X-Ray of the Humerus - PDF

Humerus – shaft Dr khudhir ahmed aljoboury Board in diagnostic radiology Alkitab university Simple anatomy Shaft of the humerus ,is apart extend from shoulder to the elbow joint , Antero-posterior – supine Clinical indication When movement of the patient’s arm is restricted, mean trauma position...

Humerus – shaft Dr khudhir ahmed aljoboury Board in diagnostic radiology Alkitab university Simple anatomy Shaft of the humerus ,is apart extend from shoulder to the elbow joint , Antero-posterior – supine Clinical indication When movement of the patient’s arm is restricted, mean trauma position of patient and cassette • The patient lies supine on the X-ray table, • The cassette is positioned under the affected limb • The arm is slightly abducted and the elbow joint is fully extended, • The forearm is immobilized using a sandbag. direction and centring of the X-ray beam • The vertical central ray is centred to a point midway between the shoulder and elbow joints ssential image characteristics • Both joints should be seen on the image. • The elbow joint and the shaft of humerus and shoulder Humerus – shaft Antero-posterior – erect Its a routine exam Position of patient and cassette are erect • The cassette is placed in an erect cassette holder. • The patient sits or stands with their back in contact with the cassette. • The patient is rotated towards the affected side to bring the posterior aspect of the shoulder, upper arm and elbow into contact with the cassette. •. Direction and centring of the X-ray beam • The central ray is directed at right-angles to the shaft of the humerus mean horizontal and centred midway between the shoulder and elbow joints. Lateral – erect Clinical indication . If the arm is immobilized in order to obtain a true lateral projection, i.e. one that is at rightangles to the antero-posterior, Position of patient and cassette • The cassette is placed in an erect cassette holder. • From the anterior position, the patient is rotated through 90 degrees until the lateral aspect of the injured arm is in contact with the cassette. Direction and centring of the X-ray beam • The horizontal central ray is directed at rightangles to the shaft of the humerus and centred midway between the shoulder and elbow joint. Horizontal x ray beam midway between the shoulder and elbow joint. Essential image characteristics • shaft of the humerus . Glenohumeral joint Dr khudhir ahmed aljoboury .alkitab university the glenohumeral joint is a ball and socket joint that includes articulation between the glenoid of the scapula and the proximal humerus Antero-posterior – erect To demonstrate the glenoid cavity and glenohumeral joint space, the body of the scapula should be parallel to the cassette so that the glenoid cavity is at right-angles to the cassette. The horizontal central ray can now pass through the joint space Position of patient and cassette • The patient stands with the affected shoulder against the cassette and is rotated approximately 30 degrees to bring the plane of the glenoid fossa perpendicular to the cassette. • The arm is supinated and slightly abducted away from the body. • The cassette is positioned so that its upper border is at least 5 cm above the shoulder Direction and centring of the X-ray beam • The horizontal central ray is centred to the palpable coracoid process of the scapula. • The primary beam is collimated to an 18 24-cm cassette. Essential image characteristics • The image should demonstrate clearly the joint space between the head of the humerus and the glenoid cavity. • The image should demonstrate the head, the greater and lesser tuberosities of the humerus, together with the lateral aspect of the scapula and the distal end of the clavicle. Antero-posterior – supine (trauma) There are occasions when the patient cannot be examined in the erect position, e.g. due to multiple trauma or immobility Position of patient and cassette • The patient lies supine on the trolley, and the unaffected shoulder is raised slightly to bring the scapula on the affected side parallel to the cassette. • The arm is partially abducted and supinated • The cassette is positioned under the patient so that its upper border is at least 5 cm above the shoulder , then cassette tray under the trolley can be used. Direction and centring of the X-ray beam • The vertical central ray is centred to the palpable coracoid process of the scapula. • It may be necessary to direct the primary beam caudally in order to project the head of the humerus . Essential image characteristics • The subacromial space should be visible. • The proximal end of the humerus, the lateral aspect of the scapula and the whole of the clavicle need to be included. • The greater tuberosity will be in profile when the arm is supinated. • Lateral oblique ‘Y’ projection (alternate) Clinical indicatin , dislocation/fracture proximal humerus If the arm is immobilized and no abduction of the arm is possible, then a lateral oblique ‘Y’ projection is taken