UPPER LIMB

THUMB KALLEN (Tangential)

AP - Metacarpal head fx
- CR: PERP
- Lewis: 10 – 15 degrees proximally LATERAL EXTENSTION
o To show 1st MC free of
- Foreign bodies
superimposition
- MC displacement and fx
- Superimposed
ROBERTS METHOD (AP)
- 1st CMC displacement LATERAL FLEXION
- Bennetts fx – transverse fx of the
- Ant. And post.
base of first MCP
FAN LATERAL
RAFERT AND LONG
- Phalanges free of superimposition
- 15 degrees proximally
except PROXIMAL PHALANGES

BURMAN (AP)
FIOLE
- 45 degrees towards the elbow
- Demonstrate small growth of bone
o 1st CMC
located on 3rd MCP
o Magnified concavoconvex
outline of 1st CMC
BALL’S
o Trapezium in concave
CATCHER/NORGAARD/BREWERTON by
Stapezynski
FOLIO
- UCL rupture - Rheumatoid arthritis
- Skier’s thumb - Base of little finger fx
- 1st CMC
WRIST
HAND
PA
PA - Han arc slightly
- Normal abduction of phalanges - SCAPHOD AND CAPITATE
- 30 degrees towards elbow:
AP  To elongate scaphoid
- Alternative to PA if px hand cannot and capitate
be extended - 30 degrees towards fingertips
 To elongate capitate
PA OBLIQUE - RP: midway b/w ulnar and radial
- Demonstrates bony and soft styloid processes
tissues
Lateral / LATEROMEDIAL
REVERSE PA OBLIQUE (Lane, kennedy, - RP: Styloid process
Kushner) - Capitate, Lunate, distal radius
- Severe metacarpal deformities - Ant. And post. Fx
 - BARTONS, COLLES/BAYONET/
SMITH
SUPEROINFERIOR/ TANGENTIAL
PA OBLIQUE - Dorsiflex ang wrist
- Scaphoid and trapezium - 45 degrees angle sponge –
- Distal radius and ulna suggested my MARSHALL
- Anatomic snuffbox - CR: 25 – 35 degrees towards long
axis of forearm
PA with ULNAR DEVIATION - PISIFORM in profile
- Open spaces and joints of adjacent
carpals on LATERAL SIDE CARPAL BRDIGE
- 10 – 15 degrees proximally or - Tangential image of carpus
distally - Fx of scaphoid
- Correct foreshortening of scaphoid - Lunate dislocation
- calcification
PA with RADIAL DEVIATION - Chip fx in dorsal aspect of carpal
- Open interspaces and joints at bone
medial side - 45 degrees toward long axis of
forearm
STETCHER (PA AXIAL)
- Ulnar/Radial Deviation AP
- 25-30 degrees towards the elbow - Carpal interspaces
- HAMMETE, PISIFORM, and - Distal radius and ulna
TRIQUETRUM
- To show fx angled superiorly, angle AP OBLIQUE (MEDIAL ROTATION)
the CR towards the digits - PISIFORM, HAMETE, TRIQUETRUM
- INCLINED PA/PA axial - PISIFORM IN PROFILE
- IR 20 degrees - Used to separate pisiform from
adjacent carpal bones
GAYNOR HART/ TEMPLETON and ZIM
- Wrist 4 inches above table RAFERT AND LONG METHOD (PA AXIAL
- 25-30 degrees long axis of hand OBLIQUE PROJECTION)
- Demonstrates: - Scaphoid fractures
 Fx of hamete of - 0-10-20-30 cephalad CR
hamulus ANGULATIONS
 Abnormal calcification
of carpal sulcus CLEMENTS NAKAYAMA METHOD (PA AXIAL
 Compression of medial OBLIQUE)
nerve - Trapezium and its articulations
- To prevent superimposition of - Demonstrates TRAPEZIUM WITH
pisiform hamete, rotate internally OSTEOARTHRITIS
10 degrees - Radiography of polyarthritic hand
- Macquillin martensen – suggested in ulnar deviation
o CR parallel to palm - HOLLY: recommended to ulnar
o 15 degrees towards palm if deviate the wrist
wrist cannot be extended - 45 degrees distally
 - 90 degrees flexion
- Demonstrates OLECRANON
PROCESS
BONE AGE - ANTERIOR AND SUPINATOR FAT
- PA HAND AND WRIST (L) PADS
- Evaluate patient’s age - GRISWOLD – 2 reasons of 90
- GRUELICH AND PYLE METHOD degrees flexion
 Demonstrates
olecranon fossae
FOREARM
 Elbow fat pads one
- SERIES
least compressed
- AP, LAT
- 30 – 35 degrees flexion for soft
tissue injury
AP
- HAND SUPINATED
AP OPBLIQUE (MEDIAL ROTATION)
- RP: MIDFOREARM
- Hand pronated 45 degrees
- Demonstrates OLECRANON
LATERAL
PROCESS and elbow joint
- Can demonstrate “MADELUNG’S
DEFORMITY -a rare condition that
AP OBLIQUE (LATERAL ROTATION)
affects the growth plate in radius
- Hand supinated 45 degrees
- Demonstrates RADIAL HEAL,NECK,
Hutchinson’s (chauffeur’s) fracture
TUBEROSITY AND CAPITULUM
- Intra articular fx of radialy styoild - 1ST AND 2ND digit slightly touches
processes the IR

