Flashcards in Elbow Deck (12)
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1
What are the routine views for an elbow?
BASIC ELBOW
AP Fully extended, 164
AP Partially flexed, 165
AP Oblique projection: Lateral (external) rotation, 164
Lateral, 166
SPECIAL
Acute flexion (Jones method), 169
Trauma axial laterals for radial head only (Coyle method), 170
Radial head laterals, 171 (not assessed)
2
Explain the procedure for ap fully extended elbow radiograph.
CP
Pt position
What you should see...
- Centre point- mid elbow joint
- Elbow and shoulder should be on the same plane
- Patient should lean laterally until they’re in a true lateral position
- Both humeral epicondyles should appear in profile and not rotated
Elbow joint space should be well opened
3
What form of radiation protection do we give the patient?
Shielding: Place lead shield over abdo/pelvic area.
Sit patient along side table.
4
For an AP partially flexed image, what are the two images to take?
And what should you see in each.
- AP view of a partially flexed elbow with the forearm in contact with IR.
Note that the radial head is demonstrated in profile.
- Same patient with the partially flexed elbow in AP position with humerus in contact with IR. This produces a partially enface view of radial head providing a clearer demonstration of the comminuted fracture. This compromise view of the elbow but can be utilized to advantage with some types of radial head fracture.
5
Purpose of a 45 degree oblique?
Purpose of 45o lateral oblique is to demonstrate radial head & radial neck free of superimposition & unobstructed demonstration of radioulnar joint
6
Lateral Elbow Expected Image Criteria
1.Soft tissue margins demonstrated (this image is cropped)
2.Elbow flexed 90o with joint space open
3. Humerus epicondyles are superimposed
4.Olecranon process ulna is well-seen in profile
5.Radial tuberosity should appear in profile
6. (About ½ radial head should be superimposed on coronoid process of ulna)
7. Capitellum & trochlea of distal humerus should be seen concentric circles a true lateral
7
There will generally be two basic corrections for lateral elbow malposition, what are they?
- raise hand/lower hand (external rotation/internal rotation of humerus)
- raise/lower elbow (adduct/abduct humerus)
8
Explain the proximal radial line and what it should indicate/point too......
Proximal radial line should always bisect capitellum in any projection
Proximal radial line essentially points to the capitellum.
9
what happens when the elbow is too externally rotated?
When elbow is too externally rotated, capitellum (side away from IR) rotates posteriorly.
10
Error 1: Shoulder higher than elbow.
Explain and give solution
For a true lateral, shoulder should be at level of elbow. * If shoulder is higher than elbow, radius & capitellum will project onto ulna.
-Solution is either to lift table which will lift the elbow or to lower shoulder by placing patient on a smaller chair.
11
Error 2: Wrist lower than elbow
Explain and give solution
The lateral structures (capitellum) and the radius will move anteriorly, while a medial epicondyle (and trochlea) will move posteriorly.
The wrist should be higher than elbow to compensate for normal valgus position of the elbow. (valgus: deformity involving oblique displacement of part of a limb away from the midline.The hand should be with the 'thumb up'.
12
