The Elbow

Question 1

List indications for an x-ray of the elbow

Answer 1

• Fractures and dislocations of the elbow e.g.
  supracondylar and head of radius fractures
• Pathologic processes, such as osteomyelitis and arthritis

Question 2

Basic projections of the elbow.

Answer 2

a.Lateral
b.Antero-posterior

Question 3

Lateral projection of the elbow requirements.

Answer 3

• Is done first
• 18 x 24 cm IR( one for each projection.
• 24 x 30 cm split into 2 parts
• sheet of rubber
• Sand bag
• Lead protective waist apron

Question 4

Lateral projection of the elbow how its done.

Answer 4

• The patient sits alongside the x-ray couch with affected side
  nearest the couch.
• The elbow is flexed to 90° and the palm of the hand is
  rotated so that it is at 90° to the tabletop.
• The shoulder is lowered or the height of the table increased
  so that it is on the same plane as the elbow and wrist
• such that the medial aspect of the entire arm is in contact
  with the tabletop.
• Apply waist lead apron

Question 5

Centering point of the lateral of the elbow.

Answer 5

Lateral epicondyle of humerus

Question 6

Direction of central ray.

Answer 6

• Vertical at 90 to IR

Question 7

Evaluation criteria for lateral image of elbow joint

Answer 7

• Olecranon process soft tissues and fat pads of the elbow are visible.
• Long axis of the forearm should be aligned with the long axis of the IR with elbow flexed 90.
• About one-half of radial head should be superimposed by the
  coronoid process and olecranon process visualized in the profile.
• The true lateral view is indicated by 3 concentric arcs of the trochlear sulcus, double ridges of the capitulum and trochlear and the trochlear notch of the ulnar.

Question 8

Antero-posterior projection of the elbow.

Answer 8

• Lengthwise

Question 9

What happens during the Antero-posterior projection of the elbow.

Answer 9

• Seat the patient sideways along the x-ray couch and low
  enough to place the shoulder joint, humerus and elbow in
  the same plane
• The arm is extended fully at the elbow joint so that the
  posterior aspect of the entire limb is in contact with the
  tabletop
• The palm of the hand in full supination (the thumb should
  touch the table)
• Adjust the arm such that the medial and lateral epicondyles are equidistant from the ir.

Question 10

Centering point of the Antero-posterior projection of the Elbow.

Answer 10

In the midline 2.5 cm distal to a line
joining the epicondyles of the humerus

Question 11

Evaluation criteria for AP projection of the elbow joint

Answer 11

• Distal humerus, elbow joint space, and proximal radius and ulna are visible.
• Long axis of the arm should be aligned with the long axis of the ir.
• No rotation is evidenced by the appearance of the bilateral epicondyles.
• Olecranon process should be seated in the olecranon fossa with
  fully extended arm.