Upper Extremity Anatomy
(Shoulder,elbow,and wrist)
IN COMPUTED TOMOGRAPHY
Frank Cairo R.T. ( R ) ( CT ) ( MR )
General Imaging Methods
• CT is a major method for the evaluation of MSK
anatomy and disease; it
– Provides specific information about bone and
other mineralized tissue
– Is useful for evaluating bone and soft tissue
tumors
– Adds details to information obtained with
conventional radiography in cases of multiple
fractures
– Is used to evaluate joints, especially after air or
iodinated CM is injected into the joint
General Imaging Methods (cont’d)
• Techniques to scan the MSK system are tailored to
each patient and region being examined
• Patients are positioned so that both sides are as
symmetric as possible
• Lower extremities are usually scanned with the
patient supine and feet-first into the scanner
• Upper extremities are often scanned with the patient
supine and head-first into the scanner
General Imaging Methods (cont’d)
• AP and lateral scout images are taken to localize the area of interest
• In general, when scanning long bones, the plane of the CT section should
be perpendicular to the long axis
• IV contrast medium is not routinely administered for MSK trauma, but is
valuable for other indications
• Most MSK protocols include multiplanar reformations
• If a fracture is seen on the cross-sectional images, 3D reformations are
often performed
General Imaging Methods (cont’d)
• The patient should be made as comfortable as
possible so that inadvertent motion does not
degrade the study
• It is seldom necessary for a patient to breath-hold
• The reconstruction algorithm is based on the clinical
application
– A standard algorithm is used if soft tissue or
muscle is of primary interest
– If bone detail is needed, data are also
reconstructed in a bone algorithm
Annotating the Upper Extremity
• Special care must be taken when annotating the hand,
wrist, forearm, or elbow
• CT annotation systems begin with the assumption that
the patient is in the anatomic position
• This system is disrupted for the upper extremity when
the patient is positioned so that the arm is raised over
the head, or is positioned on the far end of the scanner
with the arm extended
• Consult the manufacturer’s instructions for suggestions
on particular makes of scanners
• Place small radiopaque markers on the extremities at
one edge of the scan range
Musculoskeletal Protocols
• Shoulder or scapula
• Elbow
• Wrist
Indications
•
•
•
•
•
Trauma
Pain
RCT tear
Bursitis
Arthritis
GROSS ANATOMY OF THE SHOULDER
GROSS ANATOMY
GROSS ANATOMY OF SCAPULA
SCAPULA
ROTATOR CUFF
• The rotator cuff is a group of muscles which work together to
provide the Glenohumeral (shoulder) joint with dynamic
stability, helping to control the joint during rotation (hence
the name). The rotator cuff muscles include:
•
•
•
•
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
Rotator Cuff cont.
•
•
•
•
Supraspinatus: 1st 10 degrees of abduction
Infraspinatus: external rotation
Teres minor: external rotation
Subscapularis: internal rotation
ROTATOR CUFF
LABRUM
Shoulder
SUPERIOR VIEW
SAGITAL VIEW
POSTERIOR VIEW
ANTERIOR VIEW
SHOULDER
1- Head of Humerus
2- Acromion and part
of spine
SHOULDER
1- Head of Humerus
2
2- coracoid process
3- glenoid process
4- scapula
3
1
4
SHOULDER
1- Bicipitial
groove
1
2- Body of
scapula
2
SAGITAL MPR
1
2
3
1- AC Joint
2- Acromion process
3- Clavicle
4- Corocoid Process
4
SAGITAL MPR
1- Bicipital Groove
2- Greater Tubercle
3
1
2
3- Humeral Head
CORONAL MPR
1- AC Joint
2
1
2- Humeral Head
CORONAL MPR
1- Acromion Process
1
2
2- Glenoid Fossa
Elbow
ELBOW
ELBOW
ELBOW
Elbow
Elbow
ELBOW
1- Medial
Epicondyle
2
1
2- Lateral
Epicondyle
ELBOW
1- Olecranon
Process of the
ulna
1
ELBOW
1- Head of Radius
1
2
2- Ulna
Sagital MPR of the elbow
Medial
Lateral
1
1
3
2
2
1- Coronoid process
2- Trochlea of the humerus
3- Olecranon process
3
1- Radial tuberosity
2- Radial head
3- Capitulum
CORONAL MRR
1- Medial
epicondyle
2- Lateral
epicondyle
1
3- Olecranon
process
2
3
CORONAL MPR
1- Capitulum
2- Radial head
3- Trochlea
4- Coronoid
process
3
1
4
2
Hand and Wrist Bony Anatomy
Consists of:
• Distal Radius and Ulna – Styloid processes on
each side, site of tendon attachment
• 8 Carpal Bones
– Proximal Row – Scaphoid, Lunate, Triquetral, Pisiform
– Distal Row – Trapezium, Trapezoid, Capitate, Hamate
• 5 Metacarpals – Base (P), Body and Head (D)
• 14 phalanges – 3 phalanges with exception at
thumb (2)
Anatomy
Anatomy
Anatomy
Wrist bones
• Wrist Bones Mnemonic
– Proximal Row (Radial to ulnar wrist)
• Scaphoid or Carpal Navicular (Some)
– Links proximal to distal carpal row
• Lunate (Lovers)
• Triquetrum (Try)
• Pisiform (Positions)
– Distal Row (Radial to ulnar wrist)
• Trapezium/Greater multangular (That)
• Trapezoid/Lesser multangular (They)
• Capitate (Can't)
• Hamate (Handle)
Anatomy
Anatomy
Anatomy
Wrist bones
• Wrist Bones Mnemonic
– Proximal Row (Radial to ulnar wrist)
• Scaphoid or Carpal Navicular (Some)
– Links proximal to distal carpal row
• Lunate (Lovers)
• Triquetrum (Try)
• Pisiform (Positions)
– Distal Row (Radial to ulnar wrist)
• Trapezium/Greater multangular (That)
• Trapezoid/Lesser multangular (They)
• Capitate (Can't)
• Hamate (Handle)
WRIST
1- RADIUS
2- ULNA
1
2
WRIST
1
2
3
1- SCAPHOID
2- LUNATE
3- TRIQUETRUM
WRIST
3
4
1- HAMATE
2
1
2- CAPITATE
3- TRAPEZOID
4- TRAPEZIUM
WRIST
2
1
3
4
1- TRAPEZIUM
2- TRAPEZOID
3- CAPITATE
4- HAMATE
WRIST
WRIST
1- METACARPALS
1
WRIST CORONAL MPR
1- TRAPEZOID
2
3
1
2- CAPITATE
3- HAMATE
4
4- TRIQUETRUM
6
5
5- LUNATE
6- SCAPHOID