RT 301 L1-6 (Finals) PDF

Elbow 3. Lateral Elbow Routine AP Lateral Oblique Medial Oblique Lateral CR: 1 inch Distal from Lateral Epicondyle....

Elbow 3. Lateral Elbow Routine AP Lateral Oblique Medial Oblique Lateral CR: 1 inch Distal from Lateral Epicondyle. Patient is Seated with Elbow flexed 90° Humerus and Forearm Parallel to IR. 1. AP Elbow Evaluation Criteria CR to Mid-Elbow Joint. Patient is Seated with Elbow Fully 3 Concentric Arcs. Fat Pad Signs, Supinator Stripe and Fractures. Extended. Olecranon Process in profile. Epicondyles Parallel to IR. 2 Partially Flexed AP Projections CR perpendicular to Mid-Elbow. When Elbow cannot be fully Extended. 1. Humerus Parallel 2. Forearm Parallel Elbow Special Projections Acute Flexion Trauma Axial Lateral Radial Head Jones Method Coyle Method Projections 2. Oblique Projections of Elbow – Lateral and Medial Oblique 1. Acute Flexion Lateral Oblique Medial oblique CR: 2 inches Superior from Olecranon Process. 45° External (Lateral) Rotation. 45° Internal (Medial) Rotation. 1. CR Perpendicular to Humerus 2. CR Perpendicular to Forearm 2. Trauma Axial (Lateral) Lateromedial Projections – Coyle Method Evaluation Criteria For Radial Head For Coronoid Process CR 45° to shoulder. CR 45° away shoulder. Lateral Oblique 90° Flexion 80° Flexion Radial Head, Neck, and Tuberosity. Lateral Epicondyle and Capitulum. Medial Oblique Coronoid Process. Medial Epicondyle and Trochlea. Alternative Supine Projections AP Proximal Humerus – (External Rotation) Epicondyles Parallel to IR. A. Greater Tubercle - Lateral (in profile) B. Lesser Tubercle - Anterior 3. Radial Head Lateromedial Projections 1. Hand Supinated – Maximum External Rotation. Lateral Proximal Humerus – (Internal Rotation) Epicondyles Perpendicular to IR. A. Greater Tubercle - Anterior B. Lesser Tubercle - Medial (in profile) 2. Hand Lateral Oblique Proximal Humerus – (Neutral Rotation) 3. Hand Pronated Epicondyles 45° to IR. A. Greater Tubercle (not in profile) B. Lesser Tubercle - Anteriorly (not in profile) 4. Hand Internal Rotation – Maximum Internal Rotation. Humerus Routine Routine AP Lateral Rotational Lateral Horizontal Beam Lateral 1. AP Humerus Projection Lateral Mid and Distal Humerus – Trauma Position CR to Midhumerus. Evaluation Criteria Include both Shoulder and Elbow Joints. Mid and Distal Humerus. Evaluation Criteria Distal ⅔ Humerus demonstrated. 90° perspective from AP Projection. Humerus demonstrated. Epicondyles superimposed. Greater Tubercle in profile. Medial and Lateral Epicondyles in profile. 4. Horizontal Beam Transthoracic Lateral Humerus (Trauma) 2. Lateromedial and Mediolateral Humerus Projections CR to mid aspect to involved Humerus. Demonstrates entire Humerus without rotation. CR to Midhumerus. Unaffected Limb raised over Head. Epicondyles Perpendicular to IR. Shoulder Routine 3. Lateral Humerus Recumbent – Rotational Lateral Routine External Rotation Neutral Rotation Internal Rotation Epicondyles Perpendicular to IR. Evaluation Criteria Shoulder (AP) Humerus demonstrated. Patient in Upright or Supine Position. Lesser Tubercle. Shield Gonads and Use Thyroid Shield if it does not Obscure the Shoulder. Epicondyles superimposed. Suspend Respiration Collimate 4 sides: Proximal Humerus is Visualized. External Rotation – (AP Proximal Humerus) CR 1 inch (2.5 cm) Inferior to Coracoid Process. Epicondyles Parallel. Evaluation Criteria Supine with Head, Shoulder, and Elbow elevated 3 inches from the table. Rule of Thumb: Patient’s head should be away from area of interest. Greater Tubercle profiled Laterally. Collimation: 1 inch shadow above and below. 12 inches Length. Scapulohumeral Joint centered. Proximal Humerus, Upper Scapula, and Clavicle visualized. Evaluation Criteria Lesser Tubercle profiled anteriorly. Humeral Head profiled. Glenoid Fossa profiled. Maximal External Rotation Demonstrate possible Hill-Sachs Defect. Transthoracic Lateral Shoulder – Lawrence Method Neutral Position of affected side. Internal Rotation – (Lateral Proximal Humerus) CR: 1 inch below Coracoid Process. CR 1 inch (2.5 cm) inferior to Coracoid Process. Epicondyles Perpendicular. Evaluation Criteria Lesser Tubercle profiled Medially. Scapulohumeral Joint centered. Proximal Humerus, Upper Scapula, and Clavicle visualized. 2. PA Transaxillary Projection – (Hobbs Modification) Non-Trauma Alternative to Lawrence Method. Upright or Recumbent with affected arm raised high. Recumbent Position PA Oblique Shoulder – Scapular Y CR: 2 inches Inferior and Medial from Scapulohumeral Joint. Upright or Prone with hand raised or away from shoulder. Medial Scapular Border Perpendicular to IR (superimposed) 45 - 60 body rotation from MCP. Suspend Respiration Collimation: 12 inches length, 1 inch shadow. 