Upper Limb Imaging Tutorial PDF

Radiology Tutorial Matthew G. Fanelli Penn State Hershey College of Medicine *Modified by Gillian L. Moritz UNR Med Lazarus M, Fanelli M, Stanley A, Brian P. Upper Limb Anatomy Tutorial Using an Imaging Platform. MedEdPORTAL. 2015;11:10167. https://doi.org/10.15766/mep_2374-8265.10167 Please set thi...

Radiology Tutorial Matthew G. Fanelli Penn State Hershey College of Medicine *Modified by Gillian L. Moritz UNR Med Lazarus M, Fanelli M, Stanley A, Brian P. Upper Limb Anatomy Tutorial Using an Imaging Platform. MedEdPORTAL. 2015;11:10167. https://doi.org/10.15766/mep_2374-8265.10167 Please set this PowerPoint to “Slide Show” mode for maximum resource benefit. Instructions: Labeling 1. The first mouse click will provide an arrow and/or outline indicating a structure. Click now for example 2. The second click will provide the name of the indicated structure. Click now for example. 3. If a question is asked, the next click will reveal the answer. Humerus In clinical practice, all radiology images are labeled right or left by convention. These labels have been omitted in this tutorial as the anatomic principles shown do not vary with respect to laterality. Structure Displayed (Image View, Radiology Study Type) Information about image Proximal SAMPLE SLIDE Medial Lateral Radiology image with “scout line” to provide perspective for other image. Information about image orientation Radiology Image Distal Instructions: Information Boxes Clinical Correlation/Application Radiology Instruction/Information Anatomy Relationship/Fact Question/Answer Reading Radiology Images An axial image is a plane that divides the body into superior (more towards the head) and inferior (more towards the feet) parts, with respect to anatomical position. By convention, an axial image is viewed from the inferior perspective (as if standing at the patient’s feet). The axial plane is represented by the horizontal lines. Axial Plane (MR, T1W) Reading Radiology Images A sagittal image is a plane that divides the body into right and left parts, with respect to anatomical position. The axial plane is represented below by the vertical lines. Sagittal Plane (MR, T1W) Reading Radiology Images A coronal image is a plane that divides the body into anterior and posterior parts, with respect to anatomical position. The axial plane is represented below by the vertical lines. Coronal Plane (MR, T1W) Reading Radiology Images Question: What plane does the scout line represent? Coronal Plane (MR, T1W) Axial Plane (MR, T1W) Anterior-Posterior Radiograph Sagittal Plane (MR, T1W) Interpreting Radiology Images Question: Does this hand show any pathology or injury? Answer: Yes! The PIP of the 3rd digit is dislocated. This is more evident on the lateral view. Anterior-Posterior Radiograph It is important to remember that multiple views of an area may be required to determine if an issue is present. Radiologist: “One view = no views” Lateral Radiograph The glenohumeral (shoulder) joint Shoulder Joint The shoulder joint Shoulder Joint Movements Flexion at the shoulder is a decrease in the angle of the upper limb relative to the coronal plane of the body. Flexion Extension at the shoulder is an increase in the angle of the upper limb relative to the coronal plane of the body. Extension Shoulder Joint Movements Abduction at the shoulder is movement of the upper limb away from the median axis of the body with respect to anatomical position. Abduction Adduction at the shoulder is movement of the upper limb towards the median axis of the body with respect to anatomical position. Adduction Shoulder Joint Movements Range: 0-15° Muscle: Supraspinatus Nerve: Suprascapular Range: 15°-90° Muscle: Deltoid Nerve: Axillary Range: 90°-160° Muscle: Trapezius Nerve: Accessory (Cranial Nerve XI) Range: 160°-180° Muscle: Serratus Anterior Nerve: Long Thoracic Abduction of the upper limb at the shoulder joint involves four different muscles, supplied by four different nerves, to achieve the full range of motion from 0°-180° Shoulder Joint (Anterior-Posterior Radiograph) The clavicle transmits forces from the upper limb to the axial skeleton. Acromial end of clavicle Acromion of scapula Coracoid process of scapula Diaphysis of clavicle Superior border of scapula Head of humerus Spine of scapula Lateral border of scapula Medial border of scapula