Pos elbow humerus shldr scap

(Baystate) Elbow protocol (3 views)

1. 8x10 at 40 SID TT

2. Technique: 1-1.8 mAs @ 60-64 kVp

3. Pt instructions = dont’ move

4. AP: arm fully extended with epicondyles parallel to IR + upper extremity (humerus) on same plane CR @ mid-elbow joint

• Eval. criteria: radial head, neck, tuberosity slightly superimposed over proximal ulna, elbow joint open, no rotation of humeral epicondyles 

5. External OBL: lateral oblique with elbow rotated 45 degrees laterally (thumb side)

• Eval. criteria: radial head, neck, tuberosity projected free of ulna + open elbow joint 

6. Lateral: elbow flexed 90 degrees with epicondyles perpendicular to IR and humerus/forearm parallel to IR wrist in lateral position CR @ mid-elbow joint

• Eval. criteria: 3 concentrics arcs visible, olecron process in profile, epicondyles superimposed 

7. (not Baystate Protocol) Internal oblique elbow: forearm pronated 45 degrees

• Eval. criteria: demonstrates coronoid process, trochlea notch, medial trochlea; also shows fractures of medial epicondyle/coronoid process

Trauma Elbow (2)

1.  two partially flexed AP projections (when elbow cannot be fully extended)

2. Humerus parallel = CR perpendicular to mid elbow

3. Forearm parallel = CR perpendicular to mid elbow 

Elbow joint

1.  synovial (diarthrodial hinge joint), 3 joints enclosed in common capsule 2 articulations 

1. Proximal radioulnar joint 

2. Humeroulnar joint 

3. Humeroradial joint 

• Trochlea of humerus articulates with trochlear notch of ulna

• Capitulum of humerus articulates with head of radius

Elbow fat pads/stripes (3)

c. anterior fat pad

d. posterior fat

e. supinator fat stripe

Three concentric arcs

1. Trochlear sulcus

2. Outer ridges of capitulum and trochlear

3. Trochlear notch of ulna 

Proximal ulna (2)

1. olecranon process proximal + posterior 

2. coronoid process proximal + anterior 

AP elbow

Lateral elbow

Monteggia fracture

1.  fracture of proximal third ulna with dislocation of radial head

supracondylar fracture

fracture of distal humerus above humeral condyles; most common in children

Humerus (Baystate) protocol

1.  2 views

1. 14x17 lengthwise 40 SID wall bucky

2. Pt instructions: don’t move don’t breathe

3. Technique (depends whether done TT/Bucky) = 1.5-5 mAs @68-70

4. AP (wall bucky) = CR @ mid humerus, include both shoulder/elbow joints no AEC, turn collimator as needed to help collimation, do not allow soft tissue to overlap onto the ribs, ensure epicondyles parallel to IR

• Eval. criteria = entire humerus demonstrated with greater tubercle, medial and lateral epicondyles in profile

5. Lateral (lateromedial/mediolateral humerus project.) = CR @ mid humerus with epicondyles perpendicular to IR (lateral elbow)

6. Lateral humerus recumbent rotational lateral (supine pos.) = epicondyles perpendicular to IR, CR @ midhumerus using table bucky, suspend respiration

• Eval. criteria = entire humerus demonstrated with lesser tubercle in profile and epicondyles superimposed 

distal fracture (humerus)

1. crosstable lateral medial position

2. lateral medial pos.

Transthoracic Humerus (for proximal fracture)

1. place affected arm against bucky + raise unaffected arm; use breathing technique to blur our rids (longer secs exposure)

2. used for fractures of upper 1/3rd of humerus; 63 mAs @ 80 kVp

Shoulder (non trauma) protocol (2 views)

1. 10x12 crosswise 40 SID wall bucky

2. Technique: 4-8 mAs @ 66-70 kVp

3. Pt instructions: don’t move don't breathe (suspend respiration)

4. External rotation shoulder = CR @ 1 inch inferior to coracoid process (soft divot), epicondyles parallel, include SC joint over in light field, palm up

