UNIVERSITY OF PORT HARCOURT, CHOBA

FACULTY OF BASIC MEDICAL SCIENCES

DEPARTMENT OF HUMAN ANATOMY

COURSE: ANA314

ASSIGNMENT ON
To
DISCUSS THE RADIOLOGICAL ANATOMY OF THE ANKLE,
ELBOW AND WRIST JOINT

DONE BY

KUENI TRIUMPH GIFT

U2021/4792047

SEPTEMBER, 2024
 THE ANATOMY OF THE ANKLE

INTRODUCTION
The ankle is one of the most injured joint and the most common type of fracture to be treated by
orthopedic surgeons. The estimated incidence of ankle fractures is approximately 187 per 100,000
people per year. It appears that the incidence of these fractures is increasing in developed countries.
Due to fairly presentation of ankle fractures knowledge of the proper imaging technique of this complex
ascent of anatomy is necessary.

ANATOMY
The ankle joint is formed by the tibia, fibula and talus. The medial malleolus is an osseous
excrescence from the medial distal tibia. The posterior lip of the distal tibia is often referred to as the
posterior malleolus. The lateral malleolus is the most distal extension of the distal fibula.

STRUCTURE OF THE ANKLE

The ankle is a complex hinge joint that connects the leg to the foot. Structures includes the following:
BONES:
 Tibia (Shin bone)
 Fibula
 Talus (Ankle bone)
 Calcanous (Heel bone)
 Malleoli

LIGAMENT
 Anterior talofibula ligament
 Posterior talofibula ligament
 Calcaneofibular ligament
 Deltoid ligament

TENDONS
 Tibialis anterior tendon (Anterior)
 Achillis tendon (Posterior)
 Flexor hallucis Longus tender (Medial)
 Peroneal tendon (Lateral)

The arterial supply to the ankle comes from the following arteries:
1. Anterior Tibial Artery (ATA): Supplies the anterior (front) aspect of the ankle, including the tibialis
anterior muscle and the skin over the shin.
2. Posterior Tibial Artery (PTA): Supplies the posterior (back) aspect of the ankle, including the calf
muscles and the skin over the calf.
3. Peroneal Artery (PA): Supplies the lateral (outer) aspect of the ankle, including the peroneal
muscles and the skin over the outer ankle.
4. Dorsalis Pedis Artery (DPA): Supplies the dorsal (top) aspect of the foot and ankle, including the
skin and muscles on the top of the foot.
5. Lateral Plantar Artery (LPA) and Medial Plantar Artery (MPA): These arteries arise from the PTA
and supply the plantar (bottom) aspect of the foot and ankle.
 These arteries form a network of vessels that provide blood supply to the ankle joint, surrounding
muscles, and skin.
The venous supply to the ankle includes:
1. Anterior Tibial Vein (ATV): Drains the anterior aspect of the ankle and foot.
2. Posterior Tibial Vein (PTV): Drains the posterior aspect of the ankle and foot.
3. Peroneal Vein (PV): Drains the lateral aspect of the ankle and foot.
4. Great Saphenous Vein (GSV): Runs anterior to the ankle and foot, draining the superficial tissues.
5. Small Saphenous Vein (SSV): Runs posterior to the ankle and foot, draining the superficial tissues.

These veins converge to form the:

1. Popliteal Vein (PV): Formed by the merger of the ATV and PTV, it drains the ankle and knee.
2. Anterior and Posterior Tibial Veins merge to form the Popliteal Vein.
The venous supply to the ankle plays a crucial role in returning blood from the foot and ankle to the heart.

RADIOLOGIC ANATOMY OF THE ANKLE

In this part the types of fractures and the various radiographic analysis in detecting fractures in the
ankle.

FRACTURE
Medial malleolus fractures: this type of fractures is not uncommon and the most common fractures are
transversely orientated, distal to the corner of the ankle mortise.
Posterior malleolus fractures: they are typically either avulsion at the site of the attachment of the
posterior inferior tibiofibular ligament (due to external rotation) or fractures involving the joint surface due
to impaction of the talus against the posterior aspect of the tibial plafond.
Pilon fracture: this is an impaction fracture of the anterior tibial plafond with the foot in inversion and
dorsiflexion.
The Tilaux fracture: this is an avulsion fracture of the anterior tibial tubercle, that occurs with external
rotation and abduction of the foot.

