NORMAL NORMAL RADIOGRAPHIC RADIOGRAPHIC

ANATOMYANATOMY

The Extremities

Standard Shoulder SeriesStandard Shoulder Series

• AP shoulder with external rotationexternal rotation of the humerus

• AP shoulder with internal rotationinternal rotation of the humerus

AP Shoulder - External RotationAP Shoulder - External Rotation

AP Shoulder - External RotationAP Shoulder - External Rotation

• Greater tuberosity is seen in profilein profile

• Lesser tuberosity is seen en faceen face

• crescent signcrescent sign• anatomical neck• surgical neck

AP Shoulder - Internal RotationAP Shoulder - Internal Rotation

AP Shoulder - Internal RotationAP Shoulder - Internal Rotation

• Lesser tuberosity is seen in profilein profile

• Greater tuberosity is seen en faceen face

AP Shoulder - Internal RotationAP Shoulder - Internal Rotation

Accessory Shoulder Accessory Shoulder ViewsViews

Baby Arm ProjectionBaby Arm Projection

• 90º of abduction and external rotation of the humerus• gives a lateral projection of the humeral head

Grashey Spot ProjectionGrashey Spot Projection

• AP view with patient rotated 35-45° with arm in external rotation.

• Allows clear visualization of the glenohumeral joint

• No crescent signNo crescent sign is seen

Lateral Scapula or “Y” Lateral Scapula or “Y” ProjectionProjection

• Allows visualization of scapula without superimposition

Clavicle SeriesClavicle Series

AC Joint SeriesAC Joint Series

NORMAL VARIANTSNORMAL VARIANTSOF THE SHOULDEROF THE SHOULDER

Rhomboid FossaRhomboid Fossa

a developmental variation at the attachment site of the costoclavicular ligamentcostoclavicular ligament

Pectoralis Major InsertionPectoralis Major Insertion

• Region of lucency at the insertion of the pectoralis major m.pectoralis major m. on the humerus

• note the deltoid deltoid tuberositytuberosity which represents normal anatomy

Vacuum PhenomenonVacuum Phenomenon

• a radiolucency noted in the joint space

• represents gas within the joint capsule

Os InfrascapularOs Infrascapular

• An accessory ossicle at the inferior angle of the scapula

• represents an ununited secondary ossification center

Sprengel DeformitySprengel Deformity

• a congenitally high position of the scapula

• unilateral or bilateral

Supraclavicular ForamenSupraclavicular Foramen

Allows passage of the medial branch medial branch of the supraclavicular nerveof the supraclavicular nerve

Pseudotumor AppearancePseudotumor Appearance

• Cystic appearance produced by the greater tuberosity

Conoid TubercleConoid Tubercle

Normal conoid Enlarged conoid tubercle tubercle

THE ELBOWTHE ELBOW

Standard Elbow SeriesStandard Elbow Series

• AP Elbow

• Medial Oblique Elbow

• Lateral Elbow

AP Elbow ProjectionAP Elbow Projection

• Patient is positioned with supination of the forearm

AP ElbowAP Elbow

• Note the lack of superimposition of the radius and ulna

Medial Oblique Medial Oblique ElbowElbow

• patients forearm is pronated

• the radius and ulna are superimposed

Lateral Elbow ProjectionLateral Elbow Projection

• Patient positioned with 90° of elbow flexion

Lateral Elbow Lateral Elbow

Accessory Elbow Accessory Elbow ProjectionsProjections

Jones ProjectionJones Projection

• aka Tangential Tangential Olecranon Olecranon ProjectionProjection

• allows clear visualization of the trochlea-trochlea-olecranon olecranon joint spacejoint space

Jones ProjectionJones Projection

Capitellum view

• Throws the capitellum and radial head clear of the overlying trochlea and ulna and allows visualization of otherwise obscure fractures of these two structures.

Order of Appearance of the Order of Appearance of the Elbow Ossification CentersElbow Ossification Centers

• CRITOECRITOE• CCapitellum 1-8 months• RRadial Head 3-6 years• IInternal (Medial) Epicondyle 3-7 years• TTrochlea 9-10 years• OOlecranon 6-10 years• EExternal (Lateral) Epicondyle 9-13 years

Newborn ElbowNewborn Elbow

• No visible elbow ossification centers at birth

1 Year Old Elbow1 Year Old Elbow

First appearance of the capitellumcapitellum

4 Year Old 4 Year Old ElbowElbow

• Between the ages of 3 and 6 years of age, the radial radial headhead ossification center appears

5 Year Old Elbow5 Year Old Elbow• Appearance of the

internal (medial) internal (medial) epicondyle epicondyle between 3 and 7 years of age

9 Year Old Elbow9 Year Old Elbow• Appearance of the

trochlea trochlea between 9 and 10 years of age

10 Year Old 10 Year Old ElbowElbow

• Olecranon Olecranon ossification center appears between the ages of 6 and 10 years

12 Year Old 12 Year Old ElbowElbow

• Lastly, the External (Lateral) External (Lateral) Epicondyle Epicondyle appears between 9 and 13 years

Anterior and Posterior Fat Anterior and Posterior Fat PadsPads

Normal Variants of the Normal Variants of the ElbowElbow

Olecranon Olecranon ForamenForamen

aka aka Supratrochlear Supratrochlear

ForamenForamen

Olecranon Olecranon ForamenForamen

Radioulnar SynostosisRadioulnar Synostosis

• usually bilateral• may decrease supination or

pronation

Supracondylar ProcessSupracondylar Process

• An osseous projection on the anteromedial aspect of the distal humerus

• Struther’s ligamentStruther’s ligament may extend inferior from this process to the medial epicondyle

• may cause neurovascular signs or symptoms

Fracture of Supracondylar ProcessFracture of Supracondylar Process

Ununited Ununited Secondary Secondary OssificatioOssification Center - n Center -

Medial Medial EpicondyleEpicondyle

Pseudotumor Pseudotumor appearance of appearance of

the Radial the Radial TuberosityTuberosity

Name the AnomalyName the Anomaly

Anomaly ?Anomaly ?

Normal Normal Variant?Variant?

Normal Variant ?Normal Variant ?

Anomaly ?Anomaly ?

Accessory Shoulder Projection?Accessory Shoulder Projection?

Accessory Accessory Shoulder Shoulder

Projection ?Projection ?

Thank YouThank You