Upper Limb –wrist_ forearm_ elbow

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					Upper Limb –Part 2
Wrist, Forearm, Elbow

Denise Ogilvie
July 2007
Anatomy
   Bones of wrist:
   Trapezium
   Scaphoid
   Lunate
   Triquetrum
   Pisiform
   Hamate
   Capitate
   Trapezoid
PA Wrist
   Patient Position:axilla in
    contact with table
   Shoulder,elbow, wrist in
    same plane
   Forearm on table, elbow
    90°
   Hand, forearm parallel to
    long axis of IR fingers
    relaxed
   CR: straight
   CP: midway between radial
    & ulna styloid process
PA Wrist-critique
   Clearly shows:
   Distal radius & ulna,
    proximal half of
    metacarpals
   No rotation
   Soft tissue bony
    trabeculation
Oblique Wrist
   PP: same position as
    PA, then raise lateral
    aspect of wrist 45°,
    resting palm of hand on
    sponge
   CR: straight
   CP: midway between
    styloid processes
Oblique Wrist - critique
   Clearly shows:
   Trapezium & distal
    half of scaphoid
   Distal radius & ulna,
    proximal half
    metacarpals
   Slight overlap of distal
    radius & ulna
   Soft tissue & bony
    trabeculation
Lateral Wrist
   PP: rotate hand further
    laterally till thumb
    uppermost. Slight tilt
    back
   CR:straight
   CP: radial styloid
    process
Lateral Wrist - critique
   Clearly shows:
   Lateral of proximal
    metacarpals, carpals &
    distal radius & ulna
   Superimposed radius &
    ulna,metacrpals,carpals
   Increase exposure
    slightly to compensate
    for extra thickness
Scaphoid
   PP: PA wrist, deviate
    hand toward ulna
   CR: 30°toward
    elbow(p124 note)         30°
   CP: over the scaphoid
   Scaphoid Series-
   PA, oblique, lateral,
    PA with ulna deviation
    & 30°angle toward
    elbow
Scaphoid - critique
   Scaphoid clear of
    overlapping bones
   No rotation of wrist
   Elongated scaphoid
   Soft tissue & bony
    trabeculation
AP Forearm
   PP:seated at end of table
   Hand supinated, elbow
    extended, both joints on IR
   Lean patient slightly
    laterally to roll arm into
    true supinated position
   CR: Straight
   CP:midpoint of forearm
   SID:100cm
   IR: 24 x 30 crosswise or 30
    x 40
AP Forearm - Critique
   Epicondyles of
    humerus parallel to IR
   Show elbow, wrist and
    radius & ulna not
    overlapping
   Some superimposition
    of radial head with
    proximal ulna
Lateral Forearm
   Flex elbow 90°
   Rotate arm into
    lateral position so
    thumb is uppermost
    and ulna aspect
    against IR
   CR: straight
   CP:mid shaft radius
Lateral Forearm - critique
   Wrist & distal humerus
   Radius & ulna
    superimposed at distal
    end
   Radial tuberosity
    facing anteriorly
   Superimposed humeral
    epicondyles
AP Elbow
   Elbow extended, hand
    supinated
   Lean patient laterally so
    epicondyles parallel to IR
   CR: straight
   CP:to the elbow joint
   SID:100cm
   IR: 24 x 30 detail or 18 x
    24 detail
    AP Elbow - critique
   Joint, proximal forearm,
    distal humerus
   Radial head, neck,
    tuberosity slightly
    superimposed over
    proximal ulna
   Elbow joint open
   No rotation of epicondyles
Lateral Elbow
   PP:elbow flexed 90°,
    humerus & forearm
    in same plain
   Hand can be slightly
    elevated,lateral
    position
   CR: straight
   CP: lateral
    epicondyle of
    humerus
Lateral Elbow - critique
   Humeral epicondyles
    superimposed
   Flexed elbow-shows
    fat pad & olecranon in
    profile
   Radial tuberosity
    anterior
   Open joint
External Oblique Elbow
   Arm extended as in AP
    then further externally
    (laterally) so posterior
    surface at 45° to IR
   Thumb & finger
    touching table
   CR:Straight
   CP:elbow joint
External Oblique Elbow - critique
   Radial head, neck,
    tuberosity free of ulna
   Capitulum
   Open joint
Internal Oblique Elbow
   Arm extended as for
    AP.
   Medially rotate hand &
    pronate-anterior
    surface at 45° to IR
   CR: Straight
   CP: mid joint
Internal Oblique Elbow - critique
   Coronoid process in
    profile
   Trochlea
   Ulna superimposed by
    radial head and neck
   Olecranon seen in
    olecranon process
Radial Head
   Elbow in true lateral
    position                45°
   CR: 45° up humerus
   CP: radial head
Radial Head - critique
   Radial head and neck
    away from ulna
   Humeral epicondyle
    distorted
   Radial tuberosity
    facing posteriorly
   Open joint between
    capitulum and radial
    head
References
   Frank, E, Long, B, Smith, B, Merrill’s atlas of radiographic
    positioning & procedures, 11th edn, vol 1

   Windle, R, Projections upper limb, 2006

				
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