155 - Imaging of the Musculoskeletal System - Upper Limb

Question 1

*BONENUMBERS

Answer 1

1 = Greater tuberosity 2 = Epiphyseal scar 3 = Where bicipital groove would sit (between greater and lesser tuberosities) 4 = Base of the coracoid process 5 = Acromion 6 = Glenoid 7 = Clavicle 8 = Coracoid process

Question 2

Arrangement of glenoid head and humeral head on an X ray

Answer 2

Should be congruent.

Question 3

Relationship between humerus surgical neck and shaft on an X ray

Answer 3

Line between midline of humerus and a line through the anatomical neck should be ~140 degrees to one another.

Question 4

Things to look for on an X ray of the shoulder

Answer 4

•Alignment •Joint surfaces and joint •Trabecular bone and lines •Bone outline •Soft tissues •Growth plates •Invisible structures

Question 5

Common projections for a shoulder X ray 1 2 3 4 5

Answer 5

– AP – Lateral – Internal and external rotation – Axillary lateral – AP with cranio-caudal downtilt

Question 6

Axillary view

Answer 6

A top-down view of shoulder

Question 7

How can you tell where anterior is on an X ray of a shoulder?

Answer 7

Coracoid points anteriorly.

Question 8

Most common type of shoulder dislocation

Answer 8

Antero-inferior

Question 9

Number of secondary ossification centres in head of humerus

Answer 9

Three. All fused by teeneage years

Question 10

Fossae on either side of the humerus in the elbow

Answer 10

Olecranon fossa (posterior) and coronoid fossa (anterior)

Question 11

In flexion, what fits into the coronoid fossa?

Answer 11

Coronoid process of the ulna.

Question 12

What sit inside the olecranon and coronoid fossa?

Answer 12

Fat pads (intracapsular, extrasynovial)

Question 13

When can fat pads be elevated out of the olecranon and coronoid fossae?

Answer 13

When there has been recent trauma of the elbow (EG fracture). Fluid from synovial joint pushes fat pads out of fossae.

Question 14

Appearance of caputulum secondary ossification centre

Answer 14

1st year

Question 15

Age of appearance of medial epicondyle secondary ossification centre

Answer 15

5th year

Question 16

Age of appearance of radial head secondary ossification centre

Answer 16

5th year

Question 17

Age of appearance of trochlear, lateral epicondyle and olecranon secondary ossification centres

Answer 17

10th year

Question 18

When do medial and lat epicondyle, radial head, olecranon secondary ossification centres fuse?

Answer 18

Between 15 and 20 years

Question 19

Wrist joint were pronation, supination occurs

Answer 19

Distal radioulnar joint

Question 20

*How to know if carpal bones of the wrist are aligned on an Xray

Answer 20

Arcs should line up with proximal and distal edges of 1st row, proximal margin of 2nd row

Question 21

How to know if carpal bones of the wrist are aligned on an Xray (lateral view)

Answer 21

Scaphoid, capitate and lunate should be in a ~straight line with the radius and metacarpals. Line drawn through scaphoid should be at ~30-60 degrees to the straight line.

Question 22

Layers of shoulder joint 1 2 3 4

Answer 22

• Layer 1 – labrum – deepens socket • Layer 2 - capsule with ligamentous thickenings • Layer 3 - tendons – rotator cuff • Layer 4 – bones – Coracoid, acromion, coraco-acromial arch

Question 23

Appearance of fat on a fat-suppressed T2 MRI

Answer 23

Fat appears dark

Question 24

Rotator cuff that inserts on the greater tuberosity

Answer 24

Supraspinatus