NICE PPT

1. RADIOLOGICAL
ANATOMY OF
UPPER LIMB
BY DR BHASKAR 2ND YEAR RESIDENT IN
SVIMS

2.  Th e upper limb consists of the shoulder, arm, forearm and hand.
 Those regions are connected by the shoulder, elbow and wrist joints
overlain by transitional zones, the axilla, antecubital fossa and
carpal tunnel, which facilitate the passage of neurovascular
structures.

3. SHOULDER JOINT

5.  The three bones that make up the shoulder joint include the clavicle
(collarbone), scapula (shoulder blade), and humerus (long bone of the
arm).
 The shoulder has two joints that work together to allow arm movement.
 The acromioclavicular (AC) joint is a gliding joint formed between the
clavicle and the acromion. The acromion is the projection of the
scapula that forms the point of the shoulder. The AC joint gives us the
ability to raise the arm above the head.
 The glenohumeral joint, or shoulder joint, is a ball-and-socket type joint.
The "ball" is the top, rounded part of the humerus, and the "socket" is the
bowl-shaped part of the scapula, called the glenoid, into which the ball
fits. This joint allows the arm to move in a circular rotation as well as
towards and away from the body.

6.  Shoulder has great mobility at the cost of stability & most vulnerable joint for Injury.
 Articular surface incongruity is the cause for instability.
 Stability of the joint maintained by
coracoacromial arch or secondary
socket
musculotendinous cuff of the shoulder
deepening of the glenoid cavity by the glenoid labrum.
muscles attaching humerus to the
pectoral girdle.

8. LIGMENTS
 GLENOID LABRUM
 CAPSULAR LIGAMENT
 GLENOHUMERAL LIGAMENT
 CORACOHUMERAL LIGAMENT
 TRANSVERSE HUMERAL LIGAMENT
 CORACOACROMIAL LIGAMENT
 CORACOCLAVICULAR LIGAMENT

9. MUSCLES OF THE ROTATORY CUFF 
 Rotator cuff is a structure formed by supra spinatus,infraspinatus,teres minor and
subscapularis muscles and their connection with articular capsule of the shoulder joint
and attachments of tendons to humerus.
TUBERCULUM MAJUS
 Supraspinatus
 Infraspinatus
 Teres minor
TUBERCULUM MINUS
 Subscapularis
 In childhood the particular muscles of the rotator cuff can be differentiated. In maturity
these muscles are fussed, and it is not possible to differentiate the particular muscles in
the cuff.

10. PLAIN X-RAY
 Provides a comprehensive anatomical overview at low cost and low
radiation dose, generally, the first imaging test.
 Combined with the clinical assessment, plain films alone will often
allow a reasonable provisional diagnosis and management plan to be
formulated without the need for more sophisticated tests.

11. Regular views 
AP Internal & External rotation
Axillary
Specialized views 
Abduction ( Baby arm ) view
Grashey’s or Glenoid cavity view
Y view or Lateral scapular view
Apical oblique view
Stryker notch
West point view
Outlet or Tunnel views

12. AP Internal Rotation Projection
Part Position: The patient is rotated to be at 30° to the bucky. The coracoid is
centered to the bucky and the arm internally rotated until the elbow epicondyles
are perpendicular to the film
 Demonstrates
 the position of the humeral head relative to the
glenoid fossa by tracing the smooth transition from the
medial humerus across the glenoid fossa to the axillary
border of the scapula, creating a smooth continuous
arc.
 Specifically outline the greater and lesser tuberosities.
The distal clavicle, scapula, and upper ribs are also
visible.

13. AP External Rotation Projection
Part Position: The patient is rotated to 30° to the bucky. The coracoid is
centered to the bucky, and the arm externally rotated until the elbow
epicondyles are parallel to the film.
Demonstrates
 Alignment: Elevation of the
humerus within the glenoid fossa is
a sign of rotator cuff tendon tear.
 Additional landmarks are the
distance between the
undersurface of the acromion and
the opposing humeral head
(acromiohumeral space, normally
10 mm) and glenohumeral joint
space (4-6 mm).

