Upper Extremities Flashcards
PP: Hand slightly arch (places wrist in close contact with IR)
RP: Midcarpal area
CR: ┴
SS: Slightly oblique rotation of ulna (AP should be taken if ulna is under examination)
PA PROJECTION
PP: Hand slightly arch (places wrist in close contact with IR)
RP: Midcarpal area
CR: 30o toward the elbow; 30o toward the fingertips
SS: Elongated scaphoid & capitate (toward the elbow); elongated capitate only (toward the fingertips)
ER: To better demonstrate the scaphoid & capitate
Daffner-Emmerling-Buterbaugh
Recommendation
PP: Hand supinated; digits elevated (places wrist in close contact with IR)
RP: Midcarpal area
CR: ┴
SS: Carpal interspaces better demonstrated; no rotation of ulna
AP PROJECTION
PP: Elbow flexed 90o; hand & forearm in lateral position; ulnar surface against IR; radial surface against IR (for comparison)
RP: Midcarpal area
CR: ┴
SS: Proximal metacarpals & distal radius & ulna; trapezium & scaphoid (more anterior)
ER: To demonstrate anterior or posterior
displacement in fractures
LATERAL PROJECTION
Lateromedial
PP: Wrist in palmar flexion (rotates the scaphoid in dorsovolar position)
RP: Scaphoid
CR: ┴
SS: Lateral position of the scaphoid
Burman & et al. Suggestions
First to describe carpe bossu (carpal boss), a small bony growth occurring on the dorsal surface of the 3rd CMC joint
Foille
Best demonstrated in a lateral position of
wrist in palmar flexion
Foille Method
PP: Palmar surface against IR; hand pronated & rotated 45olaterally; wrist ulnar deviation (for scaphoid only)
RP: Midcarpal area
CR: ┴
SS: Carpals on the lateral side (Scaphoid &
Trapezium)
PA OBLIQUE PROJECTION
Lateral Rotation
PP: Dorsal surface against IR; hand supinated & rotated 45omedially
RP: Midcarpal area
CR: ┴
SS: Carpals on the medial side (Pisiform,
Triquetrum & Hamate)
AP OBLIQUE PROJECTION
Medial Rotation
CR: ┴; 10-15o proximally/distally (clear
delineation)
SS: Scaphoid; opens carpal interspaces on lateral side
ER: To correctscaphoid foreshortening
PA PROJECTION In Ulnar Deviation
PP: Hand pronated; wrist in extreme radial
deviation
RP: Midcarpal area
CR: ┴
SS: Opens carpal interspaces on medial side
PA PROJECTION In Radial Deviation
Stecher Method with ulnar deviation
Bridgman Method
ER (20o Angulation):
To place scaphoid at right angles to the CR
-To project scaphoid w/o self-
superimposition
STECHER METHOD
PA AXIAL PROJECTION
SS: Scaphoid with minimal superimposition
ER: To diagnose scaphoid fractures
RAFERT-LONG METHOD
PA & PA AXIAL PROJECTIONS
In Ulnar Deviation
To demonstrate trapezium fractures
CLEMENTS-NAKAYAMA METHOD
PA AXIAL OBLIQUE PROJECTION
To demonstrate fractures of scaphoid, lunate dislocation, dorsum of wrist calcifications and foreign bodies & dorsal aspect of carpal bones chip fractures
LENTINO METHOD
TANGENTIAL PROJECTION
SS: Carpal canal/tunnel (Carpal sulcus+Flexor retinaculum)
ER:
-To demonstrate carpal tunnel syndrome
-To demonstrate fractures of hook of hamate, pisiform & trapezium
GAYNOR-HART METHOD
TANGENTIAL PROJECTION
SS: Carpal canal/tunnel
ER: Taken when patient cannot assume/maintain Gaynor-Hart Method
SUPEROINFERIOR PROJECTION
-For limited dorsiflexion of the wrist
-Placed 45o sponge under palmar surface of the hand
o Slightly elevates the wrist to place
the carpal canal tangent to CR
-With slight degree of magnification due to
increased OID
Marshall Suggestion
SS: Elbow joints; radius & ulna; distorted carpal bones (proximal row)
Slight superimposition of radial head, neck &tuberosity over the proximal ulna
AP PROJECTION
-It crosses the radius over the ulna at its
proximal third
-It rotates the humerus medially
Hand Pronation
SS: Elbow joints; radius & ulna; carpal bones (proximal row)
Superimposed radius & ulna at their distal end
Superimposed radial head over the coronoid process
Superimposed humeral epicondyles
Radial tuberosity facing anteriorly
LATERAL PROJECTION
PP: Erect/seated-upright (more comfortable); arm abducted slightly; hand supinated; humeral epicondyles // to IR
RP: Midshaft
CR: ┴
SS: Humeral head & greater tubercle in profile
AP PROJECTION Upright
PP: Erect/seated-upright (more comfortable); arm rotated internally; elbow flexed approximately 90o; palmar aspect of hand against hip; humeral epicondyles ┴ to IR
