Atlas of Musculoskeletal Imaging

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Thomas Lee Pope, Jr. Stephe11 Loehr Thieme

Atlas of Musculoskeletal Imaging

Atlas of Musculoskeletal Imaging Thomas Lee Pope, Jr., M.D., F.A.C.R.

Stephen Loehr, M.D.

Professor of Radiology and Orthopaedics

Division of Radiologic Sciences

Medical University of South Carolina

Wake Forest University

Charleston, South Carolina

The Bowman Gray School of Medicine Winston-Salem, North Carolina

Contributing author: Chris Hagenstad, M.D. House Officer Medical College of Virginia Richmond, Virginia

2000

I Thieme

New York· Stuttgart

Thieme New York 333 Seventh A venue New York. NY 10001 Executive Editor: Jane Pennington. Ph.D. Editorial Director: Ave McCracken Assistant Editor: Jinnie Kim Director, Production

&

Manufacturing: Anne Vinnicombe

Production Editor: Xenia Golovchenko Marketing Director: Phyllis Gold Sales Manager: Ross Lumpkin Chief Financial Officer: Seth S. Fishman Presiden!: Brian D. Scanlan Cover Designer: Marsha Cohen Compositor: PRD Group Printer: Edwards Brothers Library of Congress Cataloging-in. Publication Data Pope. Thomas Lee. Atlas of musculoskeletal imaging/Thomas L. Pope, Jr. and Stephen Loehr. p.

cm.

includes bibliographical references (p.

) and index.

ISBN 0- 86577·695·4 (hardcover)

I. Musculoskeletal I]. Title.

RC925.7.P67

system-Magnetic resonance imaging.

I. Loehr. Stephen.

1998

616.7'07548-dc21 DNLMfDLC for Library of Congress

98·27858 CIP

Copyright

©

2000 by Thieme Medical Publishers, Inc. This book. including all parts thereof, is legally protected by copyright. Any use,

exploitation or commercialization outside the narrow limits set by copyright legislation. without the publisher's consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying. mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage. Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed 10 be reliable in their efforts to provide information that is complete and in accord with the standards accepted at the time of publication. However. in view of the possibility of human error by the authors, editors, or publisher of the work herein, or changes in medical knowledge, neither the authors. editors, publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein witb other sources. For example. readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection witb new or infrequently used drugs. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain. Printed in the United States of America 5 4 3 2 I TNY ISBN 0·86577-6954 GTV ISBN 3·13·108061·2

Dedication

This book is dedicated to my dad and hero, the late Thomas Pope, Sr.; to my family, Roger (and Cathy) and Florence Pope; and especially to my emotional support, my wife, Lou and my sons David and Jason. Without all of them, life would be much less tolerable. Thomas Lee Pope, Jr., M.D., F.A.C.R.

I dedicate this work to my loving wife, Laura; to Dr. C. Douglas Maynard; and to the Department of Radiology at Wake Forest University Medical Center for their encouragement, support, and patience during completion of this project. Stephen Loehr, M.D.

Contents

Foreword by Lee F. Rogers, M.D. ................. ......... ........................................... ...... ... ................... ...... .......... . .....

ix

Preface

XI

.

.

.

.

.

.

.

. .

............................................ . ....... . . . . . .......... . . . . . . . . . .... . . . .. . . . . . . ........ ...... . . . . . .................................................................

I.

Introduction: General Technical Considerations

2.

The Shoulder and the Upper Extremity ......................................................................................................

7

The Shoulder: Axial Anatomy..................................................................................................................

13

The Shoulder: Oblique Sagittal Anatomy...............................................................................................

25

The Shoulder: Oblique Coronal Anatomy..............................................................................................

43

B. The Upper Extremity..................................................................................................................................

59

The Upper Extremity: Axial Anatomy ....... ............................................. ..............................................

63

The Upper Extremity: Sagittal Anatomy ........................................................................................... ....

69

The Upper Extremity: Coronal Anatomy ................ .......... .......... .................................. .....................

81

.

.

.

.

3.

7

A. The Shoulder................................................................................................................................................

.

.

.

The Elbow and Forearm ..................... ... ........ ....................... ..... ..................... ......... ...... .

.

.

.

.

.

..

. .. ... ...........

....

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.

.

93

The Elbow: Axial Anatomy ......... ............................ ......... .... ........... .................... ....... ..................... 105 .

.

.

.

.

.

...

The Elbow: Sagittal Anatomy.... . .............. ................................................................... . .

.

...................... 1 1 9

....

The Elbow: Coronal Anatomy. ........ ............................... ............ ................... .......... . ............ ........... 1 4 1 .

.

.

..

.

. .

.

The Forearm: Axial Anatomy. ....................................... .................... ............................................ ...... 1 55 .

.

..

.

The Forearm: Sagittal Anatomy ............................ . ...................... ... ... ..................... ................. ...... 1 6 1 ..

.

.

.

.

...

.

The Forearm: Coronal Anatomy .................... ..................................... ..................... .. ...... ................ 1 73 ..

VII

.

.

..

..

Contents

VIII

4.

The Wrist and Hand

.. .

............................................... .....

.

. ..

.. ......... ................ . . . . .. . . . . ... ..

..

. ........

.

. . . . . . . . ..............

1 85

The Wrist and Hand: Axial Anatomy ..................................................................................................... 1 93 The Wrist and Hand: Sagittal Anatomy

...........

209

... . . . . . . . . . . . . . . . .. . . . . . . . ................. ....... ............................................

.

.

223

.

.

The Hips: Sagittal A natomy .

.......

The Hips: Coronal A natomy

...... . . . . . . .

.

232

................................... . . . . . . ........ . . . . .. . . . . . . . . . .. . . . . . .................

.

245

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..

...

...

.... ................ ....

..

.....

. ..

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.

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.

..

.

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...

..

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..

..

............

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.. . . .

..

.

.. ... . . . .

.

.

.............. .......

.

. . . .... .. ......................... ..

.

...........................

.. .

. . . . . . . . . . . .................................... .... .....

....

..

..

. . ............ . . . .........

.

..

...... ......

..

.

................... .

....

......................... . . . .

.

. . . . . . .................... . . . . . . . . .................................................

.

. . ..... ......................... ...................................................

. . . . . . ........... .. . . . .......

.

. . ............................................................................

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. . . . ..... . . ................. . . . . . .

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. .

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.

. . . . .... . . . . . . ... . . . . . . . . . . . . . ..................... . . . . . . . . . . . . ............................................ ....

The Lower Extremity: Axial Anatomy

. .

.

. . . . . . . .......... . . . . ...... .. ........ . . . . . . ......................... ................... .........

The Lower Extremity: Sagittal Anatomy

.. .

..................

The Lower Extremity: Coronal Anatomy

.

.

.

.

................. ........ . . . . . .

. ..

..

. . . .............. . . . . . . . . . .

..

.......................... .

The Ankle: Coronal Anatomy

.

. . . ......

.

.

.

.

.. .. .

. . . . . . .......

.

.. .. .

. . . . . . . . . . ........ . .......

.. .. ... .

.

.....

.

.

.

.

.

..

.....

.

.

257 269 289 301 311 323

343 355 377 393 413 423 43 1

. . 445

. ...... ..... ............. .

..

............. . . . . . . . . . . . . ...... . . . . . . . . . . .

. . . . ........ . . . . .....

. . . . . . . ..........................

....... . . . . . .

............................... . . . . . . . . .......... . . . . . . . . . .

The Ankle: Sagittal Anatomy

.

.. ...... . . . . . . . . . ..... . . ..................... ...........................

.......................................................... .

The Ankle: Axial Anatomy

. ..

.

The Knee and the Lower Extremity

The Knee: Coronal A natomy

.

.......................... .............

....

................................... . . . . . .. . . . . . ..... . . ......... . . . . . . .. . . . . ................................... . . . .

The Knee: Sagittal Anatomy .

...

.

.........

.............

... .

....

. . . . . . . . ...................

455 47 1

.. :............................................... 485

. . . . . . . . . ..... . . . . . . . . . .

.

.. .

........................................ .....................................................

...

. . . . . ......... . . . . . . . . . . . ..............

505

.

511

...

5 17

.... . . . .

523

. . . .................. ............. .......................... . . . . . . . . . . . ................................. . . . . ........... . . . . . .......................... .............. . . . . . . . .. . ....

525

The Lumbar Spine: Axial Anatomy

Works Consulted

.

. .

.

............................. .. ......

The Lumbar Spine: Sagittal Anatomy

Index

. . . ...

.

.

.... .

The Lumbar Spine

.

......... .........

. . . . . . ....... . . . ....... ..................... ............

The Thigh: Axial Anatomy ..

The Knee: Axial Anatomy

8.

.

...

.

....... ............

The Thigh: Sagittal Anatomy

The Ankle and Foot

..

. . ........ . . ....................

..

The Thigh: Coronal Anatomy

7.

..

.

.......... ...................... . .......... ................................ ............. . . ......................

.

6.

..

. . . ...................... ....................

The Hips: Axial Anatomy

.

. . . ............... ........................... ........

..................

. . . . . . . . ...

The Hips and Thigh

.. . . . . . . . . .

.

The Wrist and Hand: Oblique Coronal. .

5.

.

...... ...........

The Wrist and Hand: Coronal Anatomy

.

.

.

..

....... ............. ..................... ......... . . . .

.

.

. . . ..

.

............. .... ........................................................... ........ ... . . . . . . . .

.. .

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..

.

.

..

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. .

......

..

.. ..........

.

Foreword

Anatomy is important. In musculoskeletal radiology, as in real estate, it is location, location, location. Where the property is located or where the lesion is located makes all the difference in the world. In real estate, location is the major determinant of property value, whereas in the interpretation of musculoskeletal imaging, location is a major determinant in the recognition of the true nature of a lesion and a key to the development of an appropriate differential diagnosis. Where a lesion is goes a long way to telling you what it is. And by knowing precisely where it is and what is around it, the surgeon can devise an approach to the lesion and knows what to watch out for along the way. There is simply no substitute for knowledge of anatomy. Very few radiologists involved in cross-sectional imaging, even specialists in skeletal radiol ogy, know human anatomy so well that they can confidently interpret magnetic resonance imaging and computer tomography without feeling the need to refer to an anatomic atlas of some sort from time to time. This is particularly true when faced with an examination of an infrequently examined joint. And even more so when the area of interest is at a distance from a joint. Because of the heightened role of cross-sectional imaging in the assessment of soft tissue abnormalities (i.e., tumors, infections, and the like), such examinations are much more frequent than in the past and, indeed, in some medical centers have become an everyday occurrence. Therefore, there is a frequent need to refer to an anatomic atlas to aid in the interpretation of these examinations. So you go to the bookcase seeking information in order to properly identify the appropriate muscles, tendons, and fascial planes, and determine the critical relationships of the lesion in question to the surrounding nerves and vascular structures. After taking down an atlas to look up the important anatomy, you often find it to be devoid of information regarding anatomy along the shaft of long bones away from the joints. Unfortunately the anatomical diagrams and accompanying images are limited to the joints and there is no illustration of the anatomy in between. This portion of the anatomy is left to your imagination! Or maybe you are lucky enough to find an illustration of the anatomy you seek, only to realize that the illustration is of the opposite extremity-that is, the side opposite the one you IX

x

Foreword

are interested in, the side opposite that in which the lesion in question is located. All illustrations are limited to a single extremity, say the right extremity, and it j ust so happens that you are faced with a lesion in the left extremity. There is, of course, a 50/50 chance that this will occur. You are out of luck and posed with the requirement of "mirror-image thinking." You have to reverse the image in your mind to determine the anatomy on the side you are interested in, the side opposite that displayed in the atlas. This is not always easy; realizing, of course, that if you are not careful you could make a mistake. This work was borne out of the preceding frustrating experiences, spawned by authors who came to the realization that there must be a better way. And there is. Why not an atlas that depicts both extremities and does away with "mirror-image" thinking? And while we're at it, let's illustrate the anatomy between the joints, as well. Anyone who interprets cross sectional images would immediately recognize the value of such a work. Well, here it is. You hold it in your hands. Feast your eyes on its content. Peruse the illustrations. Yes, left and right, both sides at the joints and all points in between are there. All in all, a practical, useful, and instructive contribution. If you do musculoskeletal imaging, if you interpret musculoskeletal images, or if you are an orthopaedist, rheumatologist, or physiatrist, I am certain this work will be of value to you in your practice. This is the atlas we've been waiting for. The authors are to be commended for their fine efforts. Drs. Pope and Loehr have produced an easy-to-use, comprehensive, and informative atlas that should prove to be of immeasurable value to all who have the need for precise knowledge of musculoskeletal anatomy as displayed by all forms of musculoskeletal im agmg. Lee F. Rogers, M.D. Winston-Salem, North Carolina

Preface

This atlas was conceived at the view box while reading clinical MR images. While interpreting these images, we would invariably need to consult the standard anatomy books. However, these texts were often insufficient: The image to be interpreted showed the right extremity, but the anatomy book demonstrated the left, or vice versa. This mismatch resulted in some interesting and challenging translations from the reference book to our clinical images. Further more, the middle regions of the extremities usually were not included in the standard anatomy texts. Therefore, only by extrapolation from the highest or lowest images of the joint exhibited in the textbook could we estimate the anatomy in the midportion of the extremities of our images. Finally, many textbooks of anatomy do not include the origin and insertion of muscles or any discussion of the joints that are exhibited. These shortfalls prompted us to consider how we could design a text to overcome most of these problems. The solution, in our opinion, was to create an atlas that not only demonstrated both right and left-sided images as they are usually interpreted at the view box, but that also included the middle regions of the extremities. Such an atlas would also need to include the origin and insertion of the major muscles of each anatomic region and a brief introduction to the joint at the beginning of each chapter. Atlas of Musculoskeletal Imaging is the result of our ideas. The major joints, the pelvis, and selected images of the spine are included. Detailed, yet practical labeling of each anatomic image is provided. The atlas is not intended to be all inclusive, and we have selected only the most clinically practical images. Each chapter is organized as follows: A brief "introduction" to the anatomic area precedes the "practical protocol suggestions" section that outlines general hints about obtaining optimal images. Next is the "menu of protocols" that includes the more common technical parameters used in each anatomic area. An outline of "major osteochondral structures/landmarks" is next and lists the important structures with which to be familiar in each organ system. Finally, the "origin/insertion/innervation of major muscles" section provides a practical body of information often needed when interpreting clinical images. These sections were created because they seem to be most practical in the day-to-day clinical situations. XI

xii

Preface

Our intention is for this text to serve as a practical and user-friendly guide that can be used in the day-to-day interpretation of MR images. We hope that it will find a home on the shelves beside the reading room rollerscopes or workstations, in the libraries, or in the offices of radiologists who interpret musculoskeletal M R images, and on the shelves of the offices of orthopaedic surgeons and rheumatologists who request these studies. We solicit the suggestions of anyone who has an opportunity to use the book and look forward to hearing your comments. No book is without flaws, and this one may contain some errors that were missed. If so, please let us know, and we will ensure that they are addressed in the next edition. Thomas Lee Pope, Jr., M.D., F.A.C.R. Stephen Loehr, M.D.

Acknowledgments

No textbook is a single-handed endeavor, and this book is no exception. We greatly appreciate the frustration expressed by many musculoskeletal fellows and residents because they could not find a simple-to-use atlas. Without their difficulty, the idea for this book would not have been developed. We thank Ms. Sharon Meister for her tireless dedication to excellence in transcribing the text for the book, and for coordinating and collating text. We also thank Dr. Donna Garrison and Mr. Terry Poovey, the medical editors of our department, who made sure that we all sound good on paper. Finally, we thank our Chair, Dr. C. Douglas Maynard, for creating a professional atmosphere conducive to academic productivity and cooperative interpersonal relationships, both requirements for completing projects like this one. Thomas Lee Pope, Jr., M.D., F.A.c. R. Stephen Loehr, M.D.

xiii

1 INTRODUCTION: GENERAL TECHNICAL CONSIDERATIONS Patients undergoing musculoskeletal magnetic resonance (MR) imaging should be examined with the smallest coil that covers the body part, thereby achieving the highest signal-to-noise ratio and the best spatial resolution. For imaging of the joints and extremities, surface coils are mandatory as they improve the signal-to-noise ratio by four to six times compared to the head or body coils. The smallest field of view possible should be used. Individual variations are present among the wide range of scanners now available, and each location should determine for itself which sequences are best. The protocols described in each section were developed primarily on General E lectric l.5-T magnets. Obviously, images of diagnostic quality can be obtained with a variety of scanners, and the recommended protocols may require modification to suit the scanner at the institution and the personal preferences of the imager. The general principles regarding selection of pulse sequence and planes are most important. Furthermore, the major indicator of success is the satisfaction of the imager and the referring physician with their diagnostic results when these results are confirmed by arthroscopy, surgery, or patient outcome. Positioning the patient properly in the M R imaging scanner is critical to obtaining diagnostic images. Technologists should pay particular attention to the placement of an extremity within the coil for an optimal selection of the slices. For best results, images should be obtained in axial, coronal, and sagittal planes. Axial MR images are probably most critical in the evaluation of a soft-tissue mass thought to be a tumor, so that the relationship of the mass to the neurovascular bundles and other important structures can be ascertained.

1

2


KEY TO ACRONYMS

Acronym

Explanation/Meaning

EPI ETL FA FMPIR FOV FS FSE GAD GRASS GRE IR MPGR NEX PS RL SE SI SPGR ST/G TE TI TR VAR

Echoplanar imaging Echo-train length Flip angle (900 unless otherwise specified) Fast multi planar inversion recovery Field of view (cm) Fat saturation Fast spin echo Gadolinium Gradient-recalled acquisition in the steady state Gradient echo, gradient-recalled echo Inversion recovery Multiplanar GRASS Number of excitations Pulse sequence Right to left Spin echo Superior to inferior Spoiled GRASS Slice thickness and gap (mm) Time to echo (msec) Inversion time Time to repetition (msec) Variable (dependent upon size of abnormality or patient)


3

SUMMARY OF FAST MR TERMS

Term

Abbreviation

Explanation

Example of Manufacturer

Characteristic Feature

General EPI ETl FOV GRE IR MR NEX NSA SE SNR TE TI TR

Echoplanar imaging Echo train length Field of view Gradient-recalled echo Inversion recovery Magnetic resonance Number of excitations Number of signals averaged Spin echo Signal-to-noise ratio Echo time Inversion time Repetition time

FLASH FFE PSR FE MP-RAGE

Fast low-angle shot Fast field echo Partial saturation recovery Field echo Magnetization-prepared rapid gradient echo

Siemens, Bruker Philips Picker Elscint

SPGR

Spoiled gradient-recalled imaging

General Electric

GRE sequence with spoiling gradient GRE sequence with spoiling gradient GRE sequence with spoiling gradient GRE sequence with spoiling gradient 1800 IR pulse GRE sequence with spoiling gradient GRE sequence with spoiling gradient

SSFP PSIF

Siemens Siemens

GRE sequence with TE GRE sequence with TE

> >

TR TR

Picker

GRE sequence with TE

>

TR

FSE

Steady-state free precession Reversed fast imaging with steady state precession, collection of the refocused echo Contrast-enhanced Fourier-acquired steady-state technique Fast spin echo

FAIST

Fast-acquisition interleaved spin echo

GRASE

Gradient and spin echo

T1-weighted sequence

T2-weighted sequence

CE-FAST

More than one echo per excitation with multiple 1800 pulses More than one echo per excitation with multiple 1800 pulses Multiple 1800 pulses and gradient recalled echoes ( continued)

4



Term

Abbreviation GREASE RARE

Explanation

(CONTINUED) Example of Manufacturer

Characteristic Feature GRE with multiple 180° pulses More than one phase-encoding step per excitation Half Fourier imaging FRE with multiple 180° pulses

turboFLASH

Gradient echo and spin echo Rapid acquisition with relaxation enhancement Rapid acquisition spin echo Turbo gradient spin echo, identical to GRASE Turbo fast low-angle shot

turboSE

Turbo spin echo, identical to FSE

Siemens

GRASS

Gradient-recalled acquisition in the steady state Fast imaging with steady-state precession Fourier-acquired steady-state technique

General Electric

GRE without spoiling gradient

Siemens Picker

GRE without spoiling gradient GRE without spoiling gradient

RASE TGSE

Siemens Siemens Siemens, Bruker

180° inversion recovery pulse plus GRE sequence More than one echo per excitation with multiple 180° pulses

T1- + T2-weighted sequence and variable weighting FISP FAST Echoplanar sequence ABEST BEST EPISTAR Instascan MBEST mesh

Asymmetric blipped echoplanar singlepulse technique Blipped echoplanar signal-pulse technique Echoplanar imaging with signal targeting and alternating radiofrequency Brand name for EPI sequence Modulus-blipped echoplanar single-pulse technique Interleaved K-space scan

Advanced NMR Systems

One 90° pulse, rectangular scanning of K-space One 90° pulse, rectangular scanning of K-space One 90° pulse, rectangular scanning of K-space One 90° pulse, rectangular scanning of K-space One 90° pulse, rectangular scanning of K-space Meshed scanning of K-space (cantin ued)



Term

Abbreviation

Explanation

5

(CONTINUED) Example of Manufacturer

Characteristic Feature

Motion suppression technique COPE

Cardiac-ordered phase encoding

FAT SAT FRODO

Fat saturation pulse Flow and respiratory artifact obliteration with directed orthogonal pulses

MAST ROPE

Motion artifact suppression technique Respiratory-ordered phase encoding

STIR

Short inversion time inversion recovery

Phase-encoding steps triggered by ECG Presaturation pulse suppresses signal from fat Presaturation pulse suppresses signal from vessels and from tissue outside the area of interest Phase-encoding steps triggered by respiration lR sequence with short T1

From Dr. Saini, with permission. Petersein J, Saini S. Appendix: Summary of fast MR terms. Fast MR Imaging: Technical Strategies. AJR 1995;165:1105-1109.

2 THE SHOULDER AND THE UPPER EXTREMIlY A. THE SHOULDER

The glenohumeral joint is commonly evaluated by magnetic resonance (MR) imaging. The major indications for MR imaging are suspected rotator cuff abnormality, glenohumeral instabil ity, and chronic and unexplained shoulder pain. The most common pathologic processes are tendinosis, partial or complete tears of the rotator cuff tendons (injuries to the supraspinatus are by far the most frequent), glenoid labral abnormalities, biceps tendon displacement or injury, and spinoglenoid ganglia. PRACTICAL PROTOCOL CONSIDERATIONS

The patient is routinely imaged in the supine position, with either a surface coil or paired fiat coils placed above and below the shoulder in a Helmholtz configuration. The advantage of the Helmholtz configuration is the additive signal-to-noise ratio created by the two coils. Flexible quadrature and phased-array coils have also been used recently to improve the signal-to-noise ratio and increase the anatomic area covered by the study. The patient's arm is at his or her side and is either in the neutral position or slightly externally rotated position to decrease overlapping of the infraspinatus and supraspinatus tendons. Abduc tion and external rotation have also been used to facilitate evaluation of partial rotator cuff tears, but this positioning is not in common use today.

