Elbow RAD 101 2024 PDF

Elbow RAD 101 Re f e r e n c e : B o n t r a g e r 1 0 t h e d i t i o n Po s i t i o n i n g a n d Re l a t e d A n a t o m y 1 1 t h e d i t i o n Learning Outcomes Identify the following parts and prominences on an image or skeleton: Humerus Capitulum...

Elbow RAD 101 Re f e r e n c e : B o n t r a g e r 1 0 t h e d i t i o n Po s i t i o n i n g a n d Re l a t e d A n a t o m y 1 1 t h e d i t i o n Learning Outcomes Identify the following parts and prominences on an image or skeleton: Humerus Capitulum Trochlea Medial epicondyle Lateral epicondyle Olecranon fossa Coronoid fossa Radial Fossa Learning Outcomes Identify the structures best shown on routine images for the upper extremity and shoulder girdle. Describe the routine and special projections for each of the following radiographic procedures: Elbow Discuss why each of the projections maybe requested Elbow https://www.bmj.com/content/bmj/371/bmj.m3494/F2.large.jpg Review of Proximal Radius & Ulna Distal Humerus Body (Shaft) -Long center section Humeral Condyle Expanded distal end of humerus (broken into medial and lateral parts) Trochlea Medial Condyle – Articulates with ulna Shaped like a pulley or spool Two rim-like outer margins and a smooth depressed center Trochlear sulcus (groove) The smooth depressed center of the trochlea On lateral view appears as a less dense (more radiolucent) area Capitulum (Capitellum) Lateral Condyle – articulates with radial head Means “little head” Memory aid – “Cap” is on top of “Head” Distal Humerus Lateral Epicondyle Small projection on the lateral aspect of distal humerus above capitulum Medial Epicondyle Larger and more prominent than lateral epicondyle Located on medial edge of distal humerus Depressions Coronoid Fossa Anterior depression (more Medial) Receives the coronoid process Radial Fossa Anterior depression (more lateral) Receives the radial head Olecranon Fossa Posterior depression Receives the olecranon process of the ulna when arm is fully extended  True Lateral Elbow G ood Crit erion t o eva lua t e you r im ag e: - elb ow f lexed 90˚ - Three concentric arcs - 1st and smallest arc – Trochlear sulcus - 2nd intermediate arc double lined - smallest of the 2 - Capitulum - Largest of the 2 - Trochlea - 3 rd arc – Trochlear notch of the ulna Another name for trochlear notch? Practice Labeling Anatomy Joints Elbow Joint Proximal Radioulnar joint  Fat Pads 3 s i gn i f i c a n t f at p a d s / s t r ip e - Ant e r io r f a t p a d (C ) ( V i s i bl e on la t e ra l e lb o w p r o j ec t io n ) - Po s t e r i o r f a t p a d (D ) ( N ot t y p ic a l ly vi s i bl e o n x - ray u n le s s t h e r e i s t ra um a o r e lb o w i s n o t f le xed c or r e c t ly ) - S u p i n a t o r f a t s t r i p e (E ) ( M ay i nd i c a t e di a gn o s i s o f rad i al h e ad o r n ec k f ra c t u r e s t h a t ar e n o t e a s il y s ee n )  What projections are Review: Distal fat stripes these? Lateral Medial Oblique Oblique Rotational Movements of Radius & Ulna AP – Proximal radius and ulna are slightly superimposed Medial Oblique (hand pronated) - completely superimposes the proximal radius and Ulna Lateral Oblique –Separates the proximal radius and ulna AP Common Pathologies: Osteomyelitis: infection of bone or bone marrow, may be caused by bacteria induced by trauma or surgery Bursitis: Inflammation of the bursae or f luid f illed sac that enclose the joints, causes pain and limited movement Osteopetrosis: abnormally dense bone “marble bone” Hmm…What is osteoporosis? Common Positioning Considerations 40 SID Remove any artifacts /jewelry from patient Try to maintain shoulder and upper extremity on the same plane Routine Projections - Elbow Alternate AP – Lateral (External) AP Partial flexion Oblique Medial (internal) Lateral Oblique  AP Projection - Elbow Clinic al I nd ica t ion s: -Fra ct ur es a nd d isloca t ions of t h e elbow -Pa t h ologic p r oc esses , s u ch as ost eomyelit is & ar t h rit is 40 SI D Elbo w fu lly e xte nded wit h ha nd s up ina t ed M ay n eed t o lea n p a tien t la t era lly for t ru e A P p roj ect ion -Feel ep icon d yles t o ens ur e t h ey' re p arallel to IR C R is p erp en d icu lar to IR, d ir ected at m id -elb o w j o int -( 3/4 in d ist a l t o m id p oin t of ep icon d yles)  F. G. Practice A. labeling H. B. Anatomy C. I. A. G. B. H. J. D. C. I. D. J. E. K. E. K. F.  Alternate AP – Partial Flexion - Elbow * W he n e lb o w c a nno t b e f u l ly e x t e n d e d C l in ic a l I n d i c a t i o n s : - F ra c t u r e s a n d d i s lo c at i o ns o f t h e el b ow - Pa t ho l og i c p r o c e s s e s , s u c h a s o s te o my e li t i s a n d a r t h r it i s 40 SID O b t a in 2 p r o j e c t i o n s - 1 wi t h fo r e a r m p a ral le l t o I R - 1 wi t h h um e r us p a ral le l t o I R C R : Pe r p en d ic u l a r t o I R , d i r ec t e d a t m i d - e l b o w j o i n t Humerus Parallel to Forearm IR Parallel to IR  Lateral (External) AP Oblique Projection - Elbow Clinical Indications: Fractures and dislocations of the elbow, primarily the radial head and neck *Best visualizes radial head and neck of radius and capitulum of humerus 40 SID Arm fully extended on the same plane as shoulder Supinate hand and rotate arm laterally about 45˚ CR mid-elbow joint Evaluation Criteria: Radial head, neck, and tuberosity should be free of superimposition by ulna  What projection is A. seen in the x-ray? Practice Labeling B. Anatomy C. D. E. What structures are visualized F. best?  Medial (Internal) AP Oblique Projection - Elbow C l in ic a l I n d ic a t io n s : Fra c t ur es a n d d is lo c a t io n s o f t h e e l bo w, p r i m ar i l y t he c o r o n o i d p r o c e s s a n d c e r t a in p a t h ol o gi c p r o c e s s e s , s u c h a s o s t eo p o r o s i s a n d a r t h r i ti s B e s t v is ua l iz e s c o r o n o i d p r o c e s s o f ulna a n d t r o c hl e a 40 SID A r m f u ll y e x t en d e d P r o n a t e h a nd i nt o a na t u ra l p a lm - d o w n p os it io n t h e n r o t a t e a r m i n te r n a ll y a s n e c e s s a r y t i ll d i s t a l h u m e r u s / a n t e r i o r e lb o w a r e r o t a t ed 4 5 ˚ C R p e r p en d ic u la r t o I R , d i r ec t e d t o m id - e l b o w j o i nt. Medial Oblique Elbow Evaluation Criteria: radial head and neck superimposed and centered over the proximal ulna Lateral Projection - Elbow Clinical Indications: -Fractures and dislocations of the elbow -Certain bony pathologic processes, such as osteomyelitis and arthritis -Elevated or displaced fat pads of the elbow joint may be visualized Lateral (Lateromedial) Projection - Elbow 40 SI D Sea t p a tien t a t end of t ab le, wit h elbo w f lexed 9 0˚ Dr op s hou ld er so it is on t h e s a me p lan e a s f or ea rm Rota t e h a n d & wris t in to tr u e lat era l p osit ion (t h u mb u p ) CR – Per p en dic ula r t o IR, d irec ted to m id - e lbo w jo in t Lateral elbow What are the 3 concentric arcs?  