Medical Imaging of the Upper Limb

1. Medical Imaging of the Upper Limb X rays

2. How to read X -Ray

3. 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. 

4. 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

5. 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

6. Techniques - Projection P-A (relation of x-ray beam to patient)

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

8. 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.

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

10. 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.

11. Lateral

12. 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.

13. Important • 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.

15. Topics • Clavicle • Shoulder Dislocation • Humerus • Elbow • Forearm • Distal Radius • Scaphoid

17. Normal axillary view

18. CLAVICLE

19. Junction of Medial 2/3rd and Lateral 1/3rd

20. Clavicle fracture

21. Shoulder dislocations • Most commonly dislocated large joint • Anterior in 97% • Mechanism: force on abducted/externally rotated shoulder

22. Anterior shoulder dislocation

23. HUMERUS

24. 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

25. Proximal Humerus Fracture

26. Proximal Humerus Fractures

27. Supracondylar Fracture: 

28. Fracture of Mid Shaft Humerus

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

32. Radius and ulna

34. Fall on Out stretched Hand This is more common in older person

36. Fracture of-------

37. Wrist

40. Scaphoid Fracture:Anatomy • Blood supplied from distal pole • The more proximal the fracture, the greater the risk of avascular necrosis (AVN) or delayed union

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