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Presentation1.pptx, radiological anatomy of the upper limb joint.
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Radiological anatomy of the upper limb joints. Dr/ ABD ALLAH NAZEER. MD.
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Transcript of Presentation1.pptx, radiological anatomy of the upper limb joint.
Radiological anatomy of the upper limb joints
Dr ABD ALLAH NAZEER MD
Radiological imaging of the upper limb joints
1- Plain X-Ray2- Ultrasonography3- Computerized tomography
(CT Scan)4- Magnetic resonance imaging
(MRI) study
Anatomy of the ShoulderThe shoulder comprises bones ligaments tendons and muscles that connect the arm to the torso The three bones that make up the shoulder joint include the clavicle (collarbone) scapula (shoulder blade) and humerus (long bone of the arm) The shoulder has two joints that work together to allow arm movementThe acromioclavicular (AC) joint is a gliding joint formed between the clavicle and the acromion The acromion is the projection of the scapula that forms the point of the shoulder The AC joint gives us the ability to raise the arm above the headThe glenohumeral joint or shoulder joint is a ball-and-socket type joint The ball is the top rounded part of the humerus and the socket is the bowl-shaped part of the scapula called the glenoid into which the ball fits This joint allows the arm to move in a circular rotation as well as towards and away from the bodyThe labrum is a piece of cartilage that cushions the humerus head and the glenoid This cartilage also helps to stabilize the joint The rotator cuff is a group of four muscles that pull the humerus into the scapula The rotator cuff muscles stabilize the glenohumeral joint and help with rotation of the armTwo sac-like structures called bursae are also located in the shoulder The bursae secrete a lubricating fluid which helps reduce friction between the moving parts of the joint Together all of these structures create one of the most flexible joints in the body
The glenohumeral joint is the main joint of the shoulder and the generic term shoulder joint usually refers to it It is a ball and socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body It is formed by the articulation between the head of the humerus and the lateral scapula (specifically-the glenoid fossa of the scapula) The ball of the joint is the rounded medial anterior surface of the humerus and the socket is formed by the glenoid fossa the dish-shaped portion of the lateral scapula The shallowness of the fossa and relatively loose connections between the shoulder and the rest of the body allows the arm to have tremendous mobility at the expense of being much easier to dislocate than most other joints in the body Approximately its 4 to 1 disproportion between the large head of the humerus and the shallow
glenoid cavity The capsule is a soft tissue envelope that encircles the glenohumeral joint and attaches to the scapula humerus and head of the biceps It is lined by a thin smooth synovial membrane
JointsThere are three joints of the shoulder The glenohumeral acromioclavicular and the sternoclavicular joints
This capsule is strengthened by the coracohumeral ligament which attaches the coracoid process of the scapula to the greater tubercle of the humerus There are also three other ligaments attaching the lesser tubercle of the humerus to lateral scapula and are collectively called the glenohumeral ligamentsThere is also a ligament called semicirculare humeri which is a transversal band between the posterior sides of the tuberculum minus and majus of the humerus This band is one of the most important strengthening ligaments of the joint capsule
Sternoclavicular jointThe sternoclavicular occurs at the medial end of the clavicle with the manubriumor top most portion of the sternum The clavicle is triangular and rounded and the manubrium is convex the two bones articulate The joint consists of a tight capsule and complete intra-articular disc which ensures stability of the joint The costoclavicular ligament is the main limitation to movement therefore the main stabilizer of the joint A fibrocartilaginous disc present at the joint increases the range of movement Sternoclavicular dislocation is rare but may result from direct trauma to the clavicle or indirect forces applied to the shoulder Posterior dislocations deserve special attention as they have the potential to be life-threatening because of the risk of damage to vital structures in the mediastinum
Anatomy
bull 3 Bones
ndash Humerus
ndash Scapula
ndash Clavicle
bull 3 Joints
ndash Glenohumeral
ndash Acromio-clavicular
ndash Sternoclavicular