Special Projections - Elbow Trauma axial Radial head laterals (Coyle laterals method)  Trauma Axial Laterals (Coyle Method) - Elbow 40 SID 2 different projections: *Theses are effective projections if your patient is unable to extend elbow fully for medial and lateral oblique projections Axial Lateromedial Projection -radial head best visualized Axial Mediolateral Projection - Coronoid process best visualized  Axial Lateromedial Projection – Elbow (Radial Head) -Clin ica l in d ica t ion s: fra ct u res an d d isloca t ion s of t h e ra d ial h ea d -E lb ow f le xe d 9 0˚ if p oss ible, Ha n d p ro n at ed -CR a n g led 4 5˚ to wa rd s ho u lder, cen t ered t o ra dia l h ea d, mid-e l bow jo in t E valu ation Cr iter ia : Join t sp a ce b etween rad ial h ead a n d ca p itu lu m is op en , radial h ead , n eck, an d t u b erosit y is f ree of su p er imp osit ion  Axial Mediolateral Projection - Elbow Clinic al I nd ica t ion s: f ra ct u res an d d isloca t ions of t h e co ro n oid p ro ces s E lb ow f le xed o n ly 8 0˚ , h an d pr on a ted CR – a n g led 4 5˚ f ro m th e s ho u ld er, in t o m id -elb ow join t E valu a tion Cr iter ia : a nt erior p or tion of th e cor onoid a p pea r s elong a t ed b u t in p rof ile, j oin t sp ace b etween coron oid p rocess an d t roc hlea sh ou ld b e op en, ra d ia l hea d a n d n eck sh ou ld b e su p erim p osed b y u ln a Which Axial Lateral Coyle view is this? Which Axial Lateral Coyle view is this?  Radial Head Laterals - Elbow Clinical Indications: Occult fractures of the radial head or neck 40 SID Arm flexed 90˚ Upper extremity & shoulder all on the same plane Take 4 projections 1) Supinate hand and externally rotate as far as patient can tolerate 2) Place hand in true lateral 3) Pronate hand 4) Internally rotate hand as far as patient can tolerate CR – perpendicular to IR and directed at radial head Evaluation criteria: Radial tuberosity should be visualized in different positions 4 different views Quiz Me: Which of the following structures located on the humerus articulates with the proximal ulna? a. Capitulum b. trochlea c. lateral epicondyle d. radial tuberosity Quiz Me: Which fossa is located on the Humerus and receives the radial head? a. radial fossa b. olecranon fossa c. coronoid fossa d. ulnar notch Quiz Me: T or F: The medial epicondyle is larger and more prominent than the lateral epicondyle. Quiz Me: What are the 3 concentric arcs? What is another name for the trochlear notch? What are the names of the 2 fat pads and 1 fat stripe located near the elbow? – Can you identify their location on a radiograph? Quiz Me: Can you identify the differences between a medial and lateral oblique elbow by looking at radiographs? How is the radius and ulna in relation to one another on an AP elbow radiograph? Which of the oblique elbow projections causes the proximal radius and ulna to be completely superimposed? Quiz Me: What is osteomyelitis? What is bursitis? What is osteopetrosis? Quiz Me: What is the CR location of an AP elbow? How is the hand positioned for an AP elbow position? How do we find the mid-elbow joint? Quiz Me: How do you perform a partial flexion elbow projection on a patient? -Where do you center? -What do you do with their arm? -Is it one or two images? Quiz Me: Which elbow projection best demonstrates the radial head and neck as well as the capitulum of the humerus? How much do you rotate for the external (lateral) oblique elbow? What is the SID for elbow projections? Quiz Me: What structure is best visualized on a medial (internal) AP oblique elbow projection? How is the hand positioned for a medial AP oblique elbow projection? Quiz Me: How much is the elbow bent for a lateral elbow projection? T or F: When positioning for the lateral elbow, it is impor tant to have the shoulder higher than the elbow. What is the CR location for a lateral elbow? How do you located the mid-elbow joint for the lateral projection? Quiz Me: Which Coyle method shows the radial head best? Which Coyle method do you pronate the hand? Which Coyle method do you angle the CR 45 degrees toward the shoulder? Quiz Me: Can you identify the correct Coyle method based on looking at an x-ray? -axial lateromedial? -axial mediolateral?