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

2. 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

3. 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

4. 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

5. 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

6. 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

7. Musculoskeletal Protocols
Shoulder or scapula
Elbow
Wrist

8. Indications
Trauma
Pain
RCT tear
Bursitis
Arthritis

9. GROSS ANATOMY OF THE SHOULDER

10. GROSS ANATOMY

11. GROSS ANATOMY OF SCAPULA

12. SCAPULA

13. 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

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

15. ROTATOR CUFF

16. LABRUM

17. Shoulder

18. SUPERIOR VIEW

19. SAGITAL VIEW

20. POSTERIOR VIEW

21. ANTERIOR VIEW

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

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

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

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

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

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

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

29. Elbow

30. ELBOW

31. ELBOW

32. ELBOW

33. Elbow

34. Elbow

35. ELBOW
1- Medial Epicondyle
2- Lateral Epicondyle 2 1

36. ELBOW
1- Olecranon Process of the ulna 1

37. ELBOW
1- Head of Radius
2- Ulna 1 2

38. 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

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

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

41. 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)

42. Anatomy

43. Anatomy

44. Anatomy

45. 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)

46. Anatomy

47. Anatomy

48. Anatomy

49. 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)

50. WRIST
1- RADIUS
2- ULNA 1 2

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

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

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

54. WRIST

55. WRIST
1- METACARPALS 1

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