3. Inferosuperior Axial Projection – (Clements Modification) Shoulder Special – Non-trauma CR Perpendicular to IR. 1. Inferosuperior Axial Projection – (Lawrence Method) CR 5° to 15° to Axilla Medially: If patient cannot abduct Arm. Alternative to Lawrence Method. CR 15 / 25° to 30° medially to Axilla horizontally. (Exits AC Joint). Patient in Lateral Recumbent to see Hill Sachs Defect. Arm Supinated, Abducted 90° (or as near 90° as possible)  5. Tangential Projection – (Fisk Method) Intertubercular Groove (Erect) CR: 15° to 20° to Humerus. Patient is leaning forward towards the table. Perpendicular to IR. Tangential Projection – Intertubercular Groove (Supine) CR 15° to 20° Posterior to Humerus. If patient can’t do Erect. 4. Posterior Oblique (AP) – Glenoid Cavity (Grashey Method) Evaluation Criteria CR Perpendicular to IR (Scapulohumeral or Glenohumeral Joint). Anterior Humeral Head profiled. CR: 2 inches (5 cm) Inferior and Medial from Superolateral Border of Humerus. Groove profiled between Greater and Lesser Tubercles. Patient in Supine or Upright. 35° to 45° oblique rotation of the body. Abduct arm slightly with palm on abdomen. Body of Scapula is Parallel to IR. Suspend Respiration. Evaluation Criteria Glenoid Cavity profiled. Scapulohumeral Joint centered. Shoulder Trauma Routine Routine AP- Neutral Rotation Scapular Y Transthoracic Lateral 1. AP Neutral Rotation CR to Scapulohumeral Joint. Evaluation Criteria Greater Tubercle superimposed. Apical AP Axial Shoulder Scapulohumeral Joint centered. Grashey Modification: Apple Method 2. Transthoracic Lateral – Proximal Humerus Affected shoulder side abducted in 90 while holding 1 palm of weight. CR Perpendicular to Surgical Neck. Evaluate the extent of Glenohumeral Joint injury and Articulation. Breathing technique. Evaluation Criteria Outlet Projection (Neer Method) CR Perpendicular Proximal Humerus clearly seen. Humeral Head and Glenoid Cavity seen. Humeral Head in Neutral Rotation. 2. AP Apical Oblique Axial – Garth Method CR to Scapulohumeral Joint. CR 45° caudad. 45° body oblique rotation. 3. Scapular Y Lateral – Lateral Shoulder and Proximal Humerus. See Lung Apices CR to Proximal Humerus — 2 inches (5 cm) below Top of Shoulder. Evaluation Criteria Evaluation Criteria Humeral Head, Glenoid Cavity, and Neck free of superimposition. Scapulohumeral Joint centered. Body of Scapula superimposed on end. Acromion and Coracoid Processes in profile. Humeral Head and Glenoid Cavity superimposed. Clavicle Routine Special Neer Method AP Apical Oblique Axial Routine AP AP Axial 1. Outlet Projection – (Neer Method) 1. AP Clavicle CR 10° to 15° Caudad. CR: Perpendicular to Midpoint of Clavicle. Used if Scapular Y is not much Visualized. Suspend Respiration. Patient in Upright Position. Lateral Proximal Humerus Collimation: AC to SC Joints. CR Perpendicular. 2. AP Axial Clavicle Evaluation Criteria – (Neer Method vs. Scapular Y Lateral Projection) CR: 15° - 30° Cephalad for AP CR: 15° - 20° Caudad for PA Supraspinatus Outlet open and in profile compared to Perpendicular. Assess Clavicles free from superimposition on lower parts. Coracoacromial Arch Demonstrated.  CR Perpendicular to midclavicle CR 15° to 30° Cephalad Evaluation Criteria Entire Scapula demonstrated. Lateral Border of Scapula free of Ribs and Lungs. Evaluation Criteria Clavicle demonstrated. Four-sided collimation. AP Axial: More of Clavicle seen above Ribs. Lateral Scapula – Scapular Y AC Joints – Pearson Method CR Perpendicular to mid-vertebral protruding border. 45 - 60 Body Rotation. CR Perpendicular to midpoint between AC joints. Body of Scapula is Perpendicular to IR. Patient in Upright Position. Hand of Unaffected shoulder is away from the body or on the shoulders to Center of AC Joints to Center of IR. avoid superimposition. 5 – 10 lbs. Sandbags in both hands to show separation of AC Joints. 72 - inches (183 cm) SID. Body of Scapula. Upper Scapula (Acromion or Coracoid). IR: Landscape or Crosswise Routine AP Bilateral with Weights AP Bilateral without Weights Lateral Scapula – (Recumbent Position) Evaluation Criteria Body of Scapula in Profile (Lateral Scapula). Scapula Routine Borders of Scapula superimposed. Routine AP Lateral Free of superimposition by Ribs. Arm elevated to demonstrate Scapular Body. AP Scapula CR to Midscapular Area. 2 inches Inferior to Coracoid Process Expose in Respiration: Deep, Slow Breathing to blur out Rib Margin. Upright, Abduct Arm and Flex Elbow. Body of Scapula is Parallel to IR.