1. This radiograph of the upper arm was taken after a fall. The flexed elbow is at the top of the image. Which description BEST fits the injury?
Humerus
The humerus runs from the shoulder to the elbow. A routine humerus is an AP and a rotational lateral that include both joints; trauma patients get a transthoracic lateral instead of rotating the arm.
Overview
Bones
Proximal
- Head
- Anatomical neck
- Surgical neck
- Greater tubercle
- Lesser tubercle
- Intertubercular (bicipital) groove
Shaft
- Deltoid tuberosity
- Radial groove
Distal
- Capitulum
- Trochlea
- Medial epicondyle
- Lateral epicondyle
- Olecranon fossa
- Coronoid fossa
Registry must-knows
- If a fracture is suspected, don't rotate the arm. Use a transthoracic lateral (Lawrence) or a scapular Y.
- AP: epicondyles parallel to the IR puts the greater tubercle in profile laterally. Lateral: epicondyles perpendicular puts the lesser tubercle in profile medially.
- The surgical neck is a common fracture site in older adults after a fall.
- The radial nerve runs in the radial groove, so it can be injured with a midshaft fracture.
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- Include both the shoulder and elbow joints; use a second image if the IR is too short.
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Radiographs 3
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Projections 3
Tap a projection for positioning, central ray and image criteria. See every exam in the Positioning Guide ›
AP humerus
CR: Perpendicular
- Position
- Erect or supine, arm slightly abducted, hand supinated, epicondyles parallel to the IR.
- Central ray
- Perpendicular
- Centering
- Mid-humerus
- Typical technique
- 70–75 kVp · 6–10 mAs · 40" SID
Image criteria
- Shoulder and elbow joints included.
- Epicondyles in profile; greater tubercle in profile laterally.
- Humeral head partly superimposes the glenoid.
Lateral humerus (rotational)
CR: Perpendicular
- Position
- Rotate the arm internally (back of the hand against the hip), epicondyles perpendicular to the IR.
- Central ray
- Perpendicular
- Centering
- Mid-humerus
- Typical technique
- 70–75 kVp · 6–10 mAs · 40" SID
Image criteria
- Shoulder and elbow joints included.
- Epicondyles superimposed; lesser tubercle in profile medially.
- Do not use when a fracture is suspected.
Transthoracic lateral
LawrenceCR: Perpendicular (10–15° cephalad if the opposite shoulder can't be raised)
- Position
- Affected arm against the IR in neutral rotation; opposite arm raised over the head. Breathing technique blurs the ribs and lung markings.
- Central ray
- Perpendicular (10–15° cephalad if the opposite shoulder can't be raised)
- Centering
- Surgical neck
- Typical technique
- 75–85 kVp · 20–40 mAs · 40" SID
- Best shows
- Proximal humerus seen through the thorax, for trauma
Image criteria
- Proximal humerus seen through the thorax, clear of the opposite humerus.
- Ribs and lung markings blurred by breathing.
Technique values are typical starting points; follow your department's technique chart.
Labeled diagrams
Quick check
2. This patient's humeral fracture prevents any rotation or abduction of the arm. Which projection should the radiographer use to obtain a lateral view of the proximal humerus?
3. For a non-trauma AP projection of the humerus, how should the humeral epicondyles be positioned?
4. On this AP humerus, the greater tubercle is seen in profile on the lateral side of the humeral head. How was the arm positioned?
5. An AP shoulder projection is taken with the hand supinated and the humeral epicondyles parallel to the digital detector. Which structure is placed in profile on the lateral side of the proximal humerus?