14. Abduction Projection
Part Position: The patient’s back is flat to the bucky. The arm is
abducted to 90°, the elbow is flexed to 90°, and the palm of the hand
faces the tube. Demonstrates
 Alignment: Elevation of the humerus
within the glenoid is a sign of rotator cuff
tendon tear and is accentuated more in
this view than in any other projection; it is
judged abnormal when the space is < 5
mm (acromiohumeral distance). The
distal clavicle and acromion should be
aligned.
 The greater and lesser tuberosities are
superimposed and approximate the
undersurface of the acromion. At the
scapula the glenoid rim, scapula neck,
axillary border, acromion, coracoid, and
spine can all be identified.

15. Axillary view
 Demonstrates: glenohumeral joint
narrowing (best view), Os Acromionale,
glenoid version, glenoid erosion, humeral
head subluxation.
 Helpful for: determining the amount of
acromion which remains in patients who
have undergone previous surgery; relation
of humeral head to glenoid; Hill-Sachs
lesions, Os Acromionale, AC joint, Shoulder
dislocation,

16. Scapular Y view
 Demonstrates: lateral projection of scapular
body and humeral head overlapping the
glenoid.
 Helpful for: Shoulder dislocation;Proximal
humerus fx. ; scapular body fracture

17. Neer view , Supraspinatus Outlet view
 Demonstrates: outlet/impingement of
the supraspinatus and
coracoacromial arch.
 Helpful for: Subacromial
impingement, assessing acromial
morphology, unfused acromial
epiphysis.

18. APVIEW
IN ANTERIOR DISLOCATION
Humeral head and glenoid surfaces
are not alignedThe humeral head lies
below the coracoid

19. Y VIEW
The humeral head lies anterior to
the glenoid and inferior to the
coracoid process

20. The humeral head surface is no longer aligned with
the glenoid.The humeral head lies anterior to the
glenoid

21. Posterior dislocation
 The glenohumeral joint is widened
 Cortical irregularity of the humeral
head indicates an impaction
fracture
 Following posterior dislocation the
humerus is held in internal rotation
and the contour of the humeral
head is said to resemble a 'light
bulb

22.  Posterior shoulder dislocation - Y
view
 The humeral head (blue line) no
longer overlies the glenoid (red
line)
 The correct position of the humeral
head is shown (green line

23. Glenohumeral joint
Superiorly
 coracoacromial arch and
 coracoacromial ligament
 long head of the biceps tendon
 tendon of the supraspinatus
 muscle
Anteriorly
 anterior labrum
 glenohumeral ligaments SGHL,
 MGHL, IGHL (anterior band)
 subscapularis tendon
Posteriorly
 posterior labrum
 posterior band of the IGHL
 infraspinatus and teres minor
 tendon

24. ACJ
 The ACJ is a plane synovial joint between the lateral surface of the
clavicle and the medial surface of the acromion.
 Stabilization is by a combination of static reinforcement by
ligaments and dynamic reinforcement by muscles.

25.  LIGAMENTS
Acromioclavicular ligament
coracoclavicular ligament
conoid ligament(main stabilizer in preventing superior and anterior
displacement and rotation )
trapezoid ligament(e main stabilizer in the posterior direction and limits
rotation)
coracoacromial ligament(protecting the humerus from superior
subluxation)
. MUSCLES
deltoid
trapezius

26. Mechanism
.Direct blow to the acromion with the shoulder in the adducted
position.
.The scapula is pushed inferoanteriorly relative to the clavicle with
resulting sequential stretching or tearing of the acromioclavicular
ligaments, coracoclavicular ligaments, and trapezius insertion

27. Acromioclavicular joint Acromioclavicular joint (ACJ) - Normal
 The inferior margins of the acromion and
clavicle are well aligned (red lines) indicating
integrity of the acromioclavicular ligaments
 The coracoid is not widely separated from the
clavicle - this indicates integrity of the
coracoclavicular ligaments.

