General Radiology of the Limbs PDF

General Radiology MPA 502 Limbs By: Bernadee Evi, MCMS, PA-C 1  Objec!ves Approach ordering and reading extremity radiographs systema!cally. Iden!fy anatomical structures on radiographs of the shoulder, elbow, forearm, wris...

General Radiology MPA 502 Limbs By: Bernadee Evi, MCMS, PA-C 1  Objec!ves Approach ordering and reading extremity radiographs systema!cally. Iden!fy anatomical structures on radiographs of the shoulder, elbow, forearm, wrist, hand, hip, femur, knee, lower leg, and foot. 2  Approach to Radiograph of the Limbs AP and lateral views When a fracture is seen, one must obtain 0lms of the joint above and the joint below. LOOK FOR: 1. Black lines (fractures) 2. Cortex of the joint (intraar!cular fracture); borders should be smooth 3. Joint space narrowing or widening 4. So: !ssues – enlargement (swelling) or displaced fat pads (radial head) Describe area, views, loca!on, paern and type 3 Fracture Paerns Avulsion - tendon or ligament pulls o= a piece of the bone impac!on AKA buckle or torus - bone is compressed 4  Fracture Paerns Simple - 2 pieces; aka closed Comminuted - >2 pieces 5  Fracture Paerns Compound - through skin or another organ 6  Fracture Paerns Greens!ck – 1 side broken and 1 side bent. Refer if >15 degree angula!on * Complete 7  Fracture Paerns Fracture Disloca!on – fracture with misalignment of joint (look at distal bone for direc!on) 8 Fracture Paerns Pathologic fracture – due to metabolically weakened bone Stress – small crack due to repe!!ve small trauma 21-y/o male with hyperparathyroidism presen!ng with stress fracture. 9 hps://www.cfp.ca/content/63/8/610  Fracture Paerns Transla!on - the sideways mvmt of a fx bone away from the other bone fragments Rotated - fragment rotated in rela!on to proximal one 10  Fracture Paerns Angula!on - a:er reduc!on fragments form angle 11  Fracture Paerns Displacement – fragments have moved out of place. A broad term that includes transla!on, angula!on, and rota!on. (look at proximal piece for direc!on) displaced !b 0b fracture transverse compound fracture of distal !bia with medial displacement. 12  Fracture Paerns Shortened - distal fracture component moving proximally 13  References Ouellee H, MD; Tetreault P, MD. Clinical Radiology, made ridiculously simple, 2nd ed. Miami: MedMaster, 2008 Radiology Masterclass – free tutorials hps://www.radiologymasterclass.co.uk/tutorials/tutorials Basics of Radiology, Heřman, Miroslavetal. hps://eds.p.ebscohost.com/eds/ebookviewer/ebook/ ZTAwMHhuYV9fMzE3NzAwN19fQU41?sid=6f3abe64-8c91-41ae-8aee- 5a81004c8a33@redis&vid=1&format=EB The End of Part 1 14  General Radiology MPA 502 Limbs By: Bernadee Evi, MCMS, PA-C 1  Objec!ves Iden!fy anatomical structures on radiographs of the shoulder, elbow, forearm, wrist, hand. Based on e!ology, pathophysiology, history, physical, and radiographic images, iden!fy shoulder injuries, including clavicular fractures, humeral sha, fractures, proximal humerus fractures (Neer’s classi1ca!on), glenohumeral disloca!on, and AC joint separa!on. Iden!fy glenohumeral and AC joint disloca!ons Based on e!ology, pathophysiology, history, physical, and radiographic images or report, iden!fy elbow injuries including, distal humerus fractures, proximal ulnar fractures, elbow disloca!ons, radial head subluxa!on and fractures, Monteggia fracture-disloca!on, and Galeazzi fracture disloca!on. Based on e!ology, pathophysiology, history, physical, and radiographic images, iden!fy wrist injuries including Colles’ fracture, Smith’s fracture, Barton’s fracture, scaphoid fracture, and wrist disloca!ons. Based on e!ology, history, physical, and radiographic images, iden!fy hand injuries including Benne’s fracture, Rolando’s fracture, Skier’s thumb, and boxer’s fracture, and mallet 1nger. 2  Approach to Radiograph of the Limbs AP and lateral views When a fracture is seen, one must obtain 1lms of the joint above and the joint below. LOOK FOR: 1. Black lines (fractures) 2. Cortex of the joint (intraar!cular fracture); borders should be smooth 3. Joint space narrowing or widening 4. So, !ssues – enlargement (swelling) or displaced fat pads (radial head) Describe area, views, loca!on, paern and type 3 Shoulder Anatomy (A) greater tubercle (B) acromion (C) Clavicle (D) humeral head (E) glenoid process, (F) medial or vertebral border of scapula (G) coracoid process (H) inferior angle of scapula (I) (I) 5th rib (J) axillary border of scapula. 4  Shoulder Anatomy AP View 1, Clavicle. 2, Acromion. 3, Greater tubercle. 4, Lesser tubercle. 5, Neck of the humerus 6, Humerus 7, Coracoid Process. 8, Scapula 9, Rib. Arrow, Glenohumeral joint space. 5  Shoulder Anatomy Transcupular Y view is used to look for disloca!on. The humeral head should occupy the circle and be overlapping glenoid. 6  Shoulder Views Radiographic views should include AP, Transcupular (Y), and axillary views (at least); stress views of the AC joint where indicated. AP Lateral (Y)(Scapular) view MB (Mercedes Benz sign) 7  Y View Shoulder Views Axillary 8  Proximal Humeral Fracture H&P – fall onto an outstretched hand (FOOSH) or MVA; swelling, bruising, pain, and restricted shoulder movement. Complicaons – adhesive capsuli!s; axillary n. damage; ischemia; loss of func!on (fxn). Dx – X-ray or CT 9  Proximal Humeral Fracture hp://www.youtube.com/watch?v=IXCD_BcbgOw Proximal Head Fracture 10 hps://www.youtube.com/watch?v=AZNlBOnfm4U hps://www.ncbi.nlm.nih.gov/pmc/ar!cles/PMC3528923/  Shoulder Disloca!ons Anterior and Posterior Shoulder Dislocaons 11  Anterior Shoulder Disloca!on AKA Anterior Glenohumeral joint disloca!on H&P – FOOSH, MVA, seizure, “shoulder popping out”, 90% of shoulder disloca!ons; bump Dx – Scapular Y view; Hillsachs and Bankart lesions 12 hps://www.msdmanuals.com/professional/mul!media/video/how-to-reduce-anterior-shoulder-disloca!ons-hennepin-technique Anterior Shoulder Disloca!on Frontal 1lm – humeral head is medial and Transcupular-Y view- disrup!on of inferior to glenoid fossa MB sign and humeral head is 13 displaced anteriorly  Anterior Shoulder Disloca!on Ant. Disloca!on – Y View 14  Anterior Shoulder Disloca!on Associated Injuries A Hill-Sachs lesion - The humeral head has a groove or inden!on at the site of impact. Bankart lesion - inferior glenoid rim is broken (avulsion of glenoid labrum). sack of humor Hi! My name is Glen Bank Heart hps://www.youtu be.com/watch?v=a 6BWiufgmsc 15  Posterior Shoulder Disloca!on AKA Posterior Glenohumeral joint disloca!on Both the lateral and H&P – Anterior Lateral especially the axillary directed View view clearly trauma, demonstrate the electrical shock, rela!onship between seizure; arm the glenoid and the held in humeral head and adduc!on and con1rm a posterior internal disloca!on. rota!on.