The scapula makes up a large portion of the shoulder joint. This can be visually appreciated by looking at the light green labels that indicate scapular features. Medial Lateral Sternal end of clavicle Shoulder Joint (Anterior-Posterior Radiograph) Shoulder dislocation results in damage to the glenohumeral ligaments, glenoid labrum, and the glenohumeral joint capsule. Additionally, a lesion of the axillary nerve can result causing weakness of external rotation and abduction of the shoulder joint. Humerus fractures commonly occur at the surgical neck and can result in a lesion of the axillary nerve. Medial Lateral Clavicle AN SN Brachial Plexus Axillary Nerve Clavicle result from a fall on the AN:fractures Anatomical neck of humerus shoulder or outstretched manus (hand) and can result in a lesion of of thehumerus brachial plexus. SN: Surgical neck Shoulder Joint (Grashey View, Radiograph ) Lesser tubercle Coracoid process Anatomical neck of humerus Spine of scapula Glenoid cavity Glenoid fossa of scapula Supraclavicular pain can result from “referred pain”. The nerve roots (C3-C4) give rise, in part, to the cutaneous sensory nerve fibers over the shoulder as well as to the phrenic nerve to the diaphragm. The common origin can result in shoulder pain secondary to diaphragmatic irritation. Lateral Medial The Grashey view is taken 30-40° oblique to the coronal plane of the body with respect to anatomical position. This view enables estimation of joint space narrowing that occurs jointis not obscured by bones. Clavicle commonly with arthropathy since the glenohumeral jointAC space Cutaneous Acromion distribution of supraclavicular Greater tubercle nerve (C3-C4) Anterior The x-ray beam is directed in line with the body of the scapula. This view evaluates Clavicle glenohumeral dislocation and may help characterize scapular fractures. NOTE this view is insufficient to rule out dislocation. Acromial angle of scapula Superior angle of scapula The alignment of the Glenoid fossa glenoid fossa and the head Coracoid process of of the humerus suggests a scapula Humerus non-dislocated shoulder. Long thoracic nerve Posterior Displacement of the Scapula Inferior angle of scapula Have the from patient face a hardor surface and Long thoracic nerveAnswer: injuries can result stab wounds Question: What is themastectomiessymmetrically push against this wall with his/her hands. A radical paralyzing the serratus anterior muscle. clinical test to assess for alimits movement winged of scapula willabove displace posteriorly during this This injury the arm 90°and posteriorly winged scapula? displaces the scapulamaneuver. (winged scapula). Posterior Shoulder Joint (Trans-scapular “Y” View, Radiograph) Shoulder Joint (Transscapular “Y” View, Radiograph) Clavicle Supraspinatus Acromial angle of scapula Spine of the scapula Infraspinatus The infraspinatus and teres minor muscles are inferior to the spine of the scapula. Teres minor Inferior angle of scapula Posterior Anterior Superior angle of The supraspinatus scapula muscle is superior to the spine of the scapula. Coracoid process of scapula Shoulder Joint (Axillary View, Radiograph) The radiograph is viewed as if you were looking up into Anterior patient’s underarm or down from above. It is used to evaluate joint space and glenohumeral alignment (to rule out dislocation). Humerus Coracoid process of scapula Head of humerus Lateral Medial Radial nerve Radial groove of humerus Acromion of scapula Humeral diaphysis fractures can damage the radial nerve passing through the radial groove. This injury weakens wrist joint extension, abduction, and adduction (“wrist drop”). Posterior Glenoid of scapula Shoulder Joint (Outlet-View, Radiograph) Medial Clavicle Superior angle The acromion is the most superior and lateral portion of the scapula. It provides a point of origin for the deltoid muscle (see next slide). Acromion Humerus Coracoid process Lateral The x-ray beam angled 10-15° inferiorly. This view is used to look at acromial morphology, the coracoacromial arch, and the space through which the supraspinatus passes. Shoulder Joint (Axial Plane, T1W Fat Saturated MR Arthrogram) Anterior MR Arthrogram—in The deltoid muscle originates, this study,inradiologic part, from contrast the acromion is of the scapula. injected into theThe joint muscle prior to flexes, imaging abducts to increase (beyond 15°), and visibility the extendsof the lesions. humerus. Clavicle Acromion Acromioclavicular joint Starting Superiorly Inferior Posterior Medial Lateral Superior Medial Lateral Deltoid Shoulder Joint (Axial Plane, T1W Fat Saturated MR Arthrogram) Anterior Clavicle Deltoid The supraspinatus is one of the four rotator cuff muscles. tu s Inferior Spine of scapula Posterior Moving Inferiorly Medial pin a Lateral Lateral Su pr as Medial Superior The supraspinatus muscle abducts the arm from 0 -15° and is innervated by the suprascapular nerve. Shoulder Joint (Axial Plane, T1W Fat Saturated MR Arthrogram) Anterior Coracoid process Anterior glenoid labrum Moving Inferiorly Spine of scapula Posterior Lateral Posterior glenoid labrum Sub In sc a fra pul ari sp s in at us Lateral Glenoid cartilage Medial Humerus Lateral Superior Medial Deltoid The infraspinatus is one of the four rotator cuff muscles. Inferior The infraspinatus rotates the arm laterally and is innervated by the suprascapular nerve. Shoulder Joint (Axial Plane, T1W Fat Saturated MR Arthrogram) Long head, Biceps brachii tendon Anterior The subscapularis is one of the four rotator cuff muscles. Subscapularis tendon Deltoid Superior The subscapularis muscle adducts and rotates the arm medially. It is innervated by the upper and lower subscapular Posterior nerves. Glenoid tus Sub s c ap ula ris Moving Inferiorly Inferior Medial Lateral In f ras pin a Lateral Glenoid labrum Medial Lateral Humerus Shoulder Joint (Axial Plane, T1W Fat Saturated MR Arthrogram) Long head biceps brachii tendon Anterior The biceps brachii tendon is a landmark to identify the anterior side of this axial MR. The subscapularis (anterior side of the humerus) and infraspinatus (posterior side of the humerus) can then be identified. Deltoid Superior Glenoid tus Posterior Su bsc a pu la ris Medial Lateral Medial Lateral In f ras pin a Lateral Inferior Glenoid labrum Humerus Moving Inferiorly Inferior Shoulder Joint (Axial Plane, T1W Fat Saturated MR Arthrogram) Long head biceps brachii tendon D Anterior Neurovascular bundle oi d t l e Superior Moving Inferiorly Inferior The neurovascular bundle in the axilla contains the axillary artery and nerves of the upper limb. Pressure on the axilla by a crutch may result in injury to the inferior parts of the brachial plexus. Posterior Medial Lateral Lateral Medial Lateral Humerus Shoulder Joint (Sagittal Plane, T1W Fat Saturated MR Arthrogram) Superior Acromion Long head biceps brachii tendon Infraspinatus Teres minor Deltoid Subscapularis Medial Humerus Lateral Anterior Deltoid Superior Posterior Supraspinatus The teres minor is one of the four rotator cuff muscles. Starting Laterally Inferior Coracobrachialis Inferior The teres minor rotates the arm laterally and is innervated by the axillary nerve. Shoulder Joint (Sagittal Plane, T1W Fat Saturated MR Arthrogram) Question: What muscles comprise the rotator cuff? Acromion Supraspinatus Infraspinatus Humerus Subscapularis Lateral Teres minor Posterior Anterior Long head biceps brachii tendon Deltoid Moving Medially Medial Answer: 1. Supraspinatus 2. Infraspinatus 3. Teres Minor 4. Subscapularis Superior Mnemonic: “SITS” Superior Deltoid Inferior Inferior Neurovascular bundle in quadralateral space Rotator cuff injuries result from degenerative change and acute injury. The functional deficit is limited joint mobility and strength. The specific deficit depends upon the muscle(s) or tendon(s) injured. Shoulder Joint (Sagittal Plane, T1W Fat Saturated MR Arthrogram) Superior Acromion Superior glenoid labrum Moving Medially Coracoid process Teres minor Anterior glenoid labrum Inferior Medial Anterior Deltoid Lateral Posterior glenoid labrum Deltoid Subscapularis Superior Infraspinatus Posterior Supraspinatus Inferior The glenoid labrum deepens the glenoid cavity of the scapula increasing the stability of the shoulder joint. Shoulder Joint (Sagittal Plane, T1W Fat Saturated MR Arthrogram) Superior Acromion Supraspinatus Infraspinatus Clavicle Superior Coracoid process Teres minor Body of scapula Subscapularis Coracobrachialis Triceps brachii (long head) Inferior Medial Lateral Anterior Posterior Deltoid Moving Medially The clavicle and Inferior coracoid process are excellent landmarks to determine the anterior portion of a sagittal image. Shoulder Joint (Sagittal Plane, T1W Fat