BODY BODY PEDICLE PEDICLE TRANSVERSE TRANSVERSE PROCESS PROCESS

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1 Learning Objective Radiology Anatomy of the Spine and Upper Extremity Identify anatomic structures of the spine and upper extremities on standard radiographic and cross-sectional images Timothy J. Mosher, MD Department of Radiology Phone: 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 Lumbar Vertebral Body PEDICLE TRANSVERSE PEDICLE TRANSVERSE (fractured) LAMINA SPINOUS LAMINA SPINOUS

2 SPINE FROM THE FRONT SPECIMEN RADIOGRAPH L4 PEDICLES SPINOUS TRANSVERSE TRANSVERSE ES SPINE FROM THE BACK SUP ART FACET TRANSVERSE SPECIMEN RADIOGRAPH L4 LAMINA INF ART FACET Lamina and Facets SPINOUS AP Lumbar Spine AP Lumbar Spine

3 AP Lumbar Spine Spine Viewed from Side PEDICLE PEDICLE TRANSVERSE LAMINA TRANSVERSE SPINOUS LAMINA SPINOUS Spine Viewed from Side Lateral Lumbar Spine PARS INTRAARTICULARIS SUPERIOR FACET INFERIOR FACET Lateral Lumbar Spine Lateral Lumbar Spine PEDICLE SUPERIOR FACET PARS SPINOUS INFERIOR FACET

4 CT Lumbar Spine Sagittal Reconstructions Facet Joints Axial View Inferior Facets Cervical Thoracic Lumbar Superior Facets Facet Joints Sagittal Reconstructions Intervertebral Disc Space NEURAL FORAMEN Cervical Thoracic Lumbar INTERVERTEBRAL DISC Nerve Roots Intervertebral Disc INF FACET SUP FACET Nucleus Pulposa Body Annulus Fibrosa DISC PEDICLE NERVE ROOT SPINOUS Body Sagittal Section Lumbar Spine

5 Spinal Cord (Cauda Equina) MRI: Intervertebral Disc Intervertebral Disc Nucleus Pulposa Annulus Fibrosa Neural Foramen Pedicle (L3) L3 Nerve Root L3/L4 Intervertebral Disc Pedicle (L4) Neural Foramina Cervical Spine Cauda Equina Vertebral Body Nerve Roots Cervical Spinal Cord Viewed from bottom MRI Myelogram Spinal Ligaments Spinal Ligament Anterior Longitudinal Spinal Ligament Posterior Longitudinal Spinal Ligament

6 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 Bilateral structures Facet Dislocation are likely to at be C6/7 injured? Case Study: 17 year-old Male involved in a MVA Upper Extremity Spinal Cord Injury Anterior Longitudinal Spinal Ligament Posterior Longitudinal Spinal Ligament Radiographic Anatomy X-RAY BEAM LEFT SHOULDER (FRONT) CLAVICLE ACROMION CORACOID GLENOID SCAPULA HUMERUS FILM

7 SCAPULA SHOULDER (BACK) CLAVICLE ACROMION SPINE GLENOID HUMERUS Clavicle Coracoid AP Shoulder Acromion Greater Tuberosity Glenoid LEFT SHOULDER AXILLARY VIEW FILM RIGHT SCAPULA FROM BELOW CORACOID GLENOID SPINE X-RAY TUBE ACROMION LEFT SHOULDER (AXILLARY) Anterior Coracoid Lesser Tuberosity Case Study: 52 year old male with shoulder pain Clavicle Glenoid Acromion Do you identify the cause of the shoulder pain?

8 MRI Anatomy of the Shoulder MUSCLES FROM THE FRONT SUPRASPINATUS SUBSCAPULARIS Rotator Cuff Muscles Sagittal View Rotator Cuff: Subscapularis Supraspinatus Infraspinatus Subscapularis Teres Minor Anterior Sagittal View Coronal View Rotator Cuff: Supraspinatus MUSCLES FROM THE BACK SUPRASPINATUS INFRASPINATUS TERES MINOR Sagittal View Coronal View

9 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 Supraspinatus Joint Coracoacromial liagment Coracoid Process Subscapularis Anterior View MRI Anatomy of the Rotator Cuff MRI Anatomy of the Rotator Cuff

10 Rotator Cuff Tear ROTATOR CUFF TEAR Contrast leaking into subacromial bursa through tear in supraspinatus 10/30/03 10/30/03 1/30/04 1/30/04 Contrast injected into glenohumeral joint The Elbow LEFT ELBOW FROM FRONT Lateral Trochlea Capitulum Radial Head Lateral Elbow from the Back AP ELBOW Lateral Lateral Olecranon Olecranon fossa Trochlea Capitulum Radial Head Radial Head Lateral

11 View of Elbow View of Elbow Coronoid Coronoid Radial Head Radial Head Olecranon Olecranon The Wrist The Wrist Palmar View Carpal Bones (Proximal Row) Scaphoid Lunate Triquetrum Pisiform Radius The Wrist Palmar View Carpal Bones (Proximal Row) The Wrist Palmar View Carpal Bones (Distal Row) Scaphoid Lunate Triquetrum Trapezium Trapezoid Capitate Hamate Pisiform Radius Radius

12 The Wrist Palmar View Carpal Bones (Distal Row) MR Anatomy of the Wrist Capitate Trapezium Lunate Trapezoid Capitate Radius Hamate Coronal Wrist Radius

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