Monteggias fracture AP PARTIAL FLEXION

- Fx in the proximal ulna, w/ radial - CR: perpendicular
head dislocation - Demonstrates: ELBOW JOINT,
PROXIMAL ULNA AND RADIUS,
Nursemaid’s/Jerked fracture DISTAL HUMERUS
- Partial dislocation of radial head in
child JONES METHOD (AP ACUTE FLEXION)
- Humeral epicondyle parallel
ELBOW - OLECRANON PROCESS
- To obtain visualization of soft
AP tissues outside olecranon process
- 1 inch below midpoint epicondyle - Funny bone, crazy bone
- Olecranon and coronoid fossae are
superimposed LATERAL (LATEROMEDIAL)
- Humeral epicondyles parallel to IR - 4 position series
- Radial head, neck, and tuberosity - 90 degrees elbow flexed
partially superimposed over - RADIAL HEAD is projected
proximal ulna
COYLE METHOD (Axiolateral)
LATERAL - Elbow flexion 90 degrees
 - 45 degrees towards the shoulder - ENTIRE LENGTH OF HUMERUS
 RADIAL HEAD
- 45 degrees away from the shoulder UPRIGHT LATERAL
 CORONOID PROCESS - LESSER TUBERCLE
- Demonstrates RADIAL HEAD FX for
trauma cases LAWRENCE METHOD (TRANSTHORACIC
- Recommended by GREENSPAN, LATERAL)
NORMAN, ROSEN - Full inspiration
- RP: Surgical neck
PA AXIAL PROJECTION - CR: 10 – 15 degrees CEPHALAD
- ARM 45-50 degrees from vertical
- CR: TO dorsum of olecranon SHOULDER
process
- 20 degrees towards the wrist
AP NETRUAL
o Shows extremity and
- HAND IN NEUTRAL PALM TO HIPS
articular margin of olecranon
- RP: CORACOID
process
- GREATER TUBERCLE
- POSTERIOR PART OF
HUMERUS SUPRAISPINATUS INSERTION
- HUMERUS IN OBLIQUE
RECUMBENT
- AP AP INTERNAL ROTATION
- LAT - Internally rotated
- Epicondyles are perpen
UPRIGHT - LESSER TUBRCLE
- AP - HUMERUS IN TRUE LATERAL
- LATEROMEDIAL - Body rotated 15-20 degrees
- TRANSTHORACIC (LAWRENCE
METHOD) AP EXTERNAL ROTATION
- HAND SUPINATE AND ABDUCTED
RECUMBENT AP - GREATER TUBERCLE
- Hand supinated - Body rotated 15-20 degrees
- Demonstrates GREATER TUBERCLE
AND HUMERAL HEAD TRANSTHORACIC (LAWRENCE METHOD)
- Used when arms cannot be rotated
RECUMBENT LATERAL and abducted
- Posterior surface of hand against - Orthostatic breathing
the patient’s side - PROXIMAL HUMERUS
- Humeral epicondyle perpen - 10 – 15 DEGREES CEPHALAD
- Demonstrates LESSER TUBERCLE LAWRENCE (INFEROSUPERIOR AXIAL)
- Supine
UPRIGHT AP - Head, shoulder, thorax elevated 3-
- Demonstrates arm and shoulder 4 inches
abnormalities - CR:
- GREATER TUBERCLE and HUMERAL - 90 degrees abduction: 30-35
HEAD degrees
 - 60 degrees abduction: 20 degrees - Flex elbow 90 degrees and lean
- HILL-SACHS DEFECT forward
- GLOMEROHUMERAL JOINT - CR: 5-15 degrees towards the
- POINT OF INSERTION OF TERES elbow
MINOR TENDON - INTERTUBERCULAR GROOVE