Saturated MR Arthrogram) The coracoclavicular ligament reinforces the coracoclavicular joint. Coracoclavicular joint Superior Acromion Supraspinatus Clavicle Superior Infraspinatus Sub sc a pu la ris Brachial plexus Teres minor Teres major Inferior Medial Lateral Coracoid process Posterior Anterior Deltoid Moving Medially Inferior Shoulder Joint (Coronal Plane, T1W Fat Saturated MR Arthrogram) Deltoid tendon Superior Acromion Supraspinatus tendon Supraspinatus Superior glenoid labrum Cartilage Humerus Lateral Medial Glenoid cavity of the scapula Axill ary r ec es s of joint Subs c av it capu y laris musc le Deltoid This view is used to see the medial retraction of a torn supraspinatus tendon. On this MR arthrogram, contrast would occupy the space created by the retracting tendon. Inferior The arm (shoulder joint to elbow joint) The arm (shoulder joint to elbow joint) Proximal Arm (Axial Plane, MR, T1W) Anterior The biceps and triceps muscles cross the shoulder and Starting elbow joints while the deltoid only crosses the Proximally shoulder joint. Thus, the presence of the deltoid in this axial MR is a landmark of the proximal humerus. Biceps brachii Medial Lateral Humerus Deltoid Triceps brachii Posterior Question: What is the nerve injury that can result from a proximal humerus fracture? Answer: A lesion of the axillary nerve. Distal Arm (Axial Plane, MR, T1W) Anterior Biceps brachii The medial and lateral intermuscular septa separate arm nerve into the anterior Question:the What (flexor)supplies and posterior (extensor) the anterior compartments. compartment? The posterior compartment? Medial Intermuscular Septum Answer: Anterior—Musculocutaneous Posterior—Radial Humerus Lateral Medial Anterior Compartment Co Post mp eri art or me nt Lateral Intermuscular Septum Triceps brachii Posterior Moving Distally Distal Arm (Axial Plane, MR, T1W) Biceps brachii Neurovascular Bundle Basilic Vein Cephalic Vein Medial Brachial Artery Humerus Triceps brachii Posterior Lateral Anterior The cephalic and basilic are veins of the upper limb. The basilic vein courses deep to the brachial fascia in the proximal arm while the cephalic vein is always superficial to the brachial fascia. The cephalic and basilic veins serve as landmarks for the lateral and medialSame sides of the upper As limb, respectively. Previous The elbow Joint (joins arm and forearm) The elbow Joint (joins arm and forearm) Elbow Joint Movements Flexion decreases the angle made by the arm and forearm at the elbow joint. Flexion Extension increases the angle made by the arm and forearm at the elbow joint. Extension Elbow Joint Movements Supination is external rotation of the forearm and manus (hand) with respect to the arm. Pronation is internal rotation of the forearm and manus (hand) with respect to the arm. Supination Pronation Elbow Joint (Anterior-Posterior Radiograph) This radiograph shows three different joints: 1. Humeroradial (part of elbow) 2. Humeroulnar (part of elbow) 3. Proximal radioulnar Humerus Olecranon fossa of humerus Capitulum of humerus Head of radius Neck of radius Radial tuberosity Radius Humeroulnar joint Olecranon of ulna Trochlea of humerus Coronoid process of ulna Proximal radioulnar joint Ulna Medial Lateral Humeroradial joint Elbow Joint (Anterior-Posterior Radiograph) The cubital tunnel transmits the ulnar nerve from the arm to the forearm, posterior to the medial epicondyle. Humerus Lateral epicondyle Medial epicondyle Ulnar nerve entrapment can occur at the cubital tunnel causing numbness and tingling in the 4th and 5th digits of the manus (hand). Ulna Radius Ulnar Nerve Medial Lateral Cubital tunnel Elbow Joint (Anterior-Posterior Radiograph) The common extensor tendon is the origin of the extensor muscles of the forearm and attaches at the lateral epicondyle. Humerus Lateral epicondyle Ulna Radius Medial epicondyle Medial Lateral Lateral epicondylitis (tennis elbow) is chronic inflammation that results from repetitive strain on the common extensor tendon. The common flexor tendon is the origin of the flexor muscles of the forearm and attaches at the medial epicondyle. Medial epicondylitis (Golfer’s elbow) is chronic inflammation of the common flexor tendon. Elbow Joint (Oblique Radiograph) The humeroradial (the radiocapitellar) joint is the part of the elbow that enables the forearm to pronate and supinate. Medial