28.  Acromioclavicular joint disruption
 The inferior surfaces of the clavicle
and acromion are not aligned -
indicating disruption of the
acromioclavicular ligaments
 The coracoclavicular distance is
also wide - indicating
coracoclavicular ligament injury

35. LIGMENTS
 GLENOID LABRUM
 CAPSULAR LIGAMENT
 GLENOHUMERAL LIGAMENT
 CORACOHUMERAL LIGAMENT
 TRANSVERSE HUMERAL LIGAMENT
 CORACOACROMIAL LIGAMENT
 CORACOCLAVICULAR LIGAMENT

36. GLENOID LABRUM
 It’s a fibrocartilagenous rim
attached to margin of glenoid
cavity
 It further strengthens by long head
of biceps origin and sup
glenohumeral ligament
 It is a STATIC stabiliser of joint and
prevents excessive rollback of
humerus

38. Sublabral recess

41. JOINT CAPSULE
 It is lax and attaches along
epiphyseal lines of glenoid and
humeral head and extends onto
surgical neck medially.
 Capsule is surrounded by synovial
membrane which prolongs along
tendon of biceps as tubular sheath.
 APPLIED ANATOMY-OSTEOMYELITIS
of humerus upper end spreads
directly to joint due to capsule
extension to medial side of neck

42. GLENOHUMERAL LIGAMENTS
 The glenohumeral ligaments (GHLs), joint capsule, and glenoid labrum are parts of the
passive stabilizing mechanisms of the glenohumeral joint.
 The GHLs are localized thickenings of the glenohumeral joint capsule that extend from
the anterior and inferior glenoid margin of the joint to the anatomical neck of the
humerus.
 Three ligaments have been described:
1)the superior glenohumeral ligament (SGHL)
2) the middle glenohumeral ligament (MGHL)
3)the inferior glenohumeral ligament (IGHL)
which are composed of an anterior band, a posterior band, and an axillary recess.
The main two functions of the GHLs are
A) avoid superior-inferior translation
B) to maintain anterior stability

43. GLENOHUMERAL LIGAMENTS
 SUPERIOR-It is the most superior
capsular thickening from labrum
anterior to long head of biceps at
level of coracoid base
 It passes under supraspinatus and
inserts on ANATOMICAL NECK
medial to anterosuperior base of
lesser tuberosity.

44. MIDDLE
 MIDDLE GLENOHUMERAL-most
variable in size
 Arises just inferior to superior GHL
and inserts along middle area of
ANATOMICAL NECK opposite to
lesser tuberosity

45.  Inferior glenohumeral ligament
 sometimes referred to as the inferior
glenohumeral ligament complex 4
 runs from the inferior two-thirds of
the glenoid labrum and/or neck to
the lateral humerus
 composed of three parts:
 anterior band
 posterior band
 axillary pouch: laxity between
anterior and posterior bands
 most important of the three GHLs as
it prevents dislocation at extreme
range of motion and is the main
stabiliser of the abducted shoulder

46. APPLIED ASPECTS OF
GLENOHUMERAL LIGAMENTS
 They restrain the selective arcs of abduction and external rotation.
 In arm dependent position all are slack.
 The SUPERIOR GHL is primary resistrant to inferior translation of
adducted shoulder
 The MIDDLE GHL limits external rotation at 45* of abduction
 The INFERIOR GHL limits external rotation at 45 to 90* of
abduction[mainly superior band of it].

47.  CORACOHUMERAL LIGAMENT-
arises from lateral base of
coracoid process and extends
onto both tuberosities.
 It forms roof of bicipital tendon
sheath and strengtens capsule
anteriorly.
Importance-resists inferior and
posterior translation.
 .

48.  TRANSVERSE HUMERAL LIGAMENT-
bridges upper part of bicipital
groove through which long head
of biceps passes down

49.  It’s a trapezoidal ligament from
base of acromian to apophysis of
coracoid
 It along with coracoid and
acromian forms
CORACOACROMIAL ARCH which
is a SECONDARY SOCKET to
humerus head.
 It plays role in resisting upward
displacement of humerus

51. MUSCLES OF THE ROTATORY CUFF 
 Rotator cuff is a structure formed by supra spinatus,infraspinatus,teres minor and
subscapularis muscles and their connection with articular capsule of the shoulder joint
and attachments of tendons to humerus.
TUBERCULUM MAJUS
 Supraspinatus
 Infraspinatus
 Teres minor
TUBERCULUM MINUS
 Subscapularis
 In childhood the particular muscles of the rotator cuff can be differentiated. In maturity
these muscles are fussed, and it is not possible to differentiate the particular muscles in
the cuff.

