Upper Limb and Shoulder Girdle Radiographic Anatomy, Positions, and Pathology

Comprehensive practice flashcards covering upper extremity radiographic anatomy, positions, joint classifications, fracture types, and evaluation criteria based on lecture notes.

Proximal Row of Carpals (Viewed Lateral to Medial)

Lateral to medial: scaphoid, lunate, triquetrum, and pisiform.

Distal Row of Carpals (Viewed Lateral to Medial)

Lateral to medial: trapezium, trapezoid, capitate, and hamate.

Most Frequently Fractured Carpal Bone

Scaphoid (navicular).

Largest Carpal Bone

Capitate (os magnum).

Interphalangeal (IP, PIP, DIP) type Joints

Synovial, diarthrodial hinge (ginglymus) joints.

Metacarpophalangeal (MCP) Joints (1st–5th)

Synovial, diarthrodial ellipsoidal (condyloid) joints.

1st Carpometacarpal (CMC) Joint (Thumb)

Synovial, diarthrodial saddle (sellar) joint.

2nd to 5th Carpometacarpal (CMC) Joints

Synovial, diarthrodial plane (gliding) joints.

Intercarpal Joints (Articulations Between Carpals)

Synovial, diarthrodial plane (gliding) joints.

Radiocarpal (Wrist) Joint

Synovial, diarthrodial ellipsoidal (condyloid) joint.

Why should you align digit parallel to IR?

to prevent foreshortening and to open IP joints.

Major Disadvantage of PA Projection of thumb vs. AP

Increased OID causes magnification.

Lateral Hand ('Fan') – Evaluation Criteria

All metacarpals superimposed while phalanges remain separated without overlap.

Lateral Hand ('Fan') – What It’s For

fractures and dislocations.

Alternative lateral projections used to localize foreign bodies.

Extension & Flexion

Norgaard Method (Ball Catcher’s)

to detect rheumatoid arthritis.

PA Axial w/ Ulnar Deviation

Special wrist view opening radial intercarpal spaces to view scaphoid.

Stecher Method

Specialized projection for scaphoid imaging without ulnar deviation.

PA Radial Deviation

Hand tilted toward radius to open medial carpals (lunate, triquetrum, pisiform, hamate).

Tangential projection / Gaynor-Hart Method

carpal canal calcifications and carpal tunnel syndrome.

Colle’s Fx

Distal radius fracture w/ posterior fragment displacement. / Test: Wrist

Smith’s Fx

Distal radius fracture with anterior fragment displacement. / Test: Wrist

Bennett’s Fx

Fracture at the base of first metacarpal by CMC joint. / Test: Hand

Boxer’s Fx

Fracture of the fifth metacarpal neck. / Test: Hand

AP Forearm – Positioning & Epicondyle Orientation

Arm extended w/ hand supinated; humeral epicondyles parallel to IR.

AP Forearm – Evaluation Criteria

Epicondyles in profile, parallel forearm bones, and slight distal radioulnar overlap.

Lateral Forearm – Elbow Flexion & Thumb Alignment

Elbow flexed $90^\circ$, wrist lateral w/ thumb up, distal ulna superimposed over radius

3 Concentric Arcs on True 90° Lateral Elbow

Trochlear sulcus, capitulum/trochlea outer ridges, and trochlear notch.

Positive Elbow Exam Diagnostic Indicator

Visibility of the posterior fat pad signifying joint pathology or effusion.

AP Elbow – Arm Extension & Epicondyle Alignment

Arm extended, rotated 45° medially (internal).

AP Elbow – Evaluation Criteria

Epicondyles in profile; slight radial head superimposition over the ulna.

AP Lateral Oblique Elbow (External Rotation) – Rotation & CR

Arm extended and rotated $45^\circ$ laterally (external rotation).

AP Lateral Oblique Elbow (External Rotation) – Evaluation Criteria

Radial head, neck, and tuberosity projected completely free of the ulna.

AP Medial Oblique Elbow (Internal Rotation) – Rotation & CR

Arm extended and rotated $45^\circ$ medially (internal rotation).

AP Medial Oblique Elbow (Internal Rotation) – Evaluation Criteria

Coronoid process in profile; trochlea and medial epicondyle profiled.