using a 24 30-cm cassette in an erect cassette holder Position of patient and cassette • The patient stands or sits with the lateral aspect of the injured arm against an erect cassette • The unaffected shoulder is raised to make the angle between the trunk and cassette approximately 60 degrees. • The cassette is positioned to include the superior border of the scapula. Direction and centring of the X-ray beam • The horizontal central ray is directed towards the medial border of the scapula and centred to the head of the humerus. Essential image characteristics • 1-scapula 2-head of humerus Glenoid cavity Recurrent dislocation Mean repated dislocation of the head of humerus from glenoid cavity the following projection used in recurrent dislocation . 1• antero-posterior with the humerus lateral; • 2 antero-posterior with the humerus oblique; • 3 antero-posterior (modified) – Stryker’s; • 4infero-superior. Recurrent dislocation Antero-posterior (modified) – Stryker’s This position will demonstrate a deformity of the humeral head. Position of patient and cassette • The patient lies supine on the X-ray table. • The arm of the affected side is extended fully and the elbow then flexed to allow the hand to rest on the patient’s head. • The line joining the epicondyles of the humerus remains parallel to the tabletop. • The centre of the cassette is positioned 2.5 cm superior to the head of the humerus. Direction and centring of the X-ray beam • The central ray is angled 10 degrees cranially and directed through the centre of the axilla to the head of the humerus and the centre of the cassette. Antero-posterior (modified) – Stryker’s Thank you Ministry of Higher Education and Scientific Research Al-Kitab University College of Medical Techniques Radiology and Ultrasonic .Dept second stage Radiographic Techniques AP PROJECTION—EXTERNAL ROTATION SHOULDER (NONTRAUMA) Dr khudhir ahmed aljobory board in diagnostic radiology Simple radilogical anatomy First ,,bonny compartment which include 1-clavicle bone ,which consisting of three parts ,lateral part ,middle part ,,medial part ,,the lateral articulate with acromion which is part of scapula forming acromioclavicular joint ,and the medial third articulate with the sternum forming sternoclavicular joint , Second ,the scapula bone , Its triangular bonny compartment ,located posterior to the chest wall and main parts of it 1. Acromion which located at superior anterior aspect of the scapula 2. Glenoid cavity 3. Coracoid process ,project from the upper margin of scapula , Third ,,the hemerus bone which consisting of , Head 2. Neck 3. Greater tubercle 4. Lesser tubercle 1. AP PROJECTION—EXTERNAL ROTATION SHOULDER (NONTRAUMA) Clinical Indications Fractures or dislocations of proximal humerus and shoulder girdle • Calcium deposits in muscles, tendons, or bursal structures • Degenerative conditions including osteoporosis and osteoarthritis Technical Factors • Minimum SID—40 inches (102 cm) • IR size—24 × 30 cm (10 × 12 inches), crosswise (or lengthwise to show more of humerus if injury includes proximal half of humerus) • Grid • Analog—70 to 75 kV range • Digital systems—75 to 85 kV range Shielding Shield all radiosensitive tissues outside region of interest. Patient Position Perform radiograph with the patient in an erect or supine position. (The erect position is usually less painful for patient, if condition allows.) Rotate body slightly toward affected side if necessary to place shoulder in contact with IR or tabletop. Part Position • Position patient to center scapulohumeral joint to center of IR. • Abduct extended arm slightly; externally rotate arm (supinate hand) until epicondyles of distal humerus are parallel to IR. External rotation—AP. CR CR perpendicular to IR, directed to 1 inch (2.5 cm) inferior to coracoid process Recommended Collimation Collimate on four sides, with lateral and upper borders adjusted to soft tissue margins. Respiration Suspend respiration during exposure. Note: The coracoid process may be difficult to palpate directly on most patients, but it can be approximated; it is about(2 cm) inferior to the lateral portion of the more readily palpated clavicle. Evaluation Criteria Anatomy Demonstrated: • AP projection of proximal humerus and lateral two-thirds of clavicle and upper scapula, including relationship of the humeral head to the glenoid cavity. Position: • Full external rotation is evidenced by greater tubercle visualized in full profile on the lateral aspect of the proximal humerus. • Lesser tubercle is superimposed over humeral head. • Collimation to area of interest. Exposure: • Optimal density (brightness) and contrast with no motion demonstrate clear, sharp bony trabecular markings with soft tissue detail visible for possible calcium deposits. Fracture clavicle Fracture of the head of humerus head of humerus dislocation Proximal humerus fracture Fracture scapula Supraspinatus muscle calcification Which bone is fractured ? Which bone is fractured ? Which bone is fractured ? Thank u