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Learning Objective Radiology Anatomy of the Spine and Upper Extremity

Timothy J. Mosher, MD

Department of Radiology Phone: 531-4566 Email: [email protected]

· Identify anatomic structures of the spine and upper extremities on standard radiographic and cross-sectional images

SPINE

Visual Human Sagittal View

7 Cervical Vertebra

12 Thoracic Vertebra

5 Lumbar Vertebra 5 Sacral Vertebra (fused) 3 Coccygeal Vertebra (fused)

Lumbar Vertebral Body

BODY PEDICLE TRANSVERSE PROCESS

Lumbar Vertebral Body

BODY PEDICLE TRANSVERSE PROCESS (fractured)

SPINOUS PROCESS LAMINA LAMINA

SPINOUS PROCESS

SPINE FROM THE FRONT

BODY

SPECIMEN RADIOGRAPH L4

BODY

PEDICLES TRANSVERSE PROCESS

SPINOUS PROCESS

TRANSVERSE PROCESSES

SPINE FROM THE BACK

SUP ART FACET

SPECIMEN RADIOGRAPH L4

TRANSVERSE PROCESS

LAMINA

INF ART FACET

Lamina and Facets

SPINOUS PROCESS

AP Lumbar Spine

AP Lumbar Spine

AP Lumbar Spine

BODY PEDICLE LAMINA

Spine Viewed from Side

BODY PEDICLE TRANSVERSE PROCESS

TRANSVERSE PROCESS

SPINOUS PROCESS

LAMINA

SPINOUS PROCESS

Spine Viewed from Side

PARS INTRAARTICULARIS SUPERIOR FACET

Lateral Lumbar Spine

INFERIOR FACET

Lateral Lumbar Spine

BODY PEDICLE SPINOUS PROCESS

Lateral Lumbar Spine

SUPERIOR FACET PARS INFERIOR FACET

CT Lumbar Spine Sagittal Reconstructions

Facet Joints Axial View

Inferior Facets

Cervical

Thoracic Superior Facets

Lumbar

Facet Joints Sagittal Reconstructions

Intervertebral Disc Space

NEURAL FORAMEN

Cervical

Thoracic

Lumbar

INTERVERTEBRAL DISC

Nerve Roots

INF FACET SUP FACET

Intervertebral Disc

Nucleus Pulposa Body

Annulus Fibrosa Body

BODY DISC

PEDICLE

NERVE ROOT

SPINOUS PROCESS

Sagittal Section Lumbar Spine

MRI: Intervertebral Disc

Spinal Cord (Cauda Equina) Intervertebral Disc ·Nucleus Pulposa ·Annulus Fibrosa

Neural Foramen

Pedicle (L3)

L3 Nerve Root

L3/L4 Intervertebral Disc

Pedicle (L4)

Neural Foramina Cervical Spine

Vertebral Body Nerve Roots Cervical Spinal Cord

Cauda Equina

MRI Myelogram Viewed from bottom

Spinal Ligaments

Spinal Ligament

Anterior Longitudinal Spinal Ligament

Posterior Longitudinal Spinal Ligament

Case Study: 17 year-old Male involved in a MVA

Do you see a fracture?

Case Study: 17 year-old Male involved in a MVA

Right Left

Fracture of C7 vertebral body

What other structures are likely to be injured? Bilateral Facet Dislocation at C6/7

Case Study: 17 year-old Male involved in a MVA

Spinal Cord Injury

Anterior Longitudinal Spinal Ligament Posterior Longitudinal Spinal Ligament

Upper Extremity

Radiographic Anatomy

X-RAY BEAM

LEFT SHOULDER (FRONT)

CLAVICLE ACROMION CORACOID GLENOID SCAPULA HUMERUS

FILM

SHOULDER (BACK)

CLAVICLE ACROMION SPINE GLENOID SCAPULA HUMERUS

Clavicle

AP Shoulder

Acromion

Coracoid

Greater Tuberosity

Glenoid Humerus

LEFT SHOULDER AXILLARY VIEW

FILM

RIGHT SCAPULA FROM BELOW

CORACOID GLENOID

SPINE

X-RAY TUBE

BODY ACROMION

LEFT SHOULDER (AXILLARY)

Anterior Lesser Tuberosity Coracoid Clavicle Humerus Glenoid

Case Study: 52 year old male with shoulder pain

Acromion Do you identify the cause of the shoulder pain?

MUSCLES FROM THE FRONT

MRI Anatomy of the Shoulder

SUPRASPINATUS

SUBSCAPULARIS

Rotator Cuff Muscles Sagittal View

Supraspinatus Infraspinatus

Rotator Cuff: Subscapularis

Subscapularis

Teres Minor

Anterior

Sagittal View

Coronal View

MUSCLES FROM THE BACK

Rotator Cuff: Supraspinatus

SUPRASPINATUS

INFRASPINATUS

TERES MINOR Sagittal View Coronal View

Rotator Cuff: Infraspinatus

Rotator Cuff: Teres Minor

Sagittal View

Coronal View

Sagittal View

Coronal View

Anatomy Considerations in Rotator Cuff Tears

Impingement of the Rotator Cuff

Coracoacromial Arch ·Acromion ·AC Joint Supraspinatus ·Coracoacromial liagment ·Coracoid Process Subscapularis

Anterior View

MRI Anatomy of the Rotator Cuff

MRI Anatomy of the Rotator Cuff

Rotator Cuff Tear

Contrast leaking into subacromial bursa through tear in supraspinatus

ROTATOR CUFF TEAR

10/30/03 1/30/04 10/30/03 1/30/04

Contrast injected into glenohumeral joint

LEFT ELBOW FROM FRONT

The Elbow

Medial Epicondyle

Humerus Lateral Epicondyle

Trochlea

Capitulum

Ulna Medial

Radial Head Lateral

Elbow from the Back

Humerus Medial Epicondyle Lateral Epicondyle Medial Epicondyle

AP ELBOW

Humerus Lateral Epicondyle

Olecranon

Olecranon fossa Radial Head

Trochlea

Capitulum

Ulna

Ulna Medial

Radial Head Lateral

Medial View of Elbow

Coronoid Radial Head Medial Epicondyle Humerus

Medial View of Elbow

Coronoid Humerus

Radial Head

Medial Epicondyle

Olecranon Ulna

Ulna

Olecranon

The Wrist

The Wrist Palmar View Carpal Bones (Proximal Row)

Lunate Scaphoid

Triquetrum

Pisiform

Radius

Ulna

The Wrist Palmar View Carpal Bones (Proximal Row)

The Wrist Palmar View Carpal Bones (Distal Row)

Lunate Scaphoid Triquetrum

Trapezium Trapezoid Pisiform Capitate Hamate

Radius

Ulna

Radius

Ulna

The Wrist Palmar View Carpal Bones (Distal Row)

MR Anatomy of the Wrist

Capitate Trapezium Trapezoid Capitate Radius Ulna Coronal Wrist Hamate Lunate Radius

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