7

•

8


Menu of Protocols: Glenohumeral Joint Plane

Pulse Seguence

Localizer (coronal) Localizer (coronal) Localizer (axial) Coronal (oblique) Coronal (oblique) Sagittal (oblique) Sagittal (oblique) Sagittal (oblique) Transaxial Transaxial Transaxial Transaxial

FMPIR FSE 2D SPGR SE, double echo FSE, double echo, (+/-1-FS) SE, double echo FSE ( +/-1-FS) FSE (+/-1-FS) SE, double echo MPGR 3D GRE FSE (+/-1-FS)

FA (degrees)

30 20

TE TR (msec) (msec) 2,500 600 30 2,000 3,000 2,000 3,000 5,500 2,000 450 30 3,000

30 17 min 20/80 17/102 17170 20 85 20/80 15 15 85

TI (msec)

FOV (cm)

Matrix (256X-)

ST/G (mm)

NEX

Comments

150

36 35 20 14 16 16 14 16 14 14 15 16

128 128 128 192 192 192 192 192 192 192 128 192

5/1.5 5/1.5 5/0 4/1 5/1 3/1 4/1 4/.5 4/1 4/1 1.2/0 4/.5

1 2 2 1 2 1 2 2 1 1 2 2

Either is acceptable

MAJOR OSTEOCHONDRAL STRUCTURES/LANDMARKS •

•

Scapula - Acromion - Spine of scapula - Glenoid cavity of scapula (with its articular cartilage) - Body of scapula - Coracoid process Infraglenoid tubercle (origin of long head of biceps tendon) - Proximal humerus - Humeral articular cartilage - Greater tuberosity of humerus - Lesser tuberosity of humerus - I ntertubercular sulcus (for biceps tendon) - Clavicle - Acromioclavicular joint - Anterior glenoid labrum - Posterior glenoid labrum - Superior glenoid labrum - Inferior glenoid labrum

Either is acceptable Either is acceptable Either is acceptable

Shoulder and Upper Extremity

MAJOR LIGAMENTS/TENDONS/BURSAE Tendons •

• • •

"SITS" tendons - Supraspinatus - Infraspinatus - Teres minor Subscapularis Long head of biceps Coracobrachialis

Ligaments • •

• • • •

Coracoclavicular (conoid and trapezoid components) Acromioclavicular Coracoacromial Sternoclavicular Coracohumeral Glenohumeral ligaments (focal thickenings of the anterior joint capsule) - Superior - Middle - Inferior

Bursae •

• • • • • • •

Subacromial/subdeltoid (most important) Subscapularis ( normally communicates with glenohumeral joint) Infraspinatus Subcoracoid Coracobrachialis (not identified often on MR images) Latissimus dorsi Teres major Pectoralis major

9

10


ORIGIN/INSERTION/INNERVATION OF MAJOR MUSCLES

Origin

Insertion

Innervation

-Supraspinatus (SS) -Infraspinatus (IS)

Supraspinatus fossa of scapula Infraspinatus fossa of scapula

Suprascapular nerve (N.) (C5, C6) Suprascapular N. (C5, C6)

-Teres minor (TM) -Deltoid

Lateral margin of scapula Lateral third of clavicle, acromion, scapular spine Suprascapular fossa

Greater tuberosity of humerus Greater tuberosity of humerus (below SS insertion) Posterior facet of greater tuberosity Deltoid tuberosity of humerus Lesser tuberosity

Subscapular N. (C5, C6) Thoracodorsal N. (C6-C8)

Muscle Dorsal Group

-Subscapularis -Latissimus dorsi

Spinous processes (T6-T12), thoracolumbar fascia of L spine and sacrum

Medial aspect of intertubercular groove

Sternal half of clavicle, sternum, costochondral j unctions Anterior ribs 2-5

Lateral aspect of intertubercular groove Coracoid process of scapula Inner surface of humerus

Axillary N. (C5, C6) Axillary N. (C5, C6)

Ventral Group

-Pectoralis major

-Pectoralis minor -Corabrachialis

Coracoid process of scapula

Medial/lateral anterior thoracic N. (C5-Tl) Medial pectoral N. (C8-Tl) Musculocutaneous N. (continued)


ORIGIN/INSERTION/INNERV ATION OF MAJOR MUSCLES

(CONTINUED)

Origin

Insertion

Innervation

-Teres major

Inferior and lateral aspect of scapula

Subscapular N. (CS, C6)

-Trapezius

Ligamentum nuchae, spinous processes of thoracic vertebrae Posterior tubercles, transverse processes of C1-C4

Medial aspect, intertubercular groove Distal clavicle, acromion, spine of scapula Upper and medial scapula

Cervical plexus (C3-C4)

Posterior and medial scapula Posterior and medial scapula

Dorsal scapular N. (CS) Dorsal scapular N. (CS)

Anterior and medial scapula Middle and inferior clavicle

Long thoracic N. (CS-C7) Subclavian N.

Muscle

11

Other Muscles

-Levator scapulae

-Rhomboids -Major -Minor

-Serratus anterior -Subclavius

Spinous processes of C2-TS Ligamentum nuchae, spmous processes of C7/Tl Ribs 1-9 Anterior and medial first rib

Spinal accessory and C2, C3

THE SHOULDER: AXIAL ANATOMY

14


\

clavicle humeral head

acromion coracoid process

deltoid m.

subclavian a.

supraspinatus m.

omohyoid m.

spine of scapula


15

clavicle

acromIOn

humeral head

coracoid process

subclavian a.

ol11ohyoid

111.

deltoid m.

supraspinatus m. spine of scapula

16

Atlas of Musculoskeletal I maging

lesser tubercle

ant. glenoid labrum

pectoralis major m. pectoralis minor m. biceps t. (long head) greater tubercle humeral head deltoid ill.

---

subclavian a.

--

biceps t. (short head) coracobrachialis m. serratus ant m. glenoid

post. glenoid labrum

subscapularis m. infraspinatus m.


ant. glenoid labrum

17

lesser tubercle

pectoralis major m. pectoralis minor m. subclavian a. biceps t. (short head) coracobrachialis m. serratus ant m.

biceps t. (long head) greater tubercle humeral head deltoid m.

glenoid subscapularis m. infraspinatus m.


18

Atlas of Musculoskeletal lmaging

lesser tubercle

ant. glenoid labrum

coracobrachialis ffi.

biceps t. (long head)

pectoralis major ill. __

pectoralis minor m.

greater tubercle ---

humeral head

subclavian a. biceps t. (short head) subscapularis m.

deltoid m.

serratus ant m. glenoid


infraspinatus m.


coracobrachialis m.

pectoralis major m.

ant. glenoid labrum

19

lesser tubercle


pectoralis minor m. greater tubercle subclavian a. biceps t. (short head)

humeral head

subscapularis m. serratus ant m.

deltoid m.

glenoid post. glenoid labrum infraspinatus m.

20



ant. glenoid labrum pectoralis major m.

greater tubercle ---

humeral head

pectoralis minor m. subclavian a. coracoid process

deltoid m.

--- glenoid subscapularis m.


subscapular a. & n. infraspinatus m.


ant. glenoid labrum

21

biceps t . (long head)

pectoralis major m. greater tubercle pectoralis minor m. subclavian a.

humeral head

coracoid process glenoid

deltoid m.

subscapularis m. subscapular a. & n. infraspinatus m.


22


cephalic v.

pectoralis major m. pectoralis minor m.

biceps t. (short head) coracobrach.ialis m. biceps t. (long head) brachial plexus humerus triceps m. (long head)

deltoid m. teres minor m.

subscapularis m.

scapula


pectoralis major m.

23

cephalic v.

pectoralis minor m. biceps t. (short head) coracobrachialis m. biceps t. (long head) brachial plexus _-

subscapularis m.

humerus triceps m. (long head)

deltoid

111.

teres minor m.

THE SHOULDER: OBLIQUE SAGITTAL ANATOMY

26


deltoid m. coracoclavicular lig. spine of scapula infraspinatus m.

supraspinatus m. coracoid process

scapula

pectoralis major m.

teres minor m.

pectoralis minor m.

subscapularis m. teres major m. axillary v.


27

deltoid m. coracoclavicular lig. supraspinatus m. coracoid process pectoralis major m.

pectoralis minor m.

spine of scapula infraspinatus m.

scapula

f---- teres minor m.

subscapularis m. teres major m. axillary v.

28


acromioclavicular Jig.

deltoid m.

spine of scapula

clavicle

supraspinatus m.

coracoclavicular lig. coracoid process

deltoid m.

subscapularis t & m. infraspinatus m. scapula teres minor m.

subscapular a. subscapularis m. teres major m.

---

thoracoacromial a. (pectoral br.) pectoralis minor m. pectoralis major m. axillary a. & brachial plexus


deltoid m.

clavicle coracoclavicular lig.

29

acromioclavicular lig.

spine of scapula supraspinatus m.

coracoid process subscapularis t & ill. thoracoacroillial a. (pectoral br.) pectoralis minor ill.

deltoid m. infraspinatus ill . 1---- scapula

pectoralis major ill.

teres minor m.

axillary a. & brachial plexus

subscapular a. subscapularis m. teres major m.

30



spine of scapula supraspinatus m.

clavicle

coracoclavicular Iig.

deltoid m. coracoid process

infraspinatus m. deltoid m. glenoid

thoracoacromial a. (pectoral branch) pectoralis minor t. biceps t. (long head)

teres minor m.

pectoralis major m.

subscapular a. subscapularis m. teres major m. brachial a.

coracobrachialis m.


coracoclavicular lig.

deltoid m. coracoid process thoracoacromial a. (pectoral branch) pectoralis minor t.

clavicle

31


spine of scapula supraspinatus m. infraspinatus m. deltoid m. glenoid

biceps t. (long head) pectoralis major m.

teres minor m. subscapular a.

subscapularis m. teres major m. coracobrachialis m.

brachial a.

32



acromion supraspinatus m. glenoid infraspinatus m. deltoid m. teres minor m.


deltoid m. coracohumeral lig. coracoid process biceps t. (long head) :--'11--- coracobrachialis m. & biceps t. (short head) subscapularis m.

subscapular a. pectoralis major m. teres major m.




deltoid m.

acromIOn

coracohumeral Iig.

supraspinatus m. glenoid

coracoid process biceps t. (long head) coracobrachialis m. & biceps t. (short head)

33

�--

infraspinatus m. deltoid m. teres minor m.

subscapularis m. subscapular a. pectoralis major m. teres major m.

34


supraspinatus m. & t. acromIOn infraspinatus m. deltoid m.

coracoacromial lig.

transverse humeral lig. biceps t. (long head) deltoid m. subscapularis m.& t.

humeral head pectoralis major m. teres minor m. musculocutaneous n. axillary a. triceps m. (long head) teres major m.

coracobrachialis m. brachial plexus


coracoacromial lig.

35

supraspinatus m. & t. acromIOn

biceps t. (long head) deltoid m.

infraspinatus m. deltoid m.

subscapularis m.& t. humeral head pectoralis major m. teres minor m. musculocutaneous n. axillary a. coracobrachialis m. brachial plexus

triceps m. (long head) teres major m.

36


supraspinatus m.

deltoid m.

acromion

supraspinatus t.

coracoacromial Iig.

infraspinatus m. & t.

humeral head teres minor m. post circumflex humeral a. & axillary n.


pectoralis major m.

humerus teres major m.

coracobrachialis m.


supraspinatus t.

acromIOn

37

supraspinatus m.

deltoid m.

coracoacromial lig.

infraspinatus m. & t.


pectoralis major m.

--

humeral head

---

teres minor m. post circumflex humeral a. & axillary n. humerus

coracobrachialis m.

teres major m.

38


supraspinatus m.

acromion

supraspinatus t. coracoacromial lig.

infraspinatus m. ___

humeral head deltoid m. teres minor m. post circumflex humeral a. & axillary n.

deltoid m. transverse humeral lig. biceps t. (long head)

'---- pectoralis major m.

axillary a. & v. & brachial plexus

triceps m. (long head) humerus teres major m.

coracobrachialis m.


supraspinatus t.

acromion

39

supraspinatus m.

coracoacromial lig.

infraspinatus m. deltoid m. transverse humeral lig. biceps t. (long head) pectoralis major m.

axillary a. & v. & brachial plexus

humeral. head deltoid m. teres minor m. post circumflex humeral a. & axillary n. triceps m. (long head)

coracobrachialis m.

humerus teres major m.

40


humeral head infraspinatus m. biceps t. (long head)

deltoid m.

deltoid m.

humerus, neck triceps m. (long head) deltoid m.


41

humeral head infraspinatus m. biceps t. (long head) deltoid m.

deltoid m.

humerus, neck triceps m. (long head) deltoid m.

THE SHOULDER: OBLIQUE CORONAL ANATOMY

44


clavicle coracoacromial lig. coracohumeral lig. humeral head deltoid m.

trapezius m.

supraspinatus m. coracoclavicular lig. coracoid process

brachial a. & plexus serratus ant. mm.


45

clavicle trapezius m.

supraspinatus m. coracoclavicular Jig. coracoid process

coracoacrornial lig. coracohumeral lig. humeral head deltoid m.

brachial a. & plexus serratus ant. mm.

46


acromion

trapezius ill . supraspinatus ill.

sup. glenoid labrum biceps t. (long head) deltoid ill .

suprascapular a. & o. glenoid

lesser tubercle subscapularis m. subscapularis t. post. circumflex humeral a. & axillary n. coracobrachialis ill. latissimus dorsi m.


trapezius m.

_ _

-

47

acromion

supraspinatus m. sup. glenoid labrum suprascapular a. & n. glenoid

biceps t. (long head) deltoid ffi. lesser tubercle

subscapularis m. subscapularis t. post. circumflex humeral a. & axillary n. coracobrachialis m. latissimus dorsi m.

48


clavicle trapezius m.

acromioclavicular jt. sup. glenoid labrum supraspinatus t.

supraspinatus m. __

suprascapular a. & n.

greater tubercle glenoid humeral head deltoid m.

info

glenoid labrum

biceps t. (long head) subscapularis m. post. circumflex humeral a. brachial a. coracobrachialis m.


49

clavicle trapezius m. supraspinatus m. suprascapular a. & n.

acromioclavicular jt. sup. glenoid labrum supraspinatus t. greater tubercle

glenoid

info

glenoid labrum

humeral head deltoid m. biceps t. (long head)

subscapularis m. post. circumflex humeral a. brachial a. coracobrachialis m.

SO


trapezius m.

acromion

supraspinatus ITI .

supraspinatus m.

sup. glenoid labrum deltoid m. suprascapular a. & n. greater tubercle glenoid humeral head info glenoid labrum deltoid m. subscapularis m.

post. circumflex humeral a. & axillary n. coracobrachialis m.

brachial a.

subscapular a.


trapezius m.

acromIOn

supraspinatus m. sup. glenoid labrum

51

supraspinatus m. _ _ _

deltoid m. suprascapular a. & n. greater tubercle glenoid humeral head inf. glenoid labrum deltoid ffi. subscapularis m.

post. circumflex humeral a. & axillary n. coracobrachialis m.

subscapular a.

brachial a.

52


acrorruon scapular spine supraspinatus m. & t. sup. glenoid labrum

greater tubercle humeral head

infraspinatus m.

deltoid m. glenoid

axillary n. post. circumflex humeral a. humerus brachial a.

-__

subscapular a. teres minor m.


53

acromIOn scapular spine

sup. glenoid labrum

infraspinatus m.

supraspinatus m. & t. greater tubercle humeral head deltoid m.

glenoid subscapular a. teres minor m.

axillary n. post. circumflex humeral a. humerus brachial a.

54


acromIOn

supraspinatus m.

subacromial fat

infraspinatus m.

humeral head

teres minor m.

triceps m. (long head) deltoid m. subscapular a. post. circumflex humeral a. teres major m. humerus latissimus dorsi m.


supraspinatus m.

acromIOn

infraspinatus m.

subacromial fat

teres minor m.

55

humeral head

triceps m. (long head) deltoid m. subscapular a. post. circumflex humeral a. teres major m. humerus latissimus dorsi m.

56


acromion

deltoid m.

teres minor m.

infraspinatus m.

post. circumflex humeral a.

triceps ffi . (long bead) teres major m. humerus


57

acromion

deltoid m. infraspinatus m.

teres minor m.

---

teres major m.

post. circumflex humeral a.

triceps m. (long head) humerus


59

B. THE UPPER EXTREMITY

The major indications for MR imaging of the upper arm include suspected metastatic disease, avascular necrosis, infection, and primary soft-tissue tumors. Generally, these studies are moni tored while the patient is in the scanner, and the images are approved before the patient leaves the MR imaging suite. PRACTICAL PROTOCOL CONSIDERATIONS

For an MR imaging examination of the upper arm, the patient is placed in a comfortable supine position. If there is a palpable abnormality or surgical scar, or if a suspicious area is identified during physical examination, a bath oil bead or vitamin E tablet is placed at the site. For a surgical site, both the proximal and distal ends of the scar should be marked with the bead or tablet. Whether a body or surface coil is used depends on the clinical indication for the study. I n general, sagittal, coronal, and axial planes are used. The axial plane i s the most important of these because it shows the relationship of any abnormality to the neurovascular bundle and other vital structures best. Menu of Protocols: Upper Arm Plane

Pulse Sequence

Localizer (transaxial) Coronal, sagittal Coronal Coronal Sagittal Sagittal Axial Axial, pre-GAD Axial, pre-GAD

SE SE SE FMPIR SE FMPIR SE, double echo, FS SE SE, FS

FA (degrees)

TR TE TI (msec) (msec) (msec)

FOV (cm)

Matrix (256X-)

ST/G (mm)

NEX

Comments

500 500 1,000 2,500 1,000 2,500 3,000 600 600

VAR VAR VAR VAR VAR VAR VAR VAR VAR

128 192 192 128 192 128 192 192 192

4/ 5/1.5 5/1.5 5/1.5 5/1.5 5/1.5 4/1 4/1 4/1

1 2 2 2 2 2 2 2 2

Mark area of concern

min min min 30 min 30 19/90 20 20

150 150

MAJOR OSTEOCHONDRAL STRUCTURES/LANDMARKS

(See Glenohumeral Joint and Elbow)

Repeat after GAD Repeat after GAD

60


MAJOR LIGAMENTS/TENDONS/BURSAE

(See Glenohumeral Joint and Elbow) MAJOR MUSCLES Compartments

The muscles of the upper arm are divided into an anterior group and a posterior group . Anterior compartment - Coracobrachialis - Biceps brachii - Long head - Short head - Brachialis • Posterior compartment - Triceps brachii - Long head - Medial head - Lateral head - Anconeus •


Muscle

Origin

Insertion

Innervation

Tip of coracoid process III common with short head of biceps brachii muscle Supraglenoid tubercle of scapula

Medial surface of humerus j ust proximal to its midportion

Musculocutaneous N.

After union with short head, into radial tuberosity

Median N .

Anterior Compartment

-Coracobrachialis

-Biceps brachii, long head

(continued)



(CONTINUED)

Muscle

Origin

Insertion

Innervation

-Biceps brachii, short head

Tip of coracoid process in common with coracobrachialis muscle Lower half of anterior humeral surface and two intermuscular septae

After union with long head, into radial tuberosity

Median N.

Tuberosity of ulna and anterior surface of coronoid process

Median N.

-Triceps brachii, long head

Infraglenoid tubercle of humerus

Radial N.

-Triceps brachii, lateral head

Posterior surface and lateral border of humerus above and lateral to ra dial groove, lateral intermuscular septum

Joins lateral and medial heads in a common insertion on posterior aspect of olecranon and deep fascia of up per arm Joins long and me dial heads in a common insertion

-Brachialis

61

Posterior compartment

Radial N.

( continued)

62


ORIGIN/INSERTIONIINNERVATION OF MAJOR MUSCLES

(CONTINUED)

Muscle

Origin

Insertion

Innervation

-Triceps brachii, medial head

Humerus medial and below radial groove and as high as insertion of teres major muscle to as low as humeral olecranon fascia, entire aspect of medial intermuscular septum Lateral epicondyle of humerus

Joins lateral and long heads in a common insertion

Radial N. (Branches of ulnar N.)

The side of olecra-non and one-fourth of posterior surface of ulna

Radial N.

-Anconeus

THE UPPER EXTREMITY: AXIAL ANATOMY

64


median n. cephalic v. biceps brachii m.

brachial a. &

brachialis m. ---

v.

basilic v.

humerus triceps brachii m. (med. head) triceps brachii

m.

(Iat. head) triceps brachii m. (long head)

Shoulder and Upper Extremjty

65

median n.

brachial a. & v.

basilic v.

triceps brachii m. (med. head) triceps brachii m. (long head)

./� 4 · , ��.

, I

.

\.. �-.. .

•

J .� .�.

cepbalic v. biceps brachii m. brachialis m.

humerus

triceps brachii m. (tat. head)

66


brachial a. & v.

biceps brachii m.

median n.

cephalic v. brachialis m. brachioradialis m.

---

basilic v. & branch

---

distal humerus

triceps brachii

m.


brachial a. & v. median n. basilic v. & branch

biceps brachii m. cephalic

v.

brachialis m. brachioradialis m. distal humerus

triceps brachii m.

67

THE UPPER EXTREMITY: SAGITTAL ANATOMY

70


deltoid m.

triceps m. coracobrachialis m. biceps brachii m.

bracbialis m.


71

deltoid m .

triceps m. coracobrachialis m. biceps brachii

brachialis m.

---

m.

72


deltoid m.

---

coracobrachialis m.

triceps m.

biceps brachii m.

brachialis m. ---

triceps t. humerus


73

deltoid m.

coracobrachialis m.

triceps m.

biceps bracbii m.

triceps t. humerus

bracbialis m.

74


deltoid m.

humerus

triceps m. (Jat. head)

biceps brachii m. brachialis m.

triceps m. (med. head)


75

deltoid m.

humerus

triceps m. (lat. bead)


biceps brachii m. bracbialis m.

76


deltoid m.

humerus

---

triceps m. (tat. head)

biceps brachii m.

__

triceps ill. (med. head)

brachialis m. lat. supracondylar ridge brachioradialis m. ext. carpi radialis longus m.


77

deltoid m.

humerus triceps m. (lat. head)

triceps m. (med. bead)

biceps brachii m. bracrualis m.

lat. supracondylar ridge bracbioradialis m. ext. carpi radialis longus m.

78


deltoid m.

triceps m. (tat. head)

biceps brachjj

m.

bracillalis m .


79

deltoid ill .

triceps

m.

(lat. head)

biceps brachii

brachialis m.

m.

