Radiology Anatomy of the Spine and Upper Extremity Timothy J. Mosher, MD Department of Radiology Phone: 531-4566 Email: tmosher@psu.edu

Learning Objective Identify anatomic structures of the spine and upper extremities on standard radiographic and cross-sectional images

SPINE

Visual Human Sagittal View 7 Cervical Vertebra 12 Thoracic Vertebra 5 Lumbar Vertebra 5 Sacral Vertebra (fused) 3 Coccygeal Vertebra (fused)

Lumbar Vertebral Body NETTER 143 SPINE BODY PEDICLE TRANSVERSE PROCESS SPINOUS PROCESS LAMINA

Lumbar Vertebral Body 27 year old fall from roof BODY PEDICLE TRANSVERSE PROCESS (fractured) 27 year old fall from roof SPINOUS PROCESS LAMINA

SPINE FROM THE FRONT BODY NETTER 143 SPINE TRANSVERSE PROCESS

SPECIMEN RADIOGRAPH L4 SPEC X RAY SPINE BODY PEDICLES SPINOUS PROCESS TRANSVERSE PROCESSES

SPINE FROM THE BACK NETTER 143 SPINE TRANSVERSE PROCESS LAMINA SUP ART FACET TRANSVERSE PROCESS LAMINA NETTER 143 SPINE INF ART FACET SPINOUS PROCESS

SPECIMEN RADIOGRAPH L4 SPEC X RAY SPINE Lamina and Facets

AP Lumbar Spine DRAWING AP LS

AP Lumbar Spine MS 185 NL AP LS

AP Lumbar Spine MS 185 NL CONE AP LS BODY PEDICLE LAMINA SPINOUS TRANSVERSE PROCESS SPINOUS PROCESS

Spine Viewed from Side NETTER 143 SPINE BODY PEDICLE TRANSVERSE PROCESS NETTER 143 SPINE LAMINA SPINOUS PROCESS

Spine Viewed from Side NETTER 143 SPINE PARS INTRAARTICULARIS SUPERIOR FACET NETTER 143 SPINE INFERIOR FACET

Lateral Lumbar Spine DRAWING LAT LS

Lateral Lumbar Spine BODY PEDICLE SPINOUS PROCESS MS 185 LAT LS

Lateral Lumbar Spine SUPERIOR FACET PARS INFERIOR FACET MS 185 LAT LS

CT Lumbar Spine Sagittal Reconstructions

Facet Joints Axial View Inferior Facets Superior Facets Cervical Thoracic Lumbar

Facet Joints Sagittal Reconstructions Cervical Thoracic Lumbar

Intervertebral Disc Space NEURAL FORAMEN NETTER 144 SPINE ART INTERVERTEBRAL DISC

Nerve Roots LAT ARTIC LUMB BODY DISC PEDICLE SPINOUS PROCESS INF FACET SUP FACET LAT ARTIC LUMB BODY DISC PEDICLE SPINOUS PROCESS NERVE ROOT

Sagittal Section Lumbar Spine Intervertebral Disc Body Nucleus Pulposa Annulus Fibrosa Body Sagittal Section Lumbar Spine

MRI: Intervertebral Disc Spinal Cord (Cauda Equina) Intervertebral Disc Nucleus Pulposa Annulus Fibrosa

Cauda Equina MRI Myelogram

Neural Foramen Pedicle (L3) Pedicle (L4) L3 Nerve Root L3/L4 Intervertebral Disc Pedicle (L4)

Neural Foramina Cervical Spine Vertebral Body Nerve Roots Cervical Spinal Cord Facet Joint Viewed from bottom

Spinal Ligaments

Spinal Ligament Anterior Longitudinal Spinal Ligament Posterior Longitudinal Spinal Ligament

Case Study: 17 year-old Male involved in a MVA Do you see a fracture? Fracture of C7 vertebral body

Case Study: 17 year-old Male involved in a MVA Right Left What other structures are likely to be injured? Bilateral Facet Dislocation at C6/7

