NORMAL RADIOGRAPHIC ANATOMY The Extremities

Standard Shoulder Series external rotationAP shoulder with external rotation of the humerus internal rotationAP shoulder with internal rotation of the humerus

AP Shoulder - External Rotation

in profileGreater tuberosity is seen in profile en faceLesser tuberosity is seen en face crescent signcrescent sign anatomical neck surgical neck

AP Shoulder - Internal Rotation

in profileLesser tuberosity is seen in profile en faceGreater tuberosity is seen en face

AP Shoulder - Internal Rotation

Accessory Shoulder Views

Baby Arm Projection 90º of abduction and external rotation of the humerus gives a lateral projection of the humeral head

Grashey Spot Projection AP view with patient rotated ° with arm in external rotation. Allows clear visualization of the glenohumeral joint No crescent signNo crescent sign is seen

Lateral Scapula or “Y” Projection Allows visualization of scapula without superimposition

Clavicle Series

AC Joint Series

NORMAL VARIANTS OF THE SHOULDER

Rhomboid Fossa costoclavicular ligament a developmental variation at the attachment site of the costoclavicular ligament

Pectoralis Major Insertion pectoralis major m.Region of lucency at the insertion of the pectoralis major m. on the humerus deltoid tuberositynote the deltoid tuberosity which represents normal anatomy

Vacuum Phenomenon a radiolucency noted in the joint space represents gas within the joint capsule

Os Infrascapular An accessory ossicle at the inferior angle of the scapula represents an ununited secondary ossification center

Sprengel Deformity a congenitally high position of the scapula unilateral or bilateral

Supraclavicular Foramen medial branch of the supraclavicular nerve Allows passage of the medial branch of the supraclavicular nerve

Pseudotumor Appearance Cystic appearance produced by the greater tuberosity

Conoid Tubercle Normal conoid Enlarged conoid tubercle tubercle

THE ELBOW

Standard Elbow Series AP Elbow Medial Oblique Elbow Lateral Elbow

AP Elbow Projection Patient is positioned with supination of the forearm

AP Elbow Note the lack of superimposition of the radius and ulna

Medial Oblique Elbow patients forearm is pronated the radius and ulna are superimposed

Lateral Elbow Projection Patient positioned with 90° of elbow flexion

Lateral Elbow

Accessory Elbow Projections

Jones Projection Tangential Olecranon Projectionaka Tangential Olecranon Projection trochlea- olecranon joint spaceallows clear visualization of the trochlea- olecranon joint space

Jones Projection

Capitellum view Throws the capitellum and radial head clear of the overlying trochlea and ulna and allows visualization of otherwise obscure fractures of these two structures.

Order of Appearance of the Elbow Ossification Centers CRITOECRITOE CCapitellum1-8 months RRadial Head3-6 years IInternal (Medial) Epicondyle3-7 years TTrochlea9-10 years OOlecranon6-10 years EExternal (Lateral) Epicondyle9-13 years

Newborn Elbow No visible elbow ossification centers at birth

1 Year Old Elbow capitellum First appearanc e of the capitellum

4 Year Old Elbow radial headBetween the ages of 3 and 6 years of age, the radial head ossification center appears

5 Year Old Elbow internal (medial) epicondyleAppearance of the internal (medial) epicondyle between 3 and 7 years of age

9 Year Old Elbow trochleaAppearance of the trochlea between 9 and 10 years of age

10 Year Old Elbow OlecranonOlecranon ossification center appears between the ages of 6 and 10 years

12 Year Old Elbow External (Lateral) EpicondyleLastly, the External (Lateral) Epicondyle appears between 9 and 13 years

Anterior and Posterior Fat Pads

Normal Variants of the Elbow

Olecranon Foramen aka Supratrochlear Foramen

Olecranon Foramen

Radioulnar Synostosis usually bilateral may decrease supination or pronation

Supracondylar Process An osseous projection on the anteromedial aspect of the distal humerus Struther’s ligamentStruther’s ligament may extend inferior from this process to the medial epicondyle may cause neurovascular signs or symptoms

Fracture of Supracondylar Process

Ununited Secondary Ossificatio n Center - Medial Epicondyle

Pseudotumor appearance of the Radial Tuberosity

Name the Anomaly

Anomaly ?

Normal Variant?

Anomaly ?

Accessory Shoulder Projection?

Thank You