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Elbow and humerus Xray presentation

EM

edel musngi

Transcript

ELBOW & HUMERUS

By HN Musngi

Room Preparation

Patient Identification

Lead Marking

Safety

Exposure factors

ELBOW

ELBOW

ANATOMY OF THE ELBOW

ANATOMY

  • Articulation between the distal HUMERUS and the proximal forearm (RADIUS and ULNA)

  • Classified as a SYNOVIAL joint - freely moveable or joint

  • GINGLYMUS (hinge) type of joint - permits flexion and extension movements only between the humerus and the ulna and radius

Parts of the Elbow

Major structures involve with the movement of the Elbow joints:

  • Trochlear notch of ulna and Trochlear of the humerus - join to form a fulcrom and allow flexion and extension
  • Olecron process of the ulna and olecron fossa of Humerus - helps prevent hyperextension of the forearm
  • Coronoid Process of the Ulna and Coronoid fossa of the humerus - prevents hyperflexion.

Fat Pads of the Elbow joints

AP

AP ELBOW

  • IR Size: 10x12
  • Exposure factors: 60 - 65 kvp; 5-6 mAs
  • SID: 40
  • Pt Position: Seated; elbow fully extended; entire upper limb on same horizontal plane
  • Part position: Extended elbow; supinated hand; ask patient to lean laterally as necessary for true AP ( epicondyles parallel to the IR)
  • Part Center to IR: Long axis of arm to long axis of IR; Center elbow joint to IR
  • CR: Perpenducular to IR and directed to mid elbow joint( approximately 3/4 inch distal to midepicondyles) Center of the IR
  • Collimination: on all four sides
  • patient instructions: suspend movement
  • Radiation: Gonads

Evaluation Criteria

Image:

  • Distal humerus, elbow joint space, and proximal radius and ulna

Criteria:

  • Long axis of arm should be aligned with long axis of IR.
  • No rotation, as evidenced by slight superimpositioned of proximal radius and ulna
  • humeral epicondyled in profile
  • CR and center of collimination field should be to the midelbow joint

LAT

LAT ELBOW

  • IR size: 10x12 CW
  • Technical factors: 60 to 65 Kvp; 5-6 mAs
  • Radiation safety: Gonads
  • Pt position: Seated; elbow flexed 90 degrees ; entire upper limb on same horizontal plane
  • Part position:Rotated hand and wrisat into true lateral position (thumb up); superimpose epicondyles
  • Part Center to IR: Align long axis of forearm with long axis of IR; center elbow joint on IR
  • CR: Perpendicular to IR and directed to mid-elbow joint; Center of IR
  • SID: 40
  • Collimination: On four sides to area of interest
  • PT instructions: Suspend move

Evaluation

Anatomy demonstrated:

  • Lateral projection of the distal humerus and proximal forearm
  • Olecranon process
  • Soft tissue and fat pads

Criteria:

  • Long axis of forearm aligned to long axis of IR
  • Elbow flexed 90 degrees
  • Superimposed epicondyles
  • TRUE LAT should occur, as indicated by three concentric arc of trochlear sulcus, double ridges of the capitulum and trochlea, and the trochlea notch of the ulna
  • about 1/3 of radial head should be superimposed by the coronoid process, and the olecron process should be visualized in profile
  • CR to the midpoint of the elbow joint

MED/INT OBL

MEDIAL/INTERNAL OBLIQUE

  • IR size: 10x12 LW
  • Exposure Factors: 60-65 Kvp; 5-6 mAs
  • Radiation Safety: Gonads
  • Pt position: pt seated. elbow fully extended; entire limb on same horizontal plane
  • Part position: Extend elbow, hand pronated. Palpate epicondyles to check for 45 degree internal rotation.
  • Part center to IR: long axis of the arm to long axis of the IR
  • CR: centered to the midelbow
  • SID : 40
  • Collimation: collimate on four sidesto area of interest
  • PT instruction: suspend movement.