Fractures of the lateral process of the talus: it occurs either due to ankle eversion and dorsiflexion,
which leads to the impaction of the calcaneus against the lateral process of the talus. This is also termed
the "snowboarder's fracture" and it's typically only seen on the AP ankle view.

Fractures of the posterior process of the talus: this type happens due to either forced dorsiflexion of
the ankle, which causes an avulsion or a chip fracture when the ankle is severely plantarflexed, causing
the lateral tubercle to become wedged between the posterior lip of the tibia and calcaneus. It is best
evaluated on the lateral radiographic view.

The above fracture patterns are most commonly seen in adults. Ankle fractures in children are relatively
less frequent, but when they do occur, they tend to involve the epiphysis as the open physical plate is a
plane of weakness in any bone.
RADIOGRAPHIC ANALYSIS
They include the following:
1. 1-Plain films
2. 2- Computed tomography
3. 3-Magnetic resonance

CLINICAL SIGNIFICANCE
While all fractures are important to identify the most concerning for the image interpreter are the ones
most likely to be missed. Failure to identify such fractures in the ankle can lead to delayed diagnosis,
persistent pain and instability, fracture nonunion and accelerated osteoporosis.

ANATOMY OF THE ELBOW

The elbow is a complex joint formed by the intersection of three bones and various soft tissues. The
bones are:
 -Humerus( upper arm bone)
 -Radius( forearm bone, thumb side)
 -Ulna(forearm bone, pinky finger side).

Anteriorly the elbow meats the Brachialis muscle, Biceps brachii muscle, Flexor carpi radialis muscle.
Posteriorly the elbow meets the Triceps brachii muscle, Anconeus muscle, Olecranon process, Posterior
aspect of humerus. Laterally the elbow meets the Radial head, Lateral epicondyle (humerus), Extensor
carpi radialis brevis.
Medially the elbow meets the Medial epicondyle (humerus), Ulnar nerve, Pronator there's muscle, Flexor
carpi radialis muscle, Medial collateral ligament.

STRUCTURE OF THE ELBOW:

Here's a detailed overview of the elbow's structure:
Bones:
1. Humerus (upper arm bone)
a. Medial epicondyle
b. Lateral epicondyle
c. Capitellum (articulates with radius)
d. Trochlea (articulates with ulna)
2. Radius (forearm bone, thumb side)
e. Head (articulates with humerus)
f. Neck
g. Shaft
h. Distal end (wrist)
3. Ulna (forearm bone, pinky finger side)
i. Olecranon (articulates with humerus)
j. Coronoid process
k. Shaft
l. Distal end (wrist)

Joints:
1. Humero-ulnar joint (hinge joint)
- Between humerus and ulna
2. Humero-radial joint (pivot joint)
- Between humerus and radius
4. Proximal radioulnar joint (pivot joint)
- Between radius and ulna

Ligaments:
1. Medial collateral ligament (MCL)
a. Connects humerus to ulna
2. Lateral collateral ligament (LCL)
b. Connects humerus to radius
3. Annular ligament
c. Surrounds head of radius

Muscles:
Anterior (front) compartment:
1. Biceps brachii
2. Brachialis
3. Brachioradialis
Posterior (back) compartment:
1. Triceps brachii
2. Anconeus
Tendons:
1. Biceps tendon
2. Triceps tendon
3. Lateral epicondylitis (tennis elbow)
4. Medial epicondylitis (golfer's elbow)
Nerves:
1. Radial nerve
2. Median nerve
 3. Ulnar nerve
Blood vessels:
1. Brachial artery
2. Radial artery
3. Ulnar artery
Elbow movements:
1. Flexion (bending)
2. Extension (straightening)
3. Supination (palm up)
4. Pronation (palm down)
Understanding the elbow's structure is essential for diagnosing and treating injuries or conditions.

