Medical imaging of the upper limb
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Medical Imaging of the Upper Limb. X rays. How to read X -Ray. X rays. When looking at a radiograph, remember that it is a 2-dimensional representation of a 3-dimensional object. Height and width are maintained, but depth is lost.

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X rays
X rays

  • When looking at a radiograph, remember that it is a 2-dimensional representation of a 3-dimensional object.

  • Height and width are maintained, but depth is lost.

  • The left side of the film represents the right side of the individual, and vice versa. 


Steps
Steps

  • 1.Check the patient‘s name

  • 2. Read the date of the radiograph.

  • 3. Look for markers: 'L' for Left, 'R' for Right, 'PA' for posteroanterior, 'AP' for anteroposterior.

  • 4.Density

  • 5. Note the technical quality of film.

    a. Exposure b.Rotation


Densities

Densities

The big two densities are:

(1) WHITE - Bone

(2) BLACK - Air

The others are:

(3) DARK GREY- Fat

(4) GREY- Soft tissue/water

And if anything Man-made is on the film, it is:

(5) BRIGHT WHITE - Man-made


Techniques projection

Techniques - Projection

P-A (relation of x-ray beam to patient)


Routine chest radiograph

PA view – film is placed anteriorly, X-ray beam passes from posterior aspect to anterior side.


The standard view of the chest is the posteroanterior radiograph, or "PA chest." 

This film is taken with the patient upright, in full inspiration (breathed in all the way), and the x-ray beam radiating horizontally 6 feet away from the film.


AP view

An AP film, enlarges the shadow of the heart and makes the posterior ribs appear more horizontal.


Usually obtained with a portable x-ray machine from very sick patients, those unable to stand, and infants. 

AP radiographs are generally taken at shorter distance from the film compared to PA radiographs.

The farther away the x-ray source is from the film, the sharper and less magnified the image

Since AP radigraphs are taken from shorter distances, they appear more magnified and less sharp compared to standard PA films.


Lateral

Lateral sick patients, those unable to stand, and infants. 


Medical imaging of the upper limb1
Medical Imaging of the Upper Limb sick patients, those unable to stand, and infants. 

  • Radiological examinations of the upper limb focus mainly on bony structures, because muscles, tendons, and nerves are not well visualized.


Important
Important sick patients, those unable to stand, and infants. 

  • When examining radiographs of the upper limb, it is essential to know the median times of appearance of postnatal ossification centers and when fusion of epiphyses is radiographically complete in males and females.

  • Without such knowledge, an epiphysial line could be mistaken for a fracture.


Topics
Topics sick patients, those unable to stand, and infants. 

  • Clavicle

  • Shoulder Dislocation

  • Humerus

  • Elbow

  • Forearm

  • Distal Radius

  • Scaphoid


Normal axillary view sick patients, those unable to stand, and infants. 


Clavicle
CLAVICLE sick patients, those unable to stand, and infants. 


Junction of Medial 2/3 sick patients, those unable to stand, and infants. rd and Lateral 1/3rd


Clavicle fracture
Clavicle fracture sick patients, those unable to stand, and infants. 


Shoulder dislocations
Shoulder dislocations sick patients, those unable to stand, and infants. 

  • Most commonly dislocated large joint

  • Anterior in 97%

  • Mechanism: force on abducted/externally rotated shoulder


Anterior shoulder dislocation sick patients, those unable to stand, and infants. 


Humerus
HUMERUS sick patients, those unable to stand, and infants. 


Humerus fractures

Fracture of Surgical Neck of Humerus sick patients, those unable to stand, and infants. 

Damage to Axillary nerve and Post. Circumflex humoral Artery

Fracture of Mid Shaft Humerus

Damage to Radial Nerve and Deep artery of Arm

Humerus Fractures

  • Fracture of Medial Epicondyle

  • Damage to Ulnar Nerve

Fracture of Supracondylar part:

Damage to median nerve and Brachial artery


Proximal humerus fracture
Proximal sick patients, those unable to stand, and infants. Humerus Fracture


Proximal humerus fractures
Proximal sick patients, those unable to stand, and infants. Humerus Fractures


Supracondylar fracture
Supracondylar sick patients, those unable to stand, and infants.  Fracture: 


Fracture of mid shaft humerus
Fracture of Mid Shaft sick patients, those unable to stand, and infants. Humerus


Elbow trauma
Elbow trauma sick patients, those unable to stand, and infants. 

  • Fractures

  • Dislocations

  • Ligament sprains

  • Look for compartment syndrome

  • Rule out neurovascular injury


Radius and ulna
Radius and ulna sick patients, those unable to stand, and infants. 


Fall on Out stretched Hand sick patients, those unable to stand, and infants. 

This is more common in older person


Fracture of
Fracture of------- sick patients, those unable to stand, and infants. 


Wrist
Wrist sick patients, those unable to stand, and infants. 


Scaphoid fracture anatomy
Scaphoid Fracture: sick patients, those unable to stand, and infants. Anatomy

  • Blood supplied from distal pole

  • The more proximal the fracture, the greater the risk of avascular necrosis (AVN) or delayed union


Scaphoid fracture radiographs
Scaphoid sick patients, those unable to stand, and infants.  fracture:Radiographs

  • AP

  • Lateral

  • Oblique

  • Scaphoid view

  • **Normal plain films don’t rule out a scaphoid fracture


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