bull 1 ldquoArticulationrdquo
ndash Scapulothoracic
bull Humerus
ndash Head
ndash Anatomic neck
ndash Surgical neck
ndash Greater tubercle
ndash Lesser tubercle
ndash Intertubercular groove
ndash Deltoid tuberosity
ndash Shaft
bull Scapula
ndash Bodybull Ventral (Costal) surface
bull Dorsal surface
ndash Bordersbull Superior
bull Lateral (Axillary)
bull Medial (Vertebral)
ndash Anglesbull Superior
bull Inferior
bull Lateral (Head)
bull Scapulandash Glenoid
ndash Acromion
ndash Coracoid
ndash Subscapular fossa
ndash Scapular spine
ndash Supraspinatus fossa
ndash Infraspinatus fossa
ndash Great scapular notch
ndash Suprascapular notch
bull Scapular ldquoYrdquo (Lateral)
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Radiological imaging of the upper limb joints
1- Plain X-Ray2- Ultrasonography3- Computerized tomography
(CT Scan)4- Magnetic resonance imaging
(MRI) study
Anatomy of the ShoulderThe shoulder comprises bones ligaments tendons and muscles that connect the arm to the torso The three bones that make up the shoulder joint include the clavicle (collarbone) scapula (shoulder blade) and humerus (long bone of the arm) The shoulder has two joints that work together to allow arm movementThe acromioclavicular (AC) joint is a gliding joint formed between the clavicle and the acromion The acromion is the projection of the scapula that forms the point of the shoulder The AC joint gives us the ability to raise the arm above the headThe glenohumeral joint or shoulder joint is a ball-and-socket type joint The ball is the top rounded part of the humerus and the socket is the bowl-shaped part of the scapula called the glenoid into which the ball fits This joint allows the arm to move in a circular rotation as well as towards and away from the bodyThe labrum is a piece of cartilage that cushions the humerus head and the glenoid This cartilage also helps to stabilize the joint The rotator cuff is a group of four muscles that pull the humerus into the scapula The rotator cuff muscles stabilize the glenohumeral joint and help with rotation of the armTwo sac-like structures called bursae are also located in the shoulder The bursae secrete a lubricating fluid which helps reduce friction between the moving parts of the joint Together all of these structures create one of the most flexible joints in the body
The glenohumeral joint is the main joint of the shoulder and the generic term shoulder joint usually refers to it It is a ball and socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body It is formed by the articulation between the head of the humerus and the lateral scapula (specifically-the glenoid fossa of the scapula) The ball of the joint is the rounded medial anterior surface of the humerus and the socket is formed by the glenoid fossa the dish-shaped portion of the lateral scapula The shallowness of the fossa and relatively loose connections between the shoulder and the rest of the body allows the arm to have tremendous mobility at the expense of being much easier to dislocate than most other joints in the body Approximately its 4 to 1 disproportion between the large head of the humerus and the shallow
glenoid cavity The capsule is a soft tissue envelope that encircles the glenohumeral joint and attaches to the scapula humerus and head of the biceps It is lined by a thin smooth synovial membrane
JointsThere are three joints of the shoulder The glenohumeral acromioclavicular and the sternoclavicular joints
This capsule is strengthened by the coracohumeral ligament which attaches the coracoid process of the scapula to the greater tubercle of the humerus There are also three other ligaments attaching the lesser tubercle of the humerus to lateral scapula and are collectively called the glenohumeral ligamentsThere is also a ligament called semicirculare humeri which is a transversal band between the posterior sides of the tuberculum minus and majus of the humerus This band is one of the most important strengthening ligaments of the joint capsule
Sternoclavicular jointThe sternoclavicular occurs at the medial end of the clavicle with the manubriumor top most portion of the sternum The clavicle is triangular and rounded and the manubrium is convex the two bones articulate The joint consists of a tight capsule and complete intra-articular disc which ensures stability of the joint The costoclavicular ligament is the main limitation to movement therefore the main stabilizer of the joint A fibrocartilaginous disc present at the joint increases the range of movement Sternoclavicular dislocation is rare but may result from direct trauma to the clavicle or indirect forces applied to the shoulder Posterior dislocations deserve special attention as they have the potential to be life-threatening because of the risk of damage to vital structures in the mediastinum
