Upper Extremity Imaging & Anatomy PDF

Upper Extremity Imaging & Anatomy CLINICAL IMAGING ll Brianna C. Dutton DC, MS Assistant Professor, Parker University Upper Extremity Views SHOULDER Standard AP Internal rotation AP External rotation Supplemental Abduction (Baby-arm) Lateral scapula (“Y” projection) Grashey view A/C JOINT Standard B...

Upper Extremity Imaging & Anatomy CLINICAL IMAGING ll Brianna C. Dutton DC, MS Assistant Professor, Parker University Upper Extremity Views SHOULDER Standard AP Internal rotation AP External rotation Supplemental Abduction (Baby-arm) Lateral scapula (“Y” projection) Grashey view A/C JOINT Standard Bilateral with and without weights CLAVICLE Standard Frontal Axial ELBOW Standard AP Medial oblique Lateral Supplemental Tangential (Jones) Radial head (Coyle) WRIST Standard PA Medial oblique Lateral Supplemental PA ulnar deviated HAND Standard PA Medial oblique Lateral Supplemental Norgaard view (Ball-catcher’s) FINGERS Standard PA Medial oblique Lateral THUMB Standard AP Lateral SHOULDER IMAGING SHOULDER   Standard series  AP Internal rotation  AP External rotation Supplemental views  Abduction (Baby-arm)  Lateral scapula (“Y” projection)  Grashey View AP Shoulder External Rotation KEY ANATOMY  Greater tuberosity is seen in profile  Lesser tuberosity is en face  Humeral head/glenoid overlap  Anatomical neck vs. Surgical neck AP Shoulder-Internal Rotation KEY ANATOMY  Lesser tuberosity is seen in profile  Greater tuberosity is seen en face.  Anatomical neck  Surgical neck AP External Rotation vs. AP Internal Rotation AP Abduction/Baby-arm Projection AP Abduction Projection (Baby-arm projection) KEY ANATOMY  90 degrees of abduction and external rotation of the humerus  Gives a lateral projection of the humeral head Lateral Scapula View or Y-view shoulder Lateral Scapula or “Y” Projection KEY ANATOMY  Visualization of scapula without superimposition with ribs  The coracoid and acromion make up the arms of the Y while the body makes up the stem of the Y.  Humeral head lies in the projected intersection at the glenoid fossa. Grashey View Grashey View KEY ANATOMY  The glenoid joint is free of superimposition  Coracoid process often seen in profile ACROMIOCLAVICULAR JOINT IMAGING AC Joint  Standard Series  Bilateral with and without weights AC Joint  Standard Series  Bilateral with and without weights KEY ANATOMY  Tightly collimated image  AC joint central to image  Assess for “elevation” of the distal clavicle in comparison to acromion process, especially w/weight CLAVICLE IMAGING Clavicle  Standard Series  Frontal (Either AP or PA)  Axial (Either AP or PA)  Has a 15 degree tube tilt Clavicle  Standard Series  Frontal (Either AP or PA)  Axial (Either AP or PA)  Has a 15 degree tube tilt KEY ANATOMY  Whole clavicle and AC & SC joints are all seen (one of these is usually ”cut off” on other views)  Conoid tubercle ELBOW IMAGING Elbow   Standard Series  AP  Medial oblique  Lateral Supplemental  Tangential (Jones)  Radial head (Coyle) AP Elbow Medial Oblique Elbow AP Elbow Medial oblique Elbow KEY ANATOMY KEY ANATOMY  Radius and ulna parallel to one another  Epicondyle  Radius and ulna crossed over one another Lateral Elbow KEY ANATOMY  Radial tuberosity often en face  Coranoid process  Coranoid fossa and olecranon fossa  Anterior fat pad Tangential Elbow (Jones Projection) Tangential Elbow (Jones) KEY ANATOMY  Olecranon process  Distal humerus Radial head (Coyle projection) Radial head (Coyle projection) KEY ANATOMY  Projects the radial head and capitellum away from the surrounding anatomy.  Allows visualization of otherwise obscure fracture of these two structures. WRIST IMAGING Wrist   Standard Series  PA  Medial oblique  Lateral Supplemental  PA ulnar deviated PA Wrist Medial Oblique Wrist 1 2 G M 3 H C P N L T 4 5 PA Wrist Medial oblique Wrist KEY ANATOMY KEY ANATOMY  Intermetacarpal spacing relatively even  Trapezium and trapezoid more superimposed  Intermetacarpal spacing “closes down” on radial side due to superimposition with oblique positioning  Joint between trapezium and trapezoid better seen Lateral Wrist PA Wrist, for comparison Lateral Wrist ANATOMY  Metacarpals all superimposed  3rd metacarpal  Capitellum  Lunate  Radius Carpal anatomy illustration  To navigate to this illustration, go to radiopaedia.org and search ‘80938’ in the search bar PA Wrist with Ulnar Deviation PA Ulnar deviated Wrist PA Wrist, for comparison  Elongation of scaphoid  Navicular fat stripe  Assists in occult fracture detection HAND/FINGERS/THUMB IMAGING Hand/Fingers/Thumb  Standard Hand series  PA, Medial oblique and Lateral  Supplemental Hand view   Standard Finger series   Norgaard projection (Ball-catcher’s view) PA, Medial oblique and Lateral Standard Thumb series  AP and Lateral PA Hand Medial oblique Hand KEY ANATOMY KEY ANATOMY  Intermetacarpal spacing is even  Sesamoids  Intermetacarpal spaces not even Lateral Hand KEY ANATOMY  Metacarpal superimposed  Fanning of fingers Norgaard projection (Ball-catcher’s view) KEY ANATOMY  Pisiforms projected away from triquetrum, with less superimposition  MCP joints are main focus for assessment Fingers PA Medial oblique Lateral KEY ANATOMY  Normal concavity on palmar side of phalanges Thumb AP Lateral KEY ANATOMY  Includes 1st metacarpal  Sesamoids Please communicate any questions or clarification needs to me via email: [email protected]