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Compressive and Entrapment Neuropathies of the Upper Extremities

Upper Extremity Shoulder Suprascapular Nerve Syndrome Impingement of the suprascapular nerve occurs at the scapular notch or spinoglenoid notch. The suprascapular nerve originates from the brachial plexus, and at the scapular notch it branches into the supraspinatus and infraspinatus nerves ( Fig. 17-1 ). Proximal entrapment at the scapular notch results in compression of the suprascapular nerve and denervation of both the supraspinatus and infraspinatus muscles…

Acute Osseous Trauma to the Hand

Prevalence, Epidemiology, and Definitions Acute bony trauma to the hand represents some of the most commonly occurring fractures encountered in daily clinical practice. Whether the etiology is related to sports, occupation, or trauma, the consequences can be devastating and the potential for functional loss often underappreciated. Therefore, it is essential that an accurate diagnosis and treatment plan be implemented to restore full function and form. Injuries…

Internal Derangement of the Wrist

Introduction Wrist anatomy and function is both complex and detailed. Evaluation for internal derangement assumes an understanding of the anatomy, imaging characteristics, biomechanics, and function of key ligaments and cartilaginous structures in the wrist, including the triangular fibrocartilage complex (TFCC), scapholunate ligament, lunotriquetral ligament, and extrinsic ligaments. All of these ligamentous and cartilaginous elements in the wrist function in concert to provide stability and optimal wrist…

Acute Osseous Injury to the Wrist

Prevalence, Epidemiology, and Definitions Acute osseous injury to the wrist may be encountered in a subject who has received direct trauma to the wrist or who has fallen on the outstretched hand (popularly referred to as FOOSH). Radiographic evaluation remains the primary modality for initial assessment. The multiplanar capability of CT and MRI contributes osseous and soft tissue detail useful for complex injuries and occult fracture…

Normal Wrist

Normal Wrist Technical Aspects Conventional Radiography Rationale and Indications Allows visualization of osseous anatomy and pathology, bone contours, and joint alignment Is recommended for any primary evaluation of osseous wrist pathologic processes such as fractures, dislocations or malalignment, infection, and bone tumors ( eTable 13-1 ; eFigs. 13-1 to 13-5 ) eTABLE 13–1 Conventional Radiography Projections Main Visualized Anatomy and Pathology Posteroanterior * (dorsopalmar view) Overview…

Soft Tissue Injury to the Elbow

Prevalence, Epidemiology, and Definitions Musculotendinous Injury Traumatic injury to the musculotendinous units of the elbow may result from acute trauma or repetitive micro-trauma. Furthermore, acute trauma is frequently superimposed on tendinopathy or other chronic injuries. MRI can be highly valuable in the assessment of elbow pain, owing to its superb soft tissue resolution. Even in patients with a clear clinical diagnosis of musculotendinous pathology, MRI can…

Acute Osseous Injury of the Elbow and Forearm

Anatomy (Including Gross Anatomy and Normal Variants) Fat Pads The anterior fat pad is anterior to the olecranon fossa and is routinely seen on the normal lateral view, extending inferior, from the anterior humeral cortex, obliquely. The posterior fat pad lies in the olecranon fossa and is not visible on the normal lateral view ( Fig. 11-1 ). Both fat pads are within the joint, intraarticular,…

Normal Elbow

Introduction Routine radiography, ultrasound, CT, and MR imaging (conventional and arthrography) are the main diagnostic modalities used for diagnosis of abnormalities around the elbow joint. Conventional Radiography Radiography ( Fig. 10-1 ) is used for primary evaluation of any osseous elbow pathology by assessment of the bony contours, joints, and fat pads. Limited soft tissue evaluation and ionizing radiation are major limitations. Generally, plain film series…

Glenohumeral Instability

Prevalence, Epidemiology, and Definitions Shoulder instability and labral tears are a common cause of shoulder complaints, particularly in young athletic individuals. The symptoms can be quite debilitating, and surgery is often required to reduce the pain or stabilize the shoulder. Imaging plays an important role in helping determine who might benefit from surgery. The glenoid labrum has several normal anatomic variants, however, that it is crucial…

Shoulder Impingement Syndromes

Prevalence, Epidemiology, and Definitions The etiology of rotator cuff tendinosis and tears is likely multifactorial, involving both intrinsic and extrinsic factors. Multiple causal factors have been described in association with rotator cuff pathology, including vascular, degenerative, traumatic, and anatomic/mechanical factors. The diagnosis is based on the patient's history and findings on physical examination, supplemented by imaging findings. The modern understanding of shoulder impingement owes much to…