Anatomy
bull 3 Bones
ndash Humerus
ndash Scapula
ndash Clavicle
bull 3 Joints
ndash Glenohumeral
ndash Acromio-clavicular
ndash Sternoclavicular
bull 1 ldquoArticulationrdquo
ndash Scapulothoracic
bull Humerus
ndash Head
ndash Anatomic neck
ndash Surgical neck
ndash Greater tubercle
ndash Lesser tubercle
ndash Intertubercular groove
ndash Deltoid tuberosity
ndash Shaft
bull Scapula
ndash Bodybull Ventral (Costal) surface
bull Dorsal surface
ndash Bordersbull Superior
bull Lateral (Axillary)
bull Medial (Vertebral)
ndash Anglesbull Superior
bull Inferior
bull Lateral (Head)
bull Scapulandash Glenoid
ndash Acromion
ndash Coracoid
ndash Subscapular fossa
ndash Scapular spine
ndash Supraspinatus fossa
ndash Infraspinatus fossa
ndash Great scapular notch
ndash Suprascapular notch
bull Scapular ldquoYrdquo (Lateral)
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Anatomy of the ShoulderThe shoulder comprises bones ligaments tendons and muscles that connect the arm to the torso The three bones that make up the shoulder joint include the clavicle (collarbone) scapula (shoulder blade) and humerus (long bone of the arm) The shoulder has two joints that work together to allow arm movementThe acromioclavicular (AC) joint is a gliding joint formed between the clavicle and the acromion The acromion is the projection of the scapula that forms the point of the shoulder The AC joint gives us the ability to raise the arm above the headThe glenohumeral joint or shoulder joint is a ball-and-socket type joint The ball is the top rounded part of the humerus and the socket is the bowl-shaped part of the scapula called the glenoid into which the ball fits This joint allows the arm to move in a circular rotation as well as towards and away from the bodyThe labrum is a piece of cartilage that cushions the humerus head and the glenoid This cartilage also helps to stabilize the joint The rotator cuff is a group of four muscles that pull the humerus into the scapula The rotator cuff muscles stabilize the glenohumeral joint and help with rotation of the armTwo sac-like structures called bursae are also located in the shoulder The bursae secrete a lubricating fluid which helps reduce friction between the moving parts of the joint Together all of these structures create one of the most flexible joints in the body
The glenohumeral joint is the main joint of the shoulder and the generic term shoulder joint usually refers to it It is a ball and socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body It is formed by the articulation between the head of the humerus and the lateral scapula (specifically-the glenoid fossa of the scapula) The ball of the joint is the rounded medial anterior surface of the humerus and the socket is formed by the glenoid fossa the dish-shaped portion of the lateral scapula The shallowness of the fossa and relatively loose connections between the shoulder and the rest of the body allows the arm to have tremendous mobility at the expense of being much easier to dislocate than most other joints in the body Approximately its 4 to 1 disproportion between the large head of the humerus and the shallow
glenoid cavity The capsule is a soft tissue envelope that encircles the glenohumeral joint and attaches to the scapula humerus and head of the biceps It is lined by a thin smooth synovial membrane
JointsThere are three joints of the shoulder The glenohumeral acromioclavicular and the sternoclavicular joints
This capsule is strengthened by the coracohumeral ligament which attaches the coracoid process of the scapula to the greater tubercle of the humerus There are also three other ligaments attaching the lesser tubercle of the humerus to lateral scapula and are collectively called the glenohumeral ligamentsThere is also a ligament called semicirculare humeri which is a transversal band between the posterior sides of the tuberculum minus and majus of the humerus This band is one of the most important strengthening ligaments of the joint capsule
Sternoclavicular jointThe sternoclavicular occurs at the medial end of the clavicle with the manubriumor top most portion of the sternum The clavicle is triangular and rounded and the manubrium is convex the two bones articulate The joint consists of a tight capsule and complete intra-articular disc which ensures stability of the joint The costoclavicular ligament is the main limitation to movement therefore the main stabilizer of the joint A fibrocartilaginous disc present at the joint increases the range of movement Sternoclavicular dislocation is rare but may result from direct trauma to the clavicle or indirect forces applied to the shoulder Posterior dislocations deserve special attention as they have the potential to be life-threatening because of the risk of damage to vital structures in the mediastinum
