Download Radiographic Anatomy of the Upper By

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