Lateral Elbow – Flexion & Epicondyle Orientation

Elbow flexed $90^\circ$; epicondyles superimposed and perpendicular to IR.

Lateral Elbow – Concentric Arcs & Olecranon Evaluation

Three concentric arcs aligned; olecranon process demonstrated in profile.

AP Partial Flexion Elbow (Special Protocol for Incomplete Extension)

Trauma protocol of two exposures (forearm-parallel and humerus-parallel).

AP Partial Flexion – Forearm-Parallel View Demonstration

Profiles proximal forearm without distortion when elbow cannot extend.

AP Partial Flexion – Humerus-Parallel View Demonstration

Profiles distal humerus without distortion when elbow cannot extend.

Coyle Method (Special/Trauma Indication)

Trauma projection used when patient cannot extend elbow for obliques.

Lateromedial Projection (for Radial Head)

$90^\circ$ flexion, CR $45^\circ$ toward shoulder; visualizes radial head.

Mediolateral Projection (for Coronoid Process)

$80^\circ$ flexion, CR $45^\circ$ away from shoulder; visualizes coronoid process.

Head of Humerus Articular Landmark

Rounded proximal hemisphere articulating with glenoid cavity.

Anatomic Neck of Humerus Location

Constriction situated immediately distal to articular humeral head.

Surgical Neck of Humerus Location & Fx Site

Shaft constriction distal to tubercles; most distal humeral neck.

Greater Tubercle Prominence

Large bony process on the lateral proximal humerus.

Lesser Tubercle Elevation

Smaller bony elevation on anterior proximal humerus.

Intertubercular Sulcus (Bicipital Groove)

Bicipital groove located between greater and lesser tubercles.

AP Humerus – Arm Extension & Epicondyle Alignment

Arm extended, hand supinated; epicondyles positioned parallel to IR.

AP Humerus – Evaluation Criteria

Greater tubercle in lateral profile; epicondyles in profile.

Lateral Humerus – Arm Rotation & Epicondyle Orientation

Arm internally rotated; epicondyles perpendicular to IR.

Lateral Humerus – Evaluation Criteria

Lesser tubercle in medial profile; epicondyles directly superimposed.

Transthoracic Lateral Humerus (Special/Trauma) – What It’s For

Trauma projection through the thorax when arm cannot be abducted.

Orthostatic Breathing Technique Parameters

Low mAs and long exposure ($2\text{ to }3\,\text{s}$) during quiet breathing to blur ribs.

Central Ray Angulation Rule (Inability to Elevate Unaffected Arm)

Angle CR $10^\circ\text{ to }15^\circ$ cephalad if patient cannot elevate unaffected arm.

Routine Protocol (3 Projections)

AP external rotation, AP internal rotation, and a third alternate projection.

ALTERNATE 3rd Projection Protocol Options

Scapular Y, axillary, superoinferior axial, or Grashey method.

AP Shoulder – External Rotation (Positioning & Epicondyles)

Arm extended, hand supinated; epicondyles parallel to IR.

AP Shoulder – External Rotation (Evaluation Criteria)

Greater tubercle in lateral profile; open scapulohumeral joint.

AP Shoulder – Internal Rotation (Positioning & Hand on Hip)

Arm internally rotated with hand on hip; epicondyles perpendicular to IR.

AP Shoulder – Internal Rotation (Evaluation Criteria)

Lesser tubercle in medial profile; centered scapulohumeral joint.

Inferosuperior Axial Shoulder (Lawrence Method) – CR & Positioning

Arm abducted $90^\circ$; CR angled $25^\circ\text{ to }30^\circ$ medially through axilla.

Evaluation Criteria

Lesser tubercle in anterior profile; glenohumeral joint demonstrated.

Inferosuperior w/ Exaggerated Rotation – What It’s For

Axillary shoulder modification performed to detect Hill-Sachs defects.

Superoinferior Axial Shoulder – Patient Position & CR Angulation

Patient seated over IR; CR angled $5^\circ\text{ to }15^\circ$ toward elbow.

Evaluation Criteria

Lesser tubercle in anterior profile; scapulohumeral joint open.

Glenoid Cavity (Grashey Method) – Body Obliquity

Body rotated $35^\circ\text{ to }45^\circ$ toward affected side to profile glenoid cavity.

Evaluation & What It’s For

Glenoid cavity in profile; evaluates glenoid brim fractures and Bankart lesions.