Anatomy
bull 3 Bones
ndash Humerus
ndash Scapula
ndash Clavicle
bull 3 Joints
ndash Glenohumeral
ndash Acromio-clavicular
ndash Sternoclavicular
bull 1 ldquoArticulationrdquo
ndash Scapulothoracic
bull Humerus
ndash Head
ndash Anatomic neck
ndash Surgical neck
ndash Greater tubercle
ndash Lesser tubercle
ndash Intertubercular groove
ndash Deltoid tuberosity
ndash Shaft
bull Scapula
ndash Bodybull Ventral (Costal) surface
bull Dorsal surface
ndash Bordersbull Superior
bull Lateral (Axillary)
bull Medial (Vertebral)
ndash Anglesbull Superior
bull Inferior
bull Lateral (Head)
bull Scapulandash Glenoid
ndash Acromion
ndash Coracoid
ndash Subscapular fossa
ndash Scapular spine
ndash Supraspinatus fossa
ndash Infraspinatus fossa
ndash Great scapular notch
ndash Suprascapular notch
bull Scapular ldquoYrdquo (Lateral)
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
The glenohumeral joint is the main joint of the shoulder and the generic term shoulder joint usually refers to it It is a ball and socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body It is formed by the articulation between the head of the humerus and the lateral scapula (specifically-the glenoid fossa of the scapula) The ball of the joint is the rounded medial anterior surface of the humerus and the socket is formed by the glenoid fossa the dish-shaped portion of the lateral scapula The shallowness of the fossa and relatively loose connections between the shoulder and the rest of the body allows the arm to have tremendous mobility at the expense of being much easier to dislocate than most other joints in the body Approximately its 4 to 1 disproportion between the large head of the humerus and the shallow
glenoid cavity The capsule is a soft tissue envelope that encircles the glenohumeral joint and attaches to the scapula humerus and head of the biceps It is lined by a thin smooth synovial membrane
JointsThere are three joints of the shoulder The glenohumeral acromioclavicular and the sternoclavicular joints
This capsule is strengthened by the coracohumeral ligament which attaches the coracoid process of the scapula to the greater tubercle of the humerus There are also three other ligaments attaching the lesser tubercle of the humerus to lateral scapula and are collectively called the glenohumeral ligamentsThere is also a ligament called semicirculare humeri which is a transversal band between the posterior sides of the tuberculum minus and majus of the humerus This band is one of the most important strengthening ligaments of the joint capsule
Sternoclavicular jointThe sternoclavicular occurs at the medial end of the clavicle with the manubriumor top most portion of the sternum The clavicle is triangular and rounded and the manubrium is convex the two bones articulate The joint consists of a tight capsule and complete intra-articular disc which ensures stability of the joint The costoclavicular ligament is the main limitation to movement therefore the main stabilizer of the joint A fibrocartilaginous disc present at the joint increases the range of movement Sternoclavicular dislocation is rare but may result from direct trauma to the clavicle or indirect forces applied to the shoulder Posterior dislocations deserve special attention as they have the potential to be life-threatening because of the risk of damage to vital structures in the mediastinum
Anatomy
bull 3 Bones
ndash Humerus
ndash Scapula
ndash Clavicle
bull 3 Joints
ndash Glenohumeral
ndash Acromio-clavicular
ndash Sternoclavicular
bull 1 ldquoArticulationrdquo
ndash Scapulothoracic
bull Humerus
ndash Head
ndash Anatomic neck
ndash Surgical neck
ndash Greater tubercle
ndash Lesser tubercle
ndash Intertubercular groove
ndash Deltoid tuberosity
ndash Shaft
bull Scapula
ndash Bodybull Ventral (Costal) surface
bull Dorsal surface
ndash Bordersbull Superior
bull Lateral (Axillary)
bull Medial (Vertebral)
ndash Anglesbull Superior
bull Inferior
bull Lateral (Head)
bull Scapulandash Glenoid
ndash Acromion
ndash Coracoid
ndash Subscapular fossa
ndash Scapular spine
ndash Supraspinatus fossa
ndash Infraspinatus fossa
ndash Great scapular notch
ndash Suprascapular notch
bull Scapular ldquoYrdquo (Lateral)
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
