Humerus (lateral view)

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The lateral view of the humerus is part of the humerus series and is usually taken in a standing position. However, it can also be taken in the supine position in the acute, trauma setting.

The projection demonstrates the humerus in the lateral position allowing for adequate radiographic examination of the entire humerus and its respected articulations.

Indications

Humerus views are often done to exclude large humeral shaft fractures or suspected symptomatic metastatic lesions , if an occult fracture is suspected at either the proximal or distal end, it is best to do a separate elbow or shoulder series.

Patient position

  • patient is preferably erect
  • patient stands facing the detector with the injured side closest to the detector 
  • patient is then rotated so that the lateral aspect of the shoulder of the affected side, the arm and the elbow are all in contact with the upright bucky
  • the elbow is flexed 90° (as close to 90° as possible) 
  • place the patient's hand on their ASIS or stomach to maintain position 

Technical factors

  • posteroanterior projection
  • centering point
    • mid humerus shaft
  • collimation
    • superior to the skin margins above the glenohumeral joint
    • inferior to include the distal humerus including the elbow joint
    • lateral to include the skin margin 
    • medial to include medial skin margin 
  • orientation  
    • portrait
  • detector size
    • 35 cm x 43 cm
  • exposure
    • 60-70 kVp
    • 7-15 mAs
  • SID
    • 100 cm
  • grid
    • yes (this can vary departmentally)

Image technical evaluation

  • medial and lateral epicondyles superimposed and scapula in lateral (Y-shaped) position
  • humerus is positioned away from the patient's body, minimizing superimposition

Practical points

It is best to show the patient how you want their arm to rest for the projection. Often you will have to tilt the LBD to be aligned with the long axis of the humerus.

Patients in an enormous amount of pain may struggle to bend their arm nor abduct to the ideal angle. To overcome this, let them rest their hand on their stomach instead and slowly position themselves.

There will be times where optimal positioning may not be possible. In these cases, attempt to pivot the patient less, ensuring the primary beam is directed at the mid humeral shaft and collimate very tightly to the area of interest. This will result in a suboptimal lateral projection, yet may still demonstrate the relevant pathology.