BLOOD SUPPLY TO THE ELBOW:

The blood supply to the elbow joint is provided by a network of arteries, veins, and capillaries. Here's an
overview:
Arterial Supply:
1. Brachial artery: Main artery supplying the elbow, arises from the axillary artery.
2. Radial artery: Branches off the brachial artery, supplies the lateral aspect of the elbow.
3. Ulnar artery: Branches off the brachial artery, supplies the medial aspect of the elbow.
4. Recurrent radial artery: Branches off the radial artery, supplies the elbow joint.
5. Middle collateral artery: Branches off the profunda brachii artery, supplies the lateral aspect of the
elbow.
Venous Drainage:
1. Brachial veins: Accompany the brachial artery, drain the elbow.
2. Cephalic vein: Drains the lateral aspect of the elbow.
3. Basilic vein: Drains the medial aspect of the elbow.
Capillary Network:
1. Articular capillaries: Supply the synovial membrane and cartilage.
2. Periarticular capillaries: Supply the surrounding soft tissues.

RADIOLOGIC ANATOMY OF THE ELBOW:

Elbow injuries can be acute or chronic, affecting various tissues. Here are common elbow injuries:
Acute Injuries:
1. Fractures (humerus, radius, ulna)
2. Dislocations (partial or complete)
3. Sprains (ligament stretching or tearing)
4. Strains (muscle or tendon injuries)
5. Contusions (bruises)
Chronic Injuries:
1. Tennis elbow (lateral epicondylitis)
2. Golfer's elbow (medial epicondylitis)
3. Ulnar collateral ligament (UCL) injuries
4. Medial epicondylar apophysitis (Little League elbow)
5. Osteochondritis dissecans (cartilage and bone damage)
Overuse Injuries:
1. Tendinitis (inflammation of tendons)
2. Bursitis (inflammation of fluid-filled sacs)
 3. Elbow impingement (bone or soft tissue compression)
4. Radial tunnel syndrome (nerve compression)
Traumatic Injuries:
1. Elbow fractures (radial head, coronoid process)
2. Elbow dislocations (posterior, anterior)
3. Vascular injuries (artery or vein damage)
4. Nerve injuries (radial, median, ulnar)
Sports-Specific Injuries:
1. Baseball (Little League elbow, UCL injuries)
2. Tennis (tennis elbow)
3. Golf (golfer's elbow)
4. Football (elbow dislocations, fractures)
5. Gymnastics (elbow injuries from landing incorrectly)
Symptoms:
1. Pain
2. Swelling
3. Bruising
4. Limited mobility
5. Instability
Treatment:
1. Rest, Ice, Compression, Elevation (RICE)
2. Physical therapy
3. Bracing or splinting
4. Pain management (medication)
5. Surgery (for severe or complex injuries)
Prevention:
1. Warm-up and stretching exercises
2. Proper equipment use
3. Technique correction
THE RADIOGRAPHIC ANALYSIS OF THE ELBOW:
Radiographic analysis of the elbow involves interpreting various imaging modalities to diagnose and
manage elbow disorders. Here's an overview:
Imaging Modalities:
1. X-ray (AP and lateral views)
2. Computed Tomography (CT) scans
3. Magnetic Resonance Imaging (MRI)
4. Ultrasound
5. Arthrography (joint injection with contrast)
Radiographic Views:
1. Anteroposterior (AP) view
2. Lateral view
3. Oblique views (45° and 90°)
4. Radial head view (for radial head fractures)
Elbow Radiographic Landmarks:
1. Medial epicondyle
2. Lateral epicondyle
3. Capitellum
4. Trochlea
5. Olecranon
6. Coronoid process
7. Radial head
Common Elbow Pathologies:
1. Fractures (radial head, coronoid process)
2. Dislocations (posterior, anterior)
3. Osteochondritis dissecans
4. Ulnar collateral ligament (UCL) injuries
5. Lateral epicondylitis (tennis elbow)
6. Medial epicondylitis (golfer's elbow)
MRI Findings:
1. Tendinosis (tendon degeneration)
2. Tendinitis (tendon inflammation)
3. Ligament sprains or tears
4. Bursitis (fluid-filled sac inflammation)
5. Cartilage lesions
CT Scan Findings:
1. Fracture detection
2. Bone fragmentation
3. Joint alignment
4. Loose bodies (bone or cartilage fragments)
Ultrasound Findings:
1. Tendinopathy (tendon disease)
2. Bursitis
3. Ganglion cysts
4. Nerve entrapment
Radiographic Measurements:
1. Carrying angle (normal: 5-15°)
2. Cubitus varus/valgus (abnormal alignment)
3. Joint space narrowing
Clinical Applications:
1. Diagnosis of acute and chronic injuries
2. Pre-operative planning
3. Post-operative evaluation
4. Monitoring disease progression
Limitations and Considerations:
1. Radiation exposure
2. Image quality and artifacts
3. Interpreter variability
4. Clinical correlation necessary

