5.Elbow.pptx it is a ppt of a radiographic imaging

It is a ppt of a forearm in radiographic xrays

1. Elbow

2. Contents  Related radiological anatomy  AP- fully extended, partially flexed  AP oblique- external and internal rotation  Lateral  Acute flexion (jones method)  Trauma axial lateral (coyle method)  Radial head lateral

3. Synovial joint Hinge joint Humero-ulnar joint Radio-humeral joint Radio- ulnar joint Humero-ulnar & radio-humeral joint: flexion &extension Radio- ulnar joint: Pronation & supination Anatomy

4. MUSCLES FLEXION: Brachialis muscle Brachioradialis muscle Biceps brachii EXTENSION Triceps brachii Extensor carpi radialis longus Extensor carpi ulnaris Anconeus PRONATION Pronator teres Pronator quadratus SUPINATION Supinator

5. BLOOD SUPPLY OF THE ELBOW ARTERIES Superior & inferior ulnar collateral branches- brachial artery Radial & middle collateral branches of brachii artery Anterior & posterior ulnar recurrent branches- ulnar artery Radial recurrent branch of radial artery Interosseous recurrent branch of common Interosseous artery VEINS: Radial, ulnar and brachial veins

6. NERVES Median nerve: starts from brachial plexus; runs down alongside the brachial artery. Descends into the cubital fossa. It gives off branches that serve the elbow joint and continues down to the forearm Ulnar nerve: starts from the brachial plexus, passes medial to the brachial artery continues posterior to the medial epicondyle of the humerus, and enters the forearm. Radial nerve:  starts from the brachial plexus and runs posterior to the brachial artery and anterior to the long head of the triceps. It curves around the shaft of the humerus and continues toward the cubital fossa. Musculocutaneous nerve: runs from the brachial plexus through the anterior part of the arm.

7. INDICATIONS trauma/ pathology- lateral, AP Elbow cannot be extended- lateral, AP, axial Trauma/ pathology head of the radius- AP, lateral with rotation of radius, axial Proximal radioulnar joint- lateral, AP-oblique Supracondylar fracture- AP( modified),

8. PREPARATION: remove all radio opaque things CASSETTE SIZE: 10 * 8 FACTORS: kVp - 45-50 mAs- 5-8 PROTECTION: lead approan.

9. ANTERO-POSTERIOR-Fully Extented POSITIONING OF THE PATIENT: From the lateral position the arm is laterally rotated, extended fully . Palm of the hand facing upwards. Cassette kept under the posterior aspect of the elbow. Adjust to make medial and lateral epicondyle equidistant from the film.

10. DIRECTION AND CENTRING : the vertical central ray is directed through the joint space 2.5 cm distal to the mid-point between the epicondyles of the humerus.

11. EVALUATION CRITERIA: Both the epicondyles should be equidistant from each other. Elbow joint should be in the center of the film. STRUCTURE SHOWN: Humerus, Radius and ulna, trochlea, coronoid process, Capitulum, lateral and medial epicondyle.

12. PARTIAL FLEXION- modified AP POSITIONING OF PATIENT: when the patient cannot fully extend the elbow. if the main area of interest is the upper ends of the radius and ulna, the post. aspect of the forearm should be in contact with film. If area of interest is lower end of humerus, then post. aspect of upper arm should be contact with film.

13. DIRECTION AND CENTRING OF XRAY: The central ray is directed to the midline of the forearm 2.5cm distal to the crease of elbow. The central ray is directed to a point midway between the epicondyles of the humerus.

14. EVALUATION CRITERIA: Distal humerus, including epicondyles should be demonstrated with sufficient density on humerus parellel projection. On forearm parellel projection, proximal radius and ulna should be well visualized. STRUCTURE SHOWN: Distal humerus is well visualized on humerus parellel projection and radius and ulna on forearm parellel projection. Structure in elbow joint region are partially obstructed, depending on the amount of elbow flexion possible.

15. ELBOW Oblique- medial rotation POSITIONING OF THE PATIENT: As for the basic AP projection with the hand resting on the table. Keeping the upper arm and elbow in the same position, forearm is pronated with palm resting on the table. The upper arm is further medially rotated till palm facing the trunk.

16. DIRECTION AND CENTRING: The vertical central ray is directed to the palpable lateral condyles of the humerus. STRUCTURE SHOWN: MEDIAL ROTATION- oblique view of the distal humerus and proximal radius and ulna is visible. EVALUATION CRITERIA: Optimal density and contrast with no motion should visualize soft tissue detail and sharp, bony cortical margins with clear, bony trabecular markings.

17. ELBOW Oblique- lateral rotation POSITIONING OF THE PATIENT: The patient is positioned for an AP projection of the elbow joint. The cassette is placed under the elbow joint. The humerus is then rotated laterally until the line between the epicondyles is approximately 20 ˚ to the cassette.

18. DIRECTION AND CENTRING OF XRAY BEAM: The vertical central ray is directed 2.5 cm distal to the midpoint between the epicondyles.

19. STRUCTURE SHOWN: LATERAL ROTATION- oblique view of the distal humerus and proximal radius and ulna is visible. EVALUATION CRITERIA: Optimal density and contrast with no motion should visualize soft tissue detail and sharp, bony cortical margins with clear, bony trabecular markings.

20. Lateral - POSITIONING OF THE PATIENT: Patient seated at the side of the table with arm abducted, elbow flexed to 90˚and palm of the hand 90˚to the table. Shoulder should be at the same horizontal level of elbow and wrist . Elbow of affected area in the center of the cassette.

21. DIRECTION AND CENTRING: Vertical beam is directed to the lateral epicondyle of the humerus.

22. JONES VIEW- Acute flexion POSITIONING OF THE PATIENT: With the elbow fully flexed and the palm of the hand facing the shoulder. Posterior aspect of the upper arm rest on the film with the arm parallel to the long axis of the film.

23. DIRECTION AND CENTRING OF X RAY BEAM: For lower end of humerus and olecranon process of ulna direct the vertical central ray to a point 5cm distal to the olecranon process. For proximal end of radius and ulna, direct central ray at right angles to the forearm, centering to a point 5cm distal to the olecranon process.

24. EVALUATION CRITERIA: Four sided collimation borders should be visible with CR and center of collimation field midway between epicondyles. Forearm and should be superimposed, medial and lateral epicondyles and parts of troclea, capitulum, and olecranon process all should be in profile. Proximal ulna and radius including outline of radial head and neck should be visible through superimposed distal humerus.

25. STRUCTURE SHOWN: Patients upper arm is contact to visualize lower end of the humerus and olecranon process of ulna, and for forearm to be in contact with the film if upper ends of radius and ulna are being examined

26. TRAUMA AXIAL LATERAL- (coyle method) POSITIONING OF THE PATIENT: For the lateral projection of the elbow a film can be supported between the patients trunk and elbow with medial side of the elbow in contact with the film.

27. DIRECTION AND CENTRING OF X RAY: It will be necessary to angle the x ray tube to direct the central ray perpendicular to the shaft of the humerus, centering to the lateral epicondyle.

28. EVALUATION CRITERIA: Joint space between radial head and capitulum should be open and clear. The radial head, neck and tuberosity should be proper and free of super imposition. The joint space between coronoid process and trochlea should be open and clear

29. Lateral head of Radius Keeping the upper arm and elbow in the same position the forearm- pronated Palm resting on the table. Keeping the upper arm & elbow in the same hand is further medially rotated until the palm of the hand is facing away from the trunk. Beam directed to the palpable lateral epicondyle of the humerus

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