52. Muscles Relating to the Shoulder Joint which
do not form the Rotatory Cuff
.Biceps brachii
.Deltoid.
.Teres major.
.Coracobrachialis
.Rhomboidei.
.Latissimus dorsi.
.Trapezius.
.Pectoralis major & minor.
.Triceps brachii.
.Levator scapulae.
.Serratus anterior

53. MUSCLE ORIGIN INSERTION NERVE SUPPL ACTION
DELTOID-4septa origin
Ant border lat 1/3rd clavicle
Acromian lateral border
Lower lip crest of spine of scapula
Deltoid tuberosity
on humerus
Axillary nerve[c5,6] Acromial fibres-abductors
From90*
Anterior fibres-flexors and medial
rotators
Posterior fibres-extensors and
lateral rotators
SUPRASPINATUS-medial2/3
Of supraspinatus fossa
Greater tubercle
upperimpresi
Suprascapular
nerve[c5,6]
Initiator of abduction0*15*
steadies humeralhead
INFRASPINATUS-medial2/3 of
infraspinatus fossa
Greater tubercle Suprascapular
nerve[c5,6]
Lateral rotator of arm
TERES MINOR-Upper2/3 of dorsal
surface of scapula
Greater tubercle Axillary nerve[c5,6] Lateral rotator of arm
SUBSCAPULARIS-medial 2/3 of
subscapular fossa
Lesser tubercle Upper ,lower
subscapular N
Medial rotator and adductor of
arm
BICEPS-
Short head-tip of coracoid
Long head-supraglenoid
Radial tuberosity
of posteriorly
Musculocutaneous
nerve[c5,6]
Strong supinator when forearm
flexed
Flexor of elbow
Short head-arm flexor
Long head-prevents upward
displacement
Teres minor lateral border of scapula Greater tubercle External rotation

55.  Table of page 143 chaurasia
MUSCLE ORIGIN INSERTION NERVE SUPPLY ACTION
PECTORALIS MAJOR
Ant surface of clavicl
Ant manubrium[ant lamina]
2nd-6th coastal cartilage
External oblique abdominus
aponeurosis[post lamin]
Bilaminar tendon on lateral
lip.two lamina are
continous
Fibres from sternum and
aponeurosis are twisted
and inserted
Medial and lateral
pectoral nerve
Adduction and medial
rotation of shoulder
Clavicular-arm flexor
Sternoclavicular part-
extension of flexed arm
against resistance
LATTISMUS DORSI-
Outer lip of iliac crest post
1/3rd
Posterior layer of lumbar
fascia
T7-12 spinous process
Lower 4ribs
Inf angle scapula
Winds round lower border
of teres major and forms
posterior axillary fold
Tendon is twisted upside
down insert into
intertubercular sulcus of
humerus
Thoracodorsal
nerve[c6,7,8]
Adduction,extension,media
l rotation of shoulder
Helps in voilent expiratory
effort
Climbing muscle
Holds inferior angle of
scapula in place
TERES MAJOR-
Lower 1/3rd of dorsal surface
of lateral and inferior angle
scapula
Medial lip of bicipital
groove
Lower subscapular
nerve[c5,6]
Medial rotator and
adductor arm

56. Anatomy of the rotator cuff interval.
 Sagittal T1-weighted fat-suppressed MR arthrogram image shows the
rotator cuff interval, defined by the borders of the supraspinatus tendon
(white arrow) and subscapularis tendon (white curved arrow). The rotator
interval capsule (black arrow) and long head of the biceps tendon
(arrowhead)
56

57.  MR imaging can provide information about
1)rotator cuff tears such as
A) tear dimensions,
B) tear depth or thickness,
C) tendon retraction,
D) tear shape that can influence treatment selection and help
determine the prognosis.
 In addition,
A) tear extensionto adjacent structures,
B)muscle atrophy,
C)size of muscle cross-sectional area, and fatty degeneration

58.  Rotator cuff tears can be classified according to size.
 DeOrio and Cofield (40) classified rotator cuff tears on the basis of greatest
dimension as
either small (1 cm),
medium (1–3 cm),
large (3–5 cm), or
massive (5 cm) .
The dimensions of rotator cuff tears may have implications
 for selection of treatment and surgical approach,
 postoperative prognosis, and tear recurrence.

