Imaging the Upper Limb

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Imaging the Upper Limb
Timothy Dowdell, MD Dawn Pearce, MD Joel
Rubenstein, MD Charis Kepron, MSc
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Anteroposterior View of the Shoulder
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clavicle (acromial end)
glenoid fossa
humeral head
anatomical neck
surgical neck
clavicle (sternal end)
lateral margin of scapula
humeral shaft
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acromion
scapular spine
acromioclavicular joint
coracoid process
greater tubercle
lesser tubercle
intertubercular groove
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Transaxillary View of the Shoulder (with
Abduction)
intertubercular groove
lesser tubercle
greater tubercle
humerus (shaft)
surgical neck
anatomic neck
humeral head
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coracoid process
glenoid fossa
clavicle
humerus
acromion
scapula
angle of acromion
acromioclavicular joint
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Trans-scapular Y View of the Shoulder
clavicle
coracoid process
acromion
humeral head
lesser tubercle
inferior angle of scapula
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Axillary Arteriogram
anterior circumflex humeral a.
thoracoacromial a.
posterior circumflex humeral a.
axillary a.
catheter
subscapular a.
brachial a.
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Whats Wrong With This Shoulder?
Shoulder separation
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Whats Wrong With This Shoulder? (part 1)
You shouldnt need a hint
normal
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Whats Wrong With This Shoulder? (part 2)
Anterior dislocation of humeral head
normal
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Magnetic Resonance Imaging of the Shoulder
Axial Plane
anterior
Left Shoulder
posterior
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Axial MR Image of the Shoulder with Correlation
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pectoralis major
subscapularis
anterior
biceps tendon (long head)
greater tubercle
deltoid
humeral head
glenoid labrum
glenoid
teres minor
infraspinatus
posterior
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MR Imaging of the Shoulder Coronal Oblique Plane
superior
A
P
inferior
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superior
trapezius
clavicle
acromioclavicular joint
acromion
supraspinatus
scapular notch
humeral head
glenoid
deltoid
subscapularis
inferior
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trapezius
clavicle
acromion
supraspinatus and tendon
humeral head
glenoid
subscapularis
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T2-Weighted Shoulder Arthrogram
Coronal plane
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MR Imaging of the Shoulder Sagittal Plane
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anterior
posterior
acromioclavicular ligament
acromion
clavicle
supraspinatus
coracoid process
deltoid
infraspinatus
glenoid
teres minor
subscapularis
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Whats Wrong With This Shoulder? (part 1)
Saggital MR Images
Normal
A
P
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Whats Wrong With This Shoulder? (part 2)
Coronal MR Images
Torn rotator cuff (supraspinatus)
Normal
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A-P View of the Elbow
humerus
medial epicondyle
lateral epicondyle
coronoid process
radial head
radial neck
radial tuberosity
radius
ulna
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humerus
lateral supracondylar crest
olecranon fossa
olecranon process
capitellum (capitulum)
trochlea
radial notch
radius
ulna
location of interosseus membrane
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Lateral View of the Elbow
coronoid fossa (humerus)
coronoid process (ulna)
radius
ulna
trochlear notch (ulna)
olecranon process
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radial tuberosity
radial neck
radial head
capitellum (capitulum)
cortex
medullary space
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Brachial Arteriogram
brachial artery
ulnar recurrent artery
anterior interosseus artery
ulnar artery
radial artery
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Whats Wrong With This Elbow?