epicondyle Capitulum of humerus Head of radius Olecranon Trochlear notch Radial notch of ulna Radius Ulna Medial Lateral Humerus Elbow Joint (Lateral Radiograph) Humerus The humeroulnar (ulnotrochlear) joint is the part of the elbow that enables the forearm to flex and extend. Capitellum Radius Coronoid process of ulna Trochlear notch of ulna Ulna Olecranon The forearm (elbow joint to wrist joint) The forearm (elbow joint to wrist joint) Forearm (Anterior-Posterior Radiograph) Anterior interosseous artery Interosseus memberane Posterior interosseous artery The anterior interosseous artery enters the posterior compartment of the forearm distal to the distal end of the interosseous membrane. Medial Lateral Common interosseous artery The posterior interosseous artery enters the posterior compartment of forearm proximal to the proximal end of the interosseous membrane. Forearm (Radiograph) The radius (green) and ulna (orange) are parallel when the manus (hand) is in the anatomical position. Pronation The radius (green) and ulna (orange) are crossed during pronation of the manus (hand). Neutral Supination Wrist joint and hand Wrist joint and hand Wrist Joint Movements Extension is movement of the hand dorsally increasing the angle with the forearm. Extension Anatomic Position Flexion is movement of the hand to the volar side decreasing the angle with the forearm. Flexion Wrist Joint Movements Ulnar Deviation Adduction Ulnar deviation is movement of the hand medially with respect to anatomical position. Anatomic Position Radial Deviation Abduction Radial deviation is movement of the hand laterally with respect to anatomical position. Thumb Movements Flexion Extension Play close attention to the movements of the thumb as this information facilitates understanding the names and functions of hand muscles. Adduction Abduction Finger Movements Flexion Extension Carpal Tunnel (Axial Plane, MR, T1W) NOTE: structures on this slide are for your interest/review only! (i.e. not on the practical for imaging) Guyon’s canal transmits the ulnar nerve and artery through the carpus). Trapezium Trapezoid Capitate Hamate First metacarpal Carpal Tunnel Thenar compartment Median Ulnar Nerve artery Flexor retinaculum Abductor digiti minimi Ulnar nerve Guyon’s Canal Deep palmar carpal The deep palmar carpal Carpal tunnel syndrome results from compression of structures deep ligament (in part) ligament forms the anterior to the flexor retinaculum that lie within the carpal tunnel. boundary of Guyon’s canal. Carpal Tunnel (Axial Plane, MR, T1W) NOTE: structures on this slide are for your interest/review only! (i.e. not on the practical for imaging) Question: What nerve lesion occurs in Guyon’s canal and what are the symptoms? Answer: Entrapment of the ulnar nerve in this location can result in pain, numbness, and tingling in the fourth and fifth digits, as well as atrophy of the muscles supplied by the ulnar nerve. Carpal Tunnel Guyon’s Canal Question: What nerve lesion occurs during carpal tunnel syndrome and what are the symptoms? Answer: The median nerve is compressed due to reduced size of the carpal tunnel and can result in pain, paresthesia, and atrophy of the thenar eminence. Carpal Tunnel (Axial Plane, MR, T1W) NOTE: structures on this slide are for your interest/review only! (i.e. not on the practical for imaging) Three of the tendons of flexor digitorum profundus Carpal Tunnel Three of the tendons of flexor digitorum superficialis Question: Which muscle tendons, and how many of each, are located in the carpal tunnel? Answer: The carpal tunnel contains tendons of the flexor pollicis longus (1 tendon), flexor digitorum superficialis (4 tendons) and flexor digitorum profundus (4 tendons) muscles. (NOTE: not all of these structures are shown above) Hand (Manus) Overview (Anterior-Posterior Radiograph) Distal phalanx Both extensor pollicis tendons are on the dorsal (posterior) surface of the manus (hand). Middle phalanx Sesamoid bones Extensor pollicis longus tendon Ulnar Radial Proximal phalanx Metacarpal Extensor pollicis brevis tendon Carpal bones Styloid process of radius Styloid process of ulna Distal radioulnar joint Wrist (Carpus) (Anterior-Posterior Radiograph) The hook of the hamate is in close proximity to Guyon’s canal. Capitate The carpus is comprised of eight bones: scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, and