65.  SUBACROMIAL BURSA-
protect suprspinatus
 SUBSCAPULARIS BURSA
 INFRASPINATUS BURSA

66. SUBACROMIAL BURSA
 extends from below the acromion, over the
shoulder and the greater tuberosityof the
humerus
 laterally, the bursa lies over the superior
surface of the supraspinatus and
infraspinatus tendons
 it sits deep to the deltoid muscle

67. STANDARD POSITION
 Patients are placed in the supine position with the arm beside the
body for most indications. There is no consensus regarding arm
rotation.
 In general, an approximately neutral position of the arm is obtained
by asking the patient to place his hand at the side of the body, with
the thumb pointing upwards.
 Try to avoid both internal and external rotation because in these
positions distribution of the contrast medium or joint effusion may no
longer be optimal and because anatomy may be distorted.

68. ABER position
 ABER position is obtained in the supine position with the patient
placing his hand underneath his head, resulting in external rotation
and abduction of the humerus.
 The sections are axial oblique and are planned on a oblique
coronal sequence parallel to the axis of the proximal humerus.
 In this position, tears of the anteroinferior labrum become more
conspicuous because the labrum is pulled from the glenoid by the
capsule and glenohumeral ligaments.

69.  The ABER position may also be useful for the detection of rotator cuff
abnormalities .
 The sensitivity for tears of the undersurface of the rotator cuff and/or
of the infraspinatus tendon was improved when the ABER position
was employed.

70. IMAGING PLANES
 Three main imaging planes which are applied in most MR
examinations of the glenohumeral joint:
 THE ANGLED CORONAL,
 THE ANGLED SAGITTAL,
 THE AXIAL PLANE.
70

71. ANGLED CORONAL
 Planned on axial localizers parallel to the supraspinatus
Muscle or perpendicular to the glenoid surface.
 Slice thickness is 3–4 mm in most published protocols,
 field-of-view typically between 12 and 16 cm, with an
image matrix of 256. Coronal oblique images are most
useful for determining abnormalities of
 the supraspinatus,
 the superior labrum,
 the Acromioclavicular joint, and the deltoid muscle.
71

72. ANGLED SAGITTAL
 Planned perpendicular to the supraspinatus muscle or
parallel to the glenoid surface.
 They should include the entire humeral head and the
tuberosities, where the rotator cuff tendons insert.
72

73. AXIAL
 Axial images are best planned on coronal localizers.
 Typically, slice thickness is 3–4 mm. Slices may be thinner
if three-dimensional (3D) gradient-echo sequences are
obtained.
 If the slices should include both the acromioclavicular
joint and the axillary recess, slice thickness may have to
be increased to 4 mm. Other imaging parameters are
similar to those of the angled coronal and axial images
73

74. SEQUENCES
 A combination of angled coronal T1-weighted and T2-
weighted spin-echo images is commonly used for
assessment of the supraspinatus tendon.
 T1-weighted images provide anatomical details and
information about early degeneration of the
supraspinatus tendon.
 T2-weighted images are superior in detecting partial or
full-thickness defects of the rotator cuff.
74

75.  Proton-density images can replace the T1-weighted
images in imaging of the rotator cuff. Their sensitivity is
inferior, however, to T1-weighted images in bone marrow
abnormalities.
 In the past, dual echo images have commonly been
acquired.
 The repetition time (TR) for standard spin echo
sequences was typically close to 2000 ms, the echo
times (TE) 20 and 80 ms. There is a tendency to replace
such classical sequences by long TR/intermediate TE (40–
50 ms) sequences without dual echo.
75

76.  For instability imaging, the axial plane is most important.
 If non-enhanced MR images are obtained, T2-weighted, proton-
density or dual-echo spin echo images, gradient-echo images or a
combination of these two types of sequences have been
recommended.
76

77. Axial anatomy
 Look for an os acromiale

78.  supraspinatus tendon is
parallel to the axis of the
muscle

79.  biceps tendon is attached at the 12
o'clock position.

