Clinical Radiology of the Upper Limb

Question 1

Sternoclavicular Arthritis

Answer 1

Most common abnormality in SC joint. Joint space is narrowed, joint surfaces are mildly irregular, marrow edema, joint capsule thickened/edematous, mild effusion.

Question 2

Shoulder separation

Answer 2

Affects the AC joint. Is a misnomer because it has nothing to do with the glenohumeral joint.

Question 3

Type 1 shoulder separation

Answer 3

AC joint is not gapped, tear is incomplete

Question 4

Type 2 shoulder separation

Answer 4

AC joint can be abnormally gapped, tear is complete

Question 5

Type 3 shoulder separation

Answer 5

AC joint will have significant gapping, clavicle will be superiorly displaced

Question 6

x-Ray views need in Shoulder dislocation

Answer 6

Y-view or axial view (transverse view)

Question 7

Anterior shoulder dislocation associated fractures

Answer 7

Bankart Fx, Hill-Sachs Fx

Question 8

Bankart fractures

Answer 8

Compression fracture of anterior-inferior glenoid rim, causing anterior shoulder instability

Question 9

Hill-Sachs fractures

Answer 9

Compression fracture of posterior-superior humeral head

Question 10

Posterior shoulder dislocated image

Answer 10

Light-bulb image. Often less overlapping of humeral head and glenoid fossa

Question 11

Types of Acromial down-sloping

Answer 11

Type 1: normal
Type 2: anterior down-sloping from middle third
Type 3: Anterior down-sloping from the anterior third

Question 12

Types of Acromial Lateral down-sloping

Answer 12

Type A: normal (up-sloping or flat)

Type B: down-sloping laterally

Question 13

External Subacromial Impingement

Answer 13

The subacromial bursa is pushed on/inflammed. Very common cause of shoulder pain

Question 14

Acrominon enthesiophyte

Answer 14

A spurring and ligament thickening where the coracoacromial ligament attaches

Question 15

Os Acromiale

Answer 15

Secondary ossification center of acromion never fuses with the rest of the bone. The Os can hinge inferiorly, causing shoulder impingement.

Question 16

Acromioclavicular arthrosis

Answer 16

Joint enlarges in an inferior direction

Question 17

Adhesive capsulitis

Answer 17

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

Question 18

Proximal humerus fracture classification type and sites

Answer 18

Neer Classification sites: anatomic neck, greater tubercle, lesser tubercle, surgical neck

Question 19

How to name a proximal humerus fracture

Answer 19

one part: no displacement
two part: 1 site is displaced/angulated
three part: 2 sites are displaced/angulated

Question 20

Lateral epicondylitis

Answer 20

aka Tennis elbow. Cause: strain/degeneration of common extensor tendon

Question 21

Medial epicondylitis

Answer 21

aka Golfer’s elbow. Cause: strain/degeneration of common flexor tendon

Question 22

Elbow Fractures

Answer 22

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

Question 23

Sail Sign

Answer 23

Too prominent of an anterior arm fat pad around the elbow that is a sign of a supracondylar fracture

Question 24

What to look for in “normal” elbow x-rays

Answer 24

Anterior margin of humerus aligns with middle 3rd of capitulum. Small anterior fat pad is normal. Any visibility of posterior fat pad is abnormal

Question 25

Elbow dislocation

Answer 25

3rd most common dislocated joint. Most often posterior dislocation. Usually collateral ligaments rupture.

Question 26

Strain

Answer 26

Injury of tendon or muscle

Question 27

Sprain

Answer 27

injury of ligament

Question 28

Game Keeper’s Thumb

Answer 28

injury of ulnar collateral ligament of the MCP joint of the thumb

Question 29

Distal radius fracture

Answer 29

Common in the elderly. Just describe the features of the fracture

Question 30

Colle’s fracture

Answer 30

Distal radial fracture in which the distal portion of the radius points dorsally

Question 31

Scaphoid fracture

Answer 31

Most common carpal bone to fracture. Usually not visible on initial radiograph. Necrosis can occur if not fixed. Pain in the snuffbox

Question 32

Carpal tunnel syndrome

Answer 32

Numbness/pain in the distribution of the medial nerve.

Question 33

Tinel’s sign

Answer 33

Light tapping of median nerve reproduces reported pain

Question 34

Phalen’s test

Answer 34

Hyperflexing the wrists reproduces reported pain