My name is Dr Andrew Lischuk and this lecture will cover radiology of the upper extremities, with particular emphasis on the gaseous structures and bones. The objectives of this lecture are to review the upper extremity Osseous anatomy, review several of the bony landmarks and hopefully you'll feel more comfortable evaluating and looking at x-rays following this lecture. Let's start superior early and work our way down, the shoulder girdle refers to the portions of the upper arm that make up the shoulder joint and the chromium particular joint, connecting the upper arm to the bony thorax. The structures that make up the shoulder girdle include the scapula, the clavicle and the proximal humerus. This specific radiograph was obtained with the shoulder internally rotated. We note that this is an internal rotation view because the human head on this image has the appearance of a light bulb. Notice that the human head is nearly perfectly rounded and tapers along the metastases. You chromium particular joint is formed between the distal aspect of the clavicle and the chromium process. You may have come across the term shoulder separation, this refers to an injury that occurs at this joint. The Glenna humorous joint is the true shoulder joint formed by the human head and the left side of the scapula. The acromial process is an easily palpable, bony prominence on the lateral most and superior most aspect of the shoulder. The core record process is a bony projection, extending anti relief from the scapula, just medial to the human head. This is an external rotation radiograph of the shoulder. You should note that this view appears differently than the internal rotation view in that the human head has a bony prominence laterally. Which represents the greater Tuberocity and therefore the human head, no longer has the light bulb appearance. The lesser Tuberocity sits medial to the greater tuberocity and serves as an attachment point for one of the rotator cuff attendance, the sub scapula Ariston. Between the greater tuberocity and the lesser tuberocity is the intertubercular groove, also known as the bicipital groove. Because the long head of the biceps tendon travels through this groove from its origin on the superior aspect of the glenoid. But glenoid forms the socket portion of the classic ball and socket joint and is denoted by the yellow line. The scapular wide view is a lateral projection through the plane of the scapula. This view is formed by the intersection of the scapular spine, the coracoid process and the scapular body. At the intersection point of these lines sits the glenoid, which is demarcated by the blue circle, the human head should be positioned directly over the glenoid. This view is very useful to evaluate for dislocations of the human head from the glenoid. The accident review is another very useful view for evaluating the position of the human head on the Illinois. Here, the human head represented by the yellow circle sits over the blue line, which represents the glenoid Articular surface. While this view is very useful to evaluate patients with shoulder dislocations, you should consider the ability of your patient to assume this position, which requires them to abduct their arm. This may be difficult for patients who have fractures or dislocations. The humerus is a longbone and, like all long bones, has an elongated cylindrical portion which represents the diaphysis. The epiphysis represent the articular ends of the bone at the shoulder joint and the elbow joints. The metamorphosis both approximately and distal is the flared portion of the bone. The distal metamorphosis is specifically referred to as the supracondylar region. This is a typical location for fractures to occur, especially in our pediatric population. The distal humerus forms the elbow joint with the radius and the ulna, the elbow joint is in fact, two distinct joints. The capitellum is demarcated by the red arrow, and the trochlea we see on the image here is demarcated by the blue arrow. These articulate with the proximal radius and ulna, respectively. The medial epicondyle is a bony prominence along the medial aspect of the distal humerus that serves as the attachment site for the flexor and pronader muscles of the form. The lateral epicondyle is a bony prominence on the lateral aspect of the distal humerus, which serves as the attachment site for the extensive and super musculature of the forum. The Radial head is the portion of the proximal radius, which articulates with the capitellum of the distal humerus. The proximal ulna articulates with the trophy of the distal humerus and provides most of the bony stability at the elbow. There also is a joint between the proximal radius and ulna, known as the proximal radio owner joint, where rotation occurs, allowing for both super nation and pronation. On this image, we have a lateral view of the elbow, there are two structures among the proximal ulna, which you should become familiar with. The coronoid process is a triangular shaped, bony prominence among the anterior aspect of the proximal ulna. The olecranon process is located more posterior Lee. Given that the olecranon process is so superficially located, it is prone to injury when falling directly on the elbow. It's always important to evaluate the joint space for expansion of the joint space in the setting of a joint effusion. The presence of a joint effusion could indicate an underlying pathologic process, such as an occult fracture or an inflammatory or infectious arthritis. There are two bones within the form, the radius and the ulna. The radio neck is the portion of the radius just distal to the radial head, this is a common sight of fractures in adult patients. The radial tuberocity is a bony projection along the medial aspect of the radius below the radial neck, which serves as the attachment site of the distal biceps tendon. The ulna serves as the primary Osseous stabilizer at the elbow joint, but as you can see, the owner tapers distantly and has a limited role in stability at the wrist joint. The wrist is a complex joint with multiple bones, as well as surrounding ligaments, tendons and neurovascular structures. The distal radius flares at the wrist joint and provides the bulk of the bony stability between the forearm and wrist articulations. The radial styloid is a bony projection that's easily palpable along the lateral or radial aspect of the wrist joint. The distal ulna provides minimal stability at the wrist articulation. A small bony projection along the distal ulna, is referred to as the ulnar styloid and is fairly commonly fractured in patients with a fall onto an outstretched hand. The carpal bones consist of a proximal row of four carpal bones and a distal row of carpal bones. The proximal row is made up of the scaphoid, lunate, triquetrum and pisiform bones. The distal carpal row is made up of the trapezium, trapezoid, capitate and hamate bones. Let's take a look at this lateral view radiograph of the wrist. This is often difficult to evaluate, even for a trained radiologist. The importance of this radiograph is to determine the alignment of the wrist articulations from the form through the metacarpals, the distal radius, the lunate, the capitate and the metacarpals should maintain vertical alignment and continuity. Occasionally, one of these bones or several of these bones may be misplaced, either entirely or posterily, which would indicate a dislocation of one of the carpal bones. This most commonly occurs with the limit. The oblique view radiograph offers us the opportunity to better evaluate the scaphoid bone, which is the most commonly fractured carpal bones. The skateboard has a distal pole, a waist area and a proximal pole. The blood supply to the skateboard is from a branch of the radial artery, which channels into the skateboard from distal to proximal. Therefore, a fracture through any portion of the skateboard, which disrupts the blood supply, could lead to development of a condition known as a vascular necrosis of the skateboard. Where the proximal pull fragment of the cross is due to the lack of blood flow moving distantly. We have an AP radiograph of the hand with five metacarpal bones numbered from the thumb through the small finger as denoted on the image. There are five proximal phalanges, four middle phalanges on digits two through five and five distal phalanges. Take note that the thumb only has a proximal and distal phalanges. Here we have a lateral view of the hand, with the fingers splayed so that we can best evaluate each individual joint space and phalanges with minimal overlap. There are several joint spaces within the hand, which we should become familiar with. There are the distal interphalangeal joints between the middle phalanges and distal phalanges of each digit. The proximal interphalangeal joints are formed between the proximal phalanges and middle phalanges of each digit. The metacarpal phalanges joints between the metacarpals and the proximal phalanges, the carpal metacarpal joints between the carpal bones of the distal carpal rows and the metacarpals. The intercarpal joints between the individual carpal bones and the radiocarpal joints between the radius of the typhoid and the limit. This completes our Osseous review of the upper Extremity anatomy. Thank you for listening.
