Upper Extremity A
Carpal Canal - (Tangential Projection)
Image # 1
File # 04
Critique: Correctly positioned carpal canal. Note: P = pisiform; H = Hamate
(Note: hamulus/hook of hamate not visible) S = scaphoid; Trap = Trapezium.
The carpal canal contains the tendons of the flexors of the fingers and the median nerve. Calcification
deposits and soft tissue or bony anomalies may negatively affect the function of those structures in the
carpal canal. Carpal Tunnel Syndrome.
Y view for Scapula
Image # 131 File # 04
Critique: In this case, the patient was unable to abduct his arm for the traditional lateral scapula
projection. So, the Y view was substituted with the humerus being superimposed over the scapula. Still.
One can clearly see the fracture near the superior border.
A = acromion; C = coracoid process
F = fracture; S = scapula; B = inferior angle
H = shaft of humerus.
The positioning is excellent.
Y view for Proximal Humerus
Image # 103 File # 04
Critique: Although lacking proper exposure,  75 - 100% under exposed, the fracture of the humeral
head is visualized. The positioning is excellent.
A = acromion; C = coracoid process;
F = fracture.
Y view for Proximal Humerus
Image # 2
File # 04
Critique: Note that the proximal humerus is encroaching upon the axillary ribs. This encroachment
indicates too much body rotation. While the proximal humerus is visible, the degree of body rotation
renders the image marginal relative to diagnostic quality.
Hand Series
Image # 14 A & 14 B File # 04
Critique: The AP suggests a normal hand, whereas the oblique demonstrates a fracture of the
proximal metacarpal. Two laterals were also taken. The typical fan lateral fails to adequately demonstrate
the fracture. The other lateral was positioned with the lateral aspect of the hand rotated  150
laterally/externally obliqued. Note that this approach demonstrates the fracture
in profile, while leaving little doubt regarding the position of the proximal aspect of the
metacarpal bone.
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Radial & Ulna Flexion/Deviation
Ballinger - Vol I pgs. 128-129
Image # 12
File # 04
Critique: Image # 12 C depicts radial flexion/deviation. Image # 12 D depicts ulna flexion/deviation.
Note the presence of a fracture of the scaphoid/navicular bone. Also note that
the navicular is best demonstrated in its entirety in ulnar flexion, and the fracture is also best
seen in ulnar flexion/deviation. However, a small fracture line is visible in radial flexion. Still, the
scaphoid is typically better visualized in ulna flexion/deviation. Note: ulnar flexion is typically one of the
positions employed in a navicular series. Also note the somewhat “J” shape
of the proximal navicular.
Navicular Series
Image # 13
File # 04
Critique: Correctly positioned navicular series.
A = Stecher position
B = Ulnar flexion/deviation
C = Ulnar flexion/deviation with Stecher angulation
D = Clinched fist
Note the navicular fracture at the mid-point of the navicular. Of some historical importance, a famous
quarterback (Joe Willie Namath) fractured his navicular during an exhibition game, and had to sit out the
remainder of the season. The Navicular bone is important after all!
Radial Head Axial Projection (RHAP)
Image # 15
File # 04
Ballinger-Vol I pg. 151 - Fig 4-140.
Critique: Correctly positioned RHAP. Notice how the radial head is raised above the ulna, which allows
reasonably good visualization of the fracture involving the radial neck and
radial head. The inferior portion of the radial head can be seen projected through the coronoid process,
which is due to the effect of angling the CR 450 cephalic.
Carpal Bridge
Critique: Properly positioned carpal bridge.
S = Scaphoid/Navicular
L = Lunate
C = Capitate
Image # 16
File # 04
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