Radiology upper limb

Shoulder Region
Elbow Region
Hand & Wrist
Age Determination
Common Fractures & Dislocations

1. Radiology of Upper Limb Dr Mathew Joseph MBBS, MD(AIIMS), BCC(Palliative Medicine) Assistant Professor Department of Anatomy Al Azhar Medical College & Super Speciality Hospital Thodupuzha

2. Content Shoulder Region Elbow Region Hand & Wrist Age Determination Common Fractures & Dislocations

3. Facts In X-ray , translucent portion appears black. Dense area absorbs X-ray and shows different shades of white.

4. Shoulder Region

5. Shoulder Region

6. ELBOW AP & Lateral

7. Wrist & Hand

8. Clinical Anatomy

9. Supracodylar fracture – common and most serious fractures in childhood Mechanism - Fracture is caused by a fall on an out-stretched hand. As the hand strikes the ground, the elbow is forced into hyperextension resulting in fracture of the humerus above the condyles . Extension- Distal fragment is extended( tilted backwards ) in relation to the proximal fragment Flexion- the distal fragment is flexed ( tilted forwards ) in relation to the proximal fragment.

10. Monteggia fracture Monteggia- Fracture of the upper-third of ulna with dislocation of the head of the radius.it is caused by a fall on out- streched hand.

11. Galeazzi- (Counter part of Monteggia) Galeazzi- (Counter part of Monteggia) fracture of the lower third of the radius with dislocation or subluxation of the distal radio-ulnar joint.

12. Colles Fracture

13. Colles Fracture

14. Colle’s fracture- Radius gets fractured about 2 cm above its lower end due to fall on outstretched hand Smith’s fracture- Reverse of Colle’s fracture If distal fragments gets displaced anteriorly

15. Smith Fracture

16. Age Estimation Areas where bone formation or ossification starts in cartilaginous model are known as centres of ossification . Primary centre appear before birth, secondary centre (epiphyseal centre) after birth.but primary centre of carpals and tarsals appear after birth.

17. Age Estimation In long bone with two epiphysis- centre of ossification appearing first is usually last to fuse with shaft. Long bones with single epiphysis- epiphysis at more movable end e.g. head of 2-5 metacarpals, base of first metacarpal and all phalanges. Appearance and fusion of epiphyseal centre occur about 1-2 years earlier in females

18. Shoulder Region 1 st Year- Head of humerus 2 nd –Greater tuberosity 5 th year- Lesser tub. 6 th Year- Fusion of upper end of humerus into one mass FUSION 20 th Year - Fusion of upper end of humerus with shaft

19. Elbow Appearance(Years) 1 st - Capitulum and lateral part of trochlea 5 th – Head of Radius 6 th - Medial epi. Of humerus 9 th - Medial part of trochlea 10 th - Top of Olecranon process 12 th - Lateral epi. Of humerus Fusion 15 th- Olecranon epiphysis with upper end of ulna 16 th – lateral epicondyle, capitulum and trochlea into one mass, and with shaft. 17 th - Head of radius to shaft 20 th – Medial epicondyle of humerus to shaft

20. 6 years: fusion of head with tubercles CRITOE ( mnemonic ): Count 1-3-5-7-9-11 for age C apitulum: 1 year R adial head: 3 years I nternal (medial)epicondyle: 5 years T rochlea: 7 years O lecranon: 9 years E xternal ( lateral ) epicondyle : 11 years

21. Hand and Wrist Appearance(Years) 1 st – lower end radius, capitate, hamate 2 nd – Head of 2,3,4,5 th metacarpal, bases of proximal phalanges 3 rd – Triquetral, base of first metacarpal, middle and terminal phalanges 4 th – lunate 5 th – trapezium,trapezoid , scaphoid 6 th – lower end of ulna 12 th - Pisiform Fusion(Years) 17 th – base of first metacarpal 18 th – epiphysis of metacarpals, phalanges and lower end of ulna 19 th – lower end of radius

22. Ossification Depiction of the order of appearance of the individual carpal bones. The usual sequence is : capitate (1), hamate (2 ), triquetral (3), lunate (4), trapezium (5), trapezoid (6), navicular or scaphoid (7) and pisiform (8). The distal epiphysis of the radius ossifies before the triquetum and that of the ulna before the pisiform

23. Infancy Bone age is primarily based on the presence or absence of ossification of the capitate, the hamate and the distal epiphysis of the radius. The capitate usually appears slightly earlier than the hamate, and has a larger ossification center and rounder shape. The distal radial epiphysis appears later

24. Toddler- Upto Two Years Epiphyses of the proximal phalanges; Epiphyses of the metacarpals; Epiphyses of the middle phalanges; and, Epiphyses of the distal phalanges.

25. Pre-puberty 2 years to 7 years of age Depiction of the progressive growth of the width of the epiphyses, which, during this stage of development, become as wide as the metaphyses

26. Pre- puberty During this stage, bone age is primarily based on the number of recognizable epiphyseal ossification centers in the phalanges and metacarpals

27. Early and Mid-puberty 7 years to 13 years of age Depiction of the progressive growth of the epiphyses, which, during this stage of development, become larger than the metaphyses . Special attention is also placed on epiphyseal shape, which, prior to epiphyseal fusion, overlaps the metaphyses , depicting tiny hornlike structures at both ends of the epiphysis (picture at far-right)

28. Early and Mid-puberty 7 years to 13 years of age

29. Late Puberty Females: 13 years to 15 years of age Fusion of the distal phalanges; 2) Fusion of the metacarpals; 3) Fusion of the proximal phalanges; and, 4) Fusion of the middle phalanges

30. Late Puberty Females: 13 years to 15 years of age

31. Post-puberty 15 years to 17 years of age Depiction, fromleft to right, of the progressive degrees of fusion of the ulna and the radial epiphyses, which usually begins at the center of the physis

32. Post-puberty 15 years to 17 years of age At this stage of development, skeletal maturity is based on epiphyseal fusion of the ulna, which occurs first, and the radius

33. Test

34. Full term Child Has These Centres F – femur(Distal ep.) T- Tibia(Proximal ep.) C- calcaneum H- Humerus (proximal ep) T- Talus C- cuboid

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