80. Notice superior labrum and attachment
of the superior glenohumeral ligament.
At this level look for SLAP-lesions and
variants like sublabral foramen.
At this level also look for Hill-Sachs lesion
on the posterolateral margin of the
humeral head.

81.  The fibers of the subscapularis tendon
hold the biceps tendon within its
groove

82.  At this level study the middle GHL and the
anterior labrum. Look for variants like the
Buford complex. Study the cartiage.

83.  INFERIOR GHL

84. Coronal views
 .
When we plan the coronal oblique
series, it is best to focus on the axis
of the supraspinatus tendon.

85. Notice coracoclavicular ligament and
short head of the biceps.

86. Notice coracoacromial ligament

89. Notice suprascapular nerve and
vessels

90. Look for supraspinatus-impingement by
AC-joint spurs or a thickened
coracoacromial ligament

91.  Study the superior biceps-labrum
complex and look for sublabral recess
or SLAP-tear.

92. Look for excessive fluid in the
subacromial bursa and for tears of the
supraspinatus tendon

93. Study the attachment of the IGHL at the humerus.
Study the inferior labral-ligamentary complex. Look
for HAGL-lesion (humeral avulsion of the
glenohumeral ligament)

94. Look for tears of the infraspinatus
tendon.

98. Sagittal anatomy
1.Notice rotator cuff muscles
and look for atrophy

99. Notice MGHL, which has an oblique course
through the joint and study the relation to
the subscapularis tendon

100. Sometimes at this level labral tears at the 3-
6 o'clock position can be visualized.

101. Study the biceps anchor.

102. Notice shape of the acromion

103. Look for
impingement by the
AC-joint. Notice the
rotator cuff interval
with coracohumeral
ligament.

104. Look for supraspinatus tears.

105. ELBOW JOINT
 The elbow is a complex synovial joint formed by the articulations of the humerus , the
radius and the ulna .
 Articulations. The elbow joint is made up of three articulations:
 radiohumeral: capitellum of the humerus with the radial head
 ulnohumeral: trochlea of the humerus with the trochlear notch (with separate olecranon
and coronoid process articular facets) of the ulna
 radioulnar: radial head with the radial notch of the ulna (proximal radioulnar joint )
 In full flexion, the coronoid process is received by the coronoid fossa and the radial
head is received by the radial fossa on the anterior surface of the humerus and in full
extension the olecranon process is received by the olecranon fossa on the posterior
aspect of the humerus
 Ligaments
 medial (ulnar) collateral ligament complex
 lateral (radial) collateral ligament complex

107. Adult Elbow - AP
Part Position: Arm fully extended, and the hand supinated. If
the elbow cannot be extended,
two APs are done, onea with the forearm on the film and the
second with the humerus on the film
The axial
relationships of the
humerus to the ulna
(carrying angle)
should be assessed.

108. Adult Elbow - Oblique
.
Clinicoradiologi
c Correlations:
The elbow plane
is especially
useful for
depicting the tip
of the coronoid
and olecranon
processes of the
ulna,
trochlea,
coronoid
process, and
medial
epicondyle.
Part Position: Arm fully extended and the forearm pronated

109. Adult Elbow - Lateral
Part Position: Elbow flexed to 90°, with the ulnar surface of
the forearm flat on the film. The hand is in the true lateral
position. The humerus must also be parallel to the film plane,
with the shoulder abducted to 90°.
This is a useful
view for
evaluating the
post-traumatic
elbow
for fracture. It is
this view that will
demonstrate joint
effusion, which is
often a marker for
subtle fracture or
effusions.

110.  Tendon attachments
 Common flexor tendon
Attaches at the medial epicondyle
 Ulnar collateral ligament or UCL
Starts at the undersurface of the medial
epicondyle and runs down to the sublime
tubercle, which is the medial side of the
coronoid process.
 Common extensor tendon
Originates at the lateral epicondyle.
 Lateral collateral ligament
Originates just underneath the attachment
of the common extensor tendon.

