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Plain Films - Upper Limb Overview

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Shoulder
Trauma -? Fracture,disclocation,
post reduction
1. AP to show whole shoulder girdle, arm in ext rotation 
2. AP 45 deg oblique, 10 deg caudal tube angle, arm in internal rotation (to show gleno-humeral joint space)
3. Lateral shoulder (with lat scapula) 
4. If possible Axial view to show ant/post dislocation
Acromioclavicular Joints  Both AC joints on one film (weightbearing if possible) 
Clavicle  AP affected clavicle (if not definitive AP with 20 deg cranial angulation) 
Humerus  1. AP whole Humerus
2. Lateral whole Humerus 
Elbow
If ? # Image whole forearm initially including wrist + elbow 
1. AP Elbow
2. Lateral elbow
Move injured limb as little as possible 
Radial Head 
Also demonstrates radial neck 
1. AP Elbow
2. Lat Elbow
3. Coned Radial head view (45 deg angulation up humerus) 
Forearm     (Radius and Ulna)
Always do for initial images 
1. AP forearm
2. Lateral forearm
May need separate AP elbow if patient unable to move 
Wrist follow up distal 1/3 forearm # only 1. AP
2. Lateral wrist 
Rickets Protocol  1. PA L wrist 
2. AP L knee 
Bone Age  / Renal Osteodystrophy  PA Left Hand including wrist
Middle finger should be in line with the long axis of forearm and hand should be flat 

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Document Control

  • Date last published: 23 August 2017
  • Document type: Imaging Protocol
  • Services responsible: Paediatric Radiology

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