Upper Extremity Anatomy(Shoulder,elbow,and wrist)

IN COMPUTED TOMOGRAPHY

Frank Cairo R.T. ( R ) ( CT ) ( MR )

General Imaging Methods

• CT is a major method for the evaluation of MSK anatomy and disease; it– Provides specific information about bone and

other mineralized tissue– Is useful for evaluating bone and soft tissue

tumors– Adds details to information obtained with

conventional radiography in cases of multiple fractures

– Is used to evaluate joints, especially after air or iodinated CM is injected into the joint

General Imaging Methods (cont’d)

• Techniques to scan the MSK system are tailored to each patient and region being examined

• Patients are positioned so that both sides are as symmetric as possible

• Lower extremities are usually scanned with the patient supine and feet-first into the scanner

• Upper extremities are often scanned with the patient supine and head-first into the scanner

General Imaging Methods (cont’d)• AP and lateral scout images are taken to localize the area of interest• In general, when scanning long bones, the plane of the CT section should

be perpendicular to the long axis• IV contrast medium is not routinely administered for MSK trauma, but is

valuable for other indications• Most MSK protocols include multiplanar reformations• If a fracture is seen on the cross-sectional images, 3D reformations are

often performed

General Imaging Methods (cont’d)

• The patient should be made as comfortable as possible so that inadvertent motion does not degrade the study

• It is seldom necessary for a patient to breath-hold• The reconstruction algorithm is based on the clinical

application– A standard algorithm is used if soft tissue or

muscle is of primary interest– If bone detail is needed, data are also

reconstructed in a bone algorithm

Annotating the Upper Extremity• Special care must be taken when annotating the hand,

wrist, forearm, or elbow• CT annotation systems begin with the assumption that

the patient is in the anatomic position• This system is disrupted for the upper extremity when

the patient is positioned so that the arm is raised over the head, or is positioned on the far end of the scanner with the arm extended

• Consult the manufacturer’s instructions for suggestions on particular makes of scanners

• Place small radiopaque markers on the extremities at one edge of the scan range

Musculoskeletal Protocols

• Shoulder or scapula• Elbow• Wrist

Indications

• Trauma• Pain• RCT tear• Bursitis• Arthritis

GROSS ANATOMY OF THE SHOULDER

GROSS ANATOMY

GROSS ANATOMY OF SCAPULA

SCAPULA

ROTATOR CUFF

• The rotator cuff is a group of muscles which work together to provide the Glenohumeral (shoulder) joint with dynamic stability, helping to control the joint during rotation (hence the name). The rotator cuff muscles include:

• Supraspinatus • Infraspinatus • Teres Minor • Subscapularis

Rotator Cuff cont.

• Supraspinatus: 1st 10 degrees of abduction• Infraspinatus: external rotation• Teres minor: external rotation• Subscapularis: internal rotation

ROTATOR CUFF

LABRUM

Shoulder

SUPERIOR VIEW

SAGITAL VIEW

POSTERIOR VIEW

ANTERIOR VIEW

SHOULDER

1- Head of Humerus

2- Acromion and part of spine

SHOULDER

1

2

3

4

1- Head of Humerus

2- coracoid process

3- glenoid process

4- scapula

SHOULDER

1

2

1- Bicipitial groove

2- Body of scapula

SAGITAL MPR1

2

3

4

1- AC Joint

2- Acromion process

3- Clavicle

4- Corocoid Process

SAGITAL MPR

1

2

3

1- Bicipital Groove

2- Greater Tubercle

3- Humeral Head

CORONAL MPR

12

1- AC Joint

2- Humeral Head

CORONAL MPR

1

2

1- Acromion Process

2- Glenoid Fossa

Elbow

ELBOW

ELBOW

ELBOW

Elbow

Elbow

ELBOW

1

2

1- Medial Epicondyle

2- Lateral Epicondyle

ELBOW

1

1- Olecranon Process of the ulna

ELBOW

1

2

1- Head of Radius

2- Ulna

Sagital MPR of the elbow

Medial Lateral

1

23

1

2

3

1- Coronoid process2- Trochlea of the humerus3- Olecranon process

1- Radial tuberosity2- Radial head3- Capitulum

CORONAL MRR

1

2

3

1- Medial epicondyle

2- Lateral epicondyle

3- Olecranon process

CORONAL MPR1- Capitulum

2- Radial head

3- Trochlea

4- Coronoid process

1

2

3

4

Hand and Wrist Bony Anatomy

Consists of:• Distal Radius and Ulna – Styloid processes on

each side, site of tendon attachment• 8 Carpal Bones– Proximal Row – Scaphoid, Lunate, Triquetral, Pisiform– Distal Row – Trapezium, Trapezoid, Capitate, Hamate

• 5 Metacarpals – Base (P), Body and Head (D)• 14 phalanges – 3 phalanges with exception at

thumb (2)

Anatomy

Anatomy

Anatomy

Wrist bones• Wrist Bones Mnemonic – Proximal Row (Radial to ulnar wrist) • Scaphoid or Carpal Navicular (Some) – Links proximal to distal carpal row

• Lunate (Lovers) • Triquetrum (Try) • Pisiform (Positions)

– Distal Row (Radial to ulnar wrist) • Trapezium/Greater multangular (That) • Trapezoid/Lesser multangular (They) • Capitate (Can't) • Hamate (Handle)

Anatomy

Anatomy

Anatomy

Wrist bones• Wrist Bones Mnemonic – Proximal Row (Radial to ulnar wrist) • Scaphoid or Carpal Navicular (Some) – Links proximal to distal carpal row

• Lunate (Lovers) • Triquetrum (Try) • Pisiform (Positions)

– Distal Row (Radial to ulnar wrist) • Trapezium/Greater multangular (That) • Trapezoid/Lesser multangular (They) • Capitate (Can't) • Hamate (Handle)

WRIST

1

2

1- RADIUS

2- ULNA

WRIST

1 2

31- SCAPHOID

2- LUNATE

3- TRIQUETRUM

WRIST

12

34 1- HAMATE

2- CAPITATE

3- TRAPEZOID

4- TRAPEZIUM

WRIST

1

2 3 4 1- TRAPEZIUM

2- TRAPEZOID

3- CAPITATE

4- HAMATE

WRIST

WRIST

1

1- METACARPALS

WRIST CORONAL MPR

1

2

3

4

5

6

1- TRAPEZOID

2- CAPITATE

3- HAMATE

4- TRIQUETRUM

5- LUNATE

6- SCAPHOID