RAFERT METHOD (INFEROSUPERIOR PA OBLIQUE / SCAPULAR Y

AXIAL) - Rotate px body 45-60 degrees
- Supine - RP GLENOHUMERAL JOINT
- EXAGERATED EXTERNAL ROTATION - DEMONSTRATES JOINT
OF ARM DISLOCATION
- THUMB POINT DOWNWARD - DESCRIBED BY RUBIN
- CR: 15 DEGREES MEDIALLY AND
HORIZONTALLY GARTH METHOD / AP APICAL OBLIQUE
- HILL SACHS DEFECT - Rotate 45 DEGREES towards
affected side
WEST POINT (INFEROSUPERIOR AXIAL) - CR 45 degrees CAUDALLY
- Prone - Demonstrate ACUTE SHOULDER
- Abducted 90 degrees TRAUMA
- CR: 25 degrees medially 25 - Flex elbow across the chest
degrees horizontally
- Instability of shoulder GRASHEY METHOD AP OLBIQUE RPO/LPO
- BANKART LESION - Rotate body 35-45 degrees
- ABNORMALITIES OF ANTERIOR - CR PERPEN
INFERIOR GLENOID ARM - Demonstrates GLENOID CAVITY and
SCAPULOHUMERAL JOINT
CLEMENTS MODIFICATION - JOHNSTON – landmark for lateral,
(INFEROSUPERIOR AXIAL) scapular Y
- Lateral recumbent - RECUMBENT – arms across
- 90 degrees abduction abdomen
- Pointing towards the ceiling
- 5-15 DEGREES MEDIALLY NEER METHOD (TANGENTIAL) RAO/LAO
- Glenohumeral Joint - Rotate body 45-60 degrees
- CORACOACROMIAL ARCH or
SUPERIORINFERIOR /AXIAL OUTLET
- Extend shoulder - DIAGNOSE SHOULDER
- Flex elbow 90 degrees IMPINGEMENT
- 5-15 degrees towards the elbow - SUPRASPINATUS OUTLET
- RELATIONSHIP OF PROXIMAL END
OF THE HUMERUS AND GLENOID STRYKER METHOD (AP AXIAL)
CAVITY - Demonstrate cause of shoulder
dislocation
FISK METHOD (TANGENTIAL) - Flex slight elbows and raise hand
- Supine px or standing on top of head
- Rotate head away - CR: 10 Degrees
- Coracoid process
 - Shows posterolateral aspects of - SHOWS ANTERIOR DISPLACEMENT
HUMERAL HEAD OF FRAGMENTS FX

APPLE METHOD (AP OBLIQUE) PA AXIAL

- 90 degrees abduction with weight - PRONE
- Shows the loss of articular cartilage - CR 15-30 DEGREES CAUDAD
in SCAPULOHUMERAL JOINT - Clavicle projected ABOVE RIBS AND
- ROTATE 35-40 DEGREES TOWARDS SCAPULA
- DEMONSTRATES
SCAPULOHUMERAL JOINT AND
GLENOID CAVITY
COBBS/TARRANT/TANGENTIAL
HOBBS MODIFICATION (transaxillary PA) PROJECTION
- Standing facing VCH - Px with MULTIPLE INJURIES
- Rotate 5-10 degrees anterior - Used when px cannot lordotic or
oblique recumbent
- Raised affect arm superiorly - CR 25-35 DEGREES perpendicular
- LATERAL VIEW OF PROXIMAL to long axis of clavicle
HUMERUS
SCAPULA
CORACOID
- Supine AP
- CR 15-45 degrees depends on the - 90 degrees abduct TO DRAW
shape of patients back SCAPULA LATERALLY
- Round shape greater angulation - FLEX ELBOW AND SUPINATE HAND
- KWAK, ESPINIELLA, KATTAN – 30 - 2 INCHES INFERIOR RO CORACOID
degrees cephalad PROCESS
- SLOW BREATHING
CLAVICLE COLLAR BONE
LATERAL RAO LAO
AP - Rotate px body 45-60 degrees
- Used to prevent additional injury - If BODY OF SCAPULA – extend arm
- Suspend respiration upward across chest or on top of
- Rotate body 10-15 degrees the head
- IF ACROMION AND CORACOID –
PA hand at the back flex elbow
- Mas preferred to reduce
MAGNIFICATION and IMRPOVED AP OBLIQUE RPO LPO
SPATIAL RESOLUTION - Rotate shoulder 15-25 DEGREES
- Rotate body 10 -15 degrees away from affected side
- Middle clavicle - OBLIQUE IMAGE OF SCAPULA

AP AXIAL (INFEROSUPERIOR) SCAPULAR SPINE

- SUPINE – 25 -40 DEGREES
CEPHALAD LACQUERRIERE – PIERQUIN METHOD
- ERECT 0 – 15 DEGREES CEPHALAD TANGENTIAL
 - Supine
- CR 45 degrees CAUDAD
- OBESE – 35 degrees CAUDAD

TANGENTIAL
- Hand of affected side in supination
- 45 Degrees CEPHALAD
- PRONE

ACROMIOCLAVICULAR ARTICULATIONS

PEARSON METHOD AP BILATERAL

- Equal weights 10-15 lbs
- Make shoulder contract
- Demonstrates DISLOCATION,
SEPARATION, FUNCTION of joints

ALEXANDER METHOD AP AXIAL

- CR: 15 DEGREES CEPHALAD
- AC projects above acromion
- RP CORACOID PROECESS
- AC JT SEEN SLIGHLY SUPERIORLY

3. PA AXIAL OBLIQUE RAO LAO

- body rotated 45-60 degrees
- 15 DEGREES CAUDALLY