CLINICAL SIGNIFICANCE
The elbow joint plays a vital role in daily activities, and its dysfunction can significantly impact quality of
life. Here's the clinical significance of the elbow:
Functional Importance:
1. Flexion and extension: Essential for feeding, grooming, and reaching.
2. Supination and pronation: Crucial for rotating forearm and hand.
Common Clinical Conditions:
1. Fractures and dislocations
2. Osteoarthritis
3. Rheumatoid arthritis
4. Tendinopathies (tennis elbow, golfer's elbow)
5. Nerve entrapment (cubital tunnel syndrome)
Symptoms and Signs:
Pain, Swelling, Limited mobility, Instability, Weakness, Numbness or tingling
Clinical Examination:
1. Inspection
2. Palpation
3. Range of motion (ROM) assessment
Treatment Options:
1. Conservative management (physical therapy, bracing)
2. Surgical interventions (arthroscopy)
3. Pain management
Complications:
1. Chronic pain
2. Limited mobility
3. Instability
4. Nerve damage
5. Infection
Clinical Specialties:
1. Orthopedic surgery

THE WRIST JOINT

The wrist joint, also known as the radiocarpal joint, is a complex articulation between the forearm and
hand. Here are the key structures:
Bones:
1. Radius (forearm bone)
2. Ulna (forearm bone)
3. Scaphoid bone
4. Lunate bone
5. Triquetrum bone
6. Pisiform bone
7. Trapezium bone
8. Trapezoid bone
9. Capitate bone
10. Hamate bone
Joints:
1. Radiocarpal joint (wrist joint)
2. Intercarpal joints (between carpal bones)
3. Midcarpal joint (between proximal and distal carpal rows)
Ligaments:
1. Volar radiocarpal ligament
2. Dorsal radiocarpal ligament
3. Ulnocarpal ligament
4. Intercarpal ligaments
5. Radioulnar ligament
Tendons:
1. Flexor tendons:
a. Flexor carpi radialis
b. Flexor carpi ulnaris
c. Flexor digitorum profundus
d. Flexor digitorum superficialis
 2. Extensor tendons:
e. Extensor carpi radialis brevis
f. Extensor carpi radialis longus
g. Extensor carpi ulnaris
h. Extensor digitorum communis
Muscles:
1. Flexor muscles:
 Flexor carpi radialis
 Flexor carpi ulnaris
 Flexor digitorum profundus
 Flexor digitorum superficialis
2. Extensor muscles:
 Extensor carpi radialis brevis
 Extensor carpi radialis longus
 Extensor carpi ulnaris
 Extensor digitorum communis

Nerves:
1. Median nerve
2. Radial nerve
3. Ulnar nerve
Blood vessels:
1. Radial artery
2. Ulnar artery
3. Median artery
Wrist movements:
1. Flexion (forward bending)
2. Extension (backward bending)
3. Abduction (radial deviation)
4. Adduction (ulnar deviation)
5. Rotation (supination and pronation)

BLOOD SUPPLY TO THE WRIST JOINT

The blood supply to the wrist joint is provided by a network of arteries, veins, and capillaries.
Arterial Supply:
1. Radial artery: Main artery supplying the wrist, branches off the brachial artery.
2. Ulnar artery: Branches off the brachial artery, supplies the medial aspect of the wrist.
3. Posterior interosseous artery: Branches off the ulnar artery, supplies the posterior aspect of the
wrist.
4. Anterior interosseous artery: Branches off the ulnar artery, supplies the anterior aspect of the wrist.

- Branches of Radial Artery:

Radial carpal branch, Dorsal carpal branch, Palmar carpal branch.

- Branches of Ulnar Artery:

Ulnar carpal branch, Palmar carpal branch, Dorsal carpal branch.

- Venous Drainage:
Cephalic vein, Basilic vein, Median cubital vein, Dorsal venous network
Capillary Network:
1. Articular capillaries: Supply the synovial membrane and cartilage.
2. Periarticular capillaries: Supply the surrounding soft tissues.

RADIOGRAPHIC ANALYSIS OF THE WRIST JOINT

Radiographic analysis of the wrist joint