THE UPPER EXTREMITY: CORONAL ANATOMY

82

Atlas of M usculoskeletal Imaging

deltoid m. teres major & latissimus dorsi mm.

triceps m. (Jat. head)

triceps m. (long head) triceps m. (med. head)

serratus ant. m.

latissimus dorsi m.


83

deltoid m.

teres major & latissimus dorsi mill. serratus ant. m. triceps m. (lat. bead)

latissimus dorsi m.


84


deltoid m. teres major & latissimus dorsi mm.

subscapularis m.

lung

serratus ant. m. triceps m. (lat. head) triceps m. (long head)

latissimus dorsi ill.

triceps m. (med. head) liver


85

)) �, Irf /tr r. ,

subscapularis m.

lung

deltoid m.

---

teres major & latissimus dorsi rnm.

serratus ant. m. triceps m. (lat. head) latissimus dorsi m.

liver -----7�


86


subscapularis m. deltoid m.

teres major & latissimus dorsi

triceps m. (long head)

rum.

lung

serratus ant. m.

brachialis m.

latissimus dorsi m.


humerus

liver

---


87

subscapularis m. teres major & latissimus dorsi mm. lung

deltoid m.

triceps m. (long bead)

serratus ant. m.

latissimus dorsi m.

liver

bracbialis m. triceps m. (med. bead)

humerus

88


subscapularis m. teres major & latissimus dorsi mm.

neurovascular bundle

deltoid m. lung

humerus

serratus ant. m. liver

brachialis m. triceps m. (med. head)

latissimus dorsi m.


89

subscapularis m. teres major & latissimus dorsi


mm.

deltoid m. lung

serratus ant. m. liver latissimus dorsi m.

humerus ---

brachialis m. triceps m. (med. head)

90


deltoid m. long head of biceps brachii t.

neurovascular bundle ---

lung

coracobrachialis m. & biceps brachii m. (short head)

serratus ant. m. liver

biceps brachii

m.

(long head)

---

rib



91

deltoid m . long head of biceps brachii t.

lung

serratus ant.

m.

coracobrachialis m . & biceps bracbii m. (short head)

liver biceps brachii rib

m.

(long head)

3 THE ELBOW AND FOREARM Imaging of the elbow is not performed as commonly as that of other anatomic sites such as the shoulder or knee. MR imaging can evaluate all of the osseous and soft-tissue structures of the elbow. The major indications for MR imaging of the elbow are fractures when evaluation of the nonossified cartilage is necessary, fractures with suspected injury to tendons and liga ments, acute or chronic repetitive injury to the ligaments or tendons, evaluation of osteochondri tis dissecans, suspected entrapment neuropathies, and, rarely, evaluation of arthritides such as rheumatoid or infectious arthritis. PRACTICAL PROTOCOL CONSIDERATIONS

The elbow can be imaged in a variety of ways. Typically, the patient is placed in the supine position with the arm resting comfortably at his or her side. Alternatively, the patient may be semiprone with the arm extended overhead; however, this position is not as well tolerated by the patient because of the placement of the shoulder, and images may be degraded as a result of motion. Dedicated or surface coils are mandatory to obtain diagnostic-quality images of the elbow. As in every anatomic area, if there is a suspicion of a soft-tissue mass or significant pain, a vitamin E capsule or other marker should be taped to the skin at the superior and inferior margins or the medial and lateral margins of the suspected abnormality for best results. A combination of imaging sequences can be used, and these are demonstrated in the table that follows.

93

94


Menu of Protocols Elbow Plane

Pulse Seguence

Localizer (transaxial) Localizer (transaxial) Sagittal, transaxial Transaxial Transaxial Transaxial Sagittal Sagittal Sagittal

FMPIR SE SE FSE, double echo FSE, FS SE FMPIR SE, double echo SE

FA (degrees)

TE TR (msec) (msec) 2,500 300 200 3,000 2,500 300 8,000 2,000 600

TI (msec)

FOV (cm)

Matrix (256X-)

ST/G (mm)

NEX

150

22-24 40 30 12 12-13 12-16 16-18 14-16 12

128 128 128 192 256 128 256 128 128

5/2.5 4/1 10/5 4/1 5/1 3/1 5/1 3/1 3/1

2 1 1 2 2 2 2 2 2

VAR VAR VAR VAR VAR VAR VAR VAR VAR

128 192 192 128 192 128 192 192 192

4/1 5/1.5 5/1.5 5/1.5 5/1.5 5/1.5 4/1 4/1 4/1

1 2 1 2 2 2 2 2

25 20 15 17/102 40 20 20 20/80 20

150

Comments Excellent for edema Either is acceptable Either is acceptable


Forearm Localizer (transaxial) Coronal, sagittal Coronal Coronal Sagittal Sagittal Axial Axial, pre-GAD Axial, �re-GAD

SE SE SE FMPIR SE FMPIR SE SE SE, FS

300 500 1,000 2,500 1,000 2,500 600 600 600

20 min min 30 min 30 20 20 20

150 150

Mark area of concern

Repeat after GAD Re�eat after GAD

Elbow and Forearm

95

MAJOR OSTEOCARTILAGINOUS STRUCTURES/LANDMARKS •

•

•

Distal humerus - Medial condyle - Lateral condyle - Articular surface of trochlea - Articular surface of capitellum - Olecranon fascia - Coronoid fascia - Radial fascia - Medial and lateral supracondylar crests Proximal ulna - Coronoid process - Olecranon - Radial notch of ulna Proximal radius - Radial head - Radial neck - Radial tuberosity MAJOR LIGAMENTS/TENDONS

Ligaments •

Medial collateral ligamentous complex - Anterior band ( bundle)-from inferior aspect of the medial epicondyle to the medial as pect of the coronoid process, seen best on coronal images. The anterior bundle is the primary constraint to valgus stress and is commonly injured in athletes whose sport in volves throwing - Posterior bundle - Oblique band (transverse ligament) • The posterior bundle and transverse ligament are deep to the ulnar nerve and make up the floor of the cubital tunnel

96 •


Lateral collateral ligamentous complex - Radial collateral ligament (RCL) • Arises from the anterior portion of the lateral epicondyle, blending with the fibers of the annular ligament and surrounding the radial head - Annular ligament • Primary stabilizer of the proximal radial ulnar joint • Best evaluated on axial images • Lateral ulnar collateral ligament (LUCL)-variably seen

Tendons •

•

•

•

Anterior compartment - Biceps tendon - Bracbialis tendon Posterior compartment - Triceps tendon - Anconeus tendon Medial compartment - Pronator teres tendon - Hand and wrist flexors (common flexor tendon) Lateral compartment - Supinator tendon - Brachioradialis tendon - Extensor carpi radialis longus tendon - Hand and wrist extensors (common extensor tendon)

Bursae •

Olecranon

Elbow and Forearm

97

MAJOR MUSCLES

The 19 muscles in the forearm are arranged in anterior (flexor) and posterior (extensor) compartments. They can be divided into groups by either their actions or layers as superficial and deep flexors or extensors, as demonstrated in the following categories. Compartments

Grouped by Muscle Action •

•

Anterior compartment - Rotation ( Radius on ulna) • Pronator teres • Pronator quadratus • Supinator - Flexion (Hand at wrist) • Flexor carpi radialis • Flexor carpi ulnaris • Palmaris longus - Flexion (Digits) • Flexor digitorum superficialis • Flexor digitorum profundus • Flexor pollicis longus Posterior compartment - Extension (Hand at wrist) • Extensor carpi radialis longus • Extensor carpi radialis brevis • Extensor carpi ulnaris - Extension (Digits except thumb) • Extensor digitorum • Extensor indicis • Extensor digiti minirni - Extension (Thumb) • Abductor pollicis longus • Extensor pollicis brevis • Extensor pollicis longus

98


Grouped by Layers Flexor muscles - Superficial layer • Pronator teres • Flexor carpi radialis • Palmaris longus • Flexor carpi ulnaris • Flexor digitorum superficialis - Deep layer • Flexor digitorum profundus • Flexor pollicis longus • Pronator quadratus

•

•

Extensor muscles - Superficial layer • Brachioradialis • Extensor carpi radialis longus • Extensor carpi radialis brevis • Extensor digitorum • Extensor digiti rninimi • Extensor carpi ulnaris - Deep layer • Supinator • Abductor pollicis longus • Extensor pollicis brevis • Extensor pollicis longus

Elbow and Forearm

99


Muscle

Origin

Insertion

Innervation

Anterior Compartment

Flexor Muscles-Superficial Layer

- Pronator teres

- Flexor carpi ra dialis

- Palmaris longus (absent in 1 3% of patients) - Flexor carpi ulnaris

Middle third of latTwo heads: (1) hueral surface of meral headmedial epicondyle radius of humerus and (2) ulnar headmedial side of coronoid process of ulna Medial epicondyle of Base of second meta humerus carpal and, fre quently, a slip to base of third meta carpal Medial epicondyle of Forms chief portion humerus of palmar aponeu roSIS Primarily pisiform, Two heads: (1) hu meral head hamulus of ha medial epicondyle mate, and base of fifth metacarpal of humerus and (2) ulnar head medial side of ole cranon, upper two thirds of posterior ulnar border

Median N. (C6, C7)

Median N. ( C6, C7)

Median N. ( C7, C8)

Ulnar N. (C7, C8)

( continued)

1 00



Muscle

Origin

(CONTINUED)

Insertion

Innervation

Two heads: (1) humeroulnar headmedial epicondyle, anterior epicondylar surface, ulnar collateral ligament, ulnar tuberosity, medial border of coronoid process and (2) radial head-upper twothirds of anterior border of radius Flexor Muscles-Deep Layer

Palmar aspect of shafts of middle phalanges of digits

Median N. (C7, CB, Tl)

- Flexor digitorum p rofundus

Bases of distal phalanges of digits

- Flexor digitorum superficialis

- Flexor pollicis longus

- Pronator quadratus

Proximal two-thirds of medial surface face of ulna, posterior border of ulna, interosseus membrane Anterior surface of radius and adj acent i nterosseus membrane Anterior surface of distal one-fourth of ulna

II-V

ll-V

Median N., anterior interosseous branch (C8, Tl)

Base of distal phalanx of thumb

Median N., anterior interosseus branch (C8, Tl)

Anterior surface of radius

Median, anterior interosseous N. (C8, Tl) (continued)

Elbow and Forearm


Muscle

Origin

101

(CONTINUED)

Insertion

Innervation

Lateral side of base of styloid process of radius

Radial N. (C5, C6, C7)

Dorsum of second metacarpal

Radial N. (C5, C6, C7)

Dorsum of base of third metacarpal

Radial or deep radial (posterior in terosseus) N. (C7, C8)

By four tendons on bases of middle and distal phalan ges of digits I I-V Base of proximal phalanx of fifth digit

Deep radial (poste rior interosseus) N. (C7, C8)

Extensor Muscles-Superficial Layer

- Brachioradialis

- Extensor carpi radi alis longus

- Extensor carpi radi alis brevis

- Extensor digitorum

- Extensor digiti mmnlll

Upper two-thirds of lateral epicondy lar ridge of hu merus Common extensor tendon of lateral epicondyle of hu merus, lower one third of lateral epi condylar ridge, lat eral intermuscular septum Common extensor tendon of lateral epicondyle of hu merus, intermuscu lar septa, and ra dial collateral ligament of elbow Common extensor tendon of lateral epicondyle of hu merus Common extensor tendon of lateral epicondyle of hu merus, intermuscu lar septa, overlying fascia


(continued)

1 02



Muscle

- Extensor carpi ul naris

(CONTINUED)

Origin

Insertion

Innervation

Two heads: (1) COll mon extensor ten don lateral to epi condyle of humerus and (2) middle one-half of posterior border of ulna

Ulnar side of base of fifth metacarpal


Lateral surface of up per one-third of ra dius between ante rior and posterior oblique lines Radial side of base of first metacarpal

Deep radial (poste rior interosseous) N. (C5, C6)

Base of proximal phalanx of thumb


Extensor Muscles-Deep Layer

- Supinator

- Abductor pollicis longus

- Extensor pollicis brevis

Lateral epicondyle of humerus, radial col lateral ligament, annular ligament, and fossa of ulna Middle third of poste rior surface of ulna, posterior (dorsal) surface of radius, interosseus membrane Distal end and dor sal surface of mid dle third of radius, interosseus mem brane, and ulna (sometimes)


( continued)

Elbow and Forearm

ORIGINIINSERTION/INNERVATION OF MAJOR MUSCLES

1 03

(CONTINUED)

Muscle

Origin

Insertion

Innervation

- Extensor pollicis longus

Middle third and dorsal surface of ulna, interosseus membrane distal to abductor pollicis longus muscle Posterior surface of distal third of ulna, interosseus membrane

Base of distal phalanx of thumb


Joins ulnar side of digital extensor muscle to insert on base of proximal phalanx of second digit


- Extensor indicis

THE ELBOW: AXIAL ANATOMY

1 06


ext. digitorum m.

radius

supinator m.

ext. carpi radialis longus m. ext. carpi ulnaris m.

radial n. (deep)

anconeus m.

radial n. (superficial) brachioradialis m.

ulna

biceps t.

---

radial a.

flex. digitorum profundus m . ulnar n .

ulnar a. median n. pronator teres m.

flex. carpi ulnaris m.

flex. carpi radialis m . ant. ulnar recurrent a. palmaris longus m.

brachialis m. & t.

flex. digitorum superficialis m.

Elbow and Forearm

supinator ill .

radius

1 07

ext. digitorum ill.

ext. carpi radialis longus m. ext.carpi ulnaris ill.

radial n. (deep)

anconeus ill . radial n. (superficial) brachioradialis ill.

ulna ---

flex. digitoruill profundus ill.

biceps t. radial a. ulnar a.

ulnar n.

median n. pronator teres m.

flex.carpi ulnaris m.

flex. carpi radjalis ill.

flex. djgitorum superficialis m.

palmaris longus ill.

bracrualis m. & t.

1 08


ext. digitorum m.

radial head

ext. carpi radialis longus m.

cornmonext . t.

supinator m.

ext. carpi ulnaris t.

radial n. brachioradialis m.

anconeus m. olecranon

biceps t.

coronoid

brachial a. brachialis m. & t.

flex . digitorum profundus m.

median n.

ulnar n. med. collateral lig.

pronator teres m.

flex. carpi ulnaris m.

ant. ulnar recurrent a. flex. carpi radialis m.

palmaris longus m.

flex. digitorum Slperficialis m.

Elbow and Forearm

common ext t.

radial head

109

ext. digitorumm. ext. carpi radialis longus m.

ext. carpi ulnaris t. supinator m. radial n.

anconeus m.

brachioradialis m.

olecranon coronoid flex. digitorum profundus m.

biceps t. brachial a.

--

brachialis m & t.

ulnar n.

median n. med. collateral lig.

pronator teres m.

flex. carpi ulnaris m. flex. digitorurn superficialis m.

ant. ulnar recurrent a. palmaris longus m.

flex. carpi radialis m.

1 10


supinator m.

ext. digitorurn m.


common ext. t.

brachioraclialis m. ext. carpi ulnaris t. radial n. (deep)

radial head

radial n. (superficial)

anconeus m.

biceps t. olecranon brachial a. ulnar n. median n.

flex. digitorurn profundus t. flex. carpi ulnaris m.

pronator teres m.

flex. digitorum superficial is m. flex. carpi radialis m. brachialis m. & t.

palmaris longus m.

Elbow and Forearm

radial head

111

ext. digitorum m. ext. carpi radialis longus m.

common ext. t.

supinator m.

ext. carpi ulnaris t.

radial n. (deep) radial n. (superficial) brachioradial is m.

anconeus m.

biceps t. olecranon brachial a. ulnar n.

median n.

flex. digitorum profundus m. pronator teres m. flex. carpi ulnaris m. flex. carpi radialis m. flex. digitorum superficialis m. palmaris longus m.

brachialis m. & t.

112


ext. carpi radialis longus m. capitulum common ext. t. brachioradialis m. lat. epicondyle

radial n.

anconeus m.

biceps t. brachialis m.

olecranon brachial a. ulnar n.

median n.

med. epicondyle pronator teres m.

trochlea

common flexor t.

Elbow and Forearm

1 13


common ext. t.

capitulum

lat. epicondyle

brachioradialis m. radial n.

anconeus m. biceps t. olecranon

brachialis m. brachial a.

ulnar n. median n.

med. epicondyle

pronator teres m. common flexor t.

trochlea

1 14


brachioradialis ill . ext. carpi radialis longus m. radial n. lat. epicondyle biceps t.

post. fat pad

ant. fat pad triceps m . & t. brachialis m. ulnar n.

brachial a.

median n.

brachialis m.

pronator teres m.

med epicondyle

Elbow and Forearm


115

brachioradialis m. radial n.

lat. epicondyle

biceps t.

triceps m. & t.

---

brachialis m. brachial a.

post. fat pad med. epicondyle

ant. fat pad median n. pronator teres m.

1 16


brachioradialis m.


radial n. lat. epicondyle biceps t. ant. fat pad r--- triceps m. & t.

brachialis m.

post. fat pad

brachial a.

med epicondyle median n. ulnar n.

pronator teres m.

Elbow and Forearm


1 17

brachioradialis m.

lat. epicondyle radial ll. biceps t. brachialis m.

triceps m. & t.

ant. fat pad brachial a.

post. fat pad

median n.

med. epicondyle

pronator teres m.

THE ELBOW: SAGITTAL ANATOMY

120


triceps m. (med . head) basilic

v.

ulnar n.

med. epicondyle of humerus brachialis m.

superficial flexor mm .

flexor digitorum profundus m.

Elbow and Forearm

121

triceps m. ( med . head)

---

basilic

v.

ulnar n.

med. epicondyle of humerus brachialis m.


superficial flexor mrn .

1 22


triceps m. (med . head) basilic

v.

triceps t. ant. fat pad

brachialis m.

olecranon

trochlea coronoid superficial flexor mm . ---


Elbow and Forearm

1 23

triceps m. ( med . head) basilic triceps

v.

t.

ant. fat pad

olecranon

brachialis m. trochlea

coronoid flexor digitorum profundus m.

superficial flexor mill .

1 24


biceps brachu m. brachial a.

triceps m. (med . head)

triceps t.

ant. fat pad

basilic

v.

brachialis m.

post. fat pad

olecranon

coronoid superficial flexor mm. flexor digitorum profundus m.

Elbow and Forearm


1 25

biceps brachii m. brachial a.

triceps t.

ant. fat pad post. fat pad basilic v. brachialis m.

olecranon

trochlea coronoid flexor cligitorum profundus m.

---

superficial flexor rnm .

1 26


biceps brachii m.


triceps t. ant. fat pad post. fat pad brachial a. basilic

v.

olecranon brachialis

ill .

trochlea

coronoid

superficial flexor mm . flexor digitorum profundus m.

1 27

Elbow and Forearm

triceps m. ( med . head)

biceps brachii

ffi .

triceps t. ant. fat pad post. fat pad

__

brachial a. basilic

v.

olecranon brachialis m. coronoid flexor digitorum profundus m.--

trochlea superficial flexor rnrn .

128


triceps m. (med . head) biceps brachii m. humerus triceps t. ant. fat pad post. fat pad brachialis m. basilic

v.

olecranon

trochlea coronoid superficial flexor mrn .

ulna


Elbow and Forearm


1 29

1 30

Atlas of Musculoskeletal Lmaging

triceps

111 .

biceps brachii m. humerus

ant. fat pad post. fat pad brachialis m.

olecranon

trochlea basilic v.

radial head

neurovascular bundle ulna superficial flexor mm. flexor digitorul1l profundus

111 .

Elbow and Forearm

131

triceps m. biceps brachii m. humerus

ant. fat pad post. fat pad olecranon

brachialis m. trochlea

radial head

basilic v. neurovascular bundle

ulna superficial flexor mm. flexor digitorum profundus m.

132


biceps brachii m. triceps m. ant. fat pad

humerus

brachialis m. capitulum biceps t.

radial head radial tuberosity ulna


Elbow and Forearm

1 33

biceps brachii m. triceps m. humerus

ant. fat pad

brachialis m. capitulum radial head

biceps t.

radial tuberosity ulna flexor digitorum profundus m.


134


biceps brachii m. triceps m. (lat. head) ant. fat pad

humerus

brachialis m.

capitulum

basilic

v.

radial head supinator m. radial tuberosity


134


biceps brachii m. triceps m. (lat. head)

ant. fat pad

brachialis m.

humerus

capitulum

basilic v. radial head supinator m. radial tuberosity

superficial flexor mm. flexor digitorum profundus m.

Elbow and Forearm

135

biceps brachii m. triceps m. (Iat. head) humerus

capitulum

ant. fat pad

brachialis m. basilic v.

radial head

radial tuberosity


supinator m.

superficial flexor mJ11.

136


biceps brachii m. triceps ffi. (lat. head)

ant. fat pad

brachialis m.

capitulum

radial head

supinator m.

brachioradialis m.

superficial flexor rnm .

radius

extensor carpi ulnaris m.

Elbow and Forearm

137

biceps brachii m. triceps m. (Iat. head)

ant. fat pad

brachialis m.

radial head

capitulum supinator m.

radius


brachioradialis m.

superficial flexor mm.

138


biceps brachii m. triceps m. (Iat. head)

lat. intermuscular septum

capitulum

brachioradialis m.

supinator m.

superficial flexor mm.

lat. epicondyle of humerus

radial bead

radius


Elbow and Forearm

biceps brachii m. triceps m. (lat. head)

lat. intermuscular septum

lat. epicondyle of humerus

capitulum

radial head brachioradialis m.

radius


supinator m.


139

THE ELBOW: CORONAL ANATOMY

142


humerus

brachioradialis m.

triceps m.

brachialis ill olecranon

med. epicondyle lat. epicondyle common flexort.

common extensor t. lat. coUateral & annular ligs.

---

med. collateral lig. radial head ext. carpi radialis longus& brevis mm.

coronoid median n. flex. digitorum superficialis m.

supinator m. ulna

palmaris longus m.

Elbow and Forearm

143

brachioradialis m.

humerus

brachialis m. triceps m. olecranon med. epicondyl e

lat. epicondyle

common flexor t.

common extensor t. ___

med. coll ateral lig.

--

l at. collateral & annular Iigs. radial head

coronoid ext. carpi radialis longus& brevis mm. median n. flex. digitorum superficialis m. palmaris longus m.

supinator m. ulna

144


bracrnoradialis m . humerus brachialis m . ext. carpi radialis longus m .

triceps ru.

olecranon lat . epicondyle common extensor t.

rued. epicondyle common flexor t.

lat. collateral lig. -- & annular lig. radial head

supinator ru.

ext. digitorum m .

rued. collateral lig. pronator teres m .

coronoid brachialis t.

