emergency radiology: shoulder & upper extremities
TRANSCRIPT
Orthopedic Radiology :Shoulder & Upper Extremity
2015-09-14 Staff Lecture
Dep. of Emergency Medicine
Sung Wook, Song
Reference
• Wiki Radiolgraphy http://www.wikiradiography.net/ • Schwartz D, Reisdorff E. Emergency Radiology. McGraw-Hill 2000. • Orthopedic Radiology • Knoop K, Stack L, Storrow A, Thurman RJ. The Atlas of Emergency Medicine, Third Edition. McGraw Hill Professional; 2009.
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Orthopedic Radiology: Basic
• Radiographic Dx. of a fracture 1. fracture line 의 확인 2. 주위 soft tissue 의 변화 3. skeletal contour 또는 alignment 의 변화
• Standard & Supplementary view
• Systematic Interpretation : ABC’s 3
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SHOULDER
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Shoulder AP
11 Shoulder True AP: Grashey method
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Lt. Shoulder Inferosuperior (IS) axial view
Rt. Shoulder IS axial view
CASE
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Deformity(+): Rt. shoulder prominence of the acromion
16 humeral head: not in the glenoid fossa & anterior and inferior location
17 internal rotation of the greater tuberosity ! a dip of ice cream “ice cream cone sign”
18 Posterior Shoulder Dislocation: scapular Y view
19 Posterior Shoulder Dislocation: scapular Y view
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lightbulb sign
ELBOW
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Elbow AP - Adult
27 Elbow oblique - Adult
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Elbow Lat. - Adult
29 Elbow AP - Pediatric
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Elbow oblique - Pediatric
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Elbow Lat. - Pediatric
Ossification Center : Pediatric
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Ossification Centers
C R I T O E 1 3 5 7 9 11
Elbow Injuries by age
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Radiologic evaluation: ABC’S
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Alignment: 2 lines
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1. Anterior humeral line (1-2) 2. Radiocapitellar line (3-4)
Alignment: AH & RC line
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소아: Radiocarpitellar line
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Easily missed site : Adult
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Easily missed site : Child
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CASE
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fat pad sign(+) ! supracondylar fracture
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CASE
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45 swelling & pain in the forearm, palpable radial head in antecubital fossa “Monteggia fracture”
46 fracture of the proximal 1/3 of the ulna & combined D/L of the radial head “Monteggia fracture”
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fracture of the distal 1/3 of the radius & combined D/L of the radioulnar joint “Galeazzi fracture”
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Isolated fracture of the middle third of the ulna “Nightstick fracture”
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Galeazzi fracture dislocation
Monteggia fracture dislocation
Essex Lopresti lesion
WRIST & HAND
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1st digit : thumb : 엄지 2nd digit: index finger : 검지 3rd digit: middle finger : 중지 4th digit: ring finger : 약지 5th digit: little finger : 새끼손가락
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floor : scaphoid bone ! common fx. site falling on outstretched hand(FOOSH)
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S: 배모양의 L: 초승달 TQ: 삼각골 P: 완두콩모양 H: 갈고리모양 C: 얼굴모양 TD: 사다리꼴 TM: 큰 사다리꼴
CMCJ: carpometacarpal jt. MCJ: midcarpal jt. RCJ: radiocarpal jt. DRUJ: distal R-U jt.
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tenderness over 5th MC base or pisiform
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tenderness in “anatomic snuff box”
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tenderness over volar surface of the carpals
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PA view: alignment
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3 smooth arcs abn.! carpal dislocation or Fx.
Scaphoid ring sign
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scaphoid rotatory subluxation
intercarpal joint space: 2mm 특히 scapholunate joint space
lateral view: scapholunate angle
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Dorsal / Volar intercalated segmental instability
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CASE
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distal forearm displaced dorsally classic dinner-fork deformity “Colles fracture”
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distal forearm displaced volar – reverse Colles “Smith fracture”
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volar displacement of the distal radial fregment “Smith fracture”
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4 type of distal radius fracture
CASE
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78 Perilunate dislocation
79 Perilunate Dislocation dorsal displacement of the carpal bones in relation to the lunate
80 Scapholunate Dissociation widened scapholunate joint space
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scaphoid fracture middle third of scaphoid fracture
FINGER
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CASE
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Boutonnire deformity 4th digit : flexion of PIP & extension of DIP
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Swan-Neck Deformity Index finger : hyperextension of PIP & flexion of DIP
91 Mallet Finger distal phalanx flexion & unable to extend it
92 Mallet Finger distal phalanx flexion & unable to extend it
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Boutonnire & Swan-neck deformity
• Boutonnire deformity – injury to the central slip
• Swan-neck deformity – contracture of intrinsic hand m
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96 Mallet Finger: unopposed flexion of the DIP joint (A) complete tear, (B) avulsion of a small chip fragment
97 Jersey Finger flexion if disrupted in the injured hand
Mallet & Jersey Finger
• Mallet finger: DIP " tearing the extensor mechanism – sudden axial flow to the tip of the extended finger
• Jersey finger: DIP " avulsion of the flexor mechanism – ring finger(m/c), FDP tears
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열공합시다.
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