Upper Extremities Flashcards by Trisha Labadlabad

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

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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

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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

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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

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PP: Wrist in palmar flexion (rotates the scaphoid in dorsovolar position)
RP: Scaphoid
CR: ┴
SS: Lateral position of the scaphoid

Burman & et al. Suggestions

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 First to describe carpe bossu (carpal boss), a small bony growth occurring on the dorsal surface of the 3rd CMC joint

Foille

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Best demonstrated in a lateral position of
wrist in palmar flexion

Foille Method

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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

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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

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CR: ┴; 10-15o proximally/distally (clear
delineation)
SS: Scaphoid; opens carpal interspaces on lateral side
ER: To correctscaphoid foreshortening

PA PROJECTION In Ulnar Deviation

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PP: Hand pronated; wrist in extreme radial
deviation
RP: Midcarpal area
CR: ┴
SS: Opens carpal interspaces on medial side

PA PROJECTION In Radial Deviation

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Stecher Method with ulnar deviation

Bridgman Method

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ER (20o Angulation):
To place scaphoid at right angles to the CR

-To project scaphoid w/o self-
superimposition

STECHER METHOD
PA AXIAL PROJECTION

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SS: Scaphoid with minimal superimposition
ER: To diagnose scaphoid fractures

RAFERT-LONG METHOD
PA & PA AXIAL PROJECTIONS
In Ulnar Deviation

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To demonstrate trapezium fractures

CLEMENTS-NAKAYAMA METHOD
PA AXIAL OBLIQUE PROJECTION

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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

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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

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SS: Carpal canal/tunnel
ER: Taken when patient cannot assume/maintain Gaynor-Hart Method

SUPEROINFERIOR PROJECTION

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-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

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SS: Elbow joints; radius & ulna; distorted carpal bones (proximal row)
 Slight superimposition of radial head, neck &tuberosity over the proximal ulna

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AP PROJECTION

-It crosses the radius over the ulna at its
proximal third
-It rotates the humerus medially

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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

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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

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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

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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

Upper Extremities Flashcards

(48 cards)