hamate. Trapezoid Hamate Ulnar Hook of hamate Scaphoid Triquetrum Lunate Pisiform Question: What nerve is potentially injured by a hook of the hamate fracture? Answer: the ulnar nerve Scaphoid fractures result from a fall on an outstretched manus (hand). The fracture may injure the radial artery (shown next slide). A potential serious complication is avascular necrosis of the scaphoid bone. Radial Trapezium Hand (Manus) (Anterior-Posterior Radiograph) Question: Fractures of the fifth metacarpal neck are also referred to as what? Answer: Boxer’s fracture 2nd-4th Boxer’s fracture Metacarpal 1st Metacarpal Metacarpal neck fractures often occur as a result of direct contact of an object (or person) with a closed fist. NOTE: The transverse metacarpal ligaments ligaments are taut in flexion, and slack in extension; therefore the MCP joints should be splinted in flexion to prevent shortening of the ligaments. Hand (Oblique Radiograph) The anatomical snuffbox is a triangular interval bound laterally by the tendon of extensor pollicis brevis and medially by the tendon of extensor pollicis longus. The floor, comprised of the scaphoid and trapezium, is crossed by the radial artery. Extensor pollicis longus tendon Extensor pollicis brevis tendon Radial Artery Trapezium Scaphoid Radial Ulnar Dorsal View Examination of the Anatomical Snuffbox Extensor pollicis brevis tendon Extensor pollicis longus tendon Anatomical snuffbox Scaphoid fractures can result in pain with palpation of the anatomical snuffbox. Hand (Oblique Radiographs) Question: A fracture of the scaphoid bone can damage which vessel? Answer: the radial artery Hamate Capitate Trapezium Radial Ulnar Ulnar Radial Pisiform Scaphoid Trapezoid Triquetrum Trapezoid Trapezium Triquetrum Lunate Scaphoid Radial Artery Lunate Dorsal View Medial to Lateral View Joints (Lateral Radiograph) Proximal interphalangeal joint Intermetacarpal joint The digits of the hand are flexed and extended, in part, by the tendons of muscles in the forearm. Question: Where does the common flexor tendon originate in the upper limb? Distal interphalangeal joint Metacarpophalangeal joint Carpometacarpal joint Radiocarpal joint Dorsal Palmar Answer: The medial epicondyle of the humerus Manus (Hand) (Coronal Plane, MR, T1W) NOTE: structures on this slide are for your interest/review! (i.e. not on the practical for imaging) Distal phalanx of thumb Proximal phalanx of thumb Starting on palmar side Tendons of flexor digitorum Tendon of flexor pollicis longus 1st metacarpal The flexor digitorum tendons flex the interphalangeal joints as well as the hand. Hand (Coronal Plane, MR, T1W) NOTE: structures on this slide are for your interest/review! (i.e. not on the practical for imaging) Distal phalanx of thumb Proximal phalanx of thumb Opponens digiti minimi Moving Dorsally Adductor pollicis Abductor digiti minimi Trapezium 1st metacarpal Ulna Opponens digiti minimi opposes the little finger and is innervated by the ulnar nerve. Hand (Coronal Plane, MR, T1W) NOTE: structures on this slide are for your interest/review! (i.e. not on the practical for imaging) Central axis of hand Palmar interossei Moving dorsally 1 2 The central axis of the manus (hand) is the third digit (middle finger). 3 Trapezoid Trapezium Hamate Capitate Scaphoid Triquetrum Lunate Ulna Radius Remember the palmar interossei muscles using the mnemonic “3PAD”. 3 = three muscles in each manus (hand) P = palmar side of manus (hand) AD = adductor Manus (Hand) (Coronal Plane, MR, T1W) NOTE: structures on this slide are for your interest/review! (i.e. not on the practical for imaging) Central axis of hand Trapezoid Trapezium Scaphoid 1 2 3 4 Medial Lateral Dorsal interossei Hamate Capitate Triquetrum Lunate Ulna Radius Moving dorsally Remember the dorsal interossei muscles using the mnemonic “4DAB”. 4 = four muscles in each manus (hand) D = dorsal side of manus (hand) AB = abductor Practical Exam Be able to identify the following: carpals phalanges metacarpals radius ulna clavicle spine of scapula acromion ac joint greater tubercle lesser tubercle coracoid process glenoid cavity/fossa head of humerus deltoid supraspinatus infraspinatus biceps (tendon of long head) biceps (short head) pectoralis major coracobrachialis subscapularis glenoid labrum teres minor teres major/latissimus dorsi Good luck in your anatomy studies!