lecture 4- elbow slides

7/31/2019 Lecture 4- Elbow Slides

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The Elbow And Com artments Of

The Upper Extremity


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Department of Radiology,

Vancouver General Hospital

Dr.Dr. LawrenceLawrence JoseyJosey

Magnetic Resonance Imaging FellowMagnetic Resonance Imaging Fellow


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Objectives

Be able to identif the followin structures on a lain radio ra h:

Distal end of the humerus

Lateral epicondyle

Lateral supracondylar ridge Medial supracondylar ridge Capitulum

Trochlea Proximal end of Radius

Head of Radius

Radial Tuberosity Proximal end of Ulna

Olecranon

Coronoid process Tuberosity of ulna Trochlear notch


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y v w


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Anatomy Review: Basic Terms

1. Standing

2. Feet together. rms o e s e

4. Head and palms facing forwards

requen y se erms:Apply Anatomical Position

Su erior / InferiorHigher in position / Lower in position

Lateral / Medial

Anterior / PosteriorFront / Back

Proximal / DistalCloser to origin / Away from the origin


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Anatomical Review: Basic Terms

Additional anatomic terminology may be used in the hand :

Radial

Ulnar

Radial

Anatomical position not necessary


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Anatomical Review: Basic Terms

Additional anatomic terminology may be used in the hand :

Volar or Palmar / Dorsal

Volar /Palmar

/Palmar

Dorsal

Anatomical position not necessary


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Radiograph Views of the Elbow

AP View Lateral View


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Distal Humerus Anatomy Review

There are two articulating surfaces or

cond les of the humerus:

Trochlea: Articulates with the ulna

o Spindle-shaped, concave articular

surface

Capitulum: Articulates with the radius

o Convex Articular Surface


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Anatomy Review

1 2

1

35

4

1. Trochlea2. Capitulum

3. Olecranon behind trochlea

5

4. Ulna

5. Radius


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Epicondyles - Bony protuberances

above (epi) the condyles

MedialE icond le

e a ep con y e

1. Palpable landmark on medial side

2. Attachment of forearm muscles of

the anterior compartments (wrist

flexors)

Lateral epicondyle

1. Attachment of muscles of the

Lateral

Epicondyle

posterior compartments (wrist

extensors)


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Supracondylar ridges (or epicondylar,

supraepicondylar ridge)

Formed as the shape of humerus

becomes flattened distally MedialSupracondylarRidge

Lateral supracondylar ridge

epicondyle

Lateral

Medial supracondylar ridge

Ridge located superior to medial

Ridge

epicondyle


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Proximal Radius Anatomy Review

Head

Thick disc-shaped structure

Articulates with the capitulum and

Cylindrical shape between the head

and radial diaphysis

Radial tuberosity

Large blunt projection on antero-

medial surface of radius

The surface is roughened for the

attachment of biceps brachii tendon


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Proximal Radius Anatomy Review

Radial Head

Radial Neck

a aTuberosity


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Proximal Ulna Anatomy Review

Olecranon

Large projection of bone

Attachment for triceps brachii

Coronoid process

of ulna

trochlea

Tuberosity of ulna

Triangular shaped area of

roughening

Attachment for brachialis muscle


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Coronoid Process

Tuberosity

of UlnaOlecranon


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Proximal Ulna Anatomy Review

Trochlear notch

Large depression formed by

olecranon and coronoid process

Depression on lateral side of ulna for

articulation with radial head

This articulation is involved in with

pronation and supination of the arm


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Trochlear Notch

Radial

Notch


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AP Radiograph vs. 3D Reconstruction of Elbow

Medial

Su racond larMedialSupracondylar

Ridge

LateralSupracondylar

Rid e

Ridge

Medial 1 2

3 LateralEpicondyle

12

4

6

1. Trochlea

6Radial Neck

7 2. Capitulum3. Olecranon (behindtrochlea) 5

Coronoid Process

of Ulna

5. Radius

6. Radial Head7. Radial Tuberosity

Coronoid Process

of Ulna


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AP View of Elbow

Supracondylar

RidgeLateral

Medial

Supracondylar

Ridge

p con y e LateralEpicondyle1

2Radial Neck

Coronoid Process 4

6

1. Trochlea

5

. ap tu um3. Olecranon (behind trochlea)4. Ulna5. Radius6. Radial Head

7. Radial Tuberosity


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3D Reconstruction of Right Elbow: Posterior View

89

21

.2. Lateral Epicondyle

3. Olecranon

4. Trochlear Notch5. Ulna6. Radial Head7. Radius

8. Medial Su racond lar Rid e

6

9. Lateral Supracondylar Ridge


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Lateral View of Elbow1. Shaft of Humerus2. Trochlea

. ecranon4. Coronoid Process5. Head of Radius6. Radial Tuberosit7. Tuberosity of Ulna

1

25

46

Trochlear Notch

37


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CT of Elbow (Right)- Axial


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CT of Elbow (Right)- Axial

1. ecranon2. Ulnar Nerve3. Ulna

n er or Anterior

Capitulum

Trochlea

1

1

2

3

2 Posterior

Posterior


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CT of Elbow- Coronal vs. 3D Reconstruction

1. Medial Epicondyle

2. Lateral E icond le3. Trochlea4. Capitulum

Olecranon

5. Ulna: Radial Notch6. Ulna7. Radial Head

1

Fossa

1

23

3

4

77

56 5


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Clinical Correlations

Head of Radius Fracture

Normal

Force is transmitted to radial head fracture


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Epicondylitis

pain at the origins of those muscles

Golfers elbow (wrist flexors) medial epicondylitis

Lateral Epicondylitis MRI Lateral Epicondylitis MRI

T1 Weighted T2 Weighted

Bright signaldue to high

suggests

inflammation


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The Funny Bone

When you hit your inner elbow on

a hard surface, you feel a tingling

sensation Hitting the ulnar nerve!

Ulnar nerve asses around the

posterior surface of medial

epicondyle

The ulnar nerve is the largest

un rotected nerve in the bod so

injury is common

ou can pa pa e , u w ee unny

lecture 4- elbow slides

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