Radiography of Forearm and Upper Arm

Radiography of Forearm
and Upper Arm
Relevant Anatomy
Radius
Ulna
Humerus
Radius
Head
Neck
Radial Tuberosity
Shaft
Lower End
Medial Ulnar notch
Lateral Radial Styloid
Dorsal tubercle of radius
Ulna
Olecranon
Coronoid Process
Trochlear Notch
Tuberosity of Ulna
Radial Notch
Shaft
Head with ulnar styloid
Humerus
Upper End
Head
Anatomical Neck
Surgical Neck
Greater Tubercle
Lesser Tubercle
Bicipital Groove
Ossification Center
Radiography
Factors
Basic Projections
Area
Indication
Projection
Forearm
Trauma
AP (Basic)
Lateral (Basic)
Humerus
Trauma or pathology
AP (Erect)
Lateral (Erect)
Bicipital Groove
AP (Basic)
Axial
Neck of Humerus
Fracture
Ap
Lateral Oblique
Lateral Superosuperior
Lateral Inferosuperior
Forearm AP View
Indication:pathology.
Fracture, dislocation or any
Patient position:- The patient is seated alongside

the table with the affected side nearest to the table.
Part position: The arm is abducted and the elbow joint is fully
extended, with the supinated forearm resting on
the table.
The shoulder is lowered to the same level as the
elbow joint.
The cassette is placed under the forearm to
include the wrist joint and elbow joint.
The arm is adjusted such that the radial and
ulnar styloid processes and the medial and
lateral epicondyles are equidistant from the IR .
The lower end of the humerus and the hand are
immobilized using sandbag.
Forearm AP View
Centre:- Vertical central ray is
centered midline of the forearm
to a point midway between the
wrist and elbow joints.
Shielding:- Thyroid, chest,
abdomen and pelvis.
Radiographic criteria:Both elbow and wrist joints should
be seen in the true AP position, with
the radial and ulnar styloid
processes and the epicondyles of the
humerus equidistant from the IR.
Forearm Lateral View

Position of patient and the image
receptor:From AP position the elbow is flexed 90
degrees.
The humerus is internally rotated to 90
degrees to bring the medial aspect of the
upper arm, elbow, forearm wrist joint and
the elbow joint.
The cassette is placed under the forearm
to include the wrist joint and elbow joint.
The arm is adjusted such that the radial
and ulnar styloid processes and the medial
and lateral epicondyles are superimposed.
The lower end of the humerus and the
hand are immobilized using sandbags.
Forearm Lateral View

Centre:- Vertical central ray is centered
midline of the forearm to a point midway
between the wrist and elbow joints.
Shielding:- Thyroid, chest, abdomen and pelvis.
Radiographic criteria: Both elbow and wrist joints should be seen in the
true lateral position, with the radial and ulnar
styloid processes and the epicondyles of the
humerus superimposed.
Monteggia fracture-dislocation - There is

a comminuted fracture of the ulna with
dislocation of the radial head.
Galeazzi fracture
Dislocation of the distal
ulna
accompanies the radial
Humerus Shaft AP Supine View
Indication:-
Fracture, dislocation or any pathology.
Patient position:- The patient lies supine on the Xray table, with the unaffected side rained and
supported on pads.
Part position: The cassette is positioned under the affected limb

and adjusted to include the shoulder and elbow
joints.
The arm is slightly abducted and the elbow joint is
fully extended, so that the posterior aspect of the
upper arm is in contact with the cassette.
The arm is adjusted to ensure that the medial and
lateral epicondyles are equidistant from the
cassette.
The forearm is immobilized using a sandbag.
Humerus Shaft AP Supine View
Centre:- Vertical central

ray is centered to a point
midway between the
shoulder
and elbow
joint.
abdomen and pelvis.
Radiographic criteria: An AP projection of humerus
including shoulder joint and
elbow joint in an image.
Humerus Shaft Lateral Supine

View
Part position:-
From AP position the elbow is flexed 90

degrees.
The arm is abducted and then medially

rotated through 90 degrees to bring the
medial aspect of the arm, elbow and
forearm in contact with the table.
The IR is placed under the arm and

adjusted to include both the shoulder and
the elbow joints.
The humerus is adjusted to ensure that

the medial and lateral epicondyles of the
humerus are superimposed.
The forearm is immobilised using a

sandbag.
Humerus Shaft Lateral Supine

View
Centre:- Vertical central

ray is centered to a point
midway between elbow and
shoulder.

abdomen and pelvis.
Radiographic criteria:Both elbow and wrist joints

should be seen in the true
lateral position,
Humerus Shaft AP Erect View
Part position:-
The cassette is placed in an erect cassette holder.
The patient sits or stands with their back in contact with the
cassette.
The patient is rotated towards the affected side to bring the

posterior aspect of the shoulder, upper arm and elbow into
contact with the cassette.
The position of the patient is adjusted to ensure that the

medial and lateral epicondyles of the humerus are equidistant
from the cassette.
Centre: The central ray is directed at right-angles to the shaft of the

humerus and centred midway between the shoulder and
elbow joints.
Humerus Shaft Lateral Erect

View
Position of patient and cassette
The cassette is placed in an erect cassette holder.
From the anterior position, the patient is rotated through
90 degrees until the lateral aspect of the injured arm is in
contact with the cassette.
The patient is now rotated further until the arm is just clear
of the rib cage but still in contact with the cassette.
Direction and centring of the X-ray beam

