PC. Imaging the Upper Limb (HA) - Part 1.pptx

Upper Limb Imaging anatomy Helen Anderson Objectives • Explore imaging modalities for :• Shoulder • Elbow • Wrist • Hand • Review Musculoskeletal anatomy related to imaging. Imaging modalities • X-ray • Ultrasound • CT • MRI • Fluoroscopy Shoulder Shoulder Shoulder Anatomy • ACJ • Humeral...

Upper Limb Imaging anatomy Helen Anderson Objectives • Explore imaging modalities for :• Shoulder • Elbow • Wrist • Hand • Review Musculoskeletal anatomy related to imaging. Imaging modalities • X-ray • Ultrasound • CT • MRI • Fluoroscopy Shoulder Shoulder Shoulder Anatomy • ACJ • Humeral head • Glenoid fossa • Scapula • Coracoid Shoulder Clavicle Acromion Coracoid Glenoid fossa Humerus Shoulder Acromion Coracoid Acromion Glenoid Glenoid Coracoid Shoulder CT • Look at bones • Muscles • Joints • Other soft tissues CT Shoulder CT shoulder CT shoulder - Coronal CT shoulder - Coronal ACJ Humerus Glenoid CT shoulder - Sagittal CT shoulder - Sagittal ACJ Glenoid Sternoclavicular joints Shoulder soft tissues • Rotator cuff • Glenoid labrum • Other muscles Coronal Shoulder MRI Coronal Shoulder MRI ACJ Supraspinatus Glenoid Humerus Deltoid Subscapularis Sagittal MRI Shoulder Sagittal MRI Shoulder Supraspinatus Glenoid Subscapularis Infraspinatus Axial Shoulder MRI Identify:1.Supraspinatus 2.Infraspinatus 3.Subscapularis 4.Biceps 5. Humeral head 6. Glenoid fossa Axial Shoulder MRI 4 1.Supraspinatus 2.Infraspinatus 3.Subscapularis 4.Biceps 5 6 5. Humeral head 6. Glenoid fossa 1 2 3 Shoulder USS Shoulder USS Fluoroscopic image MRI Arthrography Axial Image Coronal Image Elbow Lateral x-ray elbow AP x-ray of elbow Elbow 4 1 3 2 1. Radial head3. Olecranon 2. Ulna 4. Distal humerus Lateral x-ray elbow AP x-ray of elbow Elbow MRI Coronal MRI Sagittal MRI Elbow MRI Coronal MRI Sagittal MRI 2 4 1 1 3 1. Humerus 2. Radial head 3 3. Ulna 4. Olecranon Elbow Flexor and Extensor tendon Origins • Flexor tendons of the forearm • Originate at the medial epicondyle and include: • Extensor tendons of the forarm • Originate at the lateral epicondyle and include: • Pronator teres • Flexor carpi radialis • Palmaris longus • Flexor digitorum superficialis • Flexor carpi ulnaris • Extensor brevis • Extensor • Extensor • Extensor carpi radialis digitorum digiti minimi carpi ulnaris Wrist Metacarpals Radius Ulna Wrist 7 8 5 6 1 3 2 4 Wrist 7 8 5 6 1 1. Scaphoid 2. Lunate 3. Triquetral 4. Pisiform 5. Hamate 6. Capitate 3 4 2 7. Trapezoid 8. Trapezium Scaphoid fracture MRI Carpal Tunnel • Flexor retinaculum • Attached pisiform and hammate (ulna) • Scaphoid tubercle and trapezium (radially). • Median nerve and flexor tendons to the hand pass through it. • What does compression of the medial nerve at this level cause? • Atrophy of the thenar eminence, • Weakness of the flexor pollicis brevis, opponens pollicis, abductor pollicis brevis, • Sensory loss in the digits supplied by the median nerve Carpal Tunnel Carpal Tunnel MRI Carpal Tunnel Hands AP Right Hand Lateral Oblique Right Hand Hands 3 2 1 Metacarpals 1. Proximal Phalanx 2. Middle Phalanx 3. Distal Phalanx