Upper limb

• describe how to do an AP hand xray?

  • seated - affected side - near table
  • forearm - pronated - palmer aspect - contact with IR
  • fingers - extended and seperated
  • radial and ulnar styloid processes - equidistant to IR
• describe the centering point for AP/OB hand?

  • vertical central ray over head of 3rd metacarpal
• how many degrees is the hand externally rotated for a OB hand xray?

  • 45
• what does the correct area of interest of hand xray include?

  • distal radioulnar joint proximally
  • tips of distal phalanges - distally
  • soft tissue borders
• what does the correct positioning of a hand xray need to include?

  • symmetrical appearance of concavities to either side of phalanges and metacarpals indicating no evidence of rotation
  • fingers extended and seperated showing clear IPJ and MCPJ
  • thumb - lateral position
  • ulnar styloid process seen
• describe how to take finger xray?

  • seated - affected side nearest table
  • forarm pronated - plamer aspect - contact with IR
  • fingers - fully extended and evenly seperated
  • include adjacent digit for identification
• what is the centering point for finger xray?

  • proximal IPJ of affected finger
• describe how to take a lateral index/middle finger xray?

  • patient seated - affected side nearest table
  • abduct arm - internally rotate hand - lateral aspect contact with IR
  • index finger fully extended - middle finger slightly flexed
  • remaining fingers - flexed - held in place by thumb
• describe how to take a lateral ring and little finger xray?

  • patient seated - affected side nearest table
  • medial aspect - hand - contact with IR
  • ring and little finger - fully extended - remaining fingers flexed into palm of hand and held in place by thumb
• describe the correct area of interest for finger xray?

  • distal third of MC of affected digit proximally
  • tips of distal phalanx of affected digit, distally
  • soft tissue borders
• describe how to do a ap thumb xray?

  • patient seated - away from table - arm extended posteriorly
  • arm internally rotated - 1st MC - parallel to IR - posterior aspect in contact with
  • clear MCPJ and IPJ spaxe
  • hand rotated - 2nd and 5th MC are clear of thumb
• what is the centering point for thumb xray?

  • 1st MCPJ
• describe how to do a lateral thumb xray?

  • patient seated - affected side nearest table
  • abduct arm - internally rotate hand - placr palmer aspect in contact with IR
  • internally rotate hand further - ensure lateral aspect of thumb in contact with IR
• what is the correct area of interest for thumb xray?

  • injury distal - distal 1/3 of 1st MC proximally
  • injury proximal - entire 1st MC and carpo-metacarpal joint - proximally
  • tips of distal phalanx distally
  • soft tissue borders
• describe how to do a PA wrist xray?

  • patient seated - affected side nearest table
  • arm abducted and flexed to position anterior aspect of wrist in contact with IR
  • fingers flexed
  • radial and ulnar styloid processes adjusted - equidistant from ir
• what is the centering point for wrist xray?

  • between radial and ulnar styloid processes on posterior aspect
• describe how to do lateral wirst xray?

  • from PA position - externally rotate forearm - medial aspect in contact with IR
  • elbow flexed - 90 degrees
  • radial and ulnar styloid processes- superimposed
  • extend fingers and thumb - maintain position
• what is the correct area of interest for a wrist xray?

  • distal 1/3 of radius and ulna proximally
  • proximal 2/3 of MC , distally
  • medial and lateral soft tissue borders
• what is the 4 views for scaphoid xray?

  • PA with ulnar deviation
  • AP oblique
  • PA oblique
• how to do PA ulnar deviation?

  • same as pa wrist
  • abduct hand towards ulna
• how to do anterior oblique scaphoid xray?

  • from PA position - externally rotate hand through 45 degrees
• what is the centering point for PA ulnar deviation and Anterior oblique scaphoid xray?

  • midpoint between radial and ulnar styloid processes
• how to do a posterior oblique scaphoid xray?

  • from AO powsition - externally rotate hand 90 degrees
• how to do lateral scaphoid xray?

  • same as lateral wrist
• what is the centering point for Posterior oblique scaphoid xray?

  • to ulnar styloid processs
• what is the centering point for lateral scaphoid xray?

  • radial styloid process
• what is the area of interest for scaphoid xray?

  • distal end of radius and ulna proximally
  • proximal end of MC distally
  • soft tissue borders
• how to do AP forearm xray?

  • patient seated - affected side nearest table
  • arm abducted and extended - posterior aspect in contact with IR
  • shoulder, elbow and wirst - same plane
  • radial and ulnar styloid processes and medial and lateral epicondyles of humerus equidistance from IR
• how to do lateral forearm xray?

  • elbow flexed 90 degrees
  • humerus internally rotated 90 degrees - medial aspect - in contact with IR
  • radial and ulnar styloid processes - superimposed - medial and lateral humerus epicondyles - superimposed
  • extend fingers and thumb
• what is the centering point for forearm?

  • between elbow and wrist joints
• what is the area of interest for forearm xray?

  • entire radius and ulnar including elbow joint proximally and wrist joint distally
  • soft tissue borders
• describe how to position for an AP elbow?

  • seated - affected side closest to table
  • arm fully extended - posterior asepct of elbow in contact with ir
  • shoulder, elbow,wrist - same plane - lateral and medical epicondyles - equidistant from IR
• what is the centering point for an elbow xray?

  • vertical central ray - centre 2.5cm belwo mid point of line joining epicondyles on anterior surface
• what is the area of interest for an elbow xray?

  • elbow joint including distal 1/3 of humerus proximally
  • proximal 1/3 of radius and ulna distally
  • medial and lateral soft tissue borders
• what is the correct positioning for AP elbow?

  • elbow joint aligned to centre of the image
  • evidence of clear joint space between radial head and capitulum
  • evidence of alignment of trochlea with trochlear notch of ulna
  • no evidence of foreshortening of humerus, radius and ulna
• what is the correct positioning for lateral elbow?

  • evidence of superimposition of trochlea and capitulum of humeurs
  • evidence of clear joint space ebtween trochlea notch of ulna and trochlea of humerus
  • radial head aligned to capitulum of humeurs
  • overlap of proximal radius and ulna
• describe how to do an AP humerus xray?

  • patients stands facing xray tube
  • affected arm is abducted, extended and externally rotated until posterior aspect is in contact with IR
  • epiconydles - adjusted - equidistant from IR
  • patient head rotated away from the side being imaged
• describe the centering point for AP humerus?

  • horizontal beam - midway between shoulder and elbow joint on anterior surface
• describe how to do a lateral humerus?

  • patient stands facing IR - affected arm - abducted - flexed to 90 degrees and internally rotated to bring medial aspect close to patients torso
  • lateral aspect of humer - placed in contact with IR - moved posteriorly - ensure clear of rib cage
  • humerus adjusted - ensure medial and lateral epicondyles are superimposed
• what is the centering point for lateral humerus xray?

  • using horizontal beam - centre midway between shoulder and elbow joint on medial surface of the humerus