111.  Lateral ulnar collateral ligament
This is a somewhat confusing term for a
tendon that also originates just
underneath the common extensor
tendon. It swings down behind the
radial head and attaches at the area of
the ulna that is called the supinator
crest - see lateral view.
 Biceps tendon
Attaches on the radial tuberosity.
 Brachialis tendon
Attaches on the coronoid process.
 Annular ligament
Attaches on the volar side of the
sigmoid notch of the ulna and runs
around the radial head and attaches
on the dorsal side of the sigmoid notch.

112.  Use the axis of the epicondyles on
a axial localizer to plan the
coronal scan.
The sagittal images are scaned
perpendicular to the coronal
scan.

114. ulnar collateral ligament
 the ulnar collateral ligament (UCL) is situated on
the medial side and it has three components.
 The anterior bundle is the strongest component
and is the primary restraint against valgus forces.
On MR this is the most important structure.
 The posterior bundle attaches distally in a fan-
shape on the olecranon.
It forms the floor of the cubital tunnel.
 The transverse bundle runs from the olecranon to
the olecranon, so it doesn't do much

115.  The UCL (in yellow) originates on
the undersurface of the medial
epicondyle just beneath the origin
of the common flexor tendon.
It attaches on a small process on
the medial side of the coronoid,
which is called the sublime
tubercle.

118. tear

119. Lateral Collateral Ligament
 consists of the radial collateral, the
lateral ulnar collateral and the
annular ligament.

123. •
The common extensor tendon originates at the lateral epicondyle.
On a T1W-images the tendon should have a low signal intensity (yellow arrow).

124. he common flexor tendon originates
at the medial epicondyle.
On a T1W-images the tendon should
have a low signal intensity (red
arrow)
Medial Epicondylitis
This is the counterpart of the lateral epicondylitis
and also known as the golfer's elbow.
Here the common flexor tendon is involved.
On the sagittal image it is clear that it is only
partial tearing.

125. biceps tendon
axial images of the biceps tendon from the musculotendinous junction to the attachment on the radial tuberositas.

129.  The brachialis originates from the
lower half of the front of the humerus,
near the insertion of the deltoid
muscle.
It lies deeper than the biceps brachii,
and is a synergist that assists the
biceps in flexing the elbow.
 The thick tendon inserts on the
anterior surface of the coronoid
process of the ulna.

133.  1, Radial head. 2, Extensor carpi
radialis longus muscle. 3, Triceps
muscle (lateral
head). 4, Cephalic
vein. 5, Brachoradialis
muscle. 6, Supinator
muscle. 7, Extensor carpi ulnaris
muscle

134.  1, Radial head. 2, Supinator
muscle. 3, Anconeus muscle. 4, Triceps
muscle (lateral head). 5, Biceps
brachii muscle. 6, Extensor carpi
radialis longus muscle.7, Cephalic
vein. 8, Capitellum.

135.  1, Radial head. 2, Supinator
muscle. 3, Anconeus
muscle. 4, Capitellum. 5,Triceps muscle
(lateral head). 6, Extensor carpi radialis
longus muscle. 7, Biceps brachii
muscle. 8, Cephalic
vein. 9, Brachoradialis muscle.

136.  1, Ulna. 2, Trochlea. 3, Humerus. 4, Tric
eps muscle (lateral head). 5, Biceps
brachii muscle. 6, Brachialis
muscle. 7, Ulnar artery and vein.

137.  1, Olecranon.
 2, Triceps muscle (lateral head).
 3, Humerus.
 4, Biceps brachii muscle.
 5, Brachialis muscle.
 6, Ulnar artery and vein.
 7, Pronator teres muscle.

138.  1, Olecranon.
 2, Triceps muscle (lateral head).
 3, Humerus.
 4, Biceps brachii muscle.
 5, Brachialis muscle.
 6, Brachial artery and vein.
 7, Trochlea.
 8, Coronoid process.
 9, Pronator teres muscle.
 10, Flexor digitorum profundus muscle.

