W1 - ST Neck, ACJ, F/E CSP

AP ST Neck - Critique

• Chin F/E:

  • Mandible superimposed on base of skull

  • No overlap of pharyngeal area by mandible

• Rot’n:

  • No rotation of neck

  • SC joints symmetrical indicating no rotation

• Alignment: Spine aligned to the centre of the IR

AP ST Neck - Structures Included

• EAM → SN

• C3-T4

• Soft tissue structures of the neck

AP ST Neck - IQ

• Throat filled with air

• Visualization of pharyngolaryngeal structures

AP ST Neck - Positioning

• CP

• CR

• PT Position

• Respiration

• laryngeal prominence

• perp

• erect 

• AML // floor

• quiet inspiration to have airway filled with air

Lateral ST Neck - Critique

• The zygapophyseal joints superimposed anterior - posterior indicates no rotation

• The zygapophyseal joints superimposed superior - inferior indicates no tilt

• Mandible should be superimposed

• Base of skull should be off the c-spine indicating good head extension

Lateral ST Neck - Structures Included

• EAM to jugular notch (Merrill's) (entire nose must be included - at some sites)

• Practically - aim for nasopharynx to clavicles

• Anterior and posterior surfaces of the neck

Purpose of ST Neck

to localize foreign bodies in the upper airway 

LAT CSP Hyperflexion - Critique

• Rot’n:

  • head: mandibular rami SI ant/post

  • vertebrae seen in true LAT

• Flexion:

  • SPs well separated

  • body of the mandible almost vertical

LAT CSP Hyperflexion and Hyperextension - Structures Included

• C1-C7

• Surrounding soft tissue

LAT CSP Hyperflexion and Hyperextension - IQ

• Clear demonstration of soft tissue margins and trachea

• Clear demonstration of trabecular markings of the vertebrae

LAT CSP Hyperextension - Critique

• Rot’n:

  • head: mandibular rami SI ant/post

  • vertebrae seen in true LAT

• F/E

  • SPs depressed and closely spaced.

  • body of the mandible almost horizontal

Purpose of LAT CSP Hyper-F/E

• typically performed for soft tissue assessment

• to demonstrate the anteroposterior vertebral mobility

• commonly done to rule out "whiplash" type injuries or spinal fusion surgery f/u

Contraindications for LAT CSP Hyper-F/E

on trauma pt, unless authorized in writing (and frequently supervised) by a physician

Positioning for LAT CSP Hyperflexion and Hyperextension

• CP

• CR

• PT Position

• Respiration

• C4 and top of IR 2” above the EAM

• HB or perp

• erect in LAT, shoulder depression, pt will depress/elevate chin as much as possible

• suspended expiration

AC Joints - Critique

• Rot’n: glenoid shape is pear-shaped

• F/E: SSA SI by clav

• Tilt: both ACJ should be transversely //

AC Joints - Structures Included

Demonstrates AC joint of interest. Lateral clavicle, acromion process and superior scapular angle

AC Joints - IQ

AC joint and ST visualized.  Evidence of bony trabeculations within clavicle and acromion.  Able to differentiate between cortical margins and spongy bone.

Purpose of ACJs

examined bilaterally (for comparison) to assess separation or dislocation of the AC Joint

ACJ - Positioning

• CP

• CR

• SID

• PT Position

• ACJ

• perp

• uni = 122cm, bi = 180cm

• erect, arms by their side, shoulders relaxed, thyroid shield for bilat