RP: Midshaft
CR: ┴
SS: Lesser tubercle in profile; greater tubercle superimposed over humeral head
LATERAL PROJECTION
Lateromedial Upright
PP: RAO/LAO; patient’s hand holding the broken arm
RP: Midshaft
CR: ┴
SS: Lesser tubercle in profile; greater tubercle superimposed over humeral head
ER: For patients with broken humerus
Mediolateral Upright
PP: Supine; unaffected shoulder elevated; hand supinated; humeral epicondyles // to IR
RP: Midshaft
CR: ┴
SS: Humeral head & greater tubercle in profile
AP PROJECTION
Recumbent
For patient with known or
suspected fracture of the humerus
LATERAL PROJECTION
Lateromedial Recumbent
RP: Elbow joint
CR: ┴
SS: Elbow joints; distal arm & proximal forearm
-Radial head, neck & tuberosity slightly
superimposed over the proximal ulna
AP PROJECTION
SS: Elbow joints; distal arm & proximal forearm
-Superimposed humeral epicondyles
-Radial tuberosity facing anteiorly
-Radial head partially superimposing
coronoid process
-Olecranon process in profile
LATERAL PROJECTION
Lateromedial
2 reasons
-Olecranon process seen in profile
-Elbow fat pads are least compressed
Griswold (Elbow flexing 90o):
RP: Elbow joint
CR: ┴
SS: Coronoid process in profile; trochlea & medial epicondyle
AP OBLIQUE PROJECTION
Medial Rotation
RP: Elbow joint
CR: ┴
SS: Radial head & neck in profile; capitulum
AP OBLIQUE PROJECTION
Lateral Rotation
RP: Elbow joint
CR: ┴ to humerus
SS: Distal humerus when elbow cannot be fully extended
AP PROJECTIONS
In Partial Flexion
Distal Humerus
RP: Elbow joint
CR: ┴ to forearm
SS: Proximal forearm
ER (2 AP Projections): For patient cannot
completely extend the elbow
Proximal Forearm
PP: Elbow fully (acutely) flexed
RP: 2 in. superior to olecranon process
CR: ┴ to humerus
SS: Olecranon process
JONES METHOD AP PROJECTION
Acute Flexion Distal Humerus
PP: Elbow fully (acutely) flexed
RP: 2 in. distal to olecranon process
CR: ┴ to flexed forearm
SS: Elbow joint more open
JONES METHOD AP PROJECTION
Acute Flexion Proximal Forearm
CR: ┴
SS: Radial head in varying degrees of rotation
Radial tuberosity facing anteriorly (1st & 2nd exposures)
Radial tuberosity facing posterior (3rd & 4th exposures)
RADIAL HEAD SERIES
LATERAL PROJECTION
Four-Position Series
SS: Open elbow joint b/n radial head & capitulum or coronoid process & trochlea
ER:
To demonstrate pathologic processes or
trauma in the area of radial head & coronoid process
Cannot fully extend elbow for medial &
lateral oblique
COYLE METHOD
AXIOLATERAL PROJECTION
SS: Epicondyles; trochlea; ulnar sulcus (groove b/n medial epicondyle & trochlea); olecranon fossa
ER:
-Used in radiohumeral bursitis (tennis elbow)
-To detect otherwise obscured calcification
PA AXIAL PROJECTION
SS: Dorsum of olecranon process (┴); curved extremity & articular margin of olecranon process
(20o)
PA AXIAL PROJECTION
hand supinated; humeral epicondyles // to IR; arm abducted slightly
External Rotation
palmar/anterior aspect of
hand placed against the hip; humeral
epicondyles 45o to IR
Neutral Rotation
-dorsal/posterior aspect of hand against hip; humeral epicondyles ┴ to IR
Internal Rotation
RP: Level of surgical neck
CR: Horizontal or 10-15o cephalad (cannot elevate unaffected shoulder)
SS: Proximal humerus
LAWRENCE METHOD
TRANSTHORACIC LATERAL PROJECTION
SS:
Proximal humerus
Scapulahumeral joint
Lateral portion of coracoids process
Acromioclavicular (AC) articulation
Insertion site of subscapular tendon
Point of insertion of teres minor tendon
LAWRENCE METHOD INFEROSUPERIOR AXIAL PROJECTION
CR: Horizontal; 15o medially
SS: Coracoid process pointing anteriorly; lesser tubercle in profile
ER: Hill-Sachs compression fracture (defect)
RAFERT-LONG MODIFICATION
INFEROSUPERIOR AXIAL PROJECTION
SS: Humeral head projected free of the coracoid process
ER:
Used when chronic instability of shoulder is suspected
To demonstrate Bankart’s Lesion &
associated Hills-Sachs defect
WEST POINT METHOD
INFEROSUPERIOR AXIAL PROJECTION
SS: Acromioclavicular joint; scapulohumeral joint; glenohumeral joint
ER: When prone (Westpoint) or supine (Lawrence & Rafert-Long) position is not possible
CLEMENTS MODIFICATION
INFEROSUPERIOR AXIAL PROJECTION
