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Radiographic Anatomy of the Upper By Dr.Hayder Kadhum Hussein Upper Limb Radiographic Anatomy The scapula This flat triangular bone has three processes: The glenoid process, spine and coracoid process Plain radiographs The inferior angle of the scapula lies over the seventh rib or interspace - this is a useful guideline in identifying ribs or thoracic vertebral levels. In AP views it is not usually possible to rotate the scapulae off the lung fields this one of many factors to use PA XR in chest examinations Radiological features of the clavicle The clavicle overlies the apices of the lungs in chest radiographs. Apical or lordotic views are used to project the clavicles above the lungs to evaluate this area further On a chest radiograph, the distance between the medial end of the clavicle and the spine of the vertebrae is equal on both sides unless the patient is rotated. Radiological features of the humerus The hemispherical head of the humerus is separated from the greater and lesser tubercles by the anatomical neck. The shaft just below the tubercles is narrow and is called the surgical neck of the humerus. The lower end of the humerus is expanded and has medial and lateral epicondyles. The articular surface for the elbow joint has a capitellum for articulation with the radial head and a trochlea for the olecranon fossa of the ulna. Above the trochlea are fossae, the coronoid anteriorly and the deeper olecranon fossa posteriorly. A hook-shaped projection of bone - termed the supracondylar process - occasionally occurs about 5 cm above the medial epicondyle and may be continuous with a fibrous band, attached above the epicondyle to form a foramen that transmits the median nerve and the brachial artery. Axial radiograph of the shoulder. 1. Medullary cavity of humeral shaft 2. Cortex 3. Head of humerus 4. Lesser tuberosity 5. Tip of acromion process 6. Lateral end of clavicle 7. Acromioclavicular joint 8. Clavicle 9. Glenoid fossa of scapula 10. Coracoid process of scapula 11. Acromion process of scapula 1. Shaft of humerus 2. Olecranon fossa 3. Medial epicondyle 4. Lateral epicondyle 5. Olecranon process 6. Capitulum 7. Trochlea 8. Head of radius 9. Neck of radius 10. Coronoid process of ulna 11. Radial tuberosity 12. Shaft of radius 13. Shaft of ulna Radiological features of the radius and ulna The radius has a cylindrical head that is separated from the radial tubercle and the remainder of the shaft by the neck. Its lower end is expanded and its most distal part is the radial styloid. The upper part of the ulna - the olecranon - is hookshaped with the concavity of the hook - the trochlear fossa ,the styloid process at the distal end is narrower and more proximal than that of the radius with a line joining them on an AP radiograph lying at an angle of 110° with the long axis of the radius. 1. Distal radius 2. Styloid process of radius 3. Distal ulna 4. Styloid process of ulna 5. Distal radioulnar joint 6. Radiocarpal joint 7. Scaphoid 8. Lunate 9. Triquetral 10. Pisiform 11. Hamate 12. Hook of hamate 13. Capitate 14. Trapezoid 15. Trapezium 16. First metacarpophalangeal joint 17. Base of fourth metacarpal 18. Shaft of fourth metacarpal 19. Head of fourth metacarpal 20. Fourth metacarpophalangeal joint 21. Shaft of proximal phalanx, ring finger 22. Proximal interphalangeal joint, little finger The shoulder (glenohumeral) joint Ball & Socket SJ Consist of Head of the humerus; and the glenoid cavity of the scapula, which is made deeper by a fibrocartilaginous ring - the labrum glenoidale. Capsules attached to epiphyseal line of glenoid and humerus ,except inferiorly where it extends downwards on the medial aspect of the neck of the humerus as the axillary pouch. The capsule of the shoulder joint is lax and relatively unprotected by ligaments or muscles inferiorly. This is the site of accumulation of fluid in effusion or haematoma of the joint. The supraspinatus muscle is separated from the acromium by the subacromial-subdeltoid bursa, the largest bursa in the body. The rotator cuff muscles are ( subscapularis, infraspinatus and teres minor muscles) give stability to the joint so must concentrate on with every examination of the shoulder joint 1. Acromion process 3. Deltoid muscle 8. Supraspinatus muscle and tendon 9. Superior labrum (and long head of biceps ) 10. Suprascapular notch (containing suprascapular nerve artery and vein) 11. Biceps tendon The elbow joint synovial hinge joint Articular surfaces are the trochlea and capitellum of the humerus, thehead and ulnar notch of the radius and the trochlear fossa,and the radial notch of the ulna. The capsule of the elbow joint is lax anteriorly and posteriorly so that effusion within the joint causes distension ofthe capsule anteriorly and posteriorly which can appear on XR Both ulnar collateral and radial collateral ligaments appear hypointense on MRI sequences (tendon edema and disruption appear hyperintense) MRI ELBOW 1. Radial collateral ligament 2. Radial head and annular ligament 3. Supinator muscle belly 4. Ulnar collateral ligament 5. Medial epicondyle and common flexor tendon insertion 6. Coronoid fossa 7. Coronoid process 8. Extensor digitorum muscle belly 9. Flexor carpi radialis 10. Pronator teres