1. DEPARTMENT OF RADIOLOGY
Upper Limb Anatomy
Gerald R. Aben, MD, FACR
Associate Professor Radiology
College of Osteopathic Medicine
On this next review of images we will be reviewing anatomic objectives related to the upper limb anatomy
9/18/2018
DEPARTMENT OF RADIOLOGY

2. DEPARTMENT OF RADIOLOGY
Looking at the distal bones we are able to identify the various phalanges and metacarpals as well as the carpal bones. Intercarpal joints are demonstrated as are the metacarpal carpal joints, the interphalangeal joints and the metacarpalphalangeal joints. By using multiple projections we are able to better evaluate these various structure
9/18/2018
DEPARTMENT OF RADIOLOGY

3. DEPARTMENT OF RADIOLOGY
Evaluation of the shoulder with demonstration of the acromioclavicular joint and the relationship between acromion and clavicle. Note also the relationship between the clavicle and coracoid process which can have an import in shoulder injury. The glenoid cavity is noted in relationship to the humeral head. Both greater and lesser tubercles are identified as well as the intertubercular groove where the biceps tendon runs. The scapula superimposes portions of the thorax and can be confusing in relationship to the ribs
9/18/2018
DEPARTMENT OF RADIOLOGY

4. DEPARTMENT OF RADIOLOGY
Additionally identified on this frontal and lateral view of the humerus, are the medial and lateral epicondyles, as well as the olecranon fossa. The deltoid tuberosity is noted and the intra-tubucular sulcus is again demonstrated between the greater and lesser tuberosity. Small lines drawn on the frontal study separate anatomic from the surgical heads.
9/18/2018
DEPARTMENT OF RADIOLOGY

5. DEPARTMENT OF RADIOLOGY
3 images are obtained in the region of the elbow. On the first image we're able to identify the medial epicondyle, the lateral epicondyle, as well as the articular surfaces of the distal humerus the trochlea and the capitellum. The second view more clearly defines the lateral epicondyle and also allows us to evaluate the radial tuberosity and it's relationship to the radial head. The lateral projection in addition to allowing us to evaluate for the presence of a fat pad or collection of fat in the region of the anterior distal humerus also allows us to demonstrate the olecranon quite clearly
9/18/2018
DEPARTMENT OF RADIOLOGY

6. DEPARTMENT OF RADIOLOGY
In this special view we are able to see the relationship of the humeral head as it superimposes the acromion. The coracoid process is noted separately as is the articulation of the glenohumeral joint. The acromioclavicular joint is seen behind the humeral head in this particular instance and the scapula is noted to extend to the right and inferior as we face the image.
9/18/2018
DEPARTMENT OF RADIOLOGY

7. DEPARTMENT OF RADIOLOGY
Evaluation of the wrist includes evaluation of the various small bones of the wrist. The hamate, pisiform, capitate, scaphoid, lunate, trapezium and trapezoid can all be demonstrated by utilization of various projections. The joint spacing between these bones as well as the relationship to the metacarpals and the bones of the radius and ulna can be defined
9/18/2018
DEPARTMENT OF RADIOLOGY

8. DEPARTMENT OF RADIOLOGY
MRI evaluation of the upper arm demonstrates the presence of the superficial and bracial fascia as well as the skin. Note the high signal associated with the marrow within the humerus. Also note the vascular nerve complex just medial and lateral to the shaft of the humerus
9/18/2018
DEPARTMENT OF RADIOLOGY

9. DEPARTMENT OF RADIOLOGY
On this view near the elbow we note the neurovascular bundle superiorly which would be within the anterior portion of the forearm. Note the radius and ulna posteriorly with fat prominent within the marrow cavity.
9/18/2018
DEPARTMENT OF RADIOLOGY

10. DEPARTMENT OF RADIOLOGY
On this cross section in the humeral region we are able to identify the neurovascular bundles involved with the basilic vein and cephalic vein. We also can define the anterior and posterior compartments of the upper arm. Note the high signal in the subcutaneous fat as well as within the marrow cavity. Cortical bone is black.
9/18/2018
DEPARTMENT OF RADIOLOGY

11. DEPARTMENT OF RADIOLOGY
Detailed evaluation provided by MRI evaluation. In this case demonstrate a variety of ligaments as well as the transverse carpal ligament in relationship to the carpal tunnel
9/18/2018
DEPARTMENT OF RADIOLOGY

12. DEPARTMENT OF RADIOLOGY
Not only bony structures can be evaluated with MRI evaluation. In this case we are also able to identify the thenar and the hypothenar eminence in the base of the palm.
9/18/2018
DEPARTMENT OF RADIOLOGY

13. DEPARTMENT OF RADIOLOGY
Selective right arm angiography with injection of contrast into the subclavian artery allows selective evaluation of the various vessels arising including the axillary artery, the subscapular artery, the lateral thoracic artery, the internal thoracic artery and brachial artery and the thoracodorsal branches to the thorax.
9/18/2018
DEPARTMENT OF RADIOLOGY

14. DEPARTMENT OF RADIOLOGY
In this individual who recently experience a gunshot injury, contrast material is noted to extravasate in the upper arm as indicated by white lines. Metallic fragments from a bullet fragment and a fracture of the humerus is noted. We are able to identify the basilic artery, the ulnar artery and portions of the radial artery. The portion of the radial artery which is not filling is likely as a result of the timing of the imaging rather than reflecting occlusion of the vessel at that location
9/18/2018
DEPARTMENT OF RADIOLOGY

15. DEPARTMENT OF RADIOLOGY
Further imaging, distal in the hand and wrist demonstrates the radial, the artery anterior intraosseous artery as well as the ulnar artery. The first arch between the radial and ulnar artery also included on the examination
9/18/2018
DEPARTMENT OF RADIOLOGY