Musculoskeletal Imaging

LEARNING OBJECTIVES

After this lecture, you should be able to:

• Identify the bones of the shoulder, arm, hand on radiograph

• Locate the bones of the pelvis, leg, and foot on radiograph
 TIMELINE
ACTION TIME PERFORMER PLATFORM

Conventional 15 minutes Dr. Giang Powerpoint – Main

radiography room

Anatomy review 15 minutes Dr. Duy – Ms. Jamboard – 8

discussion Quynh Anh breakout rooms
15 minutes wrap up Powerpoint – Main
room
Clinical correlation 30 minutes Dr. Giang – Ms. Jamboard – 8
cases discussion Quynh Anh breakout rooms
30 minutes wrap up Powerpoint – Main
room
Conventional Radiography
 Conventional Radiography
Internal rotation
 Conventional Radiography
External rotation
 Conventional Radiography
Bernageau Posture
 Conventional Radiography
Oblique posture through axilla
 Conventional Radiography

Which hand is shown in

this radiograph?

https://www.scientistcindy.com/anatomical-planes.html
 Conventional Radiography

https://stock.adobe.com/vn/search/images?k=hands+up+surrender&asset_id=77368971
Which hand is shown in
this radiograph?
Conventional Radiography
 Conventional Radiography

Which foot is shown in

this radiograph? https://www.scientistcindy.com/anatomical-planes.html
 Conventional Radiography

Which foot is shown in

this radiograph?
https://www.scientistcindy.com/anatomical-planes.html
Upper Extremities
 Shoulder Greater
Acromion Clavicle
tuberosity
Radiograph (insertion of Coracoid process
supraspinatus m.)

Humeral
head

Glenoid fossa

Scapula

Penn Collection
 AP Forearm Radiograph

Humerus

Radial Olecranon
Head

Ulna
Radius

Ulnar Styloid
Radial Styloid Process
Process
Penn Collection
 Lateral Elbow Radiograph

Radial Head

Humerus
Radius Ulna

Capitellum& Trochlea

Olecranon
 Frontal Wrist Radiograph

Fifth
metacarpal

Trapezoid
Hamate
Trapezium
Capitate Pisiform
Scaphoid
Triquetrum
Radius Lunate
Ulna
 Lateral Wrist Radiograph

Capitate
Lunate

Radius Ulna

Penn Collection
 PA Hand Radiograph

Distal phalanx

Middle phalanx

Proximal Phalanx

Metacarpal

Carpals
Lower Extremities
 Frontal Pelvis Radiograph

Ilium Sacrum

Sacroiliac
joint

Acetabulum

Superior pubic
ramus
Obturator Pubic
foramen symphysis

Ischium
Inferior pubic
ramus

Penn Collection
 Frontal View of the Hip

Acetabulum

Femoral head

Greater trochanter

Femoral neck

Lesser Trochanter

Femoral shaft

Penn Collection
 Frontal Knee Radiograph

Patella
Femur

Lateral epicondyle Medial epicondyle

Lateral femoral Medial femoral

condyle condyle

Fibula Tibia

Penn Collection
 Lateral Knee Radiograph

Femur

Patella

Tibial Tuberosity
FIbula
Tibia

Penn Collection
AP Tibia-Fibula Radiograph

Lateral condyle Medial condyle

Fibular head

Fibula
(Fibular diaphysis) Tibia
(Tibial diaphysis)

Lateral malleolus
Medial malleolus
 AP Ankle Radiograph
Fibula
Tibia

Ankle mortise
Medial malleolus
Lateral malleolus Talus

Ankle mortise should be symmetric around the joint

Lateral Ankle Radiograph
Fibula
Tibia

Talus

Calcaneus

Penn Collection
Frontal Foot Radiograph
Distal phalanx

Proximal phalanx

Sesamoid bones
(medial and lateral)
Metatarsal
Middle and lateral
cuneiforms
Medial
cuneiform

Cuboid Navicular
Calcaneus Talus

Distal fibula
Clinical correlation cases
 Case 1: 24 y/o F s/p backwards fall while
rollerblading

A) What joint are we looking at?

B) What view is this (AP or lateral)?
C) What are the findings? (Bony
and soft tissue. Be as specific as
possible!)
D) Which artery and nerves might
be damaged during reduction of this
type of injury?

Penn Collection
 Case 2: Presents after having
jumped from a window
A) What part of the body are we
looking at?
B) What view is this?
C) What are the findings?
D) If you see this fracture,
radiographs of what other part of
the body should be recommended?

Penn Collection
 Case 3: 19 yo M w/ hand swelling after a fight

A) What joints are we looking at?

B) What view is this?
C) What are the findings?
D) What eponym is used to
describe this fracture?

Penn Collection
 Case 4: 48 y/o M presents with elbow pain

A) What joint are we looking

at?
B) What views are these?
C) What are the findings?
D) What pathologic process
might explain these findings?

