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Upper Limb

Upper Limb. Musckuloskeletal Imaging Trauma Dr Mohamed El Safwany , MD. Shoulder. Normal. Acromioclavicular (AC) separation . Mechanism of injury- fall onto point of shoulder The area will appear swollen and deformed compared with the other side.

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Upper Limb

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  1. Upper Limb • Musckuloskeletal Imaging Trauma Dr Mohamed El Safwany, MD.

  2. Shoulder

  3. Normal

  4. Acromioclavicular (AC) separation • Mechanism of injury- fall onto point of shoulder • The area will appear swollen and deformed compared with the other side. • The patient will avoid movement, due to pain. • Tenderness is felt at the site of the AC (acromioclavicular) joint.

  5. AC separation (cont) • Grade I: • AC ligament sprained, but joint remains intact • Grade II: • Rupture of AC ligament and joint separation • Grade III: • Coracoclavicular and AC ligaments ruptured with wide separation of joint

  6. Anterior Glenohumeral Dislocation “Shoulder dislocation” • Mechanism of injury: • From external rotation & abduction force on humerus • From a direct posterior blow to proximal humerus • Exam: • Palpable anterior mass representing humeral head in anterior axilla

  7. Shoulder dislocation

  8. ------Normal Shoulder dislocation->

  9. Anterior dislocation • (Much more common than posterior dislocation)

  10. Posterior dislocation

  11. Anterior Glenohumeral Dislocation Complications • 2 lesions with recurrent dislocations: • Bankhart Lesion: • Anterior capsular injury associated with a tear of the glenoid labrum off the anterior glenoid rim • Hill-Sachs Deformity: • Compression fracture of the articular surface of the humeral head posterolaterally that is created by the sharp edge of the anterior glenoid as the humeral head dislocates over it

  12. Hill-Sachs Deformity

  13. Clavicle fracture • Most common bone fractured • Weakest aspect is the junction of middle/distal thirds • Look for “Tenting” of the skin • Class A (middle third fractures) (80%). • Class B (distal third fractures) (15%). • Class C (proximal third) (5%)

  14. Normal--- -----Normal Fracture----

  15. Shoulder Fractures • Proximal Humerus Fractures: • Neerclassificaton: • Non-displaced fractures: • Displaced fractures: • 2 part fx’s are fractured either through the anatomical neck, surgical neck, greater tuberosity or lesser tuberosity • 3 part fx’s are fx’s of the surgical neck with fractures of either the greater tuberosity or lesser tuberosity • 4 part fx’s are fxs of the anatomic neck & fractures of the greater and lesser tuberosities

  16. 2 part 3 part

  17. Proximal Humerus Fracture • The vascularity is at risk with anatomical neck fractures • Most common mechanism of injury= FOOSH • Signs & symptoms: • Pain, swelling, tenderness

  18. Midshaft Humerus Fractures • Signs & Symptoms: • Arm pain, swelling, deformity • The arm is shortened with gross motion & crepitus on gentle manipulation • XR: • AP/lat including shoulder & elbow

  19. Midshaft humerus fx

  20. Elbow Fractures • Monteggia Fracture • Usually a fx of the proximal Ulna with anterior dislocation of the radial head • XR: • AP/lat/obliq

  21. GaleazziFracture/dislocation • involving distal radial shaft fracture with associated dislocation of the distal radioulnar joint(DRUJ), which disrupts the forearm axis joint.

  22. Galeazzi(Reverse Monteggia)

  23. Galeazzi

  24. Radial Head Fracture • MOI: • Fall forward with elbow extended, forearm pronated • Pain localized to radial head • XR: • AP/lat/oblique

  25. Normal Elbow

  26. Radial head fx

  27. Olecranon Fractures • Pain at elbow with movement • XR: • AP/lat/obliq

  28. Olecranon Fractures

  29. Distal Humerus Fracture • Supracondylar fracture of the Humerus: • Characterized by dissociation between diaphysis & condyles of distal humerus, frequently extended distally & involves articular surface • Caused by FOOSH or direct blow • Clinical examination: • + deformity, instability, crepitus • X Ray: • AP/lat/obliq

  30. The Wrist-Eight Carpal Bones • Proximal / Distal row from radial to ulnar position Scaphoid,Lunate,Triquetrum,Pisiform, Trapezium,Trapezoid,Capitate,Hamate + Radius and Ulna

  31. Movements at the wrist • Radial deviation (abduction) • Ulnar deviation (adduction) • Flexion • Extension • Supination • Pronation • Combination of all of the above

  32. Wrist Dislocations • Lunate dislocation caused by hyperextension of the wrist (FOOSH) • Exam: • Wrist appears shortened with a fullness over the dorsum or in the carpal tunnel • Any movement produces pain

  33. Wrist Dislocations • XR: • Minimum 4 views: AP neutral, AP ulnar deviation, oblique, lateral

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