Upper Extremity B
Y view (Humerus)
Image # 1
File # 05
Critique: Image #1 represents a correctly positioned Y view. Note that the head of the humerus
is positioned away from the axillary ribs, which indicates proper body rotation. The acromion
and the coracoid process are well demonstrated and collectively complete the “Y” impression/
configuration along with the head and shaft of the humerus.
A = acromion; C = coracoid process
S = shaft of humerus
B = inferior angle
Y view (Humerus)
Image # 2
File # 05
Critique: Image #2 represents an incorrectly positioned Y view. Note that the humerus lies well
within axillary ribs/chest wall, which indicates the degree of obliquity was too great/much, ≈ 45
- 600 . Compare this image to image # 1, which was correctly positioned .
Lateral Scapula
Image # 35
File # 05
Critique: Excellent positioning of the scapula in the lateral position. Note the space existing
between the scapula and the axillary ribs, and the slender/thin presentation of the scapula, which
ultimately demonstrates superimposition of the vertebral and axillary borders of the scapula.
Thus, the superimposition indicates perfectly positioned lateral scapula no obliquity of the
scapula borders. The metallic object in the upper scapula region is a large caliber bullet.
AP and Lateral Humerus
Image # 5A & 5B
File # 05
Critique: Image 5A represents a correctly positioned AP humerus. Note that the humeral
epicondyles are ∥ to the plane of the film, which indicates a true AP.
Image 5B demonstrates an incorrectly positioned lateral humerus because the epicondyles are not
⊥ to the plane of the film. The result is an image that appears to be slightly obliqued as opposed
to a lateral. The lateral was taken with the patient in the prone erect position, as demonstrated in
class for trauma patients. Note the simple fracture in the proximal humerus. Also note the
presence of callus material adjacent to and surrounding the fracture, which indicates the healing
process is well underway. In fact, one may refer to the image a healed fracture.
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PA and Oblique Hand
Image # 34
File # 05
Critique: The PA and Oblique images represent a common positioning error. The error for both
positions is simply that the fingers are flexed, which produces a distorted image of the carpal
phalanges. A closer look reveals significant distortion of the interphalangeal joint spaces of most
of the proximal and distal joint spaces. Hence, the value of these images relative to the carpal
phalanges is greatly diminished. Thus, the fingers should always be extended, and never flexed.
Note also the presence of Kirschner wires through metacarpals 3, 4, & 5.
Internal and External AP Shoulder
Image # 6A & 6B
File # 05
Critique: Image 6A represents a correctly positioned AP external rotation, whereas Image 6B
demonstrates a correctly positioned internal rotation of the humerus.
Note the prominence of the greater tuberosity in the external rotation, and the superimposition of
the greater tuberosity over the humeral head in the internal rotation, which gives the humeral
head a more rounded appearance.
AP and Lateral Humerus
Image # 10 A & 10 B File # 05
Critique: Images 10 A (lateral) & 10 B (AP) demonstrate the effects of breast filtration
over an otherwise correctly positioned AP and Lateral humerus. To correct for this error/
dilemma, one may ask the patient to pull the breast toward the midline, and away from the
humerus.
Transthoracic Humerus
Image # 9A & 9B
File # 05
Critique: Image 9A demonstrates a correctly positioned transthoracic lateral of the right
humerus. While the image in 9 B demonstrates essentially the same anatomy and the fracture of
the surgical neck, image 9 B places the humerus in the anterior segment of the thoracic cavity,
which means the patient is rotated, much the same as is seen in chest radiography. Note the loss
of density of the distal humerus due to the fact that the distal humerus lies in the same plane as
the abdomen with the abdomen serving as a filter. Also note that both images demonstrate the
placement of a Rush rod the medullary portion of the humerus.
AP & Lateral Elbow
Image # 3
File # 05
Critique: Correctly positioned elbow series.
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AP & Lateral Forearm
Image # 4
File # 05
Critique: Correctly positioned forearm series. However, it is not likely that a patient, such as
this one, will routinely be able to rotate their arm for the lateral as was done here in instances
where the patient has sustained a simple fracture of the ulna. The usual approach in cases such
as this one is simply to have the patient extend their forearm for the lateral as opposed to
flexing the elbow for the “textbook” type lateral.
AP & Lateral Forearm
Image # 7
File # 05
Critique: In contrast to image # 4, image # 7 demonstrates a more customary approach to
achieving the lateral forearm in cases of trauma or casting. The lateral in image # 7 simply
shows the forearm fully extended. However, image # 7 further demonstrates what can happen
when one fails to concentrate on the task at hand and images the forearm in two different
directions. This error does make viewing the image a bit more difficult.
Axillary Shoulder
Image # 8
File # 05
Critique: Correctly positioned and centered axillary projection of the shoulder. One purpose of
this projection is to visualize the scapulohumeral joint and the surrounding glenoid cavity for the
presences of joint “mice”/ calcific deposits.
A = coracoid process;
B = scapulohumeral joint;
C = Acromion
Note: this projection is not usually recommended for recent trauma patients due to the necessity
for abduction of the humerus.
AP, Oblique & Lateral Wrist
Image # 11
File # 05
Image # 36 A & 36B
File # 05
Critique: A correctly positioned wrist series.
Shoulder Series
Critique: Image # 36 A demonstrates a properly positioned internal rotation, while image # 36 B
demonstrates a lack of complete external rotation. Perhaps the numerous shotgun pellets
contributed to the failure to adequately externally rotate the humerus. On the other hand, perhaps
not.
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