Clinical Radiology of the Upper Limb Flashcards
Sternoclavicular Arthritis
Most common abnormality in SC joint. Joint space is narrowed, joint surfaces are mildly irregular, marrow edema, joint capsule thickened/edematous, mild effusion.
Shoulder separation
Affects the AC joint. Is a misnomer because it has nothing to do with the glenohumeral joint.
Type 1 shoulder separation
AC joint is not gapped, tear is incomplete
Type 2 shoulder separation
AC joint can be abnormally gapped, tear is complete
Type 3 shoulder separation
AC joint will have significant gapping, clavicle will be superiorly displaced
x-Ray views need in Shoulder dislocation
Y-view or axial view (transverse view)
Anterior shoulder dislocation associated fractures
Bankart Fx, Hill-Sachs Fx
Bankart fractures
Compression fracture of anterior-inferior glenoid rim, causing anterior shoulder instability
Hill-Sachs fractures
Compression fracture of posterior-superior humeral head
Posterior shoulder dislocated image
Light-bulb image. Often less overlapping of humeral head and glenoid fossa
Types of Acromial down-sloping
Type 1: normal
Type 2: anterior down-sloping from middle third
Type 3: Anterior down-sloping from the anterior third
Types of Acromial Lateral down-sloping
Type A: normal (up-sloping or flat)
Type B: down-sloping laterally
External Subacromial Impingement
The subacromial bursa is pushed on/inflammed. Very common cause of shoulder pain
Acrominon enthesiophyte
A spurring and ligament thickening where the coracoacromial ligament attaches
Os Acromiale
Secondary ossification center of acromion never fuses with the rest of the bone. The Os can hinge inferiorly, causing shoulder impingement.
Acromioclavicular arthrosis
Joint enlarges in an inferior direction
Adhesive capsulitis
aka Frozen shoulder syndrome. inflammation or scarring of the shoulder joint capsule limiting active and passive shoulder movement. Little old ladies “cheat” when doing active testing
Proximal humerus fracture classification type and sites
Neer Classification sites: anatomic neck, greater tubercle, lesser tubercle, surgical neck
How to name a proximal humerus fracture
one part: no displacement
two part: 1 site is displaced/angulated
three part: 2 sites are displaced/angulated
Lateral epicondylitis
aka Tennis elbow. Cause: strain/degeneration of common extensor tendon
Medial epicondylitis
aka Golfer’s elbow. Cause: strain/degeneration of common flexor tendon
Elbow Fractures
most common in ages 3-10. Look for alignment of humeral head with capitulum! Seeing posterior fat pad = supracondylar fracture. Too prominent of a anterior fat pad is another sign of fx
Sail Sign
Too prominent of an anterior arm fat pad around the elbow that is a sign of a supracondylar fracture
What to look for in “normal” elbow x-rays
Anterior margin of humerus aligns with middle 3rd of capitulum. Small anterior fat pad is normal. Any visibility of posterior fat pad is abnormal
Elbow dislocation
3rd most common dislocated joint. Most often posterior dislocation. Usually collateral ligaments rupture.
Strain
Injury of tendon or muscle
Sprain
injury of ligament
Game Keeper’s Thumb
injury of ulnar collateral ligament of the MCP joint of the thumb
Distal radius fracture
Common in the elderly. Just describe the features of the fracture
Colle’s fracture
Distal radial fracture in which the distal portion of the radius points dorsally
Scaphoid fracture
Most common carpal bone to fracture. Usually not visible on initial radiograph. Necrosis can occur if not fixed. Pain in the snuffbox
Carpal tunnel syndrome
Numbness/pain in the distribution of the medial nerve.
Tinel’s sign
Light tapping of median nerve reproduces reported pain
Phalen’s test
Hyperflexing the wrists reproduces reported pain
