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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. 
  • 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



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.

medical imaging of the upper limb1
Medical Imaging of the Upper Limb
  • Radiological examinations of the upper limb focus mainly on bony structures, because muscles, tendons, and nerves are not well visualized.
  • 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.
  • Clavicle
  • Shoulder Dislocation
  • Humerus
  • Elbow
  • Forearm
  • Distal Radius
  • Scaphoid
shoulder dislocations
Shoulder dislocations
  • Most commonly dislocated large joint
  • Anterior in 97%
  • Mechanism: force on abducted/externally rotated shoulder
humerus fractures
Fracture of Surgical Neck of Humerus

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

elbow trauma
Elbow trauma
  • Fractures
  • Dislocations
  • Ligament sprains
  • Look for compartment syndrome
  • Rule out neurovascular injury

Fall on Out stretched Hand

This is more common in older person

scaphoid fracture anatomy
Scaphoid Fracture: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 fracture:Radiographs
  • AP
  • Lateral
  • Oblique
  • Scaphoid view
  • **Normal plain films don’t rule out a scaphoid fracture