Osseous Injuries of the Shoulder Girdle

Prevalence, Epidemiology, and Definitions Osseous injuries that affect the shoulder girdle are common in adults. The acromioclavicular joint is the primary connection between the arm and the thorax, and the glenohumeral joint is inherently unstable, owing to the disproportionate size of the articular surfaces of this spheroidal joint. The majority of injuries occur either from a direct impact on a focal point on the shoulder or…

Normal Shoulder

Imaging Modalities and Technical Aspects Conventional radiography of the shoulder ( Table 6-1 , Fig. 6-1 ) is recommended for any primary evaluation of suspected pathology, including fractures, dislocations, bone tumors, and infection. It is readily available, inexpensive, and uses minimal ionizing radiation. However, soft tissue evaluation is limited, and patient positioning may be difficult (e.g., due to pain, fracture, ankylosis). TABLE 6–1 Conventional Radiography of…

Injury of the Thoracic Cage and Thoracolumbar Spine

Prevalence, Epidemiology, and Definitions Injuries of the thoracic cage and the thoracolumbar spine are common—not only in patients with severe traumatic injuries following motor vehicle accidents (MVAs) or, for example, those who fall from great heights, but also in daily clinical practice. Collapsed thoracic and lumbar vertebrae are encountered every day in our routine work, often as incidental findings on chest radiographs or CT scans. These…

Cervical Spine Injuries

The exclusion of cervical spine injuries in patients with blunt trauma is one of the major challenges facing traumatologists and emergency department physicians. This is especially daunting in unresponsive or comatose patients. “Clearing” the cervical spine is a complex interdisciplinary process and has two major components. The first is the imaging evaluation for exclusion of fracture and to determine normal vertebral alignment. Second, even with a…

Imaging of Facial and Skull Trauma

The craniofacial structures have the formidable task of protecting the brain, the soft tissues that form the upper aerodigestive tracts, and the tissues vital to the special senses of vision, smell, taste, and hearing. Injury to the craniofacial region may therefore have devastating implications to the traumatized patient. Prompt and accurate diagnosis of craniofacial injuries is necessary for appropriate treatment to minimize both functional and aesthetic…

General Principles of Osseous Injury

In this chapter, concepts are identified and described that are intrinsic to musculoskeletal trauma, such as the purpose of the imaging report, vector forces causing musculoskeletal injury, musculoskeletal injury terminology, and fractures and dislocations in which the associated soft tissue component—not routinely delineated by conventional radiography—is the principal element of the injury. Because most of the musculoskeletal injuries described in this chapter are discussed and illustrated…

General Imaging Principles

Conventional Radiography The most frequently used modality for evaluation of bone and joint disorders is radiography. Radiography is the initial modality used in the setting of trauma, infection, and arthritis. It is useful for characterizing benign and malignant bone lesions and bony changes seen in metabolic conditions; it can also be used to locate foreign objects and guide intervention. Understanding the principles of proper radiographic technique…

Three-Dimensional Ultrasound: Techniques and Clinical Applications

Introduction Fetal anatomy is three-dimensional (3D). Cross-sections obtained during real-time ultrasound (US) examination are an artificial reduction of anatomy to produce one still image, created to capture a standard view or the essence of a particular pathology. Acquisition of a good US volume is not trivial, but a comprehensive volume may enable examination at a greater level of detail than is possible from a single cross-section;…

Magnetic Resonance Imaging in Obstetrics

Introduction Assessment of fetal development and screening for congenital anomalies are essential elements of prenatal care. Ultrasound (US) imaging remains the first-line modality because of its convenience, low cost, and wide availability, but it can be limited by several factors, sometimes making US incompatible with women's expectations, or subject to misdiagnosis-related legal issues. Compared to US, magnetic resonance imaging (MRI) is less limited by fetal lie,…

Doppler Ultrasound Evaluation of the Fetus and Placenta

Introduction Doppler ultrasound (US) can be used to assess waveform patterns of blood flow in various vascular beds in the maternal, fetal, and placental circulation. The information gained from the analysis of waveforms in combination with clinical factors provides insight into maternal adaptation to pregnancy, placental resistance, and fetal cardiovascular status, and thus can guide pregnancy management in many conditions. Doppler evaluation can be roughly divided…