• Eval. criteria = greater tubercle (best shown) profiled laterally, scapulohumeral joint centered, proximal humerus, upper scapula + clavicle visualized 

5. Internal rotation shoulder = CR @ 1 inch inferior to coracoid process, epicondyles perpendicular, back of hand against upper leg (medial rotation)

• Eval. criteria = lesser tubercle (best shown) profiled medially, scapulohumeral joint centered,  

Trauma shoulder routine

1. AP grashey = 4-8 mAs @68-72 kVp

2. Y-view = 8-14 mAs @78 kVp

3. Axillary = 2.5-4 mAs @70 kVp

Grashey (posterior oblique)

1. Demonstrates glenoid cavity

2. CR = 2 inches inferior and medial from superolateral border of humerus (coracoid process)

3. 30-45 degree oblique toward affected side

4. CR perpendicular

5. 10 x 12 crosswise or lengthwise

6. Suspend respiration

7. 6-8 mAs @70-72 kVp

Evaluation criteria (Grashey; posterior oblique)

1. Glenoid cavity profiled

2. Scapulohumeral joint centered

Scapular Y lateral

1. 45-60 degree oblique, affected side farther from IR (kyphotic patient = less oblique)

2. Can be done AP or PA, but most done AP at clinical

3. CR proximal to humerus; 2 inches below top of shoulder

4. 10 x 12 lengthwise

5. Suspend respiration

6. Looking for dislocation

7. 8-14 mAs @ 78 kVp

Scapular Y lateral evaluation criteria

1. Body of scapula superimposed

2. Acromion and coracoid processes in profile

3. Humeral head and glenoid cavity superimposed

Axillary

1. CR 25-30 degrees medial to axilla 

2. 2.5-4 mAs @70 kVp

3. best shows humeral head and neck in lateral position

4. 8 × 10 crosswise

5. Arm supinated abducted 90 degrees (or as near 90 degree as possible)

6. Can be done supine or sitting down

7. in supine projections, an angle is needed

8. When patient is sitting down, a 5–15-degree angle is optional based on body habitus

Supraspinatus outlet view (Neer method)

1. Specialty view (non routine)

2. PA y-view position

3. 45-60 degree oblique

4. 10-15 caudal angle

5. Shoulder impingement

Scapula routine views

1. Ap and lateral (y-view)

2. Ap = 4-8 mAs @68-70 kVp

3. Y-view = 8-14 mAs @78

AP scapula

1. CR midscapula (2in inferior to coracoid and medial from axillary border)

2. 10 x 12 lengthwise

3. At clinical = no breathing

4. Textbook = minimal 3 sec exposure orthostatic breathing technique to blur ribs and lung markings

5. Abduct arm 90 degrees, with arm in “muscle position,” or resting on head

AP scapula evaluation criteria

1. Entire scapula demonstrated

2. Lateral border of scapula free of ribs and lungs

Lateral scapula

1. CR to proximal humerus (upper ⅓ of humerus)

2. 45-60 degree oblique

3. 10 x 12 lengthwise

4. Most often done with AP arm reaching across to move humerus away from scapula

5. Suspend respiration

Non-trauma shoulder

1. AP external and AP internal views

2. 4-8mAs @66-70 kVp

External rotation nontrauma shoulder

1. Epicondyles parallel to IR

2. CR is 1 inch inferior to coracoid process (find divot)

3. 10 x 12 crosswise (include from SC joint over in light field)

4. Suspend respiration

5. “Extra” (external) = Greater tubercle

Evaluation criteria (external shoulder)

1. Greater tubercle profiled laterally

2. Scapulohumeral joint centered

3. Proximal humerus, upper scapula, and clavicle visualized

Internal rotation shoulder

1. Epicondyles perpendicular to IR

2. CR 1 inch inferior to coracoid process

3. 10 x 12 crosswise 

4. Suspend respiration 

Evaluation criteria (shldr internal rotation)

1. Lesser tubercle profiled medially

2. Scapulohumeral joint centered