139.  1, Olecranon.
 2, Trochlea.
 3, Humerus.
 4, Triceps tendon.
 5, Triceps muscle (lateral head).
 6, Brachialis muscle.
 7, Coronoid process.
 8, Pronator teres muscle.
 9, Flexor digitorum superficialis
muscle.
 10, Flexor digitorum profundus
muscle.

140.  1, Olecranon. 2, Trochlea. 3, Triceps
muscle (lateral head). 4, Brachialis
muscle. 5,Flexor digitorum
superficialis muscle. 6, Flexor
digitorum profundus muscle.

141.  1, Ulna. 2, Anconeus muscle. 3, Extensor carpi ulnaris muscle. 4, Supinator
muscle. 5, Extensor digitorum muscle. 6, Extensor carpi radialis longus
muscle. 7, Brachoradialis muscle. 8, Radius. 9,Pronator teres muscle. 10, Flexor carpi
radialis muscle. 11, Flexor digitorum superficialis muscle. 12,Flexor carpi ulnaris
muscle. 13, Flexor digitorum profundus muscle.

143.  1, Ulna.
 2, Anconeus muscle.
 3, Extensor digitorum muscle.
 4, Extensor carpi radialis longus
muscle.
 5, Brachoradialis muscle.
 6, Radial head.
 7, Brachialis muscle.
 8, Pronator teres muscle.
 9, Flexor carpi radialis muscle.
 10, Flexor digitorum superficialis
muscle.
 11, Flexor digitorum profundus
muscle.

144.  1, Ulna
 . 2, Anconeus muscle.
 3, Extensor digitorum muscle.
 4, Extensor carpi radialis longus
muscle.
 5, Brachoradialis muscle.
 6, Brachialis muscle.
 7, Pronator teres muscle.
 8, Flexor carpi radialis muscle.
 9, Flexor digitorum superficialis
muscle.

145.  1, Humerus.
 2, Ulna.
 3, Anconeus muscle.
 4, Extensor digitorum muscle.
 5, Extensor carpi radialis longus
muscle.
 6, Brachoradialis muscle.
 7, Brachialis muscle.
 8, Pronator teres muscle.

147.  1, Medial epicondyle (Humerus). 2, Olecranon fossa. 3, Muscle triceps. 4, Lateral
epicondyle (Humerus). 5, Extensor carpi radialis longus muscle. 6, Brachoradialis
muscle. 7, Biceps brachii muscle. 8, Brachialis muscle. 9, Pronator teres muscle.

149.  1, Triceps muscle (Long head). 2, Triceps muscle (Medial head). 3, Humerus. 4, Triceps
muscle (lateral head). 5, Extensor carpi radialis longus muscle. 6, Brachoradialis
muscle. 7, Biceps brachii muscle. 8,Brachialis muscle.

150.  1, Olecranon.2, Triceps muscle (lateral head). 3, Triceps tendon. 4, Flexor carpi ulnaris
muscle. 5, Flexor digitorum profundus muscle.. 6, Anconeus muscle.

151.  1, Olecranon.
 2, Humerus.
 3, Triceps muscle (lateral head).
 4, Flexor carpi ulnaris muscle.
 5, Flexor digitorum profundus muscle.
 6, Extensor digitorum muscle.
 7,Extensor carpi ulnaris muscle.
 8, Anconeus muscle.

152.  1, Ulna.
 2, Lateral epicondyle.
 3, Triceps muscle (lateral head).
 4, Medial epicondyle.
 5, Flexor digitorum superficialis
muscle.
 6, Flexor digitorum profundus muscle.
 7, Supinator muscle.
 8, Extensor digitorum muscle.
 9, Extensor carpi ulnaris muscle.

155.  1, Radial head. 2, Extensor carpi
radialis longus
muscle. 3, Capitellum. 4,Trochlea. 5, P
ronator teres muscle. 6, Flexor
digitorum superficialis
muscle. 7,Supinator muscle.

156.  1, Cephalic vein. 2, Brachoradialis muscle. 3, Brachialis muscle. 4, Basilic
vein. 5,Pronator teres muscle. 6, Flexor carpi radialis muscle. 7, Extensor carpi radialis
longus and brevis muscle.