RAD-141 CH.5 ELBOW AND DISTAL HUMERUS

capitulum

• synovial joint - encased in a sack of fluid
• ginglymus (hinge)

• the proximal radial ulnar joint
• trochoidal

• radius and ulna
• proximal radius is superimposed by the ulna

external rotation of the arm

internal rotation of the elbow

olecranon process of the ulna

• same as the wrist
• 50-70 kv
• short exposure
• 40 SID
• Increase exposure with cast

• AP Lateral
• Internal OBL 45 degrees
• External OBL 45 degrees

the epicondyles

• 10x12
• fully extend the elbow and supinate the hand
• we palpate epicondyles to ensure they are parallel to the IR (patient may need to lean laterally)
• support hand as need by the palm
• CR to mid-elbow joint

2 ap projections one with forearm to IR (elbow down patient seated) and one with humerus parallel to IR (partially flexed with forearm part elevated on a sponge

isolates and views the radial head and neck and capitulum of the radius

• CR to mid elbow
• supinate hand and rotate the entire arm laterally 45 degrees (patient must lean laterally for sufficient rotation)
• the crease of the elbow has to be 45 degrees

• elevated or displaced fat pads and best to visualize the olecrenon process
• flex elbow 90 degrees and drop shoulder so that the humerus are on the same horizontal plane

 

best to view distal humerus and proximal forearm and tip of olecranon process

distal humerus: CR perpendicular to IR and humerus directed midway of epicondyles with patients arm in the flexed position

proximal forearm: proximal humerus, CR perpendicular to forearm (angle is needed) and directed 2inches above olecranon process

Position elbow flexed 90 degrees hand pronated

• CR directed to 45 degrees toward the shoulder, centered to the radial head
• best demonstrates the joint space between radial head and capitulum
• radial head neck and tuberosity are in profile and free of superimposition except for a small part of the coronid process

elbow flexed 80degrees hand pronated

CR directed 45 degrees from the shoulder centered to the radial head

Best views the space btw coronoid process and trochlea

• 4 projections only thing that changes is the hand and wrist
• hand supinated
• hand lateral
• hand pronated
• hand with maximum internal rotation

palpate the epicondyles to ensure parallel to  IR (patient may need to lean laterally)

• mid humerus
• fully extended and supinate the hand
• patient must hold their breath
• shoulder and elbow joint

position patient with back to IR and elbow partially flexed. Body may be rotated toward affected side as needed to bring humerus and should in contact with casette

palpate epicondyles to make sure they are perpendicular

CR to mid humerus

need both joints

• patient is recumbent take image with a horizontal beam
• flex elbow if possible but do not attempt to rotate arm
• gently placed IR between arm and thorax
• CR to midpoint of distal two thirds of humerus

• epicondyles must be perpendicular to the IR
• mediolateral projection with patient in a slight rao

• ap
• lateromedial or mediolateral

• 10x12
• pronate hand and rotate the entire arm as needed until the sidtal humerus and anterior surface of the elbow are medial obliqued 45 degrees
• CR to mid elbow
• coronoid process of the ulna