The horizontal central ray is directed at right-angles to the
shaft of the humerus and centred midway between the
shoulder and elbow joint.
Essential image characteristics

The exposure should be adjusted to ensure that the area of
interest is clearly visualized.
Humerus Intertubercular Sulcus

Bicipital Groove Axial Projection
Patient position:- Patient lies

supine on the X-ray table
Part position: The cassette is supported

vertically above the shoulder.
The arm is rested on the
tabletop with the palm of the
hand facing the patients side
and the line joining the
epicondyles of the humerus at
45 degrees to the table.
Centre:- The central ray is

directed almost horizontally
and centered to the anterior
part of the head of humerus.
Humerus Intertubercular Sulcus

Bicipital Groove Axial Projection
Technical factors: The exposure is made on

arrested respiration.

abdomen and pelvis.
Radiographic criteria: The sulcus should be seen in

profile, and the exposure is
such as to demonstrate lesions
within or impingements on the
sulcus.
Humerus Neck AP View

The patient stands or lies supine facing the Xray tube.
The patient is rotated towards the affected side
to bring the posterior aspect of the injured
shoulder into contact with the midline of the
cassette.
The cassette is positioned to include the
acromion process and the proximal half of the
humerus.

The central ray is directed at right-angles to the
humerus and centred to the head of the
humerus.
Humerus Neck AP View

Essential image
characteristics
The image should include the
acromion process and proximal half
of the shaft of the humerus.
The exposure should demonstrate
adequately the neck of the humerus
clear of the thorax.
Humerus Neck Lateral View

Supero-inferior
The patient is seated at one end of the table, with the trunk
leaning towards the table, the arm of the side being examined
in its maximum abduction, and the elbow resting on the
table.
The height of the table is adjusted to enable the patient to

adopt a comfortable position and to maximize full coverage
of the neck of the humerus and the shoulder joint.
The cassette rests on the table between the elbow and the
trunk.

Supero-inferior
The vertical central ray is directed from above to the acromion

process of the scapula.
Owing to increased object-to-cassette distance, a small focal

spot together with an increased FFD should be selected.
The image should include the acromion and coracoid

processes, the glenoid cavity and the proximal head and neck
of the humerus.
The exposure should demonstrate adequately the neck of the

humerus.

Infero-superior

The patient lies supine on the trolley, with the arm of the
affected side abducted as much as possible (ideally at right
angles to the trunk), the palm of the hand facing upwards,
and the medial and lateral epicondyles of the humerus
equidistant from the tabletop.
The shoulder and arm are raised slightly on non-opaque

pads, and a cassette supported vertically against the shoulder
is pressed against the neck to include as much of the scapula
aspossible in the image.

Infero-superior

The horizontal central ray is directed upwards
and centred to the patients axilla with minimum
angulation towards the trunk.
The image should include the acromion and coracoid

processes, the glenoid cavity and the proximal head and
neck
of the humerus.
The exposure should demonstrate adequately the neck
of the humerus.
Humerus Fractures
Fractures of surgical neck or greater tuberosity commonest
Spiral and oblique fractures are common
Radial nerve injury occurs in up to 30% of cases
Osteonecrosis reported in up to 50% of cases
Fracture of the
surgical neck of
the humerus: axial view.
There is marked
displacement
of the distal humerus,
with the
comminuted fracture
extending
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Radiography of Forearm

and Upper Arm

Medial Ulnar notch

Lateral Radial Styloid

Dorsal tubercle of radius

Head with ulnar styloid

Fracture, dislocation or any

Patient position:- The patient is seated alongside

Forearm Lateral View

Forearm Lateral View

Monteggia fracture-dislocation - There is

Humerus Shaft AP Supine View

Fracture, dislocation or any pathology.

Part position: The cassette is positioned under the affected limb

Humerus Shaft AP Supine View

Centre:- Vertical central

Humerus Shaft Lateral Supine

From AP position the elbow is flexed 90

The arm is abducted and then medially

The IR is placed under the arm and

The humerus is adjusted to ensure that

The forearm is immobilised using a

Humerus Shaft Lateral Supine

Centre:- Vertical central

Shielding:- Thyroid, chest,

Radiographic criteria:Both elbow and wrist joints

Humerus Shaft AP Erect View

The cassette is placed in an erect cassette holder.

The patient is rotated towards the affected side to bring the

The position of the patient is adjusted to ensure that the

Centre: The central ray is directed at right-angles to the shaft of the

Humerus Shaft Lateral Erect

Direction and centring of the X-ray beam

Essential image characteristics

Humerus Intertubercular Sulcus

Patient position:- Patient lies

Part position: The cassette is supported

Centre:- The central ray is

Humerus Intertubercular Sulcus

Technical factors: The exposure is made on

Shielding:- Thyroid, chest,

Radiographic criteria: The sulcus should be seen in

Humerus Neck AP View

Position of patient and cassette

Direction and centring of the X-ray beam

Humerus Neck AP View

Humerus Neck Lateral View

The height of the table is adjusted to enable the patient to

Humerus Neck Lateral View

The vertical central ray is directed from above to the acromion

Owing to increased object-to-cassette distance, a small focal

Essential image characteristics

The image should include the acromion and coracoid

The exposure should demonstrate adequately the neck of the

Humerus Neck Lateral View

Position of patient and cassette

The shoulder and arm are raised slightly on non-opaque

Humerus Neck Lateral View

Direction and centring of the X-ray beam