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

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 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 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

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.

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.

Topics Clavicle Shoulder Dislocation Humerus Elbow Forearm Distal Radius Scaphoid

Normal axillary view

CLAVICLE

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

Clavicle fracture

Shoulder dislocations Most commonly dislocated large joint Anterior in 97% Mechanism: force on abducted/externally rotated shoulder Shoulder d/L: 7% incidence in young athletes Axillary neurapraxia in 33%; brachial plexus

Anterior shoulder dislocation

HUMERUS

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 Fracture of Medial Epicondyle Damage to Ulnar Nerve study Fracture of Supracondylar part: Damage to median nerve and Brachial artery

Proximal Humerus Fracture

Proximal Humerus Fractures

Supracondylar Fracture:

Fracture of Mid Shaft Humerus

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

Radius and ulna

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

Fracture of-------

Wrist

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 Lateral Oblique Scaphoid view **Normal plain films don’t rule out a scaphoid fracture