1. NORMAL RADIOGRAPHIC ANATOMY The Extremities

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

3. AP Shoulder - External Rotation

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

5. AP Shoulder - Internal Rotation

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

7. AP Shoulder - Internal Rotation

8. Accessory Shoulder Views

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

10. Grashey Spot Projection AP view with patient rotated 35- 45° with arm in external rotation. Allows clear visualization of the glenohumeral joint No crescent signNo crescent sign is seen

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

12. Clavicle Series

13. AC Joint Series

14. NORMAL VARIANTS OF THE SHOULDER

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

16. 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

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

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

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

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

21. Pseudotumor Appearance Cystic appearance produced by the greater tuberosity

22. Conoid Tubercle Normal conoid Enlarged conoid tubercle tubercle

23. THE ELBOW

24. Standard Elbow Series AP Elbow Medial Oblique Elbow Lateral Elbow

25. AP Elbow Projection Patient is positioned with supination of the forearm

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

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

28. Lateral Elbow Projection Patient positioned with 90° of elbow flexion

29. Lateral Elbow

30. Accessory Elbow Projections

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

32. Jones Projection

33. 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.

34. 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

35. Newborn Elbow No visible elbow ossification centers at birth

36. 1 Year Old Elbow capitellum First appearanc e of the capitellum

37. 4 Year Old Elbow radial headBetween the ages of 3 and 6 years of age, the radial head ossification center appears

38. 5 Year Old Elbow internal (medial) epicondyleAppearance of the internal (medial) epicondyle between 3 and 7 years of age

39. 9 Year Old Elbow trochleaAppearance of the trochlea between 9 and 10 years of age

40. 10 Year Old Elbow OlecranonOlecranon ossification center appears between the ages of 6 and 10 years

41. 12 Year Old Elbow External (Lateral) EpicondyleLastly, the External (Lateral) Epicondyle appears between 9 and 13 years

42. Anterior and Posterior Fat Pads

46. Normal Variants of the Elbow

47. Olecranon Foramen aka Supratrochlear Foramen

48. Olecranon Foramen

49. Radioulnar Synostosis usually bilateral may decrease supination or pronation

50. 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

51. Fracture of Supracondylar Process

52. Ununited Secondary Ossificatio n Center - Medial Epicondyle

53. Pseudotumor appearance of the Radial Tuberosity

54. Name the Anomaly

55. Anomaly ?

56. Normal Variant?

58. Anomaly ?

69. Accessory Shoulder Projection?

71. Thank You