Upper Extremity Anatomy (Shoulder,elbow,and wrist) IN COMPUTED TOMOGRAPHY Frank Cairo R.T. ( R ) ( CT ) ( MR )

General Imaging Methods CT is a major method for the evaluation of MSK anatomy and disease; it Provides specific information about bone and other mineralized tissue Is useful for evaluating bone and soft tissue tumors Adds details to information obtained with conventional radiography in cases of multiple fractures Is used to evaluate joints, especially after air or iodinated CM is injected into the joint

General Imaging Methods (cont’d) Techniques to scan the MSK system are tailored to each patient and region being examined Patients are positioned so that both sides are as symmetric as possible Lower extremities are usually scanned with the patient supine and feet-first into the scanner Upper extremities are often scanned with the patient supine and head-first into the scanner

General Imaging Methods (cont’d) AP and lateral scout images are taken to localize the area of interest In general, when scanning long bones, the plane of the CT section should be perpendicular to the long axis IV contrast medium is not routinely administered for MSK trauma, but is valuable for other indications Most MSK protocols include multiplanar reformations If a fracture is seen on the cross-sectional images, 3D reformations are often performed

General Imaging Methods (cont’d) The patient should be made as comfortable as possible so that inadvertent motion does not degrade the study It is seldom necessary for a patient to breath-hold The reconstruction algorithm is based on the clinical application A standard algorithm is used if soft tissue or muscle is of primary interest If bone detail is needed, data are also reconstructed in a bone algorithm

Annotating the Upper Extremity Special care must be taken when annotating the hand, wrist, forearm, or elbow CT annotation systems begin with the assumption that the patient is in the anatomic position This system is disrupted for the upper extremity when the patient is positioned so that the arm is raised over the head, or is positioned on the far end of the scanner with the arm extended Consult the manufacturer’s instructions for suggestions on particular makes of scanners Place small radiopaque markers on the extremities at one edge of the scan range

Musculoskeletal Protocols Shoulder or scapula Elbow Wrist

Indications Trauma Pain RCT tear Bursitis Arthritis

GROSS ANATOMY OF THE SHOULDER

GROSS ANATOMY

GROSS ANATOMY OF SCAPULA

SCAPULA

ROTATOR CUFF Supraspinatus Infraspinatus Teres Minor Subscapularis The rotator cuff is a group of muscles which work together to provide the Glenohumeral (shoulder) joint with dynamic stability, helping to control the joint during rotation (hence the name). The rotator cuff muscles include: Supraspinatus Infraspinatus Teres Minor Subscapularis

Rotator Cuff cont. Supraspinatus: 1st 10 degrees of abduction Infraspinatus: external rotation Teres minor: external rotation Subscapularis: internal rotation

ROTATOR CUFF

LABRUM

Shoulder

SUPERIOR VIEW

SAGITAL VIEW

POSTERIOR VIEW

ANTERIOR VIEW

SHOULDER 1- Head of Humerus 2- Acromion and part of spine

SHOULDER 1- Head of Humerus 2- coracoid process 3- glenoid process 4- scapula 2 3 1 4

SHOULDER 1- Bicipitial groove 2- Body of scapula 1 2

SAGITAL MPR 1- AC Joint 2- Acromion process 3- Clavicle 4- Corocoid Process 2 3 4

SAGITAL MPR 1- Bicipital Groove 2- Greater Tubercle 3- Humeral Head 3

CORONAL MPR 1- AC Joint 2- Humeral Head 2 1

CORONAL MPR 1- Acromion Process 2- Glenoid Fossa 1 2

Elbow

ELBOW

ELBOW

ELBOW

Elbow

Elbow

ELBOW 1- Medial Epicondyle 2- Lateral Epicondyle 2 1

ELBOW 1- Olecranon Process of the ulna 1

ELBOW 1- Head of Radius 2- Ulna 1 2

Sagital MPR of the elbow Medial Lateral 1 1 2 3 2 3 1- Coronoid process 2- Trochlea of the humerus 3- Olecranon process 1- Radial tuberosity 2- Radial head 3- Capitulum

CORONAL MRR 1- Medial epicondyle 2- Lateral epicondyle 3- Olecranon process 1 2 3

CORONAL MPR 1- Capitulum 2- Radial head 3- Trochlea 4- Coronoid process 3 1 4 2

Hand and Wrist Bony Anatomy Consists of: Distal Radius and Ulna – Styloid processes on each side, site of tendon attachment 8 Carpal Bones Proximal Row – Scaphoid, Lunate, Triquetral, Pisiform Distal Row – Trapezium, Trapezoid, Capitate, Hamate 5 Metacarpals – Base (P), Body and Head (D) 14 phalanges – 3 phalanges with exception at thumb (2)

Anatomy

Anatomy

Anatomy

Wrist bones Wrist Bones Mnemonic Proximal Row (Radial to ulnar wrist) Scaphoid or Carpal Navicular (Some) Links proximal to distal carpal row Lunate (Lovers) Triquetrum (Try) Pisiform (Positions) Distal Row (Radial to ulnar wrist) Trapezium/Greater multangular (That) Trapezoid/Lesser multangular (They) Capitate (Can't) Hamate (Handle)

Anatomy

Anatomy

Anatomy

Wrist bones Wrist Bones Mnemonic Proximal Row (Radial to ulnar wrist) Scaphoid or Carpal Navicular (Some) Links proximal to distal carpal row Lunate (Lovers) Triquetrum (Try) Pisiform (Positions) Distal Row (Radial to ulnar wrist) Trapezium/Greater multangular (That) Trapezoid/Lesser multangular (They) Capitate (Can't) Hamate (Handle)

WRIST 1- RADIUS 2- ULNA 1 2

WRIST 2 1 1- SCAPHOID 2- LUNATE 3- TRIQUETRUM 3

WRIST 3 4 1- HAMATE 2- CAPITATE 3- TRAPEZOID 4- TRAPEZIUM 2 1

WRIST 2 3 1- TRAPEZIUM 2- TRAPEZOID 3- CAPITATE 4- HAMATE 4 1

WRIST

WRIST 1- METACARPALS 1

WRIST CORONAL MPR 1- TRAPEZOID 2- CAPITATE 3- HAMATE 4- TRIQUETRUM 5- LUNATE 6- SCAPHOID 2 3 1 4 6 5