Embed Size (px)
Citation preview
Case Discussion: Elbow Anterior-‐Posterior, Lateral Shoulder Anterior-‐Posterior,
Transscapular PA
Jordy Oudhuizen
7-‐2-‐2014
Case
• Type of examinaIon: Elbow AP, Lateral & Shoulder AP, Transscapular PA
– Request X-‐ray examinaIon – Anatomy, pathology – SeOngs & parameters – Image review – Report Radiologist
Jordy Oudhuizen, 16-‐2-‐2015
Request X-‐ray ExaminaIon
Jordy Oudhuizen, 16-‐2-‐2015
Clinical informaIon Direct fall on elbow a/er gymnas4cs accident QuesIon: Fracture?
Anatomy
• ArIculus CubiI
Jordy Oudhuizen, 16-‐2-‐2015
Anatomy
• ArIculus Humeri
Jordy Oudhuizen, 16-‐2-‐2015
Anatomy
• Epiphyseal Plate
Jordy Oudhuizen, 16-‐2-‐2015
Anatomy
• Epiphyseal Plate
Jordy Oudhuizen, 16-‐2-‐2015
Pathology
• Fractures: Various • Epiphyseal Plate Fractures: Salter-‐Harris ClassificaIon
Jordy Oudhuizen, 16-‐2-‐2015
Pathology
• LuxaIon
Jordy Oudhuizen, 16-‐2-‐2015
Pathology
• Bankart lesion
Jordy Oudhuizen, 16-‐2-‐2015
Pathology
• Hill-‐Sachs Lesion
Jordy Oudhuizen, 16-‐2-‐2015
SeOng & Parameters
• Elbow AP: – SeOng: • SiOng with arm in supinaIon • Humerus en lower-‐arm on the same height • Midline on elbow joint
– Parameters: • 55 kV, 2 mA.s • SmallFocus • 0 mm Cu • Focus-‐film distance: 1,05 meters
Jordy Oudhuizen, 16-‐2-‐2015
SeOng & Parameters
• Elbow Lateral: – SeOng • SiOng with elbow joint in 90 degrees • Humerus and lower-‐arm on the same height • Thumb upwards • Midline on elbow joint
– Parameters • 55 kV, 2 mA.s • Small Focus • 0 mm Cu • Focus-‐film distance: 1,05 meters
Jordy Oudhuizen, 16-‐2-‐2015
SeOng & Parameters
• Shoulder AP endorotaIon – SeOng • Standing/siOng with arm in endorotaIon • PaIent 45 degrees turned to the x-‐ray plate • X-‐ray tube 20 degrees Craniocaudal • Midline on the glenoid.
– Techniek • 66 kV, 3 mA.s • Small Focus • 0 mm Cu • Focus-‐film distance: 1,50 meters
Jordy Oudhuizen, 16-‐2-‐2015
SeOng & Parameters
• ShoulderTransscapulair PA – SeOng • Standing/SiOng with arm in endorotaIon • PaIent 30-‐45 degrees turned of the x-‐ray plate • Midline on the edge of the scapula
– Parameters • 66 kV, 3 mA.s • Small Focus • 0 mm Cu • Focus-‐film distance: 1,50 meters
Jordy Oudhuizen, 16-‐2-‐2015
Image Review
Jordy Oudhuizen, 16-‐2-‐2015
• Elbow AP
Image Review
Jordy Oudhuizen, 16-‐2-‐2015
• Elbow Lateral
AddiIonal CT-‐scan
Jordy Oudhuizen, 16-‐2-‐2015
Image Review
Jordy Oudhuizen, 16-‐2-‐2015
• Shoulder AP
Image Review
Jordy Oudhuizen, 16-‐2-‐2015
• Shoulder Transscapular
Image Review
Jordy Oudhuizen, 16-‐2-‐2015
• Shoulder Transscapular
Report Radiologist
• “X-‐rays of the le/ shoulder and le/ elbow in seen from 2 angles: Le/ shoulder shows no abnomali4es in fractures or luxa4ons. Le/ elbow shows a luxa4on fracture with a loose bone fragment on the ventral side, suspectable from the lateral humerus condyle.”
Jordy Oudhuizen, 16-‐2-‐2015
End
Jordy Oudhuizen, 16-‐2-‐2015
