Toes AP

Overview

The AP toes radiograph evaluates phalanges and metatarsal bases for fractures and dislocations. The toes are placed flat on the detector with slight separation. This targeted view provides high resolution assessment of small bone injuries.

Technique

Center the detector to the affected toes and collimate tightly to reduce dose. Use a small focal spot and appropriate exposure for fine detail. Immobilize the toes and use positioning aids for comfort.

Clinical Indications

AP toes are indicated for trauma localized pain and suspected fracture or dislocation. They help detect tuft fractures and joint subluxations. Additional oblique and lateral views complement the AP projection.

Image Assessment

Inspect cortical margins for fracture lines and evaluate joint spaces for subluxation. Look for foreign bodies and soft tissue swelling. Report findings and recommend follow up imaging if healing assessment is required.

Shoulder AP Internal External

Overview

AP shoulder views in internal and external rotation assess the glenohumeral joint and proximal humerus. External rotation demonstrates the greater tuberosity while internal rotation profiles the lesser tuberosity. These complementary views aid in detecting fractures and dislocations.

Technique

Position the patient upright or supine with the detector centered to the shoulder. Obtain external rotation with the palm facing forward and internal rotation with the back of the hand on the hip. Use appropriate collimation to include the scapulohumeral joint.

Clinical Indications

AP shoulder views are indicated for trauma pain and suspected dislocation or fracture. They evaluate joint congruity and osseous integrity. Additional views such as Grashey or axillary may be required for detailed assessment.

Image Assessment

Assess humeral head position relative to the glenoid and inspect tuberosities for fracture. Evaluate joint space and acromioclavicular relationship. Correlate with clinical exam and consider CT for complex fractures.

Shoulder Scapular Y

Overview

The scapular Y view projects the scapula in a lateral orientation to evaluate humeral head position relative to the glenoid. It is useful for detecting anterior and posterior shoulder dislocations. The Y configuration is formed by the acromion coracoid and scapular body.

Technique

Position the patient in a true lateral with the affected shoulder centered and the arm in neutral. Align the detector to include the entire scapula and humeral head. Use breath hold to minimize motion artifact.

Clinical Indications

Scapular Y is indicated for trauma and suspected dislocation when axillary views are not possible. It helps determine direction of dislocation and associated fractures. Correlate with clinical exam and consider CT for complex injuries.

Image Assessment

Assess the relationship of the humeral head to the glenoid and acromion. Look for associated fractures of the scapula or proximal humerus. Document dislocation direction and recommend reduction or orthopedic consultation.

Axillary Shoulder View

Overview

The axillary shoulder view visualizes the glenohumeral joint from an inferior superior perspective. It is valuable for detecting dislocation and assessing joint congruity. The view requires patient cooperation and appropriate arm positioning.

Technique

Obtain the axillary view with the arm abducted and the detector placed superior to the shoulder. Alternative techniques such as the Velpeau or modified axillary may be used for patients unable to abduct. Ensure proper centering to include the glenoid and humeral head.

Clinical Indications

Axillary view is indicated for suspected dislocation and evaluation of glenoid fractures. It complements AP and Grashey views for comprehensive shoulder assessment. Use alternative projections when abduction is limited.

Image Assessment

Evaluate the glenohumeral joint space and humeral head position. Inspect for fractures of the glenoid rim and humeral head. Report findings that affect reduction and surgical planning.

Elbow Lateral

Overview

The lateral elbow radiograph profiles the olecranon and distal humerus to assess alignment and displacement. The elbow is flexed 90 degrees with the forearm in neutral. This view is sensitive for detecting displaced fractures and joint effusion.

Technique

Position the elbow in true lateral with the humeral epicondyles superimposed. Use a short exposure time to minimize motion blur and include the distal humerus and proximal forearm. Ensure consistent positioning for follow up comparisons.

Clinical Indications

Lateral elbow is indicated for trauma suspected dislocation and evaluation of joint congruity. It helps identify olecranon fractures and posterior displacement. Correlate with AP and oblique views for comprehensive assessment.

Image Assessment

Evaluate the anterior humeral line and radiocapitellar alignment for pediatric fractures. Inspect the olecranon process and coronoid for cortical disruption. Document displacement and recommend orthopedic consultation when indicated.

Finger Lateral

Overview

The lateral finger radiograph profiles the phalanges to assess displacement and angulation. The digit is positioned true lateral with adjacent fingers separated. This view is essential for evaluating dorsal or volar displacement and joint alignment.

Technique

Place the finger in true lateral with the plane of interest parallel to the detector. Use a small focal spot and immobilize the digit to reduce motion. Collimate tightly to minimize dose and improve image quality.

Clinical Indications

Lateral finger is indicated for trauma suspected dislocation and assessment of angulation. It complements PA and oblique views for comprehensive evaluation. It guides management decisions for reduction and fixation.

Image Assessment

Assess dorsal or volar displacement and measure angulation when present. Evaluate joint congruity and soft tissue swelling. Report findings and recommend orthopedic consultation when indicated.