Case Study: 17 year-old Male involved in a MVA Spinal Cord Injury Anterior Longitudinal Spinal Ligament Posterior Longitudinal Spinal Ligament

Upper Extremity

Radiographic Anatomy X-RAY BEAM DRAWING SHOULDER FILM

LEFT SHOULDER (FRONT) NETTER 392 FRONT SHOULD CLAVICLE ACROMION CORACOID GLENOID SCAPULA HUMERUS NETTER 392 FRONT SHOULD

SHOULDER (BACK) NETTER 393 BACK SHOULD CLAVICLE ACROMION SPINE GLENOID HUMERUS SCAPULA NETTER 393 BACK SHOULD

AP Shoulder Clavicle Acromion Coracoid Glenoid Greater Tuberosity Humerus

LEFT SHOULDER AXILLARY VIEW FILM X-RAY TUBE DRAWING AXILLARY

RIGHT SCAPULA FROM BELOW CORACOID GLENOID SPINE SCAPULA FROM BELOW BODY ACROMION

LEFT SHOULDER (AXILLARY) Coracoid Anterior Lesser Tuberosity Clavicle Humerus Acromion Glenoid MS 29 AX SHLD

Case Study: 52 year old male with shoulder pain Do you identify the cause of the shoulder pain?

MRI Anatomy of the Shoulder

MUSCLES FROM THE FRONT NETTER 396 MUG SHOULD SUPRASPINATUS SUBSCAPULARIS NETTER 396 MUG SHOULD

Rotator Cuff Muscles Sagittal View Supraspinatus Infraspinatus Subscapularis Teres Minor Anterior

Rotator Cuff: Subscapularis Sagittal View Coronal View

Rotator Cuff: Supraspinatus Sagittal View Coronal View

MUSCLES FROM THE BACK NETTER 396 MUSC POST SHOULD SUPRASPINATUS INFRASPINATUS NETTER 396 MUSC POST SHOULD TERES MINOR

Rotator Cuff: Infraspinatus Sagittal View Coronal View

Rotator Cuff: Teres Minor Sagittal View Coronal View

Anatomy Considerations in Rotator Cuff Tears

Impingement of the Rotator Cuff Coracoacromial Arch Acromion AC Joint Coracoacromial liagment Coracoid Process Supraspinatus Subscapularis Anterior View

MRI Anatomy of the Rotator Cuff

MRI Anatomy of the Rotator Cuff

Rotator Cuff Tear Contrast leaking into subacromial bursa through tear in supraspinatus Contrast injected into glenohumeral joint

ROTATOR CUFF TEAR 10/30/03 1/30/04

The Elbow

LEFT ELBOW FROM FRONT NETTER 407 FRONT ELBOW Humerus Medial Epicondyle Lateral Epicondyle Capitulum Trochlea NETTER 407 FRONT ELBOW Ulna Radial Head Medial Lateral

Elbow from the Back Humerus Medial Epicondyle Lateral Epicondyle Olecranon fossa Olecranon Ulna Radial Head

AP ELBOW NETTER 407 FRONT ELBOW Humerus Medial Epicondyle Lateral Epicondyle Capitulum Trochlea NETTER 407 FRONT ELBOW Ulna Radial Head Medial Lateral

Medial View of Elbow Humerus Coronoid Radial Head Medial Epicondyle Olecranon Ulna

Medial View of Elbow Humerus Coronoid Radial Head Medial Epicondyle Olecranon Ulna

The Wrist

The Wrist Palmar View Carpal Bones (Proximal Row) Lunate Triquetrum Scaphoid Pisiform Radius Ulna

The Wrist Palmar View Carpal Bones (Proximal Row) Lunate Scaphoid Triquetrum Pisiform Radius Ulna

The Wrist Palmar View Carpal Bones (Distal Row) Trapezoid Trapezium Hamate Capitate Radius Ulna

The Wrist Palmar View Carpal Bones (Distal Row) Trapezoid Trapezium Capitate Hamate Radius Ulna

MR Anatomy of the Wrist Capitate Lunate Radius Coronal Wrist