Elbow and Forearm

brachioradialis humerus triceps m.

m.

brachialis m. ext. carpi radialis longus m. olecranon

med. epicondyle

lat . epicondyle

common flexor t.

common extensor t.

med. collateral lig.

lat . collateral lig. & annular lig.

pronator teres m. coronoid

brachialis t.

145

radial head

supinator m.

ext. digitorum m .

146


brachioradialis ffi. brachialis ill.

ext. carpi radialis longus

ill.

triceps ill . brachialis ffi.

ant. fat pad trochlea

common ext. t. pronator teres

ill.

lat . collateral lig. & annular lig. brachial is

ffi.

& t.

radial head radius supinator

ill.

ulnar a.

flex. carpi radialis

palmaris longus

ffi.

ffi.

Elbow and Forearm

triceps

147

ill.

bracruoradialis m. brachialis m.

ant. fat pad

bracrualis ill.

ext. carpi radialis longus

trochlea common ext. t. pronator teres m. lat . collateral lig. brachialis m. & t.

& annular lig. radial head

flex. carpi radialis m. radius palmaris longus m.

supinator m.

ulnar a.

ill.

148


brachioradialis m. brachialis m. olecranon fossa ext. carpi radialis longus & brevis mm.

humerus triceps m. brachialis m.

pronator teres m.

lat. epicondyle common ext. t. lat . collateral Jig. & annularlig.

trochlea med. collateral lig.

coronoid radial head brachialis t. supinator m. palmaris longus m. flex. digitorum superficialis m.

Elbow and Forearm

]49

humerus brachioradialis m. triceps m.

olecranon fossa

brachialis m.

lat. epicondyle

pronator teres m.

ext. carpi radialis longus & brevis mrn.

trochlea

med. collateral lig.

coronoid

brachialis t. palmaris longus m.

comrnon ext. t.

_

_ _

lat. collateral lig. & annular Jig. radial head

supinator m. flex. digitorum superficialis m.

150


brachioradialis m.

capitulum ext. carpi radialis longus & brevis mm.

lat. collateral lig. & annular lig. radial head

brachialis m.

trochlea

pronator teres m.

brachialis m. & t. biceps t.

supinator m. median n. radius ulnar a.

flex. carpi radialis m. palmaris longus

m.

Elbow and Forearm

brachialis m.

151

brachioradialis m.

capitulum trochlea

ext. carpi radialis longus & brevis mm.

pronator teres m. lat. co \lateral Ii g.

brachialis m. & t. biceps t. median n. flex. carpi radialis m. palmaris longus m.

& annular lig.

radial head supinator m. radius ulnar a.

152


brachial a. basilic v. brachioradialis m. brachialis m. radial n. median n.

brachialis m. & t. ext. carpi radialis longus m.

supinator m.

radius

pronator teres m.

brachial a. flex. carpi radialis m.

Elbow and Forearm

153

brachial a. basilic

v.

brachialis m.

median n.

brachialis m. & t. pronator teres m.

brachial a. flex. carpi radialis m.

brachioradialis m.

radial n.


supinator m. radius

THE FOREARM: AXIAL ANATOMY

156


cephalic v. biceps t.

radial a. & n. brachioradialis m. supinator

flexor digitorum superficialis m.

ffi.

ulnar a. & median n.


flexor carpi ulnaris m.

radius ext . carpi radialis brevis m. ext . digitorum ffi. extensor carpi ulnaris m.

brachialis -

rn.

flexor digitorum profundus m. ulna basilic v. anconeus m.

Elbow and Forearm

157

cephalic v. biceps t. flexor digitorum superficialis m. ulnar a. & median n. flexor carpi ulnaris m. brachialis m. flexor digitorum profundus m. ulna basilic v. anconeus

m.

radial a. & n. brachioradialis m. supinator m. ext . carpi radialis longus m. radius ext. carpi radialis brevis m. ext . digitorum m. extensor carpi ulnaris m.

158


- ' I

radial a. & n. cephalic

v.

brachioradialis m. radius ext . carpi radialis m. interosseous membrane abductor pollicis longus m. ext . digitorum m. ext. digiti rninimi m. ext . pollicis longus m.

flexor digitorum superficialis m. ulnar a. & n. flexor carpi ulnaris m. flexor digitorum profundus m. basilic v. ulna extensor carpi ulnaris m.

Elbow and Forearm

159

radial a. & n. cephalic v.

fl exor digitorum superficialis m. ulnar a. & n. flexor carpi ulnaris m. flexor digitorum profundus m.

brachioradialis m. radius ext. carpi radialis m. interosseous membrane abductor pollicis l ongus m.

basilic

v.

ulna extensor carpi ulnaris m.

ext. digitorum m. ext. digiti minimi m. ext. poll icis l ongus m.

THE FOREARM: SAGITTAL ANATOMY

162


ext. carpi radialis brevi s m. -----


ext. digitorum m. brachioradiabs m. radial head

Elbow and Forearm

163

ext. carpi radialis brevis m. ext. carpi radialis longus m. ext. digitorum m. brachioradialis m. ---

radial head

164


ulnar shaft flex. carpi ulnaris & flex. digitorum profundus mm. 1---- pronator teres m.

supinator m. radial tuberosity

r----- brachioradialis m. ---

supinator m. radial head anconeus m.

1--- capitulum

Elbow and Forearm

165

ulnar shaft

flex. carpi ulnaris & flex. digitorum profundus pronator teres m.

---

supinator m. brachioradialis m. supinator m. capitulum

---

radial tuberosity radial head anconeus m.

mm .

166

Atlas of Musculoskeletal imaging

ulnar shaft

flex. carpi ulnaris & flex. digitorum profundus mm.

brachioradialis m. radial tuberosity supinator m.

pronator teres m. coronoid process

olecranon

---

trochlea

Elbow and Forearm

167

rc \ ,

M..

ulnar shaft

flex. carpi ulnaris & flex. digitorum profundus mm.

brachioradialis m. radial tuberosity pronator teres m.

supinator m. ---

coronoid process olecranon trochlea

168


flex. digitorum profundus m.

---

flex. carpi ulnaris m. ---


brachialis m . trochlear notch olecranon

coronoid process

Elbow and Forearm

169

flex. digitorum profundus m.

superficial flexor nun . ---.'( � .

I

head of fibula gastrocnemius m. (lateral head) tibialis ant. m.

soleus m.

extensor digitorum longus m.

peroneus longus & brevis m.

Knee and Lower Extremity

429

bead of fibula gastrocnemius m. ( lateral head) tibialis ant. m.

extensor digitorum l ongu m.

peroneus longus & brevis m.

soleus m.

THE LOWER EXTREMITY: CORONAL ANATOMY

432

Atla of Mu culoskeletal I maging

va tus lateralis m. iliotibial tract lateral femoral condyle

--

vastus medialis m.

--

---

medial femoral condyle

lateral meni cus

tibia

tibiaJi ant.

ID.

---


vastus medialis m.

vastus lateralis m. iliotibial tract


lateral femoral condyle lateral meni cu

tibia

tibiali ant. m.

433

434

Atlas of Musculoskelelal Imaging

laleral femoral condyle

--

medial femora.l condyle

tibia

tibialis ant. m. --



lateral femoral condyle

tibia

tibialis ant. m.

435

436


semimembranosus m. bicep femori m.


sartorius m. ---

peroneus longus m.

--

extensor digitorum l ongus m.

---

tibialis ant. m. ---

extensor hallucis longus m. --fibula


tibia

flexor digitorum l ongu m.

Knee and Lower EXlrerruty

semimembranosus

m.

__:::

437

-

sartorius m.

bicep femoris m.



tibia

peroneu longus m. extensor digitorum l ongu m.

flexor digitorum longus m.

--

tibialis ant. m.

extensor hallucis longus m. fibula

438

ALIa of Musculoskeletal I m aging

__

biceps femori m. --lateral femoral condyle

--

lateral tibial condyle

--

head of fibula

semimembranosus m.

........ . -- sartorius m. gastrocnemius m. (medial head) medial femoral condyle medial tibial condyle

---

popliteu m. peroneus longus m.

---

flexor hallucis longus m. --exten or digitorum l ongu m. ---

fibula ---

tibialis post. m. flexor digitorum l ongus m.


439

semimembranosus m. --....-=0.. sartorius m. --....__ gastrocnemius m. (medial head)

bicep femoris m. lateral femoral condyle


lateral tibial condyle

medial tibial condyle head of fibula

popliteu m.

peroneus longus m. tibialis post. m. flexor digitorum l ongu m.

flexor hallucis longu m. --t-'

extensor digitorum l ongu m.

fibula

440


semimembranosus m. popliteal vessels

--

gastrocnemius m. (lateral head) -- gastrocnemius m. (medial head)

head of fibula

peroneus longus m. fibula peroneus brevis m.

--

'-a--- soleus m.


semimembrano us m.

441

_ _

-

popliteal ves el ga trocnerniu gastrocnemius m . (medial head)

m. ( l ateral head)

head of fibula

peroneus longus m. oleus m.

-----I..

fibula

peroneus brevis m .

442

ALIas of M usculoskeletal I m aging

gastrocnemiu m. (lateral bead)

---

soleus m. ---

gastrocnemius m. (medial head)


gastrocnemius m. (medial head)

443

gastrocnemius m. ( lateral head) ---

�-- soleu m.

7 THE ANKLE AND FOOT I nterest in M R imaging of the ankle and foot has been increasing in recent years. The most common reason for M R imaging of the foot and ankle is for evaluation of suspected injuries to the tendons, ligaments, or chondroo seous structu res, particularly osteochondrosis dis ecans of the talus. Other common indications for the study include suspected tarsal coalition, suspected stress fractures (fatigue fractures and insufficiency fractures), evaluation of the neuropathic foot in diabetes, evaluation of Morton's neuroma, and preoperative evaluation of suspected soft-tissue infection of osteomyelitis. Less common rationales for the MR imaging study include suspected plantar fasciitis, suspected soft-tissue ganglions, and evaluation of the patient with ar thritis. PRACTICAL P R OTOCOL CONSIDE RATIONS

MR imaging of the foot and ankle can be performed with the same extremity coils that are used for imaging of the knee or with dedicated extremity surface coils such as the q uadrature or phased array coils. Either of these coils can give diagnostic i mages. The patient is placed in the supine position with the foot comfortably positioned in the coil and the toes up. I n general, small fields of view (10-12 cm) are used. Ten 3-4 m m slices with 0.5- t o I -m m interslice gaps are used. Occasionally, the patient may be imaged with the foot in plantar flexion to decrease the curvature of the peroneal tendons and minimize the "magic angle ' effect. When necessary oblique axial and coronal planes may also be employed to visualize the obliquely oriented ligaments of the ankle. Intravenous gadolinium is used mainly for the evaluation of solid masses or suspected infection.

445

446


Menu of Protocols: Ankle and Foot Plane

Pulse Seguence

Localizer (transaxial) Localizer (coronal) Localizer (sagittal) Transaxial Transaxial Transaxial Coronal Coronal Coronal Sagittal Sagittal Sagittal Sagittal Sagittal Pre-GAD (axial, coronal, sagittal)

SE SE SE SE, double echo FSE, double echo FSE, FS FSE, FS FSE, double echo SE SE FMPIR FSE, double echo SE, double echo 3D FRE, SPGR, FS SE ( ± FS)

Post-GAD (axial, coronal, sagittal)

FA (degrees)

30

SE ( ± FS)

TR (msec)

TE (msec)

500 300 300 2000 6000 5200 3000 6000 300 600 5500 4000 2000 45 600

min 20 min 20/80 17/102 70 20 17/102 min 20 18 20/100 20/80 15 20

600

20

TI (msec)

150

FOV (cm)

(256X-)

ST/G (mm)

NEX

Comments

20 24 18 12 14-15 14 12 15 12-14 12 15-16 12-14 16 12-14 12-14

192 192 128 128 256 256 128 128 192 128 256 192 192 192 192

4/1 5/1 5/1 3-4/1 4/0.5 5/1 3-4/1 4/0.5 3/1.5 3/1 4/0.5 3/1 3/1 1.5/0 3/1

1 0.5 1 2 1 2 2 2 2 2 2 2 1-2 1 2


12-14

192

3/1

2

Matrix

MAJOR OSTEOCHONDRAL STRUCTURES/LANDMARKS Ankle •

Distal tibia - Tibial articular cartilage - Medial malleolus - Posterior malleolu - Fibular notch




Depends on site of abnormalityintravenous GAD for tumors, cysts, infection Depends on site of abnormalityintravenous GAD for tumors, cysts, infection

Ankle and Fool •

Distal fibula - Lateral malleolus - Fossa of lateral malleolus

Foot •

•

•

• •

•

•

Talus - Head - Neck - Trochlea - Posterior process - Medial tubercle - Lateral tubercle Calcaneus - Tuberosity - Medial process - Lateral process - Sustentaculum tali Navicular avicular tuberosity Cuboid Cuneiforms - Lateral - I ntermediate - Medial Metatarsals - Base - Shaft - Head Proximal phalanges ( I-V) - Base - Head - Tuberosity (V)

447

448 • •

•


Middle phalanges Distal phalanges - Base - Tuberosity (tuft) Se amoid bones (variable) MAJOR LIGA M E NTS/TENDONS/BURSAE

Ligaments •

•

•

• •

•

• •

Tibiofibular joint - Anterior tibiofibular - Posterior tibiofibular Lateral collateral ligamentous complex - Anterior talofibular - Calcaneofibular - Posterior talofibular Deltoid (medial) - Superficial • Anterior tibiotalar • Tibionavicular • Tibiocalcaneal • Posterior tibiofalar - Deep • Anterior tibiotalar • Posterior tibiotalar I nterosseous talocalacaneal Dorsal talonavicular B ifurcate - Calcaneonavicular portion - Calcaneocuboid portion Dorsal cuboideonavicular Dorsal cuneonavicular

Ankle and Fool • • • • •

• • • •

Dorsal intercuneiform Dorsal tarsometatarsal Dorsal metatarsal Dorsal cuneocuboid Dorsal calcaneocuboid Plantar calcaneonavicular Plantar cuboideonavicular Plantar cuneonavicular Plantar calcaneocuboid

•

Plantar tarsometatarsal Deep transverse metatarsal

•

Plantar ligaments (plates)

•

Tendons •

Anterior tendons (under superior and inferior extensor retinaculae) - Extensor djgitorum longus - Extensor hallucis longus - Tibialis anterior

•

Medial tendons (under flexor retinaculum) - Flexor hallucis longus - Flexor digitorum longus - Tibialis posterior

•

Lateral tendons - Peroneus brevis - Peroneus longus

•

Posterior tendons - Achilles tendon (largest tendon in body) Peroneus tertius

•

Bursae •

Retrocalcaneal (pre-Achilles)

449

450

Atlas of Mu culo keletal l maging

M AJOR MUSCLES

(See lower limb) ORIGIN/INSERTION/INNERVATION OF MAJOR M USCLES

(See lower limb) FOOT

Muscle

Origin

Insertion

Innervation

- Dar al interos seou ( I , I I )

From the side of metatarsals ( I , I I )

Deep branch of lateral plantar N.

- Dar al interos seou ( I I I , rV)

From the sides of metatarsals (ill, IV)

- Plantar interosseou

Bases of medial ide of metatarsal ( I I I , TV, V )

Same sides of base of proxjmal phalange (1 I I ) Lateral ides of bases of proximal phalan ges ( I I I, IV) Medial ides of proxj mal phalanges ( I I I , r v , V)

Intero

eon

Deep branch of lateral plantar N. Deep branch of lat eral plantar N.

G reat Toe Intrinsic M n cles

- Abductor haUuci

Medjal process of calcaneal tubero ity flexor retinaculum, intermuscular septum

Medial aspect of base o f proximal phalanx of fir t toe

Lateral plantar N .

(continued)

Ankle and Foot

O RI G IN/INSERTION/INNE RVATION OF M AJ O R M USCLES

Muscle

- Abductor halJuci brevi • Medial beUy

•

Lateral belly

451

(CONTINUED)

Origin

Insertion

innervation

Plantar a pect of cuboid and lateral cu neiform, tibiali an terior tendon, medial first meta tar al Plantar a pect of cuboid and lateral cuneiform, tibialis anterior tendon, medial first meta tar aJ

Blends with abductor halJucis to insert on medial a pect of ba e of proximal phalanx of fir t toe

Lateral plantar

Lateral side of ba e of proximaJ phalanx of first toe

Lateral plantar N.

Lateral ide of proxi mal phalanx of fifth toe

Lateral plantar

Ba e of proximal pha lanx of fifth toe

Superficial branch of lateral plantar

Lateral urface of fifth metatarsal

Superficial branch of lateral plantar N. or branch of nerve to flexor digiti minimi brevis

Fifth Toe Intrinsic M uscles

- Abductor digiti minimi

- Flexor digiti minimi brevi

- Opponeus digiti minimi (variably present)

Lateral and medial proces e of calca neus, intermuscular septum, lateral plan tar fa cia Tuberosity of cuboid, base of fifth meta tar aI, peroneu lon gus tendon sheath Tuberosity of cuboid, peroneu longu tendon sheath

(continued)

452

Atlas of Musculoskeletal I m aging

ORIGIN/INSERTION/INNE RVATION OF MAJOR M USCLES

(CONTINUED)

Muscle

Origin

Insertion

Innervation

- Extensor digitorum brevis

Lateral and superior calcaneal surface and inferior extenor retinaculum

Deep peroneal N.

- Flexor digitorum brevi

Medial process of calcaneus, plantar aponeurosis, intermuscular septum

Base of first meta taral (extensor hallucis brevis) base of econd proximal phalanx, bases of remaining middle phalanges Pass superficial to long flexor, divide to form opening on proximal phalanx of toes through which long flexor tendons pass then insert onto base of middle phalanx

Tendon of flexor digitorum longus muscle

Lateral plantar N.

Tendon of flexor digitorum longus muscle

Lateral plantar N .

- Quadratus plantae ( accessory to long digital flexor) • Lateral head

•

Medial head

Lateral border of plantar surface of calcaneus and from long plantar ligament Medial surface of calcaneus and medial border of long plantar ligament

Lateral plantar N.

(continued)

Ankle and Foot

ORIGIN/INS E RTION/INNE RVATION O F MAJOR M USCLES

Muscle •

Lumbricals

453

(CONTINUED)

Origin

Insertion

Innervation

Four tendons of flexor digitorum longus muscle

Medial urface of extensor expansion over lateral four toes

Lateral plantar

N.

THE ANKLE: AXIAL ANATOMY

456

Atlas of M usculoskeletal I maging

ext. digitorum longus t.

ext. hallucis longus t. & m

tibialis ant t. tibia

peroneus tertius m.

greater saphenous v. fibula

tibialis post. t.

peroneus brevis & longus tt.

flexor digitorum longus t.

post. tibial a. sural n. tibial n.

calcaneus

flexor hallucis longus t.

Ankle and Foot

tibialis ant t.

ext. hallucis longus t. & m.

tibia


peroneus tertius m.

greater saphenous v. fibula

tibialis post. t.

peroneus longu & brevis tt .


post. tibial a. sural n. tibial n.


457

calcaneus

458

Atlas of Mu culoskeletal I maging


ant. tibial a.

peroneus tertius m.

ext. hallucis longus t. & m. tibialis ant t.

ant. tibiofibular jt.

tibia

tibiotalar j t.

greater saphenous v.

fibula

tibialis post. t. flex. digitorum longus t.

peroneus longu & brevis tt.

post. tibial a. tibial n.

sural n.

calcaneus

flex. halluci longus t.

Ankle and Fool

459

v

ext. halluci longus t. & m.

ant. tibial a.

ext. digitorum longu t.

tibialis ant t.

peroneus tertius m.

tibia

ant. tibiofibular jt. tibiotalar j t.

greater saphenous v. tibialis post. t.

fibula

flex. digitorum longus t.

peroneu longus & brevis tt

po t. tibial a. tibial n.

flex. hallucis longus t.

sural n.

calcaneus

460

Atlas of Musculoskeletal Lmaging

ext. hallucis longus t. & m.

tibialis ant t.

ext. digitorum longus t. & m. med malleolus

ant. talofibular lig. talus fibula

tibialis post. t. ---

flexor digitorum longu t.

peroneus longus & brevis It.

post. tibial a.

sural n. flexor hallucis longus t. tibial n. calcaneus

quadratu plantae m.

Ankle and Foot

tibialis ant t.

461

ext. hallucis longus t. & m. ext. digitorum longus t. & m.

med. malleolus

ant. talofibular lig. talus

tibialis post. t.

fibula


peroneus longu & brevis tt.

post. tibial a.

sural n. flexor hallucis longu t. tibial n. quadratus plantae m.

calcaneus

462

Atlas of Musculo keletal Imaging

ext. hallucis longus t & m.

ext. digitorum longus t. peroneus tertius m. talus fibula

tibialis ant. t.

greater saphenous v. _ _ _

tibialis post t.

_ _ _

flexordigitorum longus t.

_ _ _

flexor hallucis longus t. peroneus longus & brevis tt.

post. tibial v.

sural n.

post. tibial a.

calcaneus

plantar n.

Ankle and FOOl

tibialis ant . t.

greater saphenous v. tibialis post t. flexor digitorum longus t.

ext. hallucis longus t.

& m

ext. digitorum longus t. peroneus tertius m. talus fibula

flexor hallucis longus t. post. tibial v. post. tibial a.

plantar n.

463

peroneus longus & brevis tt . sural n. calcaneus

464

Atlas of Mu culoskeletal lmaging

ext. baUucis longus t.

tibiali ant. t. greater apbenous v.


sustentaculum tali

talus

tibialis post. t.

peroneus tertius m. plantar talocalcaneal lig. --

flexor digitorurn longus t.

ext. digitorum brevi m.

--

flexor hallucis longus

peroneus brevis t.

---

med. plantar n.

peroneus longus t. sural n. calcaneus

abductor hallucis

m.

post. tibial a. quadratu plantae m.

t.

Ankle and Foot

tibialis ant. t. greater saphenous v. sustentaculum tali tibialis post. t.

465

ext. hallucis longus t. ext. digitorum longus t. talu peroneus tertius m.


plantar talocalcaneal lig.


ext. digitorum brevis m.

med. plantar n. abductor hallucis m.

post. tibial a. quadratus plantae m.

peroneus brevis t. peroneus longus t. sural n. calcaneu

466

Alia of Mu culoskelelal I maging

ext. hallucis longus t. ext. digitorum longus t.

tibial is ant t. greater aphenous v.

peroneus tertius t. tibialis post. t. talus

peroneu brevis t.

flex. digitorum longus t. flex. halluci longus t. med. plantar n.

peroneus longus t. abductor hallucis m. sural n. calcaneus

quadratus plantae m.