Bankart Lesion Definition & Anatomical Location

Avulsion fracture of anteroinferior glenoid brim assessed via Grashey method.

Shoulder Trauma Routine Projections Protocol

AP neutral rotation, Scapular Y, and Transthoracic lateral.

AP Neutral Rotation Shoulder – 'DO NOT Rotate Arm' Rule

Arm radiographed as presented without rotation; epicondyles at $45^\circ$.

AP Neutral Rotation Shoulder – Evaluation Criteria

Both tubercles superimposed over humeral head; neither in profile.

Scapular Y / Lateral Shoulder – Patient Obliquity Range

$45^\circ\text{ to }60^\circ$ anterior oblique placing scapular body perpendicular to IR.

Alternate Palpation Technique for Scapula Body

Superimposing medial and lateral scapular borders perpendicular to IR.

Evaluation Criteria & 'Y' Morphology

Scapular body on-end; acromion and coracoid form upper limbs of Y.

Transthoracic Lateral Proximal Humerus – Technical Criteria

Minimum 3-second exposure with orthostatic breathing to project humerus.

Tangential Shoulder (Special - Fisk Method) – Positioning & Humerus Angle

Humerus $10^\circ\text{ to }15^\circ$ from vertical; profiles the bicipital groove.

Fisk Method – Evaluation Criteria & What It’s For

Intertubercular sulcus profiled tangentially on anterior proximal humerus.

Supraspinatus Outlet (Special - Neer Method AKA Scap Y w/ an angle) – CR

$45^\circ\text{ to }60^\circ$ anterior oblique; CR angled $10^\circ\text{ to }15^\circ$ caudad.

Neer Method (Supraspinatus Outlet) – What It’s For

Demonstrates coracoacromial arch to assess supraspinatus impingement.

Neer Method (Supraspinatus Outlet) – Evaluation Criteria ('Top of Y')

Supraspinatus outlet open beneath acromion; top of Y forms closed circle.

AP Scapula – Arm Abduction & 'Salute' Position

Arm abducted $90^\circ$ in salute position; CR to mid-scapula.

AP Scapula – Lateral Border Evaluation Criteria

Entire scapula shown with lateral border clear of ribs and lungs.

Lateral Scapula – Positioning for Body of Scapula

$45^\circ\text{ to }60^\circ$ anterior oblique with arm across chest to project body free of ribs.

Lateral Scapula – Positioning for Upper Scapula (Acromion & Coracoid)

Arm at side or behind back to visualize acromion and coracoid.

AP Clavicle – CR Centering

CR directed perpendicularly to mid-shaft clavicle.

AP Axial Clavicle – CR Angulation & Suspended Inspiration

CR angled $15^\circ\text{ to }30^\circ$ cephalad on suspended full inspiration.

AP Axial Clavicle – Purpose of Suspended Full Inspiration

Full inspiration elevates ribs to cast clavicle above thoracic cage.

AP Axial Clavicle – Evaluation Criteria

Clavicle projected largely superior to ribs and thoracic cavity.

PA Axial Clavicle (Alternative Projection) – CR Angulation

CR angled $15^\circ\text{ to }30^\circ$ caudad to mid-clavicle.

AP Bilateral AC Joints (Pearson Method – Bilateral WITHOUT & WITH Weights) Protocol

Bilateral AC views at 72-inch SID taken non-weighted and weighted.

Pearson Method – Weight Stress Test Parameters

Strapping 8-10 lb weights to wrists to detect ligament tear or joint separation.

Pearson Method

Simultaneous comparison evaluating acromioclavicular symmetry under stress.

Glenohumeral / Scapulohumeral Joint

Synovial diarthrodial spheroidal (ball-and-socket) joint.

2 Clavicle Joints (Articulations)

Medial sternoclavicular (SC) and lateral acromioclavicular (AC) joints.

Scapula Borders (Three Borders)

Superior, medial (vertebral), and lateral (axillary) borders.

Scapula Angles (Three Angles)

Superior, inferior, and lateral (head) angles.

Inferior Scapula Vertebrae Level

Anatomic level corresponding to the T7 vertebra.

Subscapular Fossa (Costal Surface Mid-Area)

Smooth concave anterior (costal) surface of scapular body.