Evaluation

Anatomy demonstrated:

  • Proximal radius and ulna
  • Medial epicondyle and trochlea

Criteria:

  • Coronoid process in profile
  • Radial head/neck superimposed over ulna

LAT/EXT OBL

LATERAL/EXTERNAL OBLIQUE ELBOW

  • IR size: 10x12 LW
  • Exposure factors: 60-65 Kvp; 5-6 mAs
  • Radiation Safety: Gonads
  • Pt position: Seated, elbow fully extended; entire limb on same horizontal plane
  • Part Position: Elevate the forearm and put support under it if needed. Elbow extended and supinate hand and rotate elbow 40-45 degrees externally; more difficult for pt, lean entire upper body laterally as needed
  • Part center to IR: Long axis of the arm to long axis of the IR
  • CR: centered to the midelbow
  • SID: 40
  • Collimation: Collimate on four sides
  • Pt instructions: suspend movement

Evaluation

Anatomy demonstrated:

  • Oblique projection of distal humerus, proximal radius and ulna
  • lateral epicondyle and capitulum

Criteria:

  • Long axis of arm should be aligned with side of the border of the IR
  • Correct 45 degrees LAT OBL should allow visualization of radial head, neck, and tuberosity free of superimposition by ulna
  • humeral epicondyles and capitulum should be in profile
  • Cr and center collimation field should be to midelbow joint

PATHOLOGIES

OF THE ELBOW JOINT

PATHOLOGIES

OSTEOMYLITIS

Osteomylitis

  • Local and generalized infection of bone or bone marrow that may be caused by bacteria introduced by trauma or surgery.

  • commonly caused by straphylococcus bacteria, types of germs commonly found in skin, or in the nose of even healthy individuals

  • S/S :
  • Fever,
  • swelling, warmth and redness over the area of infection,
  • pain in the area of infection
  • fatigue

Arthritis

Arthritis

  • The swelling and tenderness of one or more joints.

  • The main symptoms are joint pain and stiffness

  • 2 common types are Rheumatoid Arthritis and Osteoarthritis

  • Osteoarthritis is noninflamatory joint disease that causes the cartilage to breakdown. Considered a normal part of aging process

  • Rheumatoid Arthritis is inflamatory chronic disease in which your immune system attacks the joints, starting with your joint lining.

Bursitis

Bursitis

  • Inflammation of the bursae or fluid-filled sacs that cushion the bones, tendons and muscles near joints

  • Common cause is repeated pressure on an area or overuse of a joint

Humerus

HUMERUS

ANATOMY

ANATOMY OF HUMERUS

  • Classified as long bone
  • largest and longest bone of the upper limb
  • Articulates proximally with scapulla at the shoulder and distally with the radius and ulna at the elbow joint
  • length on an adult equals approximately 1/5 of the body height
  • Consist of proximal extremity, shaft and distal extremity

AP

AP HUMERUS

  • IR Size: 14x17 LW B
  • Exposure Factors: 65 - 70 Kvp; 5.5 - 6 mAs
  • Anatomic Markers: placed laterally
  • Radiation safety: Gonads
  • Pt Position: Erect or supine: shoulder and humerus against bucky with hand and forearm extended
  • Part position:hand supinated until epicondyles are parallel to IR
  • Part Center to IR: Long axis of humerus to long axis of IR; shoulder and elbow joints equal distance from IR borders
  • CR: Perpendicular to IR and directed to midpoint of humerus; Center of IR
  • SID: 40
  • Collimination: include the shoulder joint and 1" of the proximal forearm
  • PT Instructions: Suspend Respiration

Evaluation

Anatomy demonstrated:

  • Entire humerus
  • shoulder joint
  • Elbow joint

Criteria:

  • Long axis of humerus aligned to long axis of IR
  • No rotation, medial and lateral epicondyles seen in profile, greater tubercle in profile laterally
  • humeral head and glenoid cavity demonstrated

LAT

Lateral Humerus

  • IR size: 14x17 LW
  • Exposure factors: 65 - 70 Kvp; 5.5 - 6 mAs
  • Anatomic markers: placed laterally
  • Radiation Safety: Gonads
  • Pt position: Erect or Supine; shoulder and humerus against bucky with hand forearm extended
  • Part position: Arm internally rotated until true LAT; Epicondyles perpendicular to IR
  • Part center to IR: Long axis of humerus to long axis of IR; shoulder and elbow joints equal distance from IR borders
  • CR: Perpendicular to IR and directed to midpoint of humerus; Center of IR
  • SID: 40"
  • Collimination: include shoulder joint and 1" of proximal foream
  • Pt instructions: Suspend Respiration

Evaluation

Anatomy Demonstrated:

  • Lateral projection of entire humerus
  • Shoulder joint
  • Elbow joint

Criteria:

  • Long axis of humerus aligned to long axis of IR
  • True LAT, epicondyles are superimposed
  • Lesser tubercle shown in profile medially, partially superimposed by lower portion of glenoid cavity
  • CR to the midpoint of the humerus

PATHOLOGIES

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