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Radiology Anatomy of the Spine and Upper Extremity

Timothy J. Mosher, MDDepartment of Radiology

Phone: 531-4566Email: tmosher@psu.edu

Learning Objective

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

SPINEVisual Human Sagittal View

7 Cervical Vertebra

12 Thoracic Vertebra

5 Lumbar Vertebra

5 Sacral Vertebra (fused)

3 Coccygeal Vertebra (fused)

Lumbar Vertebral Body

BODY

PEDICLETRANSVERSE

PROCESS

LAMINA

SPINOUS PROCESS

Lumbar Vertebral Body

BODY

PEDICLETRANSVERSE PROCESS (fractured)

LAMINA

SPINOUS PROCESS

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SPINE FROM THE FRONT

BODY

TRANSVERSE PROCESS

SPECIMEN RADIOGRAPH L4

BODY

PEDICLES SPINOUS PROCESS

TRANSVERSE PROCESSES

SPINE FROM THE BACK

TRANSVERSEPROCESS

LAMINA

SPINOUS PROCESS

INF ARTFACET

SUP ARTFACET

SPECIMEN RADIOGRAPH L4

Lamina and Facets

AP Lumbar Spine AP Lumbar Spine

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AP Lumbar Spine

BODYPEDICLE

TRANSVERSEPROCESS

SPINOUSPROCESS

LAMINA

Spine Viewed from Side

BODY PEDICLE

TRANSVERSE PROCESS

LAMINA SPINOUS PROCESS

Spine Viewed from Side

PARS INTRAARTICULARIS

SUPERIOR FACET

INFERIOR FACET

Lateral Lumbar Spine

Lateral Lumbar Spine

BODY

PEDICLE

SPINOUS PROCESS

Lateral Lumbar Spine

PARS

INFERIOR FACET

SUPERIOR FACET

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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

NEURALFORAMEN

INTERVERTEBRAL DISC

Nerve Roots

BODY DISC PEDICLE

INF FACETSUP FACET

SPINOUSPROCESSNERVE ROOT

Intervertebral Disc

Body

BodyNucleus Pulposa

Annulus Fibrosa

Sagittal Section Lumbar Spine

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MRI: Intervertebral DiscSpinal Cord

(Cauda Equina)

Intervertebral Disc•Nucleus Pulposa•Annulus Fibrosa

Neural Foramen

Pedicle (L3)

Pedicle (L4)

L3/L4 Intervertebral Disc

L3 Nerve Root

Neural Foramina Cervical Spine

Viewed from bottom

Vertebral Body

Cervical Spinal Cord

Nerve Roots

Cauda Equina

MRI Myelogram

Spinal Ligaments Spinal Ligament

Anterior Longitudinal Spinal Ligament

Posterior Longitudinal Spinal Ligament

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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

Bilateral Facet Dislocation at C6/7

Right Left

What other structures are likely to be injured?

Case Study: 17 year-old Male involved in a MVA

Spinal Cord InjuryAnterior Longitudinal Spinal Ligament

Posterior Longitudinal Spinal Ligament

Upper Extremity

Radiographic AnatomyX-RAY BEAM

FILM

LEFT SHOULDER (FRONT)CLAVICLEACROMIONCORACOIDGLENOIDSCAPULAHUMERUS

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SHOULDER (BACK)CLAVICLEACROMIONSPINEGLENOID

HUMERUSSCAPULA

AP Shoulder

Humerus

Clavicle Acromion

Greater Tuberosity

Glenoid

Coracoid

LEFT SHOULDER AXILLARY VIEW

X-RAYTUBE

FILM

RIGHT SCAPULA FROM BELOW

CORACOID

ACROMION

GLENOID

SPINE

BODY

LEFT SHOULDER (AXILLARY)

Anterior Coracoid

Clavicle

Acromion

Humerus

Lesser Tuberosity

Glenoid

Case Study: 52 year old male with shoulder pain

Do you identify the cause of the shoulder pain?

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MRI Anatomy of the ShoulderMUSCLES FROM THE FRONT

SUPRASPINATUS

SUBSCAPULARIS

Rotator Cuff Muscles Sagittal View

Anterior

Subscapularis

Supraspinatus

Infraspinatus

Teres Minor

Rotator Cuff: Subscapularis

Sagittal View Coronal View

Rotator Cuff: Supraspinatus

Sagittal View Coronal View

MUSCLES FROM THE BACK

SUPRASPINATUS

INFRASPINATUS

TERES MINOR

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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

Anterior View

Supraspinatus

Subscapularis

Coracoacromial Arch

•Acromion

•AC Joint

•Coracoacromial liagment

•Coracoid Process

MRI Anatomy of the Rotator Cuff

MRI Anatomy of the Rotator Cuff

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Rotator Cuff Tear

Contrast injected into glenohumeral joint

Contrast leaking into subacromial bursa through tear in supraspinatus

ROTATOR CUFF TEAR

10/30/03 10/30/031/30/04 1/30/04

The ElbowLEFT ELBOW FROM FRONT

Humerus

Lateral Epicondyle

Capitulum

Radial HeadUlna

Trochlea

Medial Epicondyle

LateralMedial

Elbow from the BackHumerus

Lateral Epicondyle

Olecranon fossa

Radial HeadUlna

Olecranon

Medial Epicondyle

AP ELBOWHumerus

Lateral Epicondyle

Capitulum

Radial HeadUlna

Trochlea

Medial Epicondyle

LateralMedial

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Medial View of ElbowHumerus

UlnaOlecranon

Radial Head

Coronoid

Medial Epicondyle

Medial View of ElbowHumerus

UlnaOlecranon

Radial Head

Coronoid

Medial Epicondyle

The WristThe Wrist Palmar View

Carpal Bones (Proximal Row)

Radius Ulna

Scaphoid

Lunate Triquetrum

Pisiform

The Wrist Palmar ViewCarpal Bones (Proximal Row)

Radius Ulna

ScaphoidLunate

Triquetrum

Pisiform

The Wrist Palmar ViewCarpal Bones (Distal Row)

Radius Ulna

Trapezium

Trapezoid HamateCapitate

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The Wrist Palmar ViewCarpal Bones (Distal Row)

Radius Ulna

Trapezium

Trapezoid Hamate

Capitate

MR Anatomy of the Wrist

Coronal Wrist

Radius

Lunate

Capitate