Penn Collection
 Case 5: Patient fell on outstretched hand

A) What joint are we looking at?

B) What views are these?
C) What are the findings? (Bony and soft
tissue. Be as specific as possible!)
D) What eponym is used to describe this
fracture?
E) What other fracture is often associated
with the fracture seen here?

Penn Collection
 Case 6: 82 y/o F with hip pain after fall
A) What joint are we looking at?
B) What view is this?
C) What are the findings?
D) What is the most important thing
the surgeon wants to know about
this fracture?

Penn Collection
 Case 7: Football player with leg pain
A) What joint are we looking at?
B) What view is this?
C) What are the findings? (Bony and soft
tissue. Be as specific as possible!)

Penn Collection
Case 8: Fall on outstretched hand with pain in anatomic snuffbox

A) What joint are we looking at?

B) What view is this?
C) What are the findings?
D) Why is it more important to identify
a fracture of this bone than a fracture
of most other carpal bones?

Penn Collection
 Case 9: New military recruit
foot pain after 5 miles march
A) What joints are we looking at?
B) What view is this?
C) What are the findings? (Bony and
soft tissue. Be as specific as possible!)
D) How can we tell (approximately) how
old this fracture is?

Penn Collection
Case Answers
 Case 1: 24 y/o F s/p backwards fall while rollerblading
A) Elbow
B) Lateral
C) Posterior dislocation of the radius and
ulna. There is soft tissue swelling and a
joint effusion.
D) The brachial artery and the median and
ulnar nerves

Posteriorly
dislocated elbow
 Case 2: Presents after having jumped from a
window
Calcaneal fracture
A) Heel
B) Lateral
C) Impacted fracture of
the calcaneus
D) Order spine
radiographs

Lover’s fracture: Calcaneal fractures are often

the result of a jump from a great height, as from
a window. These are often associated with
spine fractures due to the great transmission of
force. Consider spine radiographs.

Calcaneal fracture

Penn Collection
 Case 3: 19 yo M w/ hand swelling after a fight

A) Primarily the
carpometacarpal (CMC) Boxer’s
and the Fracture
metacarpophalangeal
(MCP) joints
B) Frontal view
C) Fracture of the head of
the fifth metacarpal
D) Boxer’s fracture

Boxer fractures are an impaction injury (axial loading

of the 5th metacarpal) almost always result as a
consequence of a direct blow with a clenched fist
against a solid surface.
 Case 4: 48 y/o M with history of gout
presents with elbow pain
Marked soft tissue swelling
A) Elbow
B) Frontal and lateral views
C) Soft tissue swelling
posterior to the olecranon
D) Olecranon bursitis

Frontal View Lateral View

Penn Collection
 Case 5: Patient fell on outstretched hand

Palmar Dorsal

A) Wrist
B) Frontal and lateral views
C) Fracture of the distal
radius with dorsal
Ulnar styloid fracture
displacement of the distal
fracture fragment Radial fracture

D) Colles fracture
E) Ulnar styloid fracture Radial fracture

Soft tissue swelling

Colles’ Fracture: Fracture through distal radius with dorsal displacement of distal fragment (dinner fork
deformity). Ulnar styloid fracture is commonly associated.
 Case 6: 82 y/o F with hip pain after fall
A) Hip
B) Frontal view Intertrochanteric fracture
C) Intertrochanteric fracture
D) Exactly where the fracture
line is in relation to the
trochanters because it affects
surgical management.
 Case 7: Football player with leg pain

A) Ankle
B) Frontal view
C) Comminuted fracture of the
distal fibula and a fracture of the
medial malleolus (of the tibia).
Soft tissue swelling of the ankle.
Distal tibia fracture
Distal fibula fracture
Case 8: Fall on outstretched hand with pain in anatomic snuffbox

A) Wrist
B) Frontal
C) Scaphoid waist fracture
D) There is a risk of
avascular necrosis if the
fracture is not fixed
Scaphoid Fracture

48
 Case 8: Complication of Scaphoid Fracture

Radiolucent
fracture line

Sclerotic proximal
pole of scaphoid
bone

Chronic scaphoid fracture with avascular necrosis

 Case 9: New military recruit
foot pain after 5 mile march
A) The tarsometatarsal and the
metatarsophalangeal joints. The proximal and
distal interphalangeal joints are also seen.
B) Frontal view
C) Callus formation around the second Callus formation
metatarsal surrounding the
D) The callus tells us the finding is not acute second metatarsal
because the bone has started to heal indicates healing
stress fracture

Metatarsal stress fractures are not uncommon in military recruits, hikers, and runners. Initial
radiographs may not show a fracture. Follow up radiographs several weeks after the onset of
symptoms will show callus formation around the stress fracture in the area of pain.
LEARNING OBJECTIVES

After this lecture, you should be able to:

• Identify the bones of the shoulder, arm, hand on radiograph

• Locate the bones of the pelvis, leg, and foot on radiograph
Musculoskeletal Imaging