This capsule is strengthened by the coracohumeral ligament which attaches the coracoid process of the scapula to the greater tubercle of the humerus There are also three other ligaments attaching the lesser tubercle of the humerus to lateral scapula and are collectively called the glenohumeral ligamentsThere is also a ligament called semicirculare humeri which is a transversal band between the posterior sides of the tuberculum minus and majus of the humerus This band is one of the most important strengthening ligaments of the joint capsule
Sternoclavicular jointThe sternoclavicular occurs at the medial end of the clavicle with the manubriumor top most portion of the sternum The clavicle is triangular and rounded and the manubrium is convex the two bones articulate The joint consists of a tight capsule and complete intra-articular disc which ensures stability of the joint The costoclavicular ligament is the main limitation to movement therefore the main stabilizer of the joint A fibrocartilaginous disc present at the joint increases the range of movement Sternoclavicular dislocation is rare but may result from direct trauma to the clavicle or indirect forces applied to the shoulder Posterior dislocations deserve special attention as they have the potential to be life-threatening because of the risk of damage to vital structures in the mediastinum
Anatomy
bull 3 Bones
ndash Humerus
ndash Scapula
ndash Clavicle
bull 3 Joints
ndash Glenohumeral
ndash Acromio-clavicular
ndash Sternoclavicular
bull 1 ldquoArticulationrdquo
ndash Scapulothoracic
bull Humerus
ndash Head
ndash Anatomic neck
ndash Surgical neck
ndash Greater tubercle
ndash Lesser tubercle
ndash Intertubercular groove
ndash Deltoid tuberosity
ndash Shaft
bull Scapula
ndash Bodybull Ventral (Costal) surface
bull Dorsal surface
ndash Bordersbull Superior
bull Lateral (Axillary)
bull Medial (Vertebral)
ndash Anglesbull Superior
bull Inferior
bull Lateral (Head)
bull Scapulandash Glenoid
ndash Acromion
ndash Coracoid
ndash Subscapular fossa
ndash Scapular spine
ndash Supraspinatus fossa
ndash Infraspinatus fossa
ndash Great scapular notch
ndash Suprascapular notch
bull Scapular ldquoYrdquo (Lateral)
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Anatomy
bull 3 Bones
ndash Humerus
ndash Scapula
ndash Clavicle
bull 3 Joints
ndash Glenohumeral
ndash Acromio-clavicular
ndash Sternoclavicular
bull 1 ldquoArticulationrdquo
ndash Scapulothoracic
bull Humerus
ndash Head
ndash Anatomic neck
ndash Surgical neck
ndash Greater tubercle
ndash Lesser tubercle
ndash Intertubercular groove
ndash Deltoid tuberosity
ndash Shaft
bull Scapula
ndash Bodybull Ventral (Costal) surface
bull Dorsal surface
ndash Bordersbull Superior
bull Lateral (Axillary)
bull Medial (Vertebral)
ndash Anglesbull Superior
bull Inferior
bull Lateral (Head)
bull Scapulandash Glenoid
ndash Acromion
ndash Coracoid
ndash Subscapular fossa
ndash Scapular spine
ndash Supraspinatus fossa
ndash Infraspinatus fossa
ndash Great scapular notch
ndash Suprascapular notch
bull Scapular ldquoYrdquo (Lateral)
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
bull Humerus
ndash Head
ndash Anatomic neck
ndash Surgical neck
ndash Greater tubercle
ndash Lesser tubercle
ndash Intertubercular groove
ndash Deltoid tuberosity
ndash Shaft
bull Scapula
ndash Bodybull Ventral (Costal) surface
bull Dorsal surface
ndash Bordersbull Superior
bull Lateral (Axillary)
bull Medial (Vertebral)
ndash Anglesbull Superior
bull Inferior
bull Lateral (Head)
bull Scapulandash Glenoid
ndash Acromion
ndash Coracoid
ndash Subscapular fossa
ndash Scapular spine
ndash Supraspinatus fossa
ndash Infraspinatus fossa
ndash Great scapular notch
ndash Suprascapular notch
bull Scapular ldquoYrdquo (Lateral)
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
bull Scapula
ndash Bodybull Ventral (Costal) surface
bull Dorsal surface
ndash Bordersbull Superior
bull Lateral (Axillary)
bull Medial (Vertebral)
ndash Anglesbull Superior
bull Inferior
bull Lateral (Head)
bull Scapulandash Glenoid
ndash Acromion
ndash Coracoid
ndash Subscapular fossa
ndash Scapular spine
ndash Supraspinatus fossa
ndash Infraspinatus fossa
ndash Great scapular notch
ndash Suprascapular notch
bull Scapular ldquoYrdquo (Lateral)
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
bull Scapulandash Glenoid
ndash Acromion
ndash Coracoid
ndash Subscapular fossa
ndash Scapular spine
ndash Supraspinatus fossa
ndash Infraspinatus fossa
ndash Great scapular notch
ndash Suprascapular notch
bull Scapular ldquoYrdquo (Lateral)
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
bull Scapular ldquoYrdquo (Lateral)
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
AP View of the Shoulder
bull ldquoRoutinerdquo AP View
ndash Clavicle
ndash Scapulabull Acromion amp scapular
spine
bull Coracoid
bull Borders amp angles
ndash AC amp SC joints
ndash Glenoidbull Both ant amp post lips
bull May obscure HH
