoid
capitulum- moves posterior
radius- moves proximal
trochlea- anterior
coronoid - distal
if the wrist (distal forearm) is depressed how is the capitulum and radius
capitulum- moves anterior
Radius - distal
whatever way the capitulum, how is the trochlea moving
whatever they way the capitulum is moving the trochlea is moving the opposite
whatever the way the radius is moving, how is the coronoid is moving
whatever the way the radius is moving, the coronoid is moving the opposite
when the radius is moving distal how is the coronoid moving
coronoid moving proximal
when the capitulum is moving anterior how is the trochlea moving
when the capitulum is moving anterior, trochlea moving posterior
when the capitulum is more anterior what should you do to hand , how is the trochlea, radial head, and coronoid
- drop hand down
-capitulum anterior
-trochlea post.
-radial head distal
-coronoid proximal
Radial head is positioned too far posteriorly on the coronoid process
- how is the distal capitulum
Distal capitulum surface demonstrated too far distal to the distal surface of the medial trochlea
The radial head is positioned too far anteriorly on the coronoid process
- how is the distal capitulum
Distal capitulum surface is demonstrated too far proximal to the distal medial trochlear surface
Elevated proximal Humerus: how is the capitulum and radius
Capitulum moves distal and radius moves posterior
Depressed proximal Humerus: how is the capitulum and radius
Capitulum moves proximal and radius moves anterior
If the wrist (distal forearm) elevated:
how is the capitulum and radius
Capitulum moves posterior and radius moves proximal
If the wrist (distal forearm) is depressed: how is the capitulum and radius
Capitulum moves anterior and radius moves distal
for the coyle method , how is the radial head demonstrated
45 degree angle towards shoulder (head)
needs to be at 90 degree
for coyle method, how is the coronoid demonstarted
bring arm back 80 degrees
angle down (will push radius down)
criteria for coyle method
Position the patient for a lateral elbow
Angle the central ray 45° towards the shoulder
Separates the capitulum and trochlea of the distal humerus
It positions the radial head anterior to the coronoid process
Capitulum-radial joint is open
This is used when a radial head fracture or a fracture of the capitulum is suspected
