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Trauma: Upper Extremity

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What Radiology Residents Need to Know: Musculoskeletal Radiology

Part of the book series: What Radiology Residents Need to Know ((WRRNK))

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Abstract

This chapter describes the spectrum of imaging appearances of fractures and dislocations of the shoulder, elbow, forearm, wrist, and hand.

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References

  1. Eisenberg RL. Clinical imaging: an atlas of clinical diagnosis. 5th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2010.

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  2. Swischuk LE, Jadhav SP. Emergency musculoskeletal imaging in children. New York: Springer; 2014.

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Authors and Affiliations

  1. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Ronald L. Eisenberg

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  1. Ronald L. Eisenberg
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Correspondence to Ronald L. Eisenberg .

Electronic Supplementary Material

Fig. e2.1

Acromioclavicular dislocation (type 2). Weight-bearing views of both the clavicles show widening of the left AC joint (arrow). The coracoclavicular ligament is intact [5] (JPG 416 kb)

Fig. e2.2

Acromioclavicular dislocation (type 5). Widening of the AC distance (black arrow) and coracoclavicular distance (white arrow) (JPG 537 kb)

Fig. e2.3

Anterior shoulder dislocation. The humeral head is situated inferior to the coracoid process of the scapula. There is an associated fracture of the greater tuberosity of the humerus (arrow). (Case courtesy of Dr. Maulik S. Patel, Radiopaedia.org, rID: 12197) (JPG 358 kb)

Fig. e2.4

Bankart lesion. Small bone fragment (arrow) is displaced from the inferior aspect of the glenoid fossa. Subtle compression deformity of the superolateral humeral head is consistent with a mild Hill-Sachs lesion. Both of these findings result from recurrent episodes of anterior shoulder dislocation. (Case courtesy of Dr. Maulik S. Patel, Radiopaedia.org, rID: 10089) (JPG 554 kb)

Fig. e2.5

Bankart lesion. In addition to the triangular avulsion from the anteroinferior margin of the glenoid fossa (arrowhead), there also is an acute impacted fracture of the surgical neck of the humerus (arrows). (RSatUSZ/Wikimedia) (JPG 264 kb)

Fig. e2.6

Bankart lesion. CT image clearly shows the separated fragment (arrow). (RSatUSZ/Wikimedia) (JPG 327 kb)

Fig. e2.7

Posterior shoulder dislocation. On this axillary view, the humeral head is positioned posterior to the glenoid (arrow). Note the acromioclavicular joint anteriorly for orientation (arrowhead) (JPG 126 kb)

Fig. e2.8

Posterior shoulder dislocation. CT shows an intra-articular bony fragment (arrow) (JPG 179 kb)

Fig. e2.9a

Posterior shoulder dislocation. The “trough sign” is a vertical line made by the impression fracture of the anterior portion of the humeral head (arrowheads). Note the associated “light bulb” sign. (Case courtesy of Dr. Domenico Nicoletti, Radiopaedia.org, rID: 71366) (JPG 394 kb)

Fig. e2.9b

Posterior shoulder dislocation. CT image shows a depressed impaction deformity medial to the biceps groove with engaging of the humeral head on the posterior glenoid, the so-called “reverse Hill-Sachs deformity.” (Case courtesy of Dr. Domenico Nicoletti, Radiopaedia.org, rID: 71366) (JPG 190 kb)

Fig. e2.10

Inferior dislocation of the shoulder (automobile accident). Note the abduction of the humerus. Also present is a fracture of the greater tuberosity (arrow). (James Heilman, MD/Wikimedia) (JPG 344 kb)

Fig. e2.11a

Supracondylar fracture (anterior humeral line). On the side of the fracture, the anterior humeral line intersects the capitellum through the anterior third [2] (JPG 94 kb)

Fig. e2.11b

Supracondylar fracture (anterior humeral line). On the normal side, the anterior humeral line intersects the capitellum through its posterior third [2] (JPG 90 kb)

Fig. e2.12

Supracondylar fracture. Posterior fat pad and anterior sail sign (arrows) indicate an elbow joint effusion in a child with a subtle fracture. (James Heilman, MD/Wikimedia) (JPG 380 kb)

Fig. e2.13a

Monteggia fracture. Lateral view demonstrate a fracture of the proximal ulna (arrow) with dislocation of the radial head (arrowhead) (JPG 239 kb)

Fig. e2.13b

Monteggia fracture. Frontal view demonstrate a fracture of the proximal ulna (arrow) with dislocation of the radial head (arrowhead) (JPG 280 kb)

Fig. e2.14a

Galeazzi fracture. Lateral view of the forearm demonstrate a fracture of the middle third of the radius (arrow) with malalignment of the distal ulna (arrowhead) (JPG 321 kb)

Fig. e2.14b

Galeazzi fracture. Frontal view of the forearm demonstrate a fracture of the middle third of the radius (arrow) with malalignment of the distal ulna (arrowhead) (JPG 386 kb)

Fig. e2.15a

Essex-Lopresti fracture-dislocation. Frontal view of the elbow shows a comminuted fracture of the radial head (arrow). (Sheehan SE, Dyer GS, Sodickson AD, et al. Traumatic elbow injuries: what the orthopedic surgeon wants to know. Radiographics. 2013;33:869–888) (JPG 2140 kb)

Fig. e2.15b

Essex-Lopresti fracture-dislocation. Lateral radiograph of the wrist shows dorsal subluxation of the distal ulna with widening of the radioulnar distance (arrow), findings suggestive of distal radioulnar joint dislocation in the setting of wrist pain. (Sheehan SE, Dyer GS, Sodickson AD, et al. Traumatic elbow injuries: what the orthopedic surgeon wants to know. Radiographics. 2013;33:869–888) (JPG 1686 kb)

Fig. e2.16

Smith fracture. Lateral view shows volar angulation of the distal fragment, the reverse of the appearance in a Colles’ fracture (JPG 469 kb)

Fig. e2.17

Chauffeur fracture. Oblique intra-articular fracture of the radial styloid process (arrow) (JPG 303 kb)

Fig. e2.18

Scaphoid fracture (nonunion). Sclerotic margins along the fracture line (JPG 259 kb)

Fig. e2.19

Scaphoid fracture. Coronal, proton-density, fat-sat MR image demonstrates a hypointense fracture line (arrow) with surrounding marrow edema (JPG 212 kb)

Fig. e2.20

Rolando fracture. In addition to the fracture of the ulnar margin (black arrow), another fracture line extends to the articular surface (white arrow). (Gilo1969/Wikimedia) (JPG 249 kb)

Fig. e2.21

Boxer’s fracture (arrow). (Case courtesy of Dr. Maulik S. Patel, Radiopaedia.org, rID: 10739) (JPG 280 kb)

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Eisenberg, R.L. (2022). Trauma: Upper Extremity. In: What Radiology Residents Need to Know: Musculoskeletal Radiology. What Radiology Residents Need to Know. Springer, Cham. https://doi.org/10.1007/978-3-030-72382-8_2

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  • DOI: https://doi.org/10.1007/978-3-030-72382-8_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-72381-1

  • Online ISBN: 978-3-030-72382-8

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