ndash Humerusbull Head amp necks
bull Gr amp Lsr tuberosities
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
AP View of the Shoulder
bull ldquoGlenohumeralrdquo ldquoGrasheyrdquo or ldquoScapularrdquo AP View
ndash Same structures
ndash AC joint not visualized as well
ndash Better visualize the glenoid amp humeral head (especially with ER view)
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
AP View of the Shoulder
bull AP View in External Rotationndash Greater tuberosity amp
soft tissues profiled and better visualized
ndash Best w Scapular AP
bull AP View in Internal Rotationndash May demonstrate Hill-
Sachs lesionsbull GH instability
ndash Best w Routine AP
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Axillary Lateral View of the Shoulder
bull Good view of anterior-posterior relationship of GH joint
bull Coracoid
bull Acromion
bull Humerus
bull Glenoid
bull GH joint
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Scapular ldquoYrdquo Lateral View of the Shoulder
bull Relationship bw humeral head and glenoid
bull Acromion
bull Coracoid
bull Scapular body
bull Scapular spine
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Ultrasonography
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Glenohumeral Joint
1- Anterior labrum 2- Subscapularis3- Infraspinatus4- Posterior labrum5- Humerus6- Glenoid cavity
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
CT and MR Arthrography of the Normal shoulder
Normal biceps tendon in CT and transverse MR arthrogram
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Normal superior glenohumeral ligament Sagittal fat-saturated T1- weighted MR arthrogram shows the biceps tendon (t) subscapularis tendon (S) middle glenohumeral ligament (open arrows) and superior glenohumeral ligament (solid arrow)
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Normal middle glenohumeral ligament in transverse fat-saturated MR and CT arthrogram
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Normal inferior glenohumeral ligament Sagittal fat-saturated T1- weighted MR amp CT arthrogram
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Elbow JointThe elbow is a complex synovial joint formed by the articulations of the humerus the radius and the ulna
Gross AnatomyArticulations The elbow joint is made up of three articulationsradiohumeral capitellum of the humerus with the radial headulnohumeral trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulnaradioulnar radial head with the radial notch of the ulna (proximal radioulnar joint )In full flexion the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus Ligamentsmedial (ulnar) collateral ligament complexlateral (radial) collateral ligament complexoblique cord
inconstant thickening of supinator muscle fascia and functionally insignificant runs from tuberosity of the ulna to just distal to radial tuberosity
quadrate ligament (of Denuce)thickening of the inferior aspect of the joint capsuleruns from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Joint capsuleThe joint capsule has two layers deep and superficial and attaches proximally to the radial coronoid and olecranon fossae Distally it attaches to the annular ligament of the radius and coronoid process of the ulna The volume of the joint capsule is 24-30mL
Fat padsThere are three fat pads of the elbow which sit between the two layers of the joint capsule making them extra-synovialcoronoid fossa fat pad (anterior)radial fossa fat pad (anterior)olecranon fossa fat pad (posterior)
Bursaesuperficial olecranon bursa lies between the olecranon and the subcutaneous tissuesubtendinous olecranon bursa lies between olecranon and triceps brachii tendon intratendinous olecranon bursa variably lies in the triceps brachii tendonbicipitoradial bursa
Relationsanteriorly biceps brachii tendon brachialis muscle median nerve brachial arteryposteriorly olecranon bursae triceps brachii tendonlaterally common extensor tendon supinator musclemedially ulna nerve
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Adult Elbow - AP View
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Adult Elbow - Oblique View
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Adult Elbow - Lateral View
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Adult Elbow - Lateral Radial Head View in 10 years old
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Normal elbow X-ray in 10 years old
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Normal elbow X-ray ndash AP amp Lateral Views in 10 years old
