NORMAL RADIOGRAPHIC ANATOMY The Extremities. Standard Shoulder Series external rotationAP shoulder...
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Transcript of NORMAL RADIOGRAPHIC ANATOMY The Extremities. Standard Shoulder Series external rotationAP shoulder...
NORMAL NORMAL RADIOGRAPHIC RADIOGRAPHIC
ANATOMYANATOMY
The Extremities
Standard Shoulder SeriesStandard Shoulder Series
• AP shoulder with external rotationexternal rotation of the humerus
• AP shoulder with internal rotationinternal rotation of the humerus
AP Shoulder - External RotationAP Shoulder - External Rotation
AP Shoulder - External RotationAP Shoulder - External Rotation
• Greater tuberosity is seen in profilein profile
• Lesser tuberosity is seen en faceen face
• crescent signcrescent sign• anatomical neck• surgical neck
AP Shoulder - Internal RotationAP Shoulder - Internal Rotation
AP Shoulder - Internal RotationAP Shoulder - Internal Rotation
• Lesser tuberosity is seen in profilein profile
• Greater tuberosity is seen en faceen face
AP Shoulder - Internal RotationAP Shoulder - Internal Rotation
Accessory Shoulder Accessory Shoulder ViewsViews
Baby Arm ProjectionBaby Arm Projection
• 90º of abduction and external rotation of the humerus• gives a lateral projection of the humeral head
Grashey Spot ProjectionGrashey Spot Projection
• AP view with patient rotated 35-45° with arm in external rotation.
• Allows clear visualization of the glenohumeral joint
• No crescent signNo crescent sign is seen
Lateral Scapula or “Y” Lateral Scapula or “Y” ProjectionProjection
• Allows visualization of scapula without superimposition
Clavicle SeriesClavicle Series
AC Joint SeriesAC Joint Series
NORMAL VARIANTSNORMAL VARIANTSOF THE SHOULDEROF THE SHOULDER
Rhomboid FossaRhomboid Fossa
a developmental variation at the attachment site of the costoclavicular ligamentcostoclavicular ligament
Pectoralis Major InsertionPectoralis Major Insertion
• Region of lucency at the insertion of the pectoralis major m.pectoralis major m. on the humerus
• note the deltoid deltoid tuberositytuberosity which represents normal anatomy
Vacuum PhenomenonVacuum Phenomenon
• a radiolucency noted in the joint space
• represents gas within the joint capsule
Os InfrascapularOs Infrascapular
• An accessory ossicle at the inferior angle of the scapula
• represents an ununited secondary ossification center
Sprengel DeformitySprengel Deformity
• a congenitally high position of the scapula
• unilateral or bilateral
Supraclavicular ForamenSupraclavicular Foramen
Allows passage of the medial branch medial branch of the supraclavicular nerveof the supraclavicular nerve
Pseudotumor AppearancePseudotumor Appearance
• Cystic appearance produced by the greater tuberosity
Conoid TubercleConoid Tubercle
Normal conoid Enlarged conoid tubercle tubercle
THE ELBOWTHE ELBOW
Standard Elbow SeriesStandard Elbow Series
• AP Elbow
• Medial Oblique Elbow
• Lateral Elbow
AP Elbow ProjectionAP Elbow Projection
• Patient is positioned with supination of the forearm
AP ElbowAP Elbow
• Note the lack of superimposition of the radius and ulna
Medial Oblique Medial Oblique ElbowElbow
• patients forearm is pronated
• the radius and ulna are superimposed
Lateral Elbow ProjectionLateral Elbow Projection
• Patient positioned with 90° of elbow flexion
Lateral Elbow Lateral Elbow
Accessory Elbow Accessory Elbow ProjectionsProjections
Jones ProjectionJones Projection
• aka Tangential Tangential Olecranon Olecranon ProjectionProjection
• allows clear visualization of the trochlea-trochlea-olecranon olecranon joint spacejoint space
Jones ProjectionJones Projection
Capitellum view
• Throws the capitellum and radial head clear of the overlying trochlea and ulna and allows visualization of otherwise obscure fractures of these two structures.
Order of Appearance of the Order of Appearance of the Elbow Ossification CentersElbow Ossification Centers
• CRITOECRITOE• CCapitellum 1-8 months• RRadial Head 3-6 years• IInternal (Medial) Epicondyle 3-7 years• TTrochlea 9-10 years• OOlecranon 6-10 years• EExternal (Lateral) Epicondyle 9-13 years
Newborn ElbowNewborn Elbow
• No visible elbow ossification centers at birth
1 Year Old Elbow1 Year Old Elbow
First appearance of the capitellumcapitellum
4 Year Old 4 Year Old ElbowElbow
• Between the ages of 3 and 6 years of age, the radial radial headhead ossification center appears
5 Year Old Elbow5 Year Old Elbow• Appearance of the
internal (medial) internal (medial) epicondyle epicondyle between 3 and 7 years of age
9 Year Old Elbow9 Year Old Elbow• Appearance of the
trochlea trochlea between 9 and 10 years of age
10 Year Old 10 Year Old ElbowElbow
• Olecranon Olecranon ossification center appears between the ages of 6 and 10 years
12 Year Old 12 Year Old ElbowElbow
• Lastly, the External (Lateral) External (Lateral) Epicondyle Epicondyle appears between 9 and 13 years
Anterior and Posterior Fat Anterior and Posterior Fat PadsPads
Normal Variants of the Normal Variants of the ElbowElbow
Olecranon Olecranon ForamenForamen
aka aka Supratrochlear Supratrochlear
ForamenForamen
Olecranon Olecranon ForamenForamen
Radioulnar SynostosisRadioulnar Synostosis
• usually bilateral• may decrease supination or
pronation
Supracondylar ProcessSupracondylar Process
• An osseous projection on the anteromedial aspect of the distal humerus
• Struther’s ligamentStruther’s ligament may extend inferior from this process to the medial epicondyle
• may cause neurovascular signs or symptoms
Fracture of Supracondylar ProcessFracture of Supracondylar Process
Ununited Ununited Secondary Secondary OssificatioOssification Center - n Center -
Medial Medial EpicondyleEpicondyle
Pseudotumor Pseudotumor appearance of appearance of
the Radial the Radial TuberosityTuberosity
Name the AnomalyName the Anomaly
Anomaly ?Anomaly ?
Normal Normal Variant?Variant?
Normal Variant ?Normal Variant ?
Anomaly ?Anomaly ?
Accessory Shoulder Projection?Accessory Shoulder Projection?
Accessory Accessory Shoulder Shoulder
Projection ?Projection ?
Thank YouThank You