RS212 sim positions/questions

hand, wrist, fingers // forearm, humerus, elbow // clavicle, joints, scapula, shoulder

what demonstrates the pisiform AND triquetral (triquetrum) free of superimposition?

PA oblique (wrist)

what best demonstrates the pisiform free of superimposition?

ball catchers (AP oblique) OR carpal canal

how do you diagnose a Bennetts vs Rolandos fracture?

Roberts projection

• hand 15° medially/towards thumb 

what best demonstrates the proximal and distal radioulnar joints with minimum superimposition?

AP wrist

• fist clenched

what projection best demonstrates the proximal scaphoid, capitate, and hamate free of superimposition?

PA wrist

• hand in light fist

where are the 3rd-5th metacarpals free of superimposition?

PA hand

what best demonstrates the trapezium free of superimposition and the 3rd-5th metacarpal bones superimposed?

AP oblique (wrist)

What best demonstrates impingement on the [left] median nerve?

carpal canal

• hand held back 

• CR rotated 30°

what best demonstrates anterior vs posterior displacement when the patient suffered [left] hand trauma?

Lateral (wrist)

what best demonstrates anterior vs posterior displacement of the [right] wrist?

Lateral (wrist)

what best demonstrates anterior vs posterior displacement of the [right] hand? (YOU CAN SEE ALL OF THE DIGITS IN THIS VIEW)

lateral fan (hand)

what is used to visualize a colles vs smiths fracture?

Lateral (wrist)

what projection best demonstrates anterior vs posterior displacement of the 2nd phalanx?

Lateral (finger)

what best demonstrates a [right] scaphoid fracture?

true OR modified stretchers (wrist)

• true: hand elevated

• modified: CR at 20°

what best demonstrated the scaphoid using a perpendicular CR?

true stretchers (wrist)

• hand elevated

what best demonstrates carpal tunnel syndrome?

carpal canal

• hand held back 

• CR rotated 30°

what best demonstrates early arthritic changes and both pisiforms free of superimposition?

ball catchers (AP oblique) OR carpal canal

what best demonstrates posterior displacement of the 1st digit?

lateral thumb

• hand PA then fist with thumb out 

what best demonstrates both the hamulus and pisiform free of superimposition?

carpal canal

• hand held back 

• CR rotated 30°

best projection for a lateral view of the distal radioulnar joint?

lateral (wrist)

best view of a lateral of the metacarpals and the 2nd-5th digits?

fan lateral (hand)

what projection best demonstrates a foreign body in the [left] hand?

full extension lateral (hand)

what projection shows elongation of the 1st metacarpal and the CMC joint open?

Roberts (AP thumb)

• roberts: hand 15° medially/towards thumb

what projection best demonstrates the 1st CMC joint?

roberts (AP thumb)

• Roberts: hand 15° medially/towards thumb

what projection shows the truest lateral of the metacarpals?

relaxed lateral (hand)

best demonstrates elongation of the scaphoid?

stetchers

• true: hand elevated

• modified: CR at 20°

projection used to rule out early arthritic changes in the hand(s)?

ball catcher (AP oblique)

what projection best demonstrates ligament disruption in the wrist?

AP wrist

• fist clenched

what projection best demonstrates the bases of the 1st and 2nd metacarpals free of superimposition?

PA oblique (hand)

what position best demonstrates the 1st and 2nd MCP joints?

PA oblique (hand)

best demonstrates radial head, neck, and tubercle

external/lateral oblique (elbow)

• entire body/arm is rotated laterally

• elbow at 45°

best demonstrates fat pads in elbow

lateral elbow

• elbow and humerus in same plane 

• wrist and forearm are aligned/rotated

best demonstrates the olecranon process and trochlear notch with superimposed epicondyles

lateral elbow

• elbow and humerus in same plane 

• wrist and forearm are aligned/rotated

projection used to access olecranon process

tangential: acute flexion (aka jones position) (elbow)

• CR 2in distal from olecranon

projection used for “avulsion” fracture off coronoid and when bone is broken off

axiolateral: coronoid (elbow)

• CR 45° towards ELBOW

• elbow is at 80°

• arm is in lateral

projection used as an alternate for occult intra-articular fracture

axiolateral: radial head (elbow)

• CR 45° towards SHOULDER 

• arm is in lateral 

what best demonstrates a general overview of the (elbow) joint with no rotation

AP elbow

what best demonstrates the epicondyles of the elbow

AP elbow

Projection that best shows the medial anatomy of the elbow 

internal/medial oblique (elbow)

• arm placed AP → palm is turned flat on table 

• elbow is 45°

best demonstrates the coronoid process, trochlea, and medial epicondyle (in profile)

internal/medial oblique (elbow)

• arm placed AP → palm is turned flat on table 

• elbow is 45°

best demonstrates separation of the radius and ulna

external/lateral oblique (elbow)

• entire body/arm is rotated laterally

• elbow at 45°

projection that best demonstrates the proximal radio-ulnar joint 

external/lateral oblique (elbow)

• entire body/arm is rotated laterally

• elbow at 45°

best demonstrates the lateral epicondyle and capitulum (in profile)

external/lateral oblique (elbow)

