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Medical Imaging of the Upper Limb
X rays
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How to read X -Ray
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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.
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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
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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
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Techniques - Projection
P-A (relation of x-ray beam to patient)
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Routine chest radiograph
PA view – film is placed anteriorly, X-ray beam passes from posterior aspect to anterior side.
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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.
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AP view An AP film, enlarges the shadow of the heart and makes the posterior ribs appear more horizontal.
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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.
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Lateral
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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.
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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.
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Topics Clavicle Shoulder Dislocation Humerus Elbow Forearm
Distal Radius Scaphoid
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Normal axillary view
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CLAVICLE
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Junction of Medial 2/3rd and Lateral 1/3rd
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Clavicle fracture
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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
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Anterior shoulder dislocation
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HUMERUS
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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
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Proximal Humerus Fracture
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Proximal Humerus Fractures
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Supracondylar Fracture:
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Fracture of Mid Shaft Humerus
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Elbow trauma Fractures Dislocations Ligament sprains
Look for compartment syndrome Rule out neurovascular injury
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Radius and ulna
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Fall on Out stretched Hand
This is more common in older person
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Fracture of
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Wrist
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Scaphoid Fracture: Anatomy
Blood supplied from distal pole The more proximal the fracture, the greater the risk of avascular necrosis (AVN) or delayed union
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Scaphoid fracture: Radiographs
Lateral Oblique Scaphoid view **Normal plain films don’t rule out a scaphoid fracture
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