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Elbow UltrasoundFor examination of the anterior elbow the patient is seated facing the examiner with the elbow in an extension position over the table The patient is asked to extend the elbow and supinate the forearm A slight bending of the patientrsquos body toward the examined side makes full supination and assessment of the anterior compartment easier Full elbow extension can be obtained by placing a pillow under the joint Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint perpendicular to the humeral shaft Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis musclesAlong side and medial to these muscles follow the brachial artery and the median nervethe nerve lies medially to the artery
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
a brachial artery arrow median nerve arrowheads distal biceps tendon asterisks articular cartilage of the humeral trochlea Br brachialis muscle Pr pronator muscle
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
arrows distal biceps tendon asterisk coronoid fossa and anterior fat pad Br brachialis muscle HC humeral capitellum RH radial head s supinator muscle
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
arrow brachialis tendon arrowheads anterior coronoid recess asterisks articular cartilage of distal humeral epiphysis Br brachialis muscle curved arrow anterior fat pad HC humeral capitellum HTr humeral trochlea
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
arrow posterior interosseous nerve arrowhead cutaneous sensory branch of theradial nerve Br brachialis muscle Br Rad brachioradialis muscle curved arrow main trunk of the radial nerve RH radial head RN radial neck s1 superficial head of the supinator muscle s2 deep head of the supinator muscle
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
arrow ulnar nerve asterisk triceps tendon ME medial epicondyle O olecranon process void arrowhead ulnar head of the flexor carpi ulnaris muscle white arrowhead humeral head of the flexor carpi ulnaris muscle 1 cubital tunnel retinaculum (Osborne ligament) 2 arcuate ligament 3 flexor carpi ulnaris muscle
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Magnetic resonance imaging (MRI) provides excellent delineation of the bones of the elbow and thesurrounding soft tissue structures The components of the elbow can be divided into osseous structures the joint capsule and ligaments muscles and tendons and nerves In this article the authors review the normal anatomy and the appearance of these structures on MRI as well as the anatomic variants that should be recognized and distinguished from pathologic entities The elbow is a joint consisting of three separate articulations with various structures providing stability in which the anterior bundle of the ulnar collateral ligament on the medial side and lateral ulnar collateral ligament on the lateral side play important roles With its superior evaluation of soft tissues MRI provides excellent evaluation of the osseous and neuromuscular structures Precise understanding of the imaging anatomy of the elbow and its normal variants is important in the diagnosis and management of diseases of the elbow joint
Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
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Radiological anatomy of the wristOsseous AnatomyThe osseous structures of the wrist are the distal portions of the radius and ulna the proximal and distal rows of carpal bones and the bases of the metacarpals The proximal row of carpal bones consists of the scaphoid lunate triquetrum and the pisiform The distal row of carpal bones contains the trapezium trapezoid capitate and hamate bones The distal row of bones articulates with the metacarpal bases The bases of the metacarpals articulate with the distal row of carpal bones and with each other The proximal carpal row is termed an intercalated segment because forces acting on its proximal and distal articulations determine its position This aspect of the osseous anatomy becomes important when considering the pattern of collapse that occurs in the different types of wrist instabilityArticular Compartmental Anatomy The wrist joint is separated into a number of compartments by the many ligaments that attach to the carpal bones These compartments are of considerable significance for the interpretation of standard or MR arthrogram and for identifying various patterns of arthritic involvement The compartments are as follows1 Radiocarpal compartment 2 Midcarpal compartment 3 Pisiform-triquetral compartment 4 Common carpometacarpal compartment 5 First carpometacarpal compartment 6 Intermetacarpal compartments 7 Inferior (distal) radioulnar compartment