• entire body/arm is rotated laterally

• elbow at 45°

what is this projection

AP humerus

• abduct arm slightly 

• palm foward 

what is this projection

lateral humerus

• arm internally rotated

• palm facing laterally 

what is this projection 

lateral mid and distal humerus trauma position (horizontal beam)

• positioned like lateral forearm 

what is this projection

horizontal beam transthoracic lateral humerus

• UNAFFECTED limb over head 

what is this projection

AP forearm

what is this projection

lateral forearm

best demonstrates Lesser tubercle profiled medially

AP with internal rotation (shoulder)

• hand and arm turned internally where palm is lateral

• CR directed to 1” inferior to coracoid

best visualizes the Proximal humerus, scapula, clavicle and SC joint 

AP with internal OR external rotation (shoulder)

best demonstrates Greater tubercle profiled laterally

AP with External Rotation (shoulder) 

• hand and arm rotated externally 

• CR directed to 1” inferior to coracoid

best demonstrates Glenoid cavity profiled AND the Scapulohumeral joint centered

Grashey method 

• AP oblique 

• patient 35-45° toward affected side 

• CR 2” inferior and medial from superlateral border of humerus

projection that Opens the subacromial space, elongates the humeral head & neck AND open glenohumeral joint

Garth Method

• Apical oblique axial 

• 45/45 

• IR is vertical 

• CR towards feet (caudal)

projection that best demonstrates Humeral head, glenoid cavity, and neck free of superimposition

Garth Method

• Apical oblique axial 

• 45/45 

• IR is vertical 

• CR towards feet (caudal)

best demonstrates Acromion and coracoid processes in profile

Scapular Y view

• PA with affected side towards IR

• Oblique shoulder 30° - 45° towards IR

best demonstrates Humeral head Body of scapula and glenoid cavity superimposed

Scapular Y view

• PA with affected side towards IR

• Oblique shoulder 30° - 45° towards IR

best demonstrates anterior and posterior placement of the scapula

Scapular Y view

• PA with affected side towards IR

• Oblique shoulder 30° - 45° towards IR

best visualizes Subacromial space and Anterioinferior aspect of acromion 

Apical AP axial (shoulder)

• Patient is positioned AP with arm in neutral position

• CR 30° caudal angle (towards feet)

best demonstrates SC joint to proximal humerus and entire scapula seen

Apical AP axial (shoulder)

• Patient is positioned AP with arm in neutral position

• CR 30° caudal angle (towards feet)

best demonstrates the relationship between the glenoid cavity and humeral head, showing suspected dislocations *****

Superioinferior Axillary

• CR 5-10° angle toward the distal humerus

• patient seated 

best demonstrates Supraspinatus outlet and Coracoacromial arch open and in profile with Humerus superimposed over body of scapula

Neer method 

• 10° - 15° caudal angle (towards feet)

• Patient is positioned same as PA Scapular “Y”

what projection best demonstrates a bankarts lesion 

AP with external rotation (shoulder) 

• hand and arm rotated externally 

• CR directed to 1” inferior to coracoid

what projection best demonstrates the hill sachs defect

AP with internal rotation (shoulder)

• hand and arm turned internally where palm is lateral

• CR directed to 1” inferior to coracoid

best demonstrates Reduced superimposition of the thorax with the Entire scapula seen

AP scapula 

• AP shoulder position 

• Affected arm is abducted 90°, with hand in supination

• orthostatic breathing -(3 sec) or full exhalation to improve visibility

best demonstrates the Scapula seen in truest lateral position

Lateral scapula 

• affected side closest to receptor

• patient to place forearm & hand over posterior waist

• patient PA and oblique 

best demonstrates a Visible “Y” and the Humerus not superimposed over the scapular body

Lateral scapula 

• affected side closest to receptor

• patient to place forearm & hand over posterior waist

• patient PA and oblique 

best demonstrates the Entire clavicle seen with Slight superimposition on medial end by thorax

PA and AP clavicle 

overall view of the clavicle with reduced OID

PA clavicle

• affected side closest to receptor

• must include SC and AC joints

• full exhalation

overall view of the clavicle with increased OID

AP clavicle

• posterior aspect closest to receptor

• patient erect 

• full inhalation

best demonstrates Clear visual of clavicle and separation***

AP and PA axial (clavicle)

what projection best demonstrates the clavicle superior to the ribs and scapula 

AP axial (clavicle)

• CR directed 25° – 30° cephalic (towards head)

•  AP erect with only shoulders against IR, leaning awkwardly against it 

best demonstrates clavicle superior to ribs and scapula with horizontal placement  

PA axial (clavicle)

• CR directed caudal, 25° – 30°

• full inhalation 

• positioned PA erect 

best demonstrates separation and/or dislocation of the AC joint

AP with/without weights (AC joints) 

• AP shoulder position 

• minimum 10lb weights 

• 72in SID 

• include both shoulders

• CR 1in above jugular notch

what is this projection

pa chest 

• 72 SID

• shoulders rolled forward

• double inhalation

• CR middle below scapula

what is this projection

lateral chest

• 72 SID

• hands above head

• affected side towards IR

• double inhalation

• CR middle below scapula

best demonstrates anterior vs posterior dislocation (of a humerus) in a trauma setting

transthoracic horizontal

best demonstrates anterior vs posterior dislocation (of the humerus) shot through the thorax

transthoracic hand over head