1 - University of Washington



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|RIGHT LEFT |

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|SHOULDER |

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|Arthritis - 3 V |

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|Instability Series - 3 V |

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|Axillary view |

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|Humerus - 2 V (Trauma) |

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|Trauma Series - 3V |

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|Impingement Series 4V |

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|ELBOW |

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|Matsen Elbow series - 4 V |

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|Elbow - 2 V |

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|Elbow - 3 V |

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|CLAVICLE 2V |

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|AC Series Bilat w & w/o weights |

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|AC Arthritis |

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|Serendipity View + AP SC Joint |

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|SCAPULA 2V |

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|DIAGNOSIS AND/OR SYMPTOMS |

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|Osteoarthritis Shoulder 715.91 |

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|Cuff Tear Arthropathy 716.91 |

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|Rotator Cuff Tear 840.4 |

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|Instability 718.81 |

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|Dislocation 831.00 |

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|Shoulder Stiffness 719.51 |

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|AVN Shoulder 733.41 |

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|Osteoarthritis Elbow 715.92 |

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|Impingement 726.2 |

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|Elbow Stiffness 719.52 |

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|Humerus Fx (prox closed) 812.0 |

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|Arthroplasty/repair |

|shoulder/elbow 81.8 |

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|Post op care V67.0 |

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|UWMC UCARD STAMP |

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|DATE |

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|PT # |

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|NAME |

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|D.O.B. |

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Signature_____________________________________________

X-Rays by Complaint

|Arthritis |Arthritis series |

|Rotator Cuff Tear (first visit only) |(Axillary, Grashey, and Template of Shoulder) |

|Shoulder Pain | |

|Clear History of: |Instability Series |

|Instability | |

|Bankart lesion | |

|Hx of dislocation | |

|"shoulder keeps coming out of joint" | |

|If not clear - Arthritis Series | |

|Anything about elbow |Matsen series - 4 view Elbow |

|True fracture of Humerus |AP and Lat of Humerus |

|AC separation |AC Series Bilat with and without weights |

|SC separation |Serendipity View |

| |AP SC Joint |

|When in doubt |Arthritis series |

| |(Axillary, Grashey, and Template of Shoulder) |

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X-Rays by Series

Arthritis series

Most patients need a three view arthritis series (Axillary, Grashey, and Template of Shoulder).

Indication: Arthritis, Rotator Cuff Tear (first visit only), Pain

  

Instability Series

If patients are complaining about instability, you can order an instability series.  This can be confusing since many patients are not sure how to describe their shoulder symptoms and often say they are unstable due to arthritis or pain.  Unless it is clear that they are unstable or had a dislocation, go ahead and order an arthritis series.

Indication: Instability, Bankart lesion, Hx of dislocation, "shoulder keeps coming out of joint"

  

Matsen Series - 4 view Elbow

Elbow complaints need a 4 view of the elbow

Indication: Anything about elbow

  

AP and Lat of Humerus

Fractured humeri need an AP and Lateral of Humerus

Indication: True fracture of Humerus

  

AC Series Bilat with and without weights

This is for AC separations.

Indication: AC separation

  

Serendipity View

If a patient has pain or instability in sternum area they need an Serendipity View of the SC joint.  You may also need to do an AC series to assess the Clavicle.

Indications: SC separation

  

When in doubt - order an arthritis series.

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Exam Room Map

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REQUESTING CLINIC:

Roosevelt Bone and Joint Clinic

SHOULDER SERVICE

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TRANSPORTANTION NEEDS:

WALK WHEELCHAIR

RISK FOR FALLS YES NO

PREGNANT YES NO

* PLEASE FILL OUT THE

FOLLOWING NUMBERS 1-4:

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UWMC R2

RAD

UWMC Roosevelt Radiology

Box 354755

4245 Roosevelt Way NE

Seattle, WA 98105

Phone: 206-598-6868

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Ordering MD UPIN#

Matsen, Frederick 009113

Bertelsen,bAlexanderD 341750

Bicknell, Ryan T 356660

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UWMC R2

RAD

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Version 1Feb2007

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