Ankle and Foot

467

468

Atlas of M usculoskeletal I maging

ant. tibial a.

ext. ballucis longus t.

tibialis ant t.

ext. digitorum longus t. greater saphenous v. talus sustentaculum tali

peroneus tertius m. ext. digitorum brevis m.

tibialis post. t. flex. digitorum longus t.

peroneus brevis t.

flex. hallucis longus t. peroneus longus

t.

med. plantar n. sural n.

abductor hallucis m. flex. digitorum brevis m.

calcaneus


Ankle and Foot

tibialis ant. t.

ext. halluci longus t.

greater saphenous v.

469

ant. tibial a. ext. digitorum longus t.

sustentaculum tali

talus

tibialis post. t.

peroneus tertius m.

flexor digitorum longus t. ext. digitorum brevis m. flexor hallucis longu t. peroneus brevis t.

med. plantar n.

peroneus longus t.

abductor hallucis m.

flexor digitorum brevis m.


sural n.

calcaneus

THE ANKLE: SAGITTAL ANATOMY

472

ALIas of Musculoskeletal I maging

tibia

flexor haLlucis longus m.

tendo calcaneus

ant. tibial a.

talus _--

post. tibiotalar lig.

---

subtalar joint

dorsal alonavicular Jig.

interosseous ____ talocalcaneal l ig.

calcaneus

navicular

flex. digitorum brevis m .

intermediate cuneiform cuboid

Ankle and Foot

flexor haLlucis longus m.

tibia

473

ext. halluci longus m.

tendo calcaneus ant. tibial a.

post. tibiotalar lig. subtalar joint

talus

dorsal talonavicular lig.

calcaneus interosseous talocalcaneal lig. flex. digitorum brevis m.

navicular

cuneifonn intennediate

474


tibia

flexor hallucis longus ill.

ext. haIJucis longus m.

soleus m.

ant. tibial a.

tendo calcaneus

talus

interosseous talocalcaneal tig.


ant. subtalar joint

--_

__

calcaneus

__

plantar apon. long plantar lig.

navicular rued & lat.

adductor digiti minimi m.

first metatarsal second metatarsal

third metatarsal

Ankle and FOOl

flexor hallucis longus m .

475

tibia

oleu m. ext. halluci longus m. tendo calcaneu ant. tibial a. interosseous talocalcaneal lig.

talu

dorsal talonavicular lig. calcaneus ant. subtalar joint plantar apon.

navicular

long plantar lig.

med. & lat. cunei forms


first metatarsal third metatarsal

second metatar al

476


tibia

flex. ballucis longus m.

ext. baLlucis longus t. tendo calcaneus

talus

post. talofibular lig. interosseous talocalcaneal tig.


calcaneus plantar apon.

navicular


calcanealcuboid lig. med. & lat. cuneifonns

cuneocuboid lig .

peroneus longus t.

Ankle and Foot

flex. hallucis longus m.

477

tibia

tendo calcaneus ext. hallucis longus m.

post. talofibular lig.

talus

interosseous talocalcaneal l ig.


calcaneus ----b-\---plantar apon. navicular adductor -- digiti minimi m.

calcaneocuboid lig. cuboid

peroneus longus t.

cuneocuboid lig.

478


tibia

flex. halluci longus t.

tendo calcaneu


po t. talofibular lig.

talu

interosseous talocalcaneal I ig. spring lig. calcaneus navicular

intermediate cuneiform

plantar apon.

---

--


second metatar al cuneocuboid lig.

flex. digitorum brevis m. peroneus longus t.

cuboid


Ankle and Fool

tibia

479

interosseous talocalcaneal lig.

flex. hallucis longus m.

ext. ballucis tendo calcaneu

post. talofibular lig.

longus t. talus ---

spring lig. calcaneus navicular

plantar apon.


---

adductor digiti minimi m. ---

flex. digotorum brevi m. second metatarsal


cuboid

peroneu longus t.

cuneocuboid lig

480


interosseous ral()CaJICatleaJ Jig.

talus tendo calcaneus


ext. hallucis longus m. --_


calcaneus __

plantar apon. navicular flex. digitorum brevis m. intermediate cuneiform

second metatarsal


peroneus longus t.

tibialis post. t.

Ankle and Foot

481

interos eous flex. hallucis longus t.

tendo calcaneus

tibia

talocalcaneal I ig.

talus

ext. hallucis longus m. flexor hallucis longus t. dorsal talonavicular lig. calcaneus

plantar apon.

flex. digitorum brevis m.

-I��':'-'

__

navicular __ _


second metatarsal

482

ALIas of Musculoskeletal Imaging

tibia

talus

u

pring lig.


tentaculum tali

calcaneu

_-- flexor digitorum longu t. navicular

intermediate cuneifonn ---

flex. digitorum brevis m.

plantar apon.

quadratu plantae m. first metatarsal

tibialis post. t

flexor hallucis longu t.

Ankle and Foot

tibia

483

talus

su tentaculum tali

pring lig.

calcaneus


flex. digitorwn longus t. ----&0;.-..:., flex. digitorum brevis m.

navicular

---

intermediate cuneifonn plantar apon. quadratus plantae m. flexor halluci

longus t.

tibiali post. t.

first metatar al

THE ANKLE: CORONAL ANATOMY

486



tibialis ant. t.

peroneus tertius t.

talus

ext. digitorum brevis m.

calcaneus

cuboid abductor hallucis m. lat. cuneiform

Ankle and Foot

487

ext. hallucis longus t. tibialis ant. t.

peroneus tertius t.

talus

calcaneus ext. digitorum brevis m. abductor hallucis m.

cuboid

lat. cuneiform

488


tibialis anI. t.

tibialis post. t.

----_

ext. hallucis longus I.

---

peroneus tertius I. ----

talus

tibiocalcaneal lig.

----

calcaneus

spring lig.

---

flexor digitorum longus t. cuboid

_ _ _

---

lat. cuneiform ---

abductor haJlucis m.

1---- flexor hallucis longus t.

Ankle and FOOl

489

tibialis ant. t.

tibialis post. t

ext. halluci longus t.

peroneus tertius t. tibiocalcaneal lig.

pring lig. talus calcaneus

flex. digitorum longus t.

abductor hallucis

m.


r--- cuboid

lat. cuneiform

490

Atlas of Mu culoskeletal Imaging

tibia talus

med. malleolus

tibialis post. t. ant. talofibular lig. deltoid lig. (tibioca1caneal)

sustentaculum tali

interosseous talocalcaneal lig. ---


calcaneus --peroneus brevis m.

--

cuboid

--

abductor ballucis m.

�--

flexor ballucis longus t.

quadratus plantae m. lat. cuneiform

!---- flexor digitorum brevis m.

Ankle and FOOL

491

talu

ant. talofibular lig. med. malleolu deltoid lig. (tibiocalcaneal)

tibialis po t. t.

interos eous talocalcaneal I ig. sustentaculum tali


abductor hallucis m. flexor hallucis longu t.

calcaneu

__ _

peroneus brevi m.

cuboid quadratus plantae m. lat. cuneiform

flexor digitorum brevi m.

492


tibia peroneus m. med. malleolus tibiotalar j t. deltoid lig. (tibiotalar)

ant. inf. tibiofibular lig.

talus ant. talofibular lig.

_ _

---

deltoid lig. (tibiocalcaneal) tibialis post. t.

tarsal sinus --abductor hallucis m. calcaneus peroneus brevis m. cuboid lat. cuneiform

flexor hallucis longus t. quadratus plantae m. flexor digitorum brevis m.

Ankle and Fool

493

peroneus m.

tibia

tibiotalar j t. med. malleolus ant. inf. tibiofibular lig.

deltoid lig. (tibiotalar)

talus deltoid lig. (tibiocalcaneal)

ant. talofibular lig. tarsal sinus

tibialis post. t.

calcaneu abductor hallucis m.

peroneus brevis m.

cuboid


lat. cuneiform flexor digitorum brevis m.


494

ALIas of Mu culos kelelal Imaging

tibia tibiotalar j t.

peroneus m.

med. malleolus

ant. inf. tibiofibular lig.


ant. talofibular lig.

tibiali post. t. su tentaculum tali

tarsal inus


peroneus brevis m.

r-"--- abductor haUucis m.

calcaneu cuboid


peroneus longus t. med. plantar n.

long plantar lig.


flexor digitorum brevis ITI.

Ankle and Foot

tibiotalar j t.

tibia

med. malleolus

peroneus m.


ant. inf. tibiofibular lig. talu ant. talofibular lig.

tibiali po t. t.

tarsal inus sustentaculum tali flexor digitorum longus t.

495

peroneu brevi m.

---

calcaneus


cuboid


peroneu longu t.

med. plantar n.

long plantar lig. quadratu plantae m.

496

ALias of Mu culos kelelal Imaging

tibiotalar jt.

tibia peroneus m. talus


lat. malleolus tibialis post. t. ant. info talofibular lig. flexor digitorum longus t.

tarsal sinus interosseous talocalcaneal lig.

--- flexor ballucis longus t.

peroneus brevis t. calcaneus

---

abductor ballucis m. peroneus longus t.

med. plantar n. quadratus plantae m.

long plantar lig. flexor digitorum brevis m.

Ankle and FOOl

tibiotalar j t.

497

tibia

med. malleolus peroneus m. talus lat. malleolus


ant. inf. talofibular lig.

tibialis post. t.

tarsal inus


---

interosseous talocalcaneal I ig. peroneus brevis t.


calcaneus


peroneu longus t.

med. plantar n. long plantar lig. quadratus plantae m.


498

Atlas or Musculoskeletal Imaging

tibia

peroneu m.

talus tibiotalar j t. tibiali po t. t. lat. malleolu flexor digitorum longus t.


-_ flexor hallucis longus t. abductor hallucis m. peroneus brevis t.


peroneu longu t. flexor digitorum brevis m. med. plantar n.

Ankle and FOOl

499

peroneus m. tibiotalar jl.

talu tibiali po t.

t.


lat. malleolus

calcaneu ---


flexor halluci longus t.

peroneus brevis t.


peroneus longu t. quadratu plantae m. flexor digitorum brevi m.

med. plantar n.

SOO


peroneus m. --

tibia

fibula

talu

post. tibiofibular lig.

tibialis post. t.

lat. malleolus


ant. talofibular lig. -abductor ballucis m. peroneus brevis & longus tt.

flex. ballucis longus t. quadratus plantae m.

calcaneus


abductor digiti minimi m.

med. plantar n.

Ankle and Foot

tibia

501

peroneus m. post. tibiofibular lig.

talus

fibula lat. malleolu

tibialis po t. t. flexor digitorum longus t.

ant. talofibular lig. _ _ _

peroneus brevis & longus It.

abductor hallucis m. calcaneus flexor hallucis longu t. abductor digiti minimi m. quadratus plantae m. flexor digitorum brevis m.

med. plantar n.

502

Atlas or Mu culos keletal Imaging

flexor hallucis longus m. flexor digitorum longu m. tibia po t. tibiofibular lig.

flexor hallucis longu t. flexor digitorum longu t.

lat. malleolus calcaneofibular lig.

__ _

post. tibial a. peroneus brevis t. -- abductor halluci m. peroneus longu t. quadratus plantae m.

calcaneus

flexor digitorum brevi m.

abductor digiti minimi m. med. plantar n.

Ankle and Foot

flexor digitorum longu m.

503

flexor halluci longus m.

tibia fibula flexor halluci longu

post. tibiofibular lig.

1.

lat. malleolu calcaneofibular lig. flexor digitorum longu t. peroneus brevi t. po t. tibial a.

peroneu longus t.


calcaneus


abductor digiti minimi m.

flexor digitorum bre is m.

med. plantar n.

8 THE LUMBAR SPINE MR images of the lumbar spine are often interpreted by neuroradiologists at academic institu tions. However, this anatomic region is becoming increasingly important for the imager interpre ting musculoskeletal scans. A large number of orthopaedi ts specialize in spine abnormalities and it is important for the mu culoskeletal radiologist to be able to communicate with them. The lumbar spine is included in this atlas for the sake of completeness since many other atlases do not cover this anatomic region. By far, the major indication for MR imaging of the lumbar spine is uspected degenerative disk disease. Evaluation consists of a search for disk protrusions, disk herniations, extruded disks, or secondary features of degenerative disease such as spinal stenosis. The patient who has undergone back surgery is also a candidate for MR imaging when there is suspicion of a recurrent disk herniation or complication from the surgery such as fractures or infection. MR imaging is often used in the setting of acute trauma to evaluate the equelae of injury and is an alternative to cr myelography. Finally, lumbar spine imaging is performed for suspected infection, bleeding, primary tumors of the spinal column, and congenital disease. PRACTICAL PROTOCOL CONSIDERATIONS

The patient is imaged while lying in the supine po ition. A variety of coils may be used, but the most common ones are coils with planar surfaces, quadrature coils, or the multicoil phased array design. The advantage of the phased array coil is that the areas of interest can be changed without changing the patient's position. Cardiac gating or respiratory gating may be useful in some patient .

505

506

ALIa of Mu culo

keletal

Imaging

Menu of Protocols: Lumbar Seine

Plane

Pulse Seguence

Localizer (coronal) Sagittal Sagittal Sagittal Sagittal

SE SE SE SE FSE, FS, double echo SE SE FSE

Oblique transaxial Oblique transaxial Oblique transaxial

FA (degrees)

FOV (cm)

Matrix (256X-)

ST/G (mm)

NEX

min 16 17 102 14/98

30 30 30 30 30

128 256 256 256 256

2010 4/1 4/1 4/1 4/1

1 4 2 2 2

VAR min 102

22 20 16

192 192 192

4/1 5/1 5/2

2 2 2

TR (msec)

TE (msec)

200 600 3000 4000 3000 4000 550 4500

TI (msec)

MAJOR OSTEOCHONDRAL STRUCTURES/LANDMARKS Lumbar Spine •

Vertebral bodie

•

Intervertebral disk

•

•

•

Po terior elements - Pedicle - Transver e proces - Lamjna - Spinous proce - Superior articular facet (process) - Inferior articular facet (process) Sacrum - Promontory - Sacral foramen (anterior/po terior) Coccyx (with its fu ed egment )

Comments Either is acceptable

(Repeat pre- and post-GAD)-for postoperative patients

Lumbar Spine

MAJOR LIGAMENTS/TENDONS/BURSAE Ligaments •

Anterior longitudinal

•

Ligamentum f1ava Supraspinal (connect tips of spinous processes)

•

Interspinal

•

•

Sacroiliac (across sacroiliac joint) - Ventral - Interosseous - Short/long dorsal

•

Sacrotuberous (sacrum to ischial tuberosity)

•

Sacrospinal (sacrum to ischial spine)

•

Iliolumbar (lumbar spine to superior ilium)

Tendons Bursae

MAJOR MUSCLES Deep Muscles •

Erector spinae - Longissimus - Iliocostalis lumborum - Spinalis

•

Interspinal

•

Intertransverse

507

508

Atlas of MuscuIo keletal Imaging

Transversospinal Muscles •

Multifidus

•

RotaTes

•

Quadratus lumborum

•

Psoas

Other Muscles [Visibility on MR Images of the Lumbar Spine Depends on Field of View (FOV)] •

Serratus posterior inferior

•

Latissimu dorsi

•

Transverse abdominal

•

Internal abdominal oblique

•

External abdominal oblique ORIGIN/INSERTION/INNERVATION OF MAJOR MUSCLES

Psoas, iliacus, pyriformi , gluteus maxirnus, gluteu medius (see Hips and Thigh) Muscle •

Erector spinae

- Iliocostalis lumborum - Longissimus

Origin

Common origin-pos terior sacral surface, posterior iliac crest, lumbar spine spi nous processes Crest of ilium

- Spinalis

Last two thoracic and first two lumbar vertebrae

- Inter pinal

Spinous process of vertebral body

Insertion

Innervation

Angles of lower six or seven ribs Lower nine or 10 ribs

Dorsal rami of spinal N. Dorsal rami of spinal N. Dorsal rami of spinal N.

Spinous processes be tween fourth and eighth thoracic ver tebrae Adjacent pinou proces

Dorsal ramus of spinal (continued)

Lumbar Spine

509

ORIGIN/INSERTION/INNERVATION OF MAJOR MUSCLES (CONTINUED) Muscle

- Intertransver e •

Origin

Insertion

Innervation

Transver e proce s of vertebral body

Adjacent transverse proce s

Dorsal ramus of spinal N.

Spinous proce ses of all vertebrae Adjacent or econd spinous process

Dorsal ramus of pinal N. Dorsal ramus of spinal N.

Transver 0 pinal muscle - Multifidu Posterior surface of sacrum Po terior surface of - Rotares sacrum

THE LUMBAR SPINE: AXIAL ANATOMY

512


inf. vena cava iliopsoas m. lumbar vertebral body ---

spinal nerve root

thecal sac sup. articular facet cauda equina

info articular facet

lamina epidural fat multifidus m.

spinous process

Lumbar Spine

513

ant. longitudinal lig.

iliopsoas m.

spinal nerve root

intervertebral disc

retroperitoneal fat iliac wing

sup. articular facet ----

inf articular facet cauda equina multifidus m.

514


lumbar vertebral body

pedicle

transverse process

iliopsoas m.

retroperitoneal fat spinal nerve root

iliac wing ligamentum flavum cauda equina

multifidus m.

Lumbar Spine

lumbar vertebral body

515

iliopsoas m.

transverse process spinal nerve root pedicle cauda equina ligamentum tlavum lamina

multifidus m.

516

Atlas of Musculo keletal Imaging

lumbar vertebral body inf vena cava

retroperitoneal fat

iliopsoas m.

spinal nerve root cauda equina

lamina spinous process multifidus m.

Lumbar Spine

517

Lumbar Spine: Sagittal Anatomy

vertebral body

intervertebral foramen

annulus fibrosus spinal nerve intervertebral disc pedicle

spinous process

sacral promontory

518

Atlas of Mu culoskelelal Imaging

cauda equina ant. longitudinal lig. post. longitudinal I ig. & annulus fibro us L4 vertebral

body

intervertebral disc

acral promontory

facet joint

Lumbar Spine

519

cauda equina ligamentum flavum

post. longitudinal lig. & annulus fibrosus L3 vertebral body

interspinous lig.

spinous process intervertebral disc caudal thecal sac

sacral promontory

520


intervertebral foramen LI

vertebral body

__ _

perineural fat pedicle

nerve root

intervertebral disc L5

_

_ --

spmous process

vertebral body

sacral promontory

Lumbar Spine

pedicle

nerve root

intervertebral disc of L4/ L5

521

erector spinae m.

spinous process

interfacetal articulation

sacral promontory L5 vertebral body coccyx

WORKS CONSULTED EI-Khoury GY Bergman RA, Montgomery WJ, eds. Sectional anatomy by MRI, 2nd edition. ew York: Churchill-Livingston, 1995. Kneeland JB, ed. Update in musculoskeletal MR imaging. Radiol Clin North Am

1997; 35.

Netter FR. The Ciba Collection of Medical Illustrations, Vol. 8. Musculoskeletal System, Part I, Anatomy, physiology, and metabolic disorders. Summit, NJ: Ciba-Geigy Corp, 1987. Re nick D, Kang RS, eds. lnternal derangements ofjoints-emphasis on MR imaging. Philadel phia: WB Saunders Co, 1997. Stoller DW, ed. Magnetic resonance imaging in orthopaedics and sports medicine, 2nd edition. Philadelphia: Lippincott-Raven Publisher , 1997.

523

Subject Index A

304r. 305r, 306r.307[,314[,315r, 316r, 317r. 32M. 325r. origin, insertion. innervation, 251

503r

Adduclor magnus lendon, 356£. 357r

origin. insertion, innervation, 451 Abductor hallucis brevis muscle, origin. insertion, innerva

origin. in enion, innervation. 252 origin. insertion, innervation, 346 shon bead. 306r. 307r.308r. 309f

AdduClor muscle, 29 f. 299r

origin, insertion, innervation. 252

Adduclor pollicis muscle. 21Sr. 219[,220r, 221r, 228r,229r

lion. 451

long head, 306[, 307[, 308[, 309r

326r,327[, 328r, 329[, 330[, 331r, 332[.333r

Abduclor digiti minimi muscle, 212f. 213r, 500r.50H,502r,

Biceps remoris tendon, 302r,303r, 304r,32Sr. 329r, 35Sr,

Alar synovial ral, rold, 360[. 361[, 362r, 363r

359r, 360r, 362(, 363r.364r, 365r, 366r.367r. 368r, 369r,

486[. 487r, 488f. 489[. 49Or.49H, 492[.493f.494f.495f.

Alonavicular ligamenl. dorsal, 472r

408r. 409r

496r, 497r.49Sr.499[. 500f. SOH. 502[. 503r

Anconeus muscle. l 06r. 107r. IOSf.100r,110[, IIIr,112[,

Abductor baUucis muscle, 464r,465£,466[, 467r, 468r.469r,

Biceps lendon. l06r. 107r, losr. 100r, I lOr.111[, 1m.114r, 115r.116£.117[.I32r,133r. lsor.151[,156f, 157r

113r. 156£.157r,164[,165[

origin, insertion, innervation. 450

origin. insertion. innervation. 62

Abduclor pollicis longu muscle. 15 r, 159[

long bead. 16r.17r.1St. 19r. 20r.21f. 22£.23r,3or. 3H.32r.

Ankle. 445-S03

origin. insertion, innervation, 102 Abduclor pollicis longus lendon. 196r.197r. 19Sr. 199r. 204f.

33r.35r, 36[,37r, 38r.39r, 4Or,41f, 46r.48r.49[

axial analomy. 455-69

shon head. 16f, m, ISr, 19r, 22r,23[.32r.33r

coronal analomy. 4S5-503

205r, 226r.227r.24Of.24H

Brachial arlery. 30r.31r. 4Sr,49r. sor,52r,53r, IOSr, 109[. I lOr, 1m, 113r, 114£, I15r. 116r. 1m,124r,125r, 126r.

sagillal analomy. 471- 3

Abduclor pollicis muscle, 206£.207r.215r

Annulus fibrosus, 517r

Abduclor pollicis lendon, 194r.195r

127r.152[.153[

Acelabular rossa. 272r. 273r

Arcuale poplileal Iigamenl. joinl capsule. 370r,37H

Brachial plexus, 22r.23r. 28r.29r.35r. 3Sr.39r, 44r.45[

Acelabular labrum

Arlicularis genus muscle. origin, inserlion. innervalion. 250

Brachial vein, 64r. 65r.66r.6n

amerior. 264f. 282r. 2 3[

Axillary anery. 2 r.29r. 34f. 35f. 38r. 39r

Brachiali muscle, 64r, 65r. 66r.67r.70r. 71[.72r.73r.74£.

poslerior. 265f.266£.267f.27 f.279[. 280f. 28H

Axillary nerve. 52f.53r

75r, 76r.77r, 7Sr, 86£,

superior. 294r. 295r

Axillary vein. 26r.27£. 38f.39[

115r. 116£. lin, 120r, 121r. 122r.123[,124r, 125[. 126r.