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Ligamentous AnatomyThe ligaments of the wrist have been classified into intrinsic ligaments because they arise and insert on carpal bones and extrinsic ligaments because they connect the distal portion of the radius and the carpal bones Two intrinsic ligaments join the bones of the proximal carpal row the scapholunate interosseous ligament (joining the proximal surfaces of the scaphoid and lunate) and the lunotriquetral interosseous ligament (joining the proximal surfaces of the lunate and triquetrum) These ligaments connect the bones from their palmer to dorsal surfaces The intrinsic scapholunate ligament complex and the lunotriquetral complex each consist of dorsal palmar and proximal (membranous) components When intact they separate the radiocarpal and midcarpal compartments of the wrist The ulnar ligamentous complex (ulnocarpal ligaments) is largely synonymous with the triangular fibrocartilage complex (TFCC) comprising the triangular fibrocartilage (TFC) proper (the articular disk) and the dorsal radioulnar ligament volar radioulnar ligament ulnolunate ligament ulnotriquetral ligament ulnar collateral ligament and the meniscus homologue4 The literature includes the sheath of the extensor carpi ulnaris tendon in the description of the TFCC
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Computerized Tomography (CT)As with plain radiography and arthrography CT employs ionizing radiation It allows three-dimensional visualization of the carpal bones and provides soft tissue detail Helical CT also known as spiral CT is a form of three-dimensional imaging that also uses ionizing radiation Its major advantage over conventional CT is the rapidity with which it can image large areas However relative to conventional CT spiral CT produces an image which is less sharp Because the wrist and hand have relatively small anatomic areas and because a high degree of detail is required for accurate assessment conventional CT is often more practical than spiral CT for evaluation of wristhand trauma As in other anatomic regions transaxial CT imaging of one or both wrists may be performed Images are obtained while the patient is prone and with arm(s) stretched above the head Because of the size and flexibility of the wrist it is possible to obtain direct scans of the wrist in the coronal and sagittal planes (CT scans acquired directly are sharper than reconstructed images and therefore easier to interpret) With the patient prone the elbow in 90[infinity] of flexion above the patients head and the palm face down on the CT table direct sagittal scans may be acquired through the symptomatic wrist If the patients palm is rotated 90[infinity] to face the patients head direct coronal scans of the symptomatic wrist may be acquired Last in the trauma setting CT images may be acquired in one additional plane specially designed to assess the scaphoid Images obtained in the sagittal oblique plane are taken along the long axis of the scaphoid The scan is performed with the ulnarly-deviated wrist prone against the table
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Magnetic resonance (MR) imaging is the optimal modality for characterizing the ligaments tendons muscles and neurovascular structures of the wrist joint Continued refinement in pulse sequenceand coil design permits high-resolution examination of the many small structures and complex anatomy of this region Frequent anatomic variants and common false positives such as normal areas of high signal intensity in ligaments and tendons must be recognized to avoid misdiagnosis and improper treatment MR imaging has provided us with new insights into the difficult anatomy of the wrist by allowing improved visualization of the relationship of the muscles ligaments tendons and boneIts multiplaner and exquisite soft tissue contrast capabilities allow for the depiction of the subtle osseous and soft tissue pathology
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Normal osseous anatomy Sagittal T2-weighted image with fat saturation shows normal relationship between the radius (R) lunate (L) capitate (C) and the base of third metacarpal3 dditionalstructures shown dorsal intercarpal ligament (di) dorsal radiocarpal ligament (drc) radioscaphocapitate ligament (rsc) short radiolunate ligament (srl) flexor retinaculum (fr) flexor digitorum superficialis (fds) flexor digitorum profundus (fdp) and pronator quadratusmuscle (p)
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
Thank You
Volar ligaments (A) Sagittal T2-weighted image with fat saturation shows radioscaphocapitate (rsc) and short radiolunate (srl) ligaments Capitate (C) and lunate (L) are labeled (B) Coronal GRE image shows radiolunotriquetral (rlt) and radioscaphocapitate (rsc) ligaments
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