avulsion fracture of lateral epicondyle
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Whats Wrong With This Elbow? (part 1)
Normal
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Whats Wrong With This Elbow? (part 2)
Same elbow, lateral view
Dislocation of humeroulnar joint
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A-P View of the Wrist
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head
body
first metacarpal
fifth metacarpal
base
styloid process of radius
carpal bones
styloid process of ulna
radiocarpal joint
distal radioulnar joint
radius
ulna
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hook of the hamate
trapezoid
hamate
trapezium
triquetrum
capitate
pisiform
scaphoid
lunate
location of articular disc
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base of fifth metacarpal
hamate
trapezium
pisiform
scaphoid
triquetrum
styloid process of radius
lunate
styloid process of ulna
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A-P View of the Hand
distal phalanx (third)
middle phalanx (fourth)
proximal phalanx (fifth)
metacarpals
scaphoid
lunate
ulna
radius
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head
distal phalanx
DIP joint
body
base
PIP joint
MCP joint
head
proximal phalanx
sesamoid bones
body
base
head of first metacarpal
carpometacarpal joints
base of first metacarpal
midcarpal joints
radiocarpal joint
distal radioulnar joint
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Arteriogram of The Hand
digital arteries
superficial palmar arterial arch
radial artery
ulnar artery
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Whats Wrong With This Wrist?
Fracture of distal radius
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Whats Wrong With This Wrist? (part 1)
Patient presents with wrist pain following a fall
on the outstretched hand. Whats wrong?
Normal
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Whats Wrong With This Wrist? (part 2)
Fracture of scaphoid
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Whats Wrong With This Hand?
Dislocated PIP joint
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Reduction of Dislocation
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MR Imaging of the Wrist Coronal Plane
superior
digital flexor tendons
pisiform
scaphoid
medial
lateral
hook of the hamate
trapezium
first metacarpal
hypothenar muscles
inferior
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MR Image of the Wrist Axial Plane Showing the
Carpal Tunnel
dorsal
digital extensor tendons
extensor carpi radialis longus tendon
capitate
extensor carpi ulnaris tendon
trapezoid
trapezium
hamate
hook of the hamate
thenar muscles
hypothenar muscles
carpal tunnel
median nerve
palmar
flexor retinaculum
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lunate
triquetrum
scaphoid
tendons of flexor digitorum superficialis and
profundus, flexor pollicis longus, median nerve
flexor retinaculum
carpal tunnel
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Lateral View of the Wrist With Perilunate
Dislocation
normal
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Anatomy and Radiology Resources
Books (available at Gerstein) Anatomy in
Diagnostic Imaging, 2nd Ed. P. Fleckenstein and
J. Tranum-Jensen, 2001. A great atlas of
radiologic anatomy with examples of all the
primary modalities in use today. Imaging Atlas
of Human Anatomy, 2nd Ed. J. Weir and PH
Abrahams, 1997. Another nice atlas. Internet Gray
s Anatomy online ? www.bartleby.com/107/ Net
Anatomy ? www.netanatomy.com A terrific
website! The Visible Human Project ?
www.nlm.nih.gov/research/visible For all your
cross-sectional needs. Photos, CT, MRI and more.
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Additional Material
But only if youre lucky!
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Whats Wrong With This Shoulder? (part 1)
normal
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Whats Wrong With This Shoulder? (part 2)
Fractured scapula
Same patient transcapular view
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3-D Rendering of Serial CT Images
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Whats Wrong With This Shoulder? (part 1)
Normal
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Whats Wrong With This Shoulder? (part 2)
normal
Posterior dislocation of humeral head
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Whats Wrong With This Shoulder? (part 1)
Coronal MR Images
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Whats Wrong With This Shoulder? (part 2)
Rotator cuff tear with superior migration of
humerus
Normal
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Whats Wrong With This Elbow?
Fracture of radial head with sail sign
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Whats Wrong With This Elbow? (part 1)
Normal
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Whats Wrong With This Elbow? (part 2)
Subtle radial head fracture with anterior and
posterior Sail sign (indicates elbow joint
effusion)
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Whats Wrong With This Arm?
Night stick fracture of ulna (in a cast)
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Whats Wrong With This Wrist?
Radial epiphyseal fracture with displacement
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Whats Wrong With this Wrist? (part 1)
Normal
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Whats Wrong With This Wrist? (part 2)
Scaphoid fracture with avascular necrosis
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Congenitally short metacarpal
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Whats Wrong With This Shoulder? (part 1)
Ultrasound
Coronal MR
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Whats Wrong With This Shoulder? (part 2)
Ultrasound
Axial MR
Partial rotator cuff tear with fluid in
subacromial bursa