UPPER LIMB POSITIONING

By: Dr Kushagra V

Garg

Clavicle

Scapula

Scapula

Scapula

Humerus

Sternoclavicular Joint (SC)

Acromioclavicular Joint (AC)

Glenohumeral Joint (GH)

Upper extremity consists of:

Phalanges Metacarpals Carpals Radius Ulna Humerus

View for clavicle

PA AP Inferosuperior

Postero-anterior – erect (basic)

Prone or upright Ant aspect towards the

cassette Arm should be in neutral

position Perpendicular to midclavicle According to the size of the

patient tailor-made angulation can be given

Antero-posterior – supine

Infero-superior forward-angulation of the

cassette of 15 degrees towards the shoulder

Unaffected side is slightly raised CR is given 30 degree

angulation to throw the clavicle away from the bony thorax

Clavicle should be horizontal

Infero-superior – supine

Patient is supine A NRO sponge supports the

arm under investigation The cassette is given 20-25

degree angulation and tube is given 45 degree of cranial angulation

Centering is at the mid of clavicle

Sternoclavicular jointsPostero-anterior oblique (basic)

Postero-anterior

Both SC jts are included

Semi-prone

Cross Table Lateral

Scapula(AP)

Supine or erect Affected scapula towards

the IR Forearm semi flexed IR should be 5 cms above

the shoulder CR centered at the mid of

the film with centering at the head of humerus

Scapula Y view

supine or upright Post surface of the body towards plate Affected arm in neutral position Turn the patient 30 degree away Central rays perpendicular to gh Possible dislocation of head of humerus

AC joint AP

Upright with arms on the sides

B/L image with and without stress

Central ray perpendicular to midpoint B/W the two ac joints

Rotation should be checked by sc joints

To demonstrate dislocations and subluxation

Shoulder AP(NR)

supine or upright Post surface of the body

towards plate Affected arm on patients

side CR perpendicular to

coracoid process #,dis.,tendon and lig

dam.,cyst and tumors

Shoulder AP (ER)

supine or upright Post surface of the body

towards plate Affected arm on patients

side IC line Parallel to image

receptor CR perpendicular to

coracoid process greater tubercle on the

lateral aspect

Shoulder joint ap(ir)

supine or upright Post surface of the body towards plate Affected arm on patients side IC line Perpendicular to image receptor CR perpendicular to coracoid process Lesser tubercle on the medial aspect

Shoulder inferosuperior(lawrence method) Supine IR Perpendicular to table Abduct the affected arm by

90 Neck away Non opaque sponge under

the shoulder CR horizontal towards the

axilla exit at AC joint LT superiorly GH should be clear

Shoulder inferosuperior(WEST Point method)

Supine IR Perpendicular to table Abduct the affected arm by

90 Neck away Non opaque sponge under

the shoulder CR 25 degree up and medial

to horizontal towards the axilla exit at AC joint

LT superiorly Coracoid process should not

be over the humeral head GH should be clearly

demonstrated

Clements modification

Shoulder joint AP axial Coracoid process

Supine or upright Affected arm resting on the

side Hand supinated CR 30 degree cephalad and

directed towards coracoid process

coracoid process elongated and superimposed on clavicle slightly

Shoulder glenoid cavity(grashey method)

Supine or upright Forearm resting on the chest 35 to 45 degree turn on the

affected side Scapula parallel to IR LPO for left side and vice a

versa CR perpendicular to gh Dislocation of head of

humerus Superimposition of humeral

head should not be there

Humerus(AP)

Supine or upright Fully extend the elbow Hand rest on the side IC line should be parallel to

the IR

supine or upright Flex the elbow and medially

rotate the arm IC perpendicular to IR Include both shoulder and

elbow joint CR perpendicular to

midshaft of humerus Epicondyles should be

overlapping each other LT on the medial aspect

Humerus transthoracic lat position(lawrence method)

Upright and affected Affected arm in neutral

position IR should be above the

shoulder CR horizontal and

perpendicular to the midshaft of affected humerus

NOTE :patient should breath normally

Proximal 2/3rd of humerus and GH should be demonstrated

References

Clarks radiographic positioning Radiographic positioning by greathouse Radiopedia Learning radiology Valuable inputs by my seniors and

professors

On public demand torticollisThank You