B

Acromioclavicular Iigamenl. 2Sr, 29r, 3Or. 3H.32[, 33r Acromion. 14f.32r, 33r, 34£, 35r.36£, 37r, 3 r. 39[, 46r, 47r. 50[. 5H, m, m, 54r. m. 56r. 57[

125r. 126[. 127f. 128f. 129r.130r. 13H. 134f. 135r, 152[. 153f. 156£. 157f. 15S£. 159r

15H, 152r, 153r, 156f,157r. l68r, 169r origin. insertion. innervation, 61 Brachialis lendon, 106[, lOn,IOS[,100r, I lOr.IIH.144r.

Bicep brachii muscle, 64r. 65r. 66f. 67r. 70r, 7H. 72f. 73f.

Adduclor brevis muscle, 25S[,259[, 270f. 27H,272f.273[,

9r. 112[,113[. 114r.

ImIGf.ICf.I44r.I�f.I_I�f.I_I_I�

Basilic vein. 64r,65r. 66f.67£, 120f. 121f.122[, 123r. 124r.

Acromioclavicular join I, 48r.49r

r,

127r. 128r.129r, l30r,13H. 132r.133[, l34r,135r. 136f.

Acelabulum. 276r. 277[. 28M, 2 5r. 29Of.29H. 292r. 293f. 294[, 295r.296r. 297r

7£.

74r, 75r. 76r, 77r. 7 r, 124£. l25r, 126£. 127f. l28r,

145(, l46r, 147(, l48r, 149[, 150[, 15H, 152r, 153r Brachioradialis muscle. 66r, 67r,76[, 77r, 106r. 107[, IOSr,

274f.275r.282r. 283[,302r, 303r, 328f.329r.330f. 331 f.

I29r, 130r. 13H, 132f. 133[. 134[, 135r, 136r, 137r,

100r. I lOr, 11Ir. 112r.1m. 114r, 115r, 116r. 1m, 136£,

332f. 333r, 334r. 335r, 336r. 337r, 3

l38r. 139r

137(, l38r.I39r,142r.143r. 145r. l46r, 147r. l48r, 149r,

loog head. 90[. 9H

150[.15H, I52r, 153r, l56r. 157[. l58r. 159r. 162r. 163r.

f.339f

origin. insertion. innervation. 251 Adductor digili minimi muscle, 474r,475r, 476r, 477[,478r, 479r Adduclor hialus, 314r,315r Adduclor longus muscle. 25S[,259r.272f.273r,274f.275[. 302f. 303r, 304r. 305f.314r,315[, 334r,335r. 336[,337f. 338f. 339f. 34Or, 34H origin. inserLion. innervation. 251 Adduclor magnus muscle. 27or. 271[,272r, 273r, 274f. 275f. 276[. 277f. 278f.279r. 282r. 2 3r,294f.295f. 302f.303f.

origin, insertion. innervation. 60 shon head, 9Or, 9H

l64r. 165r. l66r, 161£, 174[. 175[, 176r. 177r origin. insertion. innervation. 101

origin, insertion. innervation. 61 Biceps brachii lendon. 17Sf. 179r long head. 9Or, 9H

C Calcanenlcuboid ligamenl, 476r

Biceps remoris muscle. 304[,305r, 316[. 317f. 324r,325f.

Calcaneocuboid ligamenl, 477

326£.327[. 328f.329f. 356£.357r.358r. 359f.361f.384r.

Calcaneofibular ligamenl. S02r, 503r

3 5f. 386£. 387f.390[. 391f.408r. 409f. 410f. 41H.436f.

Calcaneus. 456r.457C.45 r, 459[.46Of. 461[. 462r.463r.464r.

437(,43 f. 439[

465[.466r. 467r. 468r, 469r. 472r,473[.474r.475r. 476r.

525

526 alcaneus

Subject Index

(co/lld)

477f. 47Sf,479f.480f.4SI[, 482f. 483f,486f,487f. 488f, 489f. 490f. 491f.492f.493f, 494f.495f,496f.497f.49 f.

lateral,486f,487f,488f, 489f. 490f, 491f. 492f, 493f

200f,201f.202f.203f,204f. 205f. 206f. 207f,21Of,21If. 212f,213f

Cuneocuboid ligament, 476f.477f,47Sf,479f

Extensor digitorum,194f,I95f, 197f, 19S[' 199f,200f,20l f,

499f. 500f.5OIf,502f. 503f Capitate.20l f,202f,203f. 204f,205[,214f,215f.216f,217f. 21 f, 219f. 228f,229f. 230f,23lf, 232f.233f.234f,235f. 236f.237f.238f. 239f. 24Of,241f Capitulum.112f, 113f, 132f, 133f, 134f, 135f, 136f, 137f.13Sf. I39f.15Of. 151f. t64f, 165f, 17 f, 179f, lSOf. ISIf

Extensor digiti minimi tendon, 194f, 196f.197f. 198f, 199f,

medial, 474f.475f.476f,477f

o

202f,203f,204[,205f,206f.207f.21Sf,219[. 22Of. 221f Extensor digitorum brevis muscle,464f.465f. 468f. 469f,

Deltoid ligament. 214f,215[,216f,217f

486f,487f

tibiocalcaneal, 49Of,49lf, 492f.493f tibiotalar, 492f, 493f, 494f. 495f.496f.497f

origin.insertion,innervation,452

Deltoid muscle.14f,15f,16f,17f,ISf, 19f, 20f.21f,22f. 23f,

Extensor digitorum longus muscle,388f,3 9f, 39Of,391f,

Cauda equina,5l2f,513f.514f,515f.516f, 51Sf,519f

26f,27f,28f,29f,JOf.3lf,32f,33f, 34f,35f,36f,37f.

398f,399f,400f, 401f.402[.403f,404f,405f,406f,407f,

Caudal thecal sac,519f

38f,39f, 4Of,4l f. 44£,45f,46f,47f, 48f,49f.5Of,5lf.

414f,415f.416f.417f. 41Sf,419f,420f, 421f, 428f,429f,

159f

76f.77f. 7Sf,S2f,83f,84f,S5f, 86f,

53f,54f,55f,56f,57f

7f, 88f.

9f.9Of.

91f

Circumflex humeral artery,36f,37f,38f,39f posterior.36f,37f,3 f. 39f,46f.47f,48£,49f,50f. 5lf, 52f.

436f.437f,438f, 439f,460f, 46If,462f

52f.53f.54f,55f,56f,57f. 7Of. 71f.72f.73f,74f, 75f.

ephalic vein.22f,23f. 64f, 65£. 66f, 67f.156f, 157f. 15 f.

origin,insertion,innervation,349 Extensor digitorum longus tendon,456f, 457f,45Sf, 459f,

46Of 46If, 462f,463f,464f,465f.466f,467f, 468f,469f

origin,insertion,innervation,10,II Digitorum pro fundus tendon, 197f,19Sf

.

Exten or digitorum muscle. l06f.107f,IOSf, l09f. I10f.11If, 144f,145f,156f, 157f,15Sf,159f, 162f.163f

Clavicle, 14f,2Sf.29f.30f, 31f, 44f, 45f,4Sf,49f Coccyx.521f Collateral ligament.medial,IOSf.l09f,I42f,143f, t44f,145f. 148f,149f Conjoint tendon,370f, 371f,3nf,373f,374f.375f,406f, 407f, 408f,409f

E

origin.insertion,innervation.101

Elbow. 93-183 axial anatomy,105-IS

420f, 421f. 436f, 437f, 456f, 457£, 45 f, 459f, 460[,

sagittal anatomy, 119-40

46lf, 462f. 463f, 4nf, 473f, 474f, 475f, 476f, 477f.

Epidural £at,512f

Coracoacromial ligament, 34f, 35f, 36f, 37[, 3Sr. 39f, 44f,45f

Erector pinae muscle. 521f

32f, 33f, 35f,36f,37f,38f, 39f,46f,47f, 48f.49f,50f, 51f, 7Of,7l f,nf.73f, 9Of,91f origin,insertion. innervation,60 Coracoclavicular ligament,26f,27f, 28f,29f,3Of. 3l f,32f, 33f, 44[,45f Coracohumeral ligament.32f,33f, 44f,45f Coracoid process, 14f. 20f,21f. 26f, 27f,28f, 29f, JOf, 31f, 32f.33f,44f,45f Coronary ligament,lateral,in ferior fascicle of, 402f,403f, 404f.405f, 406f,407f Coronoid process,IOSf,l 09f,l22f,123f,124f,125f. 126f, I 27f,l28f, 129f,142f. 143f,l 44f,145f, 148f. 149f,l66f, 167f,168f.169f,lSOf. ISl f Cruciate ligament anterior.364f, 365f,366f,367[,368f,369f,37Of,371f, 386f, 387f.402r.403f, 404f, 405r.406r.407f posterior, 364f. 365f.366f,367£,368f,369f,370f,371f. 3S4f, 385f.386f.387f,402f, 403f,404f,405f,406f. 407f, 408f,409f insertion. 3nf.373f Cuboid.4nf.473f,474f,475f. 476f.477£, 47Sf, 479f,486f. 487f.488f,4S9f.49Of. 491f,492f.493f,494f,495f Cunei form intermediate.4nf. 473f. 47Sf. 479f,480f. 481f, 482f.483f

Extensor hallucis longus muscle, 416f, 417f. 41Sf, 419f.

coronal anatomy.141-54

Corabrachialis muscle,origin,insertion,innervation, 10 Coracobrachialis muscle, 16f, 17f. I f. 19f, 22f, 23f. JOf. 3l f,

Extensor digitorum tendon,214f,215f,216f,217f,21Sf,219f

origin,insertion,innervation,508-9

479f, 48Of. 48l f origin,insertion,innervation.350 Extensor hallucis longus tendon,420f, 421f.456f.457f,45S[' 459f, 46Of, 46If, 462f, 463f.464f, 465f,466f,467f, 468f.

Extensor carpi radiali brevis muscle.142f,143f,l48f.149f,

469f.47Sr. 482r.483f. 486r.487r. 488r. 489f

15Of,151f.156f,157f,162£,I63f,17Sf,179f,ISOf,ISIf origin.insertion,innervation,l Ot Extensor carpi radialis brevis tendon.194f,195f,196f,197f. 19Sf, 199f,200f,20lf,202f,203f,204f,205f.21Sf. 219f. 22Of,221f Extensor carpi radialis longus muscle. 76f,77f,l06f,l07f,

Extensor indicis muscle.origin,insenion.innervation.103 EXlensor muscle,superficial, 182f.IS3f Extensor poUici brevis muscle, 205 origin,insertioD,innervation, 102 Extensor pollicis brevis tendon. 194f, 195f, 196f, 197f, 19Sf,

IOSf,l09f, 1I0f,Ill[,112f,113f, 114f, 116f, 117f. 142f.

199f,204f.226f. 227£, 228f,229f,230f.23If, 238f,239f,

143f,144f, 145f, 146[,147f,l48f, 149f, 150f.15H.152f,

24Of,241f

153f,156f, 157f, 162£, 163f. 174f, 175f,176f. 177f.17Sf. 179f, ISOf,ISH origio,insertion,innervation,101

Extensor pollicis longus muscle.15Sf, 159f origin.insertion.innervation,103 Extensor pollicis longus tendon,194f, 195f, 196f,197f, 19 f. 199f,200f, 20lf,202f,203f.204f, 205f. 21Sf. 219f,220f.

Extensor carpi radialis longus tendon. 194[, 195f, 196f, 197f, 19Sf. 199f, 200f, 201f. 202f, 203f, 204f. 205f. 232f, 233f Extensor carpi radialis muscle,15Sf,159f

22If Extensor retinaculum.19Sf.J99f Extensor tendon, common,IOSf,l 09f,11Of,IIIf,112f.113f. 142f.143f.144f, 145f. 146f.147f, 149f

Extensor carpi ulnaris muscle,l06f,107f, 136f.137f.13Sf. I39f, 156f, 157f, 15S[,159f origin,insertion� innervation,102 Extensor carpi ulnari tendon. IOSf, 1000,IIOf, 11If.194f. 195f. 196f. 197f, 19 f, 199f, 202f,203f,204f, 205f. 210f, 211f, 228f,229f,230f. 231f.238f. 239f,24Of, 241f Extensor digiti minimi muscle,15Sf,159f, 195f origin.insertion,innervation. 101

F Fa t MR terms.summary of, 3-5 Fat pad anterior.114f. 115f, 116f.117f, 122f.123f.124f, 125f.126f. I27f, 12Sf,129f,lJOr.l 31f. 132f.133f, 134f. 135f, 136f.137f.l46f,147f

Subject Index posterior.114f.115f. 116f.117f.124f. l25f.126f.127f. l28f. 129f.130f.131f

Flexor carpi superficiali

muscle. 174f, 175f,176f.178f.179f.

Flexor pollicis longus tendon. 194f.195f.196f.197f, 199f, 200f.201f.202f.203f.204f. 205f,206f. 207f.21 f. 219f.

ISOf, ISIf

Femoral artery.258f,259f.26Of.261f.262f.263f.264f.265f. 266f.267f.276f.277f. 278f.279f.28Of.281f.302f. 303f.

304f. 305f,306f,307f,308f. 309f deep.282f.283f, 284f 285f

Flexor carpi ulnaris muscle. l06f.107f, IOSf, 1000,IIOf. IIIf. 1�1�f.IWI_I64f.I65f.I_lml�l_

22Of.22 lf Flexor retinaculum.214f,215f,216f.217f,21 f.219f. 220f.

170f, 17 If. I78f.179f, l80f. ISIf, 194f. 195f.196f,197f. 198f, 212f, 213f

.

superficial. 314f.315f.332f.333f.334f,335f,338f,339f. Femoral circumflex artery, medial.290f. 291f, 292f.293f, 29 f,299f

origin, insertion, innervation.99 Flexor digiti minimi brevis muscle, origin, insertion. Flexor digitorum brevis muscle. 468f, 469f.472f, 473f.478f,

lateral.330f,331f,36Of. 361f.362f.363f, 364f, 365f, 366f, 367f, 368f.369f.389f, 39Of, 391f. 396f.397f.398f. 399f. 4OOf,4OIf,402f.403[,404f,405f.406f, 407f, 408f,409f. 426f, 427f.432f, 433f,434f.435f, 436f, 437f,438f,439f 364f, 365f, 366f. 367f,368[, 369f,37 f.379[, 38Of,

496f. 497f, 49 f,499f, 500f, 501f.502[.503f origin. insertion, innervation. 452 Flexor digitorum longus muscle,41Sf, 419f, 42Of.421f,436f, origin. insertion, innervation.352 Flexor digitorum longus tendon.420f.421f, 456f,457f.45 f.

3 If,382[,383f,396f.397f.39 f.399f.4OOf, 401f.

459f,460f, 461f. 462f. 463f. 464f.465f.466f .467f.468f.

402f,403f. 404f.405f.406f. 407f. 408f,409f,410f,

469f. 482f, 483f.488f. 489f, 490f.491f, 494f,495f, 497f.

411f.424f, 425f. 432f, 433f. 434f. 435f.436f.437f.

498f.499f, 500f,501f.502f. 503f Flexor digitorum profundus muscle, l06f,IOSf,100f.IIIf.

438f.439[ Femoral head. 26Of.261f.262f,263f,264f.265f. 266f.267f. 274f.275f.276f.277f.278f.279f.28Of. 281f.282f. 283f,

Forearm.93-183 axial anatomy,155-60 sagittal anatomy,161-72

479f, 48Of. 481f, 483f, 49Of, 491f. 492f. 493f.494f.495f.

437f,438f, 439f. 502f, 503f

medial,314f, 315f,316f.317f, 330f,331f, 361f, 362f, 363f.

Foot, 445-503

coronal anatomy, 173-84

innervation.451

Femoral condyle

22 If Flexor tendon, common, 112f, 113f, 142f, I 43f, 144f. 145f

Flexor carpi ulnari tendon,194f.195f.196f.197f.19 f

340f.341f

527

12Of. l2lf,122f. 123f.124f.125f,126f.127f. l28f.129f. l30f,131f.132f. 133f. l34f. 135f. 156f,157f.15Sf.159f.

G Gamellus muscle. inferior. origin, insertion, innervation.254 Gastrocnemius muscle.384f,385f,416f.417f, 426f.427f lateral head, 36Of, 361f.364f, 365f, 366f,367f,368f.369f. 370f.37 lf.372f, 373f, 374f,375f.386f.387f,388f. 389f,390f,39 lf, 408f,409f. 41Of,41H.414f, 415f. 428f.429f.44Of. 441f.442f.443f medial head. 358f.359f, 36Of. 361f.362f.363f,364f.365f, 366f.367f.368f.369f,370f. 371f.372f.373f.374f. 375f,378f.379f,380f.3 If.406f.407f.408f, 409f. 41Of.41H.414f.415f. 424f.425f. 4

284f.285f, 290f.291f.292f,293f.294f, 295f.296f. 297f,

l64f, 165f, l66f, 167f.168f.169f.170f. 171f.17 f.179f.

medial hom.382f.383f

298f.299f, 332f.333f.334f.335f. 336f.337f

ISOf,181f.214f. 215f,216f. 217f

origin. insertion, innervation,351

Femoral trochlear cartilage.362f. 363f.384f.385f. 386f, 3Sn Femoral vein, 258f, 259f, 26Of. 261 f.262f.263f. 264f. 265f. 266f,267f.276f, 277f.302f. 303f. 306f.307f.308f. 309f Femur.25 f.259f. 284f, 285f.286f.287f.290f.291f, 292f. 293f,294f. 295f.29 f.299f.302f.303f.304f, 305f.306f.

origin, insertion, innervation, 100 Flexor digitorum profundus tendon, II Of, 194f, 195f. 196f. 197f,19Sf.200f.201f. 202f.203f.204[, 205f,206f.207f. 214f,215f.216f.217f.224f.225f. 226f.227f.24Of.24If Flexor digitorum superficialis muscle. l06f, l07f,IOSf.109f.

307f,308f. 309f.332f.333f.334f. 335f.336f.337f. 356f.

110f.II If.I42f.143f.148f.I 49f.156f,157f.158f. 159f.

357f,358f. 359f. 36Of. 385f,386f. 387f.

177f,214f,215f.218f.219f

f. 389f.398f.

399f,400f, 4OIf,402f.403f.404f. 405f neck of.316f. 317f Fibrocartilage complex,triangular.196f.197f.19 f,199f. 212f.213f.228f.229f.23Of.231f. 236f.237f.238f, 239f Fibula.414f,415f.416[.417f. 41 f. 419f.42Of. 421f,426f, 427f,436f.437f,438f, 439f. 44Of. 441f.456f.457f.458f. 459f.460f, 46If, 462f, 463f, 500f.501f.502f, 503f head of.374[, 375f,390f.391f.406f. 407f.408f,409f. 42 f. 429f. 438f, 439f,440f.441f Fibular collateral ligament.362f,363f,364f,365f, 366f. 367f. 368f. 369f.37Of.371f.406f.407f Flexor carpi radialis muscle. 106f. 107f. IOSf.100f. I I Of.I I If. l46f.147f, l50f.151f.152f, 153f.174f,175f. 176f. 177f origin. insenion. innervation,99 Flexor carpi radialis tendon.194f. I95f, 196f.197f,I 98f. 199f.200f, 201f.202f. 203f.204f. 205f. 220f

origin, insertion, innervation, 100 Flexor digitorum superficialis tendon.194f.195f. 196f.197f, 198f.200f,201f.202f.203f.204f. 205f,206f.207f,214f, 215f, 216f, 217f Flexor hallucis longu

f.439f.44Of.

441f.442f, 443f

Gastrocnemius tendon. 380f.38lf.382f, 383f. 390f, 391f. 416f, 417f.418f. 419f.420f. 421f lateral head, 362f, 363f Gemellus muscle inferior, 260f.26 lf.262f.263f,264f. 27Of.27 If,272f.273f. 274£,275f.276f. 277f. 278f.279f. 28Of. 28lf,282f. 283f.284f.285f superior. 270f,271f,272f.273f.274f. 275f.276f,277f. 278f. 279f, 280f, 281f.282f. 283f,284C,285f Genicular anery inferior

muscle, 41 f, 419[, 420f, 421 f,438f,

439f, 472f, 473f, 474f,475f, 476f. 477f,479f. 502f.503f origin. insertion. innervation, 352 Flexor hallucis longu lendon, 456f. 457f. 458f, 459f,460f. 461f. 462f.463f.464f.465f.466f, 467f,468f.469f,478f. 48Of.48lf.482f. 483f.

f,489f. 490f, 491f.492f.493f.

494f,495f. 496f.497f. 498f. 499f. 500f, 501f.503f Flexor muscle, superficial. 120f.121f, 122f,123f. 124f.125f. I26f.127f.128f.I29f. l30f. 131f, 132f, 133f.134f.135f. 136f.137f. 13 f, 139f, l68f.169f, 170f. 171f. l82f.183f Flexor pollicis longus muscle, 220f.221f origin. insertion. innervation.100

lateral,396f.397f medial. 396f.397f lateral. superior.356f.357f,35Sf,359f,386f,387f.388f. 389f. 400f, 401f. 402f.403� 404f.405f.406f,407f medial. superior.356f.357f.380f,38lf. 382f, 383f, 384f. 385f Gerdy's tubercle.398f.399f Glenoid, 16f.17f.18f,19f. 2Of. 21f.3Of,31f.32f, 33f. 46f. 47f. 48f.49f.50f.51f. 52f.53f Glenoid labrum anterior.16f.17f, 18f, 19f.20f. 2 lf inferior. 48f.49C.5OC,51f

528

Subjeci Index

Glenoid labrum (co/ltd) posterior, 16f, 1 7f, 18f. 19f, 20f. 2 1 f superior, 46f. 47f, 48f, 49f. 50f, 5 1 f. 52f, 53f Gluteal anery. inferior. 264f, 265f, 266f. 267f, 270f. 271(, 272(, 273f. 274f, 275f Gluteus maximus muscle, 258f. 259f. 26Of. 261f. 262f. 263f, 264f, 265f. 266f. 267f, 270f, 27 I f, 272f, 273f, 274f, 275f, 276f, 277f, 278f, 279f, 28Of, 281f, 282f, 283f. 284f, 285f,

286f, 287f, 302f, 303f, 3 1 2f, 313f. 3 1 4f. 315f, 3 16f, 3 1 7f. 3 1 8f, 3 19f, 324f. 325f, 326f. 327f. 328f. 329f origin, insertion, innervation, 253 Gluteus medius muscle. 260f, 261f, 262f, 263(, 264f. 265f. 266f, 267f, 270f, 271 f, 274f. 275f. 276f, 277(, 278f, 279f.

89f. 128f. 129f. 13Of. 1 3 1 f, 132f. 133f. 134f. I 35f, 142f. 143f, 144f. 145f, 148f. 149f distal, 66f, 67f epicondyle of, lateral, 138f, 1 39f head. 14f, 1 5f, 16f, 17f. 18f, 19f. 20f, 2 1 f. 34f. 35f. 36f. 37f, 38f, 39f. 4Of, 4 1 f, 44f. 45f. 48f, 49f, 5Of, 5 1 f, 52f. 53f, 54f, 55f medial epicondyle of. 120f, 1 2 1 f neck. 4Of. 4 1 f 207f, 2 10f, 21 I f, 212f. 2 1 3f, 224f, 225f, 226f. 227f

Iliac spine, anterior, inferior, 284f. 285f Iliac wing, 5 13f, 514f Iliacus muscle, 29Of, 291 f. 292f, 293f, 294f, 295f, 296f, 297f, 298f, 299f origin, insertion. innervation, 255 Iliofemoral ligament, 260f. 261f. 262f, 263f, 264f, 265f, 266f. 267f. 286f. 287[, 29Of, 291f, 292f, 293f, 294f, 295f

origin. insertion, innervation. 253 Gluteus minimus tendon, 260f, 261f, 262f, 263f. 292f. 293f, 294f. 295f Gracilis muscle, 302f, 303f, 304f, 305f, 306f, 307f, 308f. 309f. 3 12f, 3m, 324f, 325f, 326f, 327f, 328f, 329f, 33Of, 331f, 332f, 333f, 334(, 335f, 336f, 337f origin, insertion. innervation, 250 Gracilis tendon, 356f, 357f. 358f, 359(, 360(. 36lf. 362f, 363f. 364f. 365f. 366f, 367f. 368f. 369f, 370(, 37l f, 372f, 373(. 374f. 375f. 398f-403f, 399f. 4OOf, 40 If, 402f, 403f, 408f, 409f. 4 10f. 4 1 1

H Hamate, 200f, 20lf, 202f. 203f, 204f, 205f, 2 12f. 21 3f, 216f. 21 7f, 228f, 229f. 230f, 231f, 232f, 233f, 236f. 237f. 238f. 239f hook of. 200f, 201f, 204f, 205f, 226f, 227f, 240f, 241f Hand, 185-244 axial anatomy, 193-208 coronal anatomy, 223-44 sagittal anatomy. 209-22 Hips, 245-341 axial anatomy. 257-60 coronal anatomy, 289-300 sagittal anatomy, 269-310 Hoffa's fat body, 370f. 371f. 372f, 373f. 384f, 385f. 386f. 387f. 388f. 389f, 394f, 395f. 396f, 397f. 398f, 399f, 4OOf, 401 f Humerus. 22f. 23f, 36f. 37f. 38f, 39f, 52f, 53f, 54f. 55f. 56f, 57f. 64f. 65f, 72f. 73f, 74f, 75f, 76f, 77f, 86f, 7f, 88f,

233f. 234f, 235f. 236f. 237[, 238f. 239f, 24Of. 24l f dorsal. 206f, 207f. 210f. 2 1 1 f, 212f. 2 1 6f. 217f. 218f. 219f. 220f. 221f origin, insertion. innervation. 450 I nterosseous talocalcaneal ligament. 472f, 473f, 474f. 475f, 476f, 477£, 478f, 479f, 48Of. 48lf, 49Of. 491f. 496f, 497f Interspinous ligament. 5 1 9f I ntervenebral disc. 5 13f, 5 17f, 5 18f. 519f. 520f

292f. 293f, 294f, 295f. 296f, 297f, 29 f, 299f

274f, 275f, 276f, 277f, 278(, 279f, 28Of, 281 f, 282f. 283f, 284f, 285f, 286f, 287f, 29Of, 291 f, 292f. 293f. 294f, 295f, 296f, 297f, 298f. 299f

I nterosseous membrane. 158f. 159f Interosseous muscle, 226f, 227f. 22 f, 229f. 230f, 23 If. 232f.

Hypothenar muscle. 200f, 201 f. 202f, 203f, 204f, 205f, 206f.

28Of, 281f, 282f. 283f, 284£. 2 5f. 286f. 287f, 29Of, 291f, origin, insertion. innervation, 253 Gluteus medius tendon, 265f. 266[, 267f, 286f, 287f Gluteus minimus muscle, 260f, 261f, 264f, 265f. 266f, 267f.

Intermuscular septum. lateral. l 38f, 139f

lIiopsoas muscle, 25 f. 259f, 260f. 261f. 262f, 263f, 264f, 265f, 266f, 267f, 270f, 271 f, 272f, 273f, 274£, 275f, 276£, 277f, 278f, 279f, 28Of, 281 f, 282f, 283f, 284(, 285f, 298f, 299f, 5 1 2f, 5 13f, 5 1 4f, 5 15f, 516f Iliopsoas tendon, 265f, 266f, 267f. 278f, 279f, 28Of, 28lf Iliotibial tract, 258f, 259f, 262f, 263f, 265f, 266f, 267f, 3 1 8f, 3 19f, 332f, 333f, 356(, 357f, 358f, 359f, 360f, 36lf. 362f, 363£, 364f, 365f, 366f. 367f. 368f, 369f. 396f, 397f. 398f. 399f. 4OOf, 4Olf, 402f, 403f, 404f, 405f, 432f, 433£ Iliotibial tract tendon, 370f, 371 f. 372f, 373f Ilium. 270f, 271f, 272f, 273f, 274f, 275f, 276f, 277£, 278f, 279f, 28Of, 281f, 282f, 283f, 284f. 285f, 29Of, 291f, 292f, 293f, 294f. 295f. 296f. 297f, 29 f, 299f Indices tendon, 194(, 195f, 196f, 197f. 1 98f, 1 99f, 200f, 20lf, 202f, 203f, 204f, 205f. 206f, 207f Inferior vena cava, 512f. 516[ l nirapateUar fat, 364f, 365f. 366f, 367f, 368f, 369f, 370£, 371f. 372[, 373f, 384f, 385f, 386f. 387£, 388f, 389f, 394f, 395f, 396f, 397f. 39 £, 399f. 400f, 40lf, 426f, 427£ Infraspinatus muscle, 16f, 17f, 1 8f, 19f, 20f, 2 I f. 26f. 27f, 28f, 29f, 3Of. 3lf. 32f, 33f, 34f, 35f, 36f. 37f, 3 f. 39f, 4Of. 4 l f, 52f. 53f, 54f, 55f. 56f, 57f

I ntervenebral foramen. 5 17f. 520f Ischial spine, 264f. 265f. 266f, 267f Ischial tuberosity, 270f, 271f, 272f, 273f, 274f, 275f Ischiofemoral ligament. 260f, 261f. 262f, 263f, 264f. 265f. 266f, 267f Ischium, 258f. 259f, 260f, 261 f, 262f, 263f. 29Of, 291 f. 292f. 293f, 294f. 295f. 296f, 297f

J Joint capsule. medial. 398f, 399f. 400f, 401f

K Key to acronyms, 2 Knee. 343-46 axial anatomy. 355-76 coronal anatomy. 393-4 12 sagittal anatomy, 377-92

L LI venebral body, 520f

L3 venebral body, 519f L4 vertebral body, 518f L5 vertebral body, 520f, 52 If Lamina, 51 2f, 5 1 5f, 516f Latissimus dorsi muscle, 46f, 47£, 54f, 55f. 82f, 3f, 84f, 85f. 86f. 87f, 88f. 89f origin. insertion, innervation, 10 Levator scapulae muscle, origin, insertion, innervation. 1 1 Ligamentum "avum, 5 1 4f, 515f. 519f

origin. insertion, innervation. 10 Infraspinatus tendon, 36f. 37£ Innervation, of muscles. 60-62. 99-103, 191, 250-55, 345-46.

Ligamentum teres, 264f, 265f, 266f, 267f, 274f. 275f. 29Of.

349-53. 450-53. 508-9 Inscnion, of muscles, 60-62. 99-103. 191. 250-55, 345-46. 349-53. 450-53. 508-9

Longitudinal ligament

Intercarpal ligament, dorsal. 21 4f. 215f Interfacetal articulation, 521f

291f. 292f. 293f Liver. 84f, 85f, 86f. 87f,

f. 89f, 9Of. 9 l f

anterior. 5 1 3f, 518f posterior. 518f, 519f Lower extremity, 343-443. 347 axial anatomy, 41 3-2 1

ubjeci I ndex coronal anatomy. 431 -44 sagittal anatomy. 423-JO Lumbar spine. 505-21 axial anatomy. 5 1 1 -2 1

Metatarsal first. 472f. 473f. 474f. 475f. 482f. 4 3f

Palmaris longus tendon. 194f. 1 95f, 196f. I 97f. 19 f. 1 99f, 202f. 203(' 204f. 205f

second, 473f. 474f. 475f. 478f, 479f. 48Of. 481f

Parana space. 1 94f. 195f

third. 473f, 474f. 475f

Patella, 336f, 337f. 359f. 360f. 36 If. 362f. 363f. 384f, 385f,

Lumbar vertebral body. 5 1 2f. 5 1 4f. 5 1 5f. 516f

Multifidus muscle, 5 1 2f. 5 1 3f. 5 1 4f. 5 1 5f. 516f

Lumbricali muscle. 226f, 227f

Muscles. origin. insertion. innervation of, 10- 1 1 . 60-62. 99-103. 1 9 1 . 250-55. 345-46, 349-53. 450-53. 5OS-9

origin, insenion, innervation. 453 Lunate. 198f, 199[, 21 4(. 2 15f, 21 6f, 2 1 7f. 226f, 227f, 228f.

386f, 387f. 388f, 389f. 394f, 395f cartilage. 358f, 359f, 360f. 361f. 362f. 363f. 386f, 387f ligament. 364f, 365f. 366f, 367f, 368f, 369f, 370f, 371f. 372f.

Musculocutaneous nerve, 35f

373f. 374f, 375f, 384f, 385f. 386f, 387f. 388f, 3 9f.

229f. 230(, 23 1 (, 236(, 237f. 238(' 239f. 240(, 241f Lung. 84f. 5f. 86f, 87f,

394f. 395f. 396f. 397f. 426f, 427f

f. 89(, 9Of. 91f

Lunotriquetral ligarnent, 228f, 229f. 23Of. 231f, 238f, 239f

Patellar retinaculum, 36 l f avicular. 472f, 473f, 474f, 475f. 476f. 477f. 478f. 479f, 48Of,

lateral, 360f. 361 [, 362f, 363f, 364f. 365f. 366f. 367f, 368f,

481f, 482f, 483f

I\t

erve root. 520f, 52 1 f

369f. 370f. 37 1 f, 394f, 395f medial, 360f. 361 f, 362f, 363f. 364f, 365f, 366f, 367f, 368f,

Neurovascular bundle. 88f. 89f, 9Of, 9 1 f. 1 30f. 1 3 1 f

Malleolus lateral, 496f. 497f. 498f. 499(. 5OOf. 501f. 502f. S03f medial, 460f. 46 1 f, 490f, 491f, 492f, 493f, 495f, 496f. 497f Median nerve. 64f. 65f, 66f. 67f. 100f. 107f. 109f. I 1 0f, I I I f. 1 1 2(, l 13f, J 1 4f, 1 1 5f. 1 1 6f. 1 17f. 142f. 143f. 150f, 1 5 1 f,

529

369f, 370f, 371 f, 394f, 395f. 396f. 397f Pectineus muscle. 258f. 259f, 260f. 261f. 262f. 263f, 264f.

o

265f. 266f. 267f. 270f. 271 f. 272f, 273f, 274f. 275f. 276f.

Oblique popliteal ligament. 364f. 365f. 366f. 367f, 372f, 373f Obturator extern us muscle. 25 f. 259f. 260f, 261 f, 27Of, 271f.

277f, 278f, 279f. 280f, 2Slf, 284f. 285f. 298f. 299f origin. insertion. innervation. 251

1 52(, 153f. 194f, 195f, 196f, 197f. 19 f, 1 99f. 200f. 201f,

272f. 273f. 274(. 275f. 276f. 277f, 278f. 279(. 280f. 281 f.

202f, 203f. 204f, 205f. 206f. 207f

282f, 283f, 290f. 291 f. 292f. 293f. 294f, 295f. 328f, 329f.

26f, 27f. 28f, 29f, 30f. 3 1 f, 32f, 33f. 35f. 36f. 37f, 38f.

3JOf. 331 f. 332f, 333f. 334f, 335f

39f

Meniscofemoral ligament anterior. of Humphrey, 384f, 385f, 386f. 3 7f posterior. of Wrisberg. 384f. 385f

origin, in ertion. innervation, 251 Obturator externus tendon. 286f. 287f, 296f, 297f, 298f, 299f Obturator intemus muscle. 25 f. 259f. 26Of. 261f, 262f. 263f.

Meniscus

264f. 265f, 266f, 267f, 272f, 273f. 290f. 291f. 292f, 293f.

lateral, 404f. 405f, 432f, 433f anterior horn, 370f. 371f, 388f. 389f. 390f. 391f. 4OOf. 40 1 f. 402f, 403f inferior fascicle of, 402f, 403f. 404f. 405f, 406f. 407f mid portion, 370f. 371f

medial, 405f, 424f. 425f

Pectoralis minor tendon. JOf, 3 1 f Perineural fat. 520f

276f. 277f. 27 f. 279f. 280f. 281f. 282f. 283f, 284f, 285f.

360f. 36 l f, 362f, 363f, 364f. 365f. 366f. 367f. 368f. 369f. 37Of, 371f. 372(, 373f. 4 1 0f, 4 1 1 f

Olecranon. 108f. 109f. I I Of, I I I f. 1 1 2f. 1 1 3f. l 22f, 1 23f. 124f. 1 25f. 1 26f. I 27f. l 28f. I 29f. IJOf, I 3 I f. 142f. 143f. 144f.

anterior horn. 370f. 37lf. 378f, 379f, 38Of. 381f. 382f.

145f. 148f. 149f. l 66f, 167f. l68f, 1 69f

383f. 398f. 399f. 400f. 401f. 402f, 403f. 404f

Omohyoid muscle. 14f Opponeus digiti mjnimi muscle. origi n. insertion, innerva

posterior hom, 37Of. 371f. 378f. 379f. 38Of. 381 f. 3 2f, 383f, 406f, 407f, 408f. 409f

tion. 451 Origin. of muscles. 1 0- 1 1 , 60-62. 99-103. 1 91 , 250-55, 345-46, 349-53, 450-53. 508-9

Metacarpal first. 200f, 201f. 206f, 207[, 226f, 227f, 228f. 229f, 24Of. 241f head. 23Of, 23 I f. 238f, 239f second. 206f, 207f, 2 18f. 2 1 9f. 220f, 221f. 23Of, 23 I f. 232f. 233f. 234(, 235f. 236f. 237f. 23 f. 239f third. 206f. 207f, 2 1 4(. 2 15f, 2 1 [, 219f. 228f, 229f. 23Of. 231f. 232f, 233f. 234f. 235f, 236f. 237f. 238f. 239f fourth. 206f. 207[. 214f. 2 1 5f. 2 1 6f, 217f. 228f. 229f. 23Of. 231 f. 232f. 233f. 236f. 237f, 238f, 239f fifth. 206f. 207f, 2 1 0f. 2 1 1 f. 21 2f, 2 1 3f. 224f. 225f. 226f, 227f. 24Of. 24 I f

Peroneal artery. 4 1 4f, 415f Peroneal nerve, common. 3OSf. 309f. 356f. 357f. 358f. 359f.

296f. 297f. 29 f, 299f

anterior. posterior horn . 424f. 425f

mid portion. 370f, 371f

26f, 27f. 2 f, 29f origin, insertion. innervation. 10

332f. 333f Obturator internus tendon. 262f, 263f. 270f. 27 I f, 274f. 275f.

407f, 4OSf. 409f

origin. insertion, innervation. 10 Pectoralis minor muscle. 1 6f. 1 7f. 18f. 1 9f. 20f. 2 1 f. 22f. 23f.

294f. 295f. 296f. 297[. 298f, 299f. 328f. 329f. 3JOf. 331 f. origin, insertion. innervation, 253

posterior horn, 37Of. 371f. 388f. 389f. 39Of. 391f. 406f.

Pectoralis major musele. 16f. 1 7f. I f. 1 9f. 2Of. 2 I f. 22f. 23f.

Peroneus brevi muscle. 41 6f. 4 1 7f. 4 1 8f. 4 1 9f. 428f, 429f, 44Of. 44 I f, 490f, 491f, 492f. 493f. 494f. 495f origin, in ertion. innervation. 351 Peroneus brevis tendon. 420f, 421 f. 456f. 457f. 45 f. 459f, 460f. 46If, 462f. 463f, 464f. 465f. 466f. 467f, 468f. 469f. 496f, 497f. 498f, 499f. 5OOf. 50 If, 502f. 503f Peroneus longus muscle, 398f, 399f, 4OOf, 4O l f, 402f, 403f, 404f. 405f. 406f, 407f. 408f, 409f, 41 4f. 4 1 5f, 4 1 6f, 417f. 4 1 Sf. 4 1 9f. 428f. 429f, 436f, 437f. 438f. 44Of, 441f

p

origin. insertion. innervalion. 350

Palmar arch artery deep. 214f, 2 1 5f. 2 1 6f, 2 1 7f superficial. 214f. 215f, 2 16f. 2 1 7f Palmar interosseous muscle, 2 1 2f. 21 3f. 2 1 6f. 217f Palmari

brevi muscle, 206f. 207f

Palmaris longus muscle, 106f. 107f. IOSf, 100f, I I Of. l i l t 142f. 1 43f. 146f. 147f. I 48f, 149f. 150f. 1 5 l f. 218f. 219f origin. insertion. innervation. 99

Peroneu

longus tendon, 420f, 421 f, 456f. 457f, 458f, 459f.

460f 46 I C. 462f. 463f, 464f. 465f. 466f. 467f, 468f. 469f. 476f, 477f. 478f. 479f, 480f, 481f. 494f, 495f. 496f, 497f. ,

498f. 499f. 500f, 501 f. 502f, 503f Peroneus muscle, 492f. 493f. 494f, 495f. 496f, 497f, 49 f. 499f, 500f. SOIf Peroneus tertius muscle. 456f. 457f. 458f. 459f. 462f, 463f. 464f. 465f. 468f. 469f

530 Peroneus tenius muscle

Subject Lndex

(coli/d)

origin, insertion. innervation. 350 Peroneus tertius tendon, 466f, 467f, 486f, 487f. 488f, 489f

Protocol menu

Psoas major muscle, origin, insertion, innervation, 254

Phalanx, proximal, 238f, 239f

Pubis. 26lf. 262f. 263f

first, 228f, 229f, 230f, 23 If, 238f, 239f, 24Of, 24 I f second, 236f, 237f 274f, 275f. 276f, 2TIf, 278f, 279f, 28Of, 28 If, 282f. 283f, origin, insertion, innervation, 254 Pisiform, 2 1 2f, 2 1 3f, 224f. 225f. 226f, 227f, 240f. 241f

Quadratus femoris muscle, 258f, 259f. 26Of, 261 f, 270[, 27 If, 272f, 273f, 274f. 275f, 276f, 277f. 278f. 279f, 280f, 281f, 282[, 283f, 284[, 285f, 286f, 287f, 296f, 297f origin, insertion, innervation. 254 Quadratus plantae muscle, 460[, 461 f, 464f, 465f, 466f, 467f, 468f, 469f. 478f, 479f, 480f, 481 f. 482£, 483f, 490£. 491f, 492f, 493f. 494f, 495f, 496f, 497f. 498f, 499f. 500f. 501 f.

Pisometacarpal ligament, 227f. 240f, 241 f Plantar aponeuro i , 474f, 475f, 476f, 4TIf, 478f, 479f, 480f, 48][, 482f, 483f Plantar ligament, long, 474f, 475f. 494f, 496f, 497f

502f, 503f origin. insertion, innervation. 452 Quadriceps femoris tendon, 340f, 34 I f Quadriceps tendon, 3 1 6f, 31 7f. 356f, 357f, 361f. 362f, 363f, 384f, 385f, 386f. 388� 389f

Plantar nerve, 462f, 463f 497f. 498f, 499f, SOOf, SOIf, 502f, 503f Plantaris muscle, 362f, 363f, 368f, 369f, 388f, 389f origin, insertion, innervation, 352 Plantaris tendon, 362f, 363f

Rhomboids minor muscle, origin, insertion. innervation, I I Rib, 9Of, 91f S acral promontory, 5 1 7f. 51 f, 519f. 520f, 52 I f acrotuberous ligament, 26Of, 261f, 262f, 263f. 264f, 265f, 266f, 267f, 29 f, 299f Sapbenous vein greater, 302f, 303f, 304f, 305f, 306f. 307[, 308f. 309f. 3 12f, 313f, 330£, 331f, 336f, 337f, 338f, 339f, 34Of, 341f, 356f, 357f. 358f, 359f, 36Of, 36lf, 362f. 363[, 364f, 365f. 366f, 367f. 368[, 369f, 370f. 371f, 372f. 373f. 374f, 375f, 378f, 379f, 410£, 4 1 H. 4 14f, 415t 4 1 6f, 4 1 7f. 41 f, 4 1 9f, 420[, 421f, 456f, 457f, 458f, 459f,

medial, 464f, 465f, 466f. 467f, 468f. 469f, 494f, 495f. 496f. Plantar talocalcaneal ligament, 464f, 465f

origin, insertion, innervation. 250. 345 Rhomboids major muscle. origin, insenion, innervation, I I

Q

Pisohamate ligament, 202f, 203f, 204f, 205f. 226f Plantae muscle. long, 495

302f, 303f. 304f, 305f, 306f, 307f, 308f, 309f. 3 1 6f. 3 l7f, 318f, 3 1 9f. 338f, 339f Retroperitoneal fat. 513f. 5 1 4f, 516f

296f, 297f Piriformis tcndon, 284f, 285f, 286f, 287f

264f. 265f, 266f. 267f, 284f, 285f, 286f, 287f, 29 f, 299f.

upper arm, 59f

Pes anserinus, 398f, 399f, 4OOf, 4O l f, 402f, 403f

Piriformis muscle, 265f. 266f, 267f, 270f. 27 1 f, 272f. 273f,

Rectus femoris muscle. 25 f, 259f. 260£, 261f, 262f, 263f,

glenohumeral joint, 8

462� 463� 464f, 465� 466f, 467f. 468� 469f

R Radial anery. l06f, l 07f, l56f, 157f. 158[, 1 59f, 194f, 195f, 196f, 197f, 19 f. 199f, 200f, 20l f, 202f, 203f, 224f, 225f, 226f, 227f Radial bead, 108f. 109[, 1 I0f, I I I f, 1 3Of, \ 3 I f, 132f. 1 33f,

lesser, 358f, 359f Sartorius muscle. 25 f. 259f, 260£, 261 f, 262f, 263f, 264f, 265f. 266f, 267f, 270f, 271f, 28Of, 281f, 282f, 283f, 284[, 285f, 286f, 287f, 302f, 303f, 304f, 305[, 306f, 307f, 308f, 309f,

1 34f, 1 35f, 136f, 1 37f, l38f. 139f, 142f, 143f, 144f. 1 45f.

3 1 4f. 3 15f, 33Of, 331f, 332f, 333f, 334f, 335f, 336f, 337f.

364f, 365f, 366f. 367f, 368[, 369f. 370f, 37 I f, 372f, 373f,

l 46f, 147f, l 48f, ISOf. 1 5 H, 162f. 163f, 164f, 165f, I 78f,

338f, 339f, 34Of, 34If, 356f, 357f, 358f, 359f, 36Of. 361f.

41Of, 4 1 1 f

t79f, lSOf, 18H

362f, 363f, 364f, 365f, 366[. 367f, 368f, 369f, 370£, 37\ f,

Popliteal anery, 33Of. 331f. 35 f, 359f, 36Of, 361f. 362f. 363f.

Popliteal ligament, oblique. 364f, 365f, 366f, 367f, 372f. 373f Popliteal vein, 358f, 359f, 36Of. 361f, 362f. 363f. 364f. 365f,

Radial nerve, 108f, 100f. 1 12f, 1 13f, 1 14f, l I5f, 1 16f, 1 17f, 152f, 153f. 1 56f. 157f. 158f, 159f

366f, 367f, 368f. 369f, 370f, 371f, 372f, 373f, 386f, 387f.

deep, l06f, 107f. 1 1Of. I I I f

4tOf, 4 1 I f

superficial, 106[, 107f, 1 I0f, I l l f

Popliteal vessels, 44Of, 44 I f Popliteus muscle, 373f. 374f, 375[, 384f, 385f, 386f, 387f, 388f, 389f, 426f, 427f, 438f, 439f origin, insertion, innervation, 352 Popliteus tendon, 364f, 365f. 366f. 367f, 368f, 369f. 370f, 371f, 372f. 388f, 389f, 390[, 391f, 406[, 407f. 408f, 409f

Radial tuberclc, 196f, 197f dorsal, Lister's tubercle, 194f. 195f Radial tuberosity. 132f, 1 33f, 134f, \35f, l64f, 165f. l66f, I 67f, 1 78f, 179f Radiocarpal ligament, dorsal, 2 1 4f, 215f Radiolunate ligament, 2 1 4f. 2 15f, 24Of, 24 I f

373f, 408f. 409f, 410f. 41 If, 436f, 437f, 438f, 439f origin. insertion, innervation, 250, 345 Sartorius tendon, 372f, 374f, 375f, 398f-403[, 399f, 4OOf, 401f, 402f, 403f, 406f, 407f, 408[, 409f Scaphoid, 198f, 199f, 2 18f. 2 1 9f, 220r, 22H, 224f, 225f, 226f, 227f, 228f, 229f, 230f, 231[, 236f, 237f, 238f. 239f, 24Of, 241f Scapbolunate ligament, 228f, 229f, 230f, 23If, 236f, 237f, 238f. 239f Scapula, 22f. 23f. 26f, 27f, 28f, 29f

Prefemoral fat, 358[, 359f, 384f, 385f, 386f, 387f, 388f, 389f

Radioscaphocapitate ligament. 2 1 8f. 219f. 220f. 221f

Profundus muscle, 107

Radioulnar joint, distal, 194f, 195f. 196f, 197f

Scapular spine, 52f, 53f

Pronator quadratus muscle, 2 1 2f, 2 1 3f, 2 1 4L 215f, 216f, 2 1 7f.

Radius. l06f. 107f. 136f, 137f, 13 f, 139f, l 46f, 147f. 150f,

Sciatic nerve, 258f. 259f. 262f, 263f. 265f, 266f, 267f, 270f,

218f, 2 1 9f, 220£, 221f origin, insertion, innervation. 100 Pronator tere muscle, l06f, 107f, 108f, 109[, 11 Of. 1 I If, 1 12f, 1 13f, 1 14f, 1 15f. 1 16f, 1 17f, l 44f. 145f, 146f. 147f, 14 f, I 49f, 150£, I 5 1 f, 1 52f, 153f, 164f. l 65f, l66f, I 67f, 174f. 175f, I 76f, 177f origin, insertion, innervation, 99

pine of, 14f, 15f, 26f, 27f, 28f, 29f. 30£, 3 1 f

1 5 1 f. 152f, 153f, l 56f, I 57f, l58f, 159f, I 74f, 175f, 176f,

271f, 272f. 273f. 274f. 275f, 276f, 277f, 278f. 279f, 28Of.

177f, 1 78f, 179f, ISOf. 18H, 194f, 195[, 196f, 197f, 1 98f.

281f, 282f, 283f, 290f, 291 f. 292f, 293f, 296f. 297f. 302f,

199f, 214f, 215f, 2 16f, 2 17f, 218f, 2 19f. 220[, 221f, 234f, 235f distal, 228f. 229f, 230f. 231 f, 232f, 233f. 236f, 237f, 238f, 239f Rectus abdominis muscle, 270f. 27 If. 272f, 273f. 274f, 275f

303f, 304f, 305f Semimembranosus muscle. 270£, 27 I f. 272f. 273f. 274f. 275f. 276f. 277f, 282f, 283f. 284f. 285f, 304f. 305f. 306f. 307f. 308f, 309f, 3 14f, 315f, 326f, 327f, 328[, 329f. 33Of, 331f. 356f, 357f, 358f, 359f. 36Of, 361 f, 362f. 363f, 378f, 379f.

ubject Index 380f, 381 f, 382f, 383f, 410f. 41 If. 436f, 437f. 438f, 439f.

Supracondylar ridge, laleral. 76f. 77f

44Of. 44 1 f

Suprapalellar bursa. 384f. 38Sf. 386f. 3 7f

axial analomy. 301-9

Suprapalellar fal. 356f. 357f. 358f, 359f

coronal analomy, 323-42

Semimembranosus lendon, 25 f. 259f, 276f, 277f, 278f, 279f,

53!

Thigh, 245-341

280f. 28If, 302f, 303f, 358f, 359f, 362f, 363f. 364f, 365f,

Suprascapular anery. 46f. 47[, 48f. 49f, sor, 5 1 f

366f, 367f, 368f, 369f, 370f, 371 f. 372f. 373f, 378f, 379f,

Suprascapular nerve, 46f, 47f, 48f, 49f, 50f, 5 1 f

Thoracoacromial artery. pecloral branch. 28f, 29f, 3Of. 3 1 f

380f. 381f, 382f, 383f. 410f, 4 1 1 f

Supraspinal us muscle. 14f, 15f, 26f, 27f, 28f, 29f, 3Of. 3 1 f. 32f,

Tibia. 374f, 375f, 384f, 3SSf. 386f, 387f. 398f. 399f. 4OOf. 40 1 f.

origin. insertion. innervation, 252 emilendinosus muscle, 302f. 303f, 304f. 305f, 306f. 307f.

402f. 403f, 404f. 405f, 406f, 407f. 408f. 409f. 41 4f. 41 5f,

49f. sor, 5 1 f. 52f. 53f. 54f. 55f

416f. 4 1 7f. 4 1 8f. 419f. 420f. 421f, 426f, 427f, 432f. 433f.

upraspinalus lendon, 34f, 35f, 36f, 37f, 38f, 39f, 48f, 49f,

361f. 362£. 363f, 364f, 365f, 366f. 367f, 368f, 369f. 370f. 371 f. 372f, 373£, 374f, 375f, 38Of. 382f, 383f, 398f-403f

52f, 53f ural nerve. 456f. 457f. 458f. 459f, 46Of, 46 1 f, 462f. 463f,

origin. insenion, innervation. 252 Serralus anlerior muscle. 1 6f. 17f, 18f. 19f. 44f. 45f, 82f.

33f, 34f, 35f, 36f. 37f, 38f. 39f. 44f. 45f, 46f. 47f, 48f. origin, insertion, innervation. 1 0

308f. 309f, 3 1 4f. 315f, 324f, 325f, 326f, 327f Semitendinosus tendon, 258f, 259f, 356[. 357f, 358f, 359f, 360f,

464r. 465r. 466f. 467r. 468r. 469f 3f.

84f, SSf, 86f, 87f, 88f. 89f, 9Of. 91f

cutaneous, laleral. 356f, 357f. 35 f. 359f. 360f. 36 1 f USlenlaculum lali, 464f, 465f, 468f. 469f. 482f. 483f, 49Of.

origin, insertion, innervation, 1 1

491f, 494f, 495f

oblique coronal anatomy. 43-58 oblique sagillal anal amy. 25-42 Soleus muscle, 374f, 375f. 384f. 385f, 388f. 389f, 390f, 391 f, 408f. 409f. 4 10f, 4 1 I f, 4 1 4f, 4 1 5f, 4 1 6f. 4 1 7f, 4 18f. 4 1 9f. 420f. 421 f. 424f. 425f. 426f. 427f. 428f. 429f. 44Of. 441 f. 442f. 443f, 474£, 475f origin, insenion. innervation. 351 Spinal nerve. 517f rool. 5 l 2f. 5 m, 5 1 4f. 5 1 5f, 516f Spinou proces , 5 l 2f. 5 1 6f, 5 l 7f, 5 1 9f, 520f, 521f Spring ligamenl. 478f. 479f. 482f. 483f. 489f

T anlerior. 46Of, 46 1 f. 490f. 491f. 492f. 493f. 494f. 495f. 49 f. 499f. 5OOf. 501f inferior. 496f. 497f poslerior. 477f. 478f. 479f Talonavicular 1igamenl. dorsal. 473f. 474f. 475f. 476f. 477f. 48Of. 481f Talu . 46Of. 461f. 462f. 463f. 464f. 465f, 466f. 467f, 468f, 469f.

52f, 53f. 54f. 55f ubscapular nerve. 20f, 2 1 f ubscapularis muscle. 1 6f. 17f. 1 8f, 19f. 20f. 21f. 22f. 23f, 26f, 27f. 28f, 29f, 30f. 3 1 f. 32f, 33f. 35f. 46f. 47f. 48f. 49f.

SOf. 5 1 f. 84f, 85f, 86f, 87f. 88f, 9f origin. insertion, innervation. 1 0 Subscapularis lendon. 28f, 29f. 35f, 46f. 47f Subtalar joinl, 472f. 473f anlerior. 474f, 475f Supinalor muscle, 100f, 107f. 108f. l09f. I I If. 1 34f. 135f. 1 36r. l m l _ I _ IGr. I�f. I 44r. I �f. I _ lm

anlerior, 374f, 375f, 4 14f. 41 5f. 416f, 41 7f. 41 f, 419f. 45 f. 459f. 468f, 469f, 472f, 473f, 474f. 475f nUlrienl. 4 1 6f. 417f

Tibial collaleral Iigamenl. 36Of. 36 1 f. 362f. 363f. 364f. 365f. 366f, 367f. 368f, 369f. 37OC. 371 f. 372f. 373f. 402f. 403f. 404f, 405f, 406f, 407f Tibial condyle laleral. 438f. 439f medial. 424f, 425f. 438f, 439f Tibial inlercondylar area, 370f. 371f Tibial nerve, 308f. 309f. 356f, 357f. 358f. 359f. 360f. 36lf, 362f, 363f. 364f, 365f. 366f. 367f. 368f. 369f, 372f, 373f. 4 10f, 41 If. 4 1 4f, 4 1 5f, 456f. 457f. 45 f, 46Of. 461f

494f, 495f. 496f. 497f. 49 f. 499f, 5OOf, 501f Tendo calcaneus, 472f. 473f. 474f. 475f, 476f. 477f, 478f. 479f.

ubscapular anery. 20f. 2 1 f. 28f, 29f. 3Of. 31f. 32f. 33f, SOf.

5OOf, 501 f, 502f. 503f Tibial artery

482f. 483f. 486f. 487f, 488f. 489f. 490f, 491f. 492f. 493f.

Subclavian anery. 14f. 16f, 17f. I f. 19f. 20f. 2 1 f

278f. 279f

490f, 49 If, 492f, 493f, 494f, 495f. 496f. 497f, 498f, 499f,

472f. 473f. 474f. 475f. 476f. 477f, 478f. 479f. 48Of. 481f,

Tarsal sinus. 492f, 493f. 494f. 495f. 496f. 497f

Subcutaneous fal. 258f, 259f. 262f. 263f. 265f. 266f, 267f,

474f, 475f. 476f. 477f, 478f, 479f. 480f, 48][, 482f. 483f,

46 1 [, 462f. 463f, 464f. 465f. 502f, S03f

Talofibular ligamenl

Subacromial fal, 54f. 55f Subclavius muscle, origin, insertion, innervation. 1 1

434f, 435f, 436f, 437f, 456f, 457f, 458f, 459f. 472f. 473f,

poslerior, 4 1 4f. 4 1 5f, 426f, 427f, 456f, 457f. 458f, 459f. 46Of,

Shoulder. 7-58 axial analomy. 13-25

sagillal analomy. 3 1 1-21

480f. 481f Tensor fasciae lalae muscle. 25 f. 259f. 260f. 261f. 262f. 263f. 264f. 265f, 266f. 267£, 294f. 295f. 3 18f. 3 1 9f, 330f. 33lf. 332f, 333f. 334f, 335f, 336f. 337f. 338f. 339f origin. insertion, innervation, 253 Tensor fasciae lalae lendon. 302f. 303f. 304f, 305f, 306f. 307f. 308f. 309f Teres major muscle. 26f. 27f, 28f. 29f. 3Of, 3 1 f. 32f. 33f. 34f. 35f. 36f, 37f, 38f. 39f, 54f, 55f. 56f. 57f. 82f. 83f. 84f. SSf. 86f. 87f. 88f, 89f origin. insertion. innervation. I I Tere minor muscle. 22f, 23f, 26f. 27f. 28f. 29f, 3Of. 3 1 f. 32f.

Tibial plaleau. 384f. 3SSf laleral. 372f. 373f. 388f. 389f. 39Of. 391f. 398f. 399f. 404f, 405f. 406f. 407f medial. 372f. 373f. 378f. 379f, 38Of, 381f, 3 2f. 383f. 39 f. 399r. 404f, 405f. 406r. 407f Tibial lubercle, 386f. 387f Tibial vein. posterior. 462f, 463f Tibialis anlerior muscle. 388f. 389f. 4 1 4f. 4 1 5f. 4 16f. 4 1 7f, 41 8f. 4 1 9f, 420f, 421f, 428f. 429f. 432f. 433f. 434f. 435f. 436f. 437f origin, insenion. innervation, 349 Tibialis anlerior lendon, 420f, 42 l f. 456f, 457f. 45 f, 459f. 46Of. 46 1 f. 462f. 463f. 464f. 466f, 467f, 468f. 469f. 486f. 487f. 4

f. 489f

Tibialis poslerior muscle. 402f. 403f. 404f. 405f. 406f. 407f.

33f. 34f. 35f. 36f. 37f. 3 f. 39f. 52f. 53f, 54f, 55f. 56f,

408f. 409f. 4 1 4f. 415f. 4 1 6f. 4 1 7f. 41 f. 4 1 9f. 420f. 421f.

57f

426f. 427f. 438f, 439f


Tibiali poslerior tendon. 456f. 457f, 458f. 459f. 46Of. 461f.

148f. 1 49f. I SOC. 1 5 1 f. 1 52f, 1 53f. l 56f. 1 57f. l64f. 165f.

Thecal sac, 512f

462f. 463f, 464f. 465f. 466f, 467f. 468f, 469f. 48Of. 481f.

l66f. 167f. 17 f. 1 79f, 1 8Of. 1 8 1 f

Thenar muscle. 200f, 202f. 203f. 204f. 205f. 206f. 207f. 2 1 f.

482f. 483f. 488f. 489f. 490f. 491f. 492f. 493f. 494f. 495f,


2 1 9f. 220f. 22 If. 224f. 225f. 226f. 227f

496f, 497f. 49 f. 499f. 5OOf. SOl f

532

ubjeci Index

Tibiocalcaneal ligament. 488f. 489f Tibiofibular joint anterior, 458f, 459f superior. 374f, 375f, 390f. 39lf. 4OSf. 409f Tibiofibular ligament anterior. inferior. 492f. 494f. 495f posterior. 500!. SOlf, 502f. 503f Tibiotalar joint. 458f, 459f, 492f, 493f, 494f, 495f, 496f, 497f.

49 f, 499f Tibiotalar ligament, posterior, 472f. 473f Transverse humeral ligament. 35f, 38f, 39f

long head. 22f. 23f. 34f, 35f, 38f, 39f, 4Of. 4 l f, 54f, 55f. 56f.

57f, 82f, 83f. 84f, 85f, 86f, 87f medial head, 74f, 75f, 76f, nf. 82f, 83f, 84f, 85f. 86f. 87f,

88f, 89f, 120f, 1 2 l f, 122f, 1 23f, 124f. 125f. 126f, 127f. 128f. 129f Triceps tendon. 72f, 73f, 1 14f. 1 1 5f, 1 16f, 1 1 7f. 122f. 124f.

228f. 229r. 230f, 231f. 236f, 237f. 238f. 239f

axial anatomy, 63-68 coronal anatomy, 81 -92 sagittal anatomy. 69-80 Urinary bladder, 29 f. 299f

V Vastu intermedius muscle, 286f. 287f. 304f. 305f, 306f. 307f,

Trochanter

3OSf, 309f, 3 16f. 3 1 7f, 31 f. 319f. 328f, 329f, 330f. 33lf.

greater, 260f. 26lf, 262f, 263f. 264f. 286f. 287f, 290f. 29lf,

Transverse meniscal ligament, 398f, 399f, 4OOf. 40 I f

292f, 293f, 294f. 295f. 296f, 297f. 330f. 33J C, 332f, 333f

Transversospinal muscle. origin, insenion, innervation, 509

Upper extremity, 7-92. 59-92

125f, I26f. 127f, 128f. 129f Triquetrum, 200f, 20lf. 210f. 2 1 1 C, 212£, 213f. 216f, 2 17f.

Transverse process. 5 14f. 515f Trapezium. 2OOf, 20lf, 202f, 203f, 204f. 205f, 220f. 221f. 224£,

Ulnolunate ligament. 198f, 199f, 216f. 217f

332f, 333f. 334f. 335f. 336f, 337f. 338f. 339f origin, insertion, innervation. 346 Vastus lateralis muscle. 258f, 259f, 290f, 291f. 292f, 293f,

294f, 295f, 296f, 297f, 304f, 305f. 306f. 307f, 308f. 309f.

Ie ser. 282f. 283f, 290f. 291f. 292f. 293C, 330f. 33)( Trochlea, 1 12f, 1 1 3f. 122C, 123f. 124f, 125f, 126f. 127f, 128f.

3 18f, 3 1 9f, 320f. 32Jf. 330f. 331f. 332f. 333f, 334f, 335f,

225f, 226f, 227f, 228f, 229f, 230f, 23lf. 238f, 239f. 240f.

1 29f, 130f. 1 3 l f, 1 46f, 147f, 148f. 149f, lSOf, 1 5 l f, 166f,

336f, 337f, 338f, 339f. 340£. 34)(, 356f, 357f. 390f, 39lf.

24lf

167f

398f. 399f. 4OOf, 40 I f, 402f, 403f. 404f. 405f, 432f. 433f

Trapezius muscle, 44f. 45f. 46f. 47f, 48f, 49f. SOf. 5 l f origin. insertion. innervation, 1 1 Trapezoid, 200f. 20lf. 202f, 203f, 204f. 205C, 2 1 f, 2 1 9f. 220£,

Trochlear notch, l68f, 169f, 170f, 1 7 l f Trochlear process. 18Of. 18lf Tubercle, lesser. 16f, 17f. I f, 19f. 46f. 47f

22lf, 228f, 229f, 230f, 23lf, 232f. 233f, 234f, 235f. 236f,

2 12f, 2 13f, 228f, 229f. 230f. 23lf, 236f, 237f, 23 f, 239f Triceps brachii muscle. 66f, 67f lateral head, 64(, 65f origin, insertion, innervatjon, 61 long head, 64f. 65f origin. insenion. innervation. 61 medial head, 64f, 65f origin, insenion. innervation, 62 Triceps muscle. 70f. 7 1 f, 72f. 73f. 1 14f. 1 15f, 1 16f, 1 17[, 130f,

\ 3 l f, I 32f. 133f. 142f, 143f, 144f. I 45f, 146f. 147f. 148f. 149f lateral head, 74f, 75f. 76f, nf. 78f, 82f, 3f. 84f, 85f, 1 34[,

135f, 136f, l37f, 13 f. 139f

372f, 373f Va tus medialis aponeurosis. 38Of, 381 f. 382f, 383f

237f, 23 f, 239f, 240£. 24lf Triangular fibrocartilage complex, 196f. 197[, 19 f, 199f,

origin, insertion, innervation. 346 Vastus lateralis tendon. 358f, 359f, 362f, 363f, 370f, 37lf.

Vast us medial.is muscle, 282f, 283f, 302f, 303f, 306f, 307f, Ulna, 106£, 107f, 128f. I29f, 130f, 13lf, 132f, 133f, 142f. 143f.

308f, 309f, 314f, 315f, 332f, 333£, 334f, 335f, 336f. 337f,

156f, 1 57f, 1 58f, 159f, 194f, 195f. 210f, 21 l f, 212f. 213f.

33 f, 339f, 340(, 34lf, 356f, 357f, 35 [, 359f, 360f, 36If,

226r. 227f, 228f. 229f. 230f. 231f. 234f. 235f

378f, 379f, 38Of, 381 f, 382f, 383f. 396f, 397f. 398f, 399f.

4OOf 4Olf, 402f. 403f, 404f, 405f, 432f, 433f

distal. 232f, 233f, 236f, 237f proximal, 182f, 183f lnar artery, 106£, IOn. 146f, 147f. 150f, 15H, 1 56£, 157f,

,

origin. insertion, innervation. 346 Vastus medialis tendon. 358f, 359f

1 58f, I 59f, 194f, 195f, 196f, 197f, 198f, 199f, 200f, 20lf.

Vena cava, inferior, 5 1 2f. 516f

202f, 203f, 204f, 205f, 206f, 207f, 212f. 213f, 216f. 217f

Vertebral body, 517f

Ulnar muscle, 1 07f. l09f, I I0f Ulnar nerve, 106f. IOSf, I l l f. 1 12f, 1 13f, 1 14f, 1 16f, 120f. 121 f.

1 58f, 159f, 194f, 195£, 200f, 20U, 202f, 203f, 204f, 205f

W Wrist, 185-244

Ulnar recurrent artery, anterior. l06f, 107f, IOS£, l09f

axial anatomy. 193-2OS

Ulnar shaft. 164f, 165[, 1 66f, 167f

coronal anatomy, 223-44

Ulnar styloid, 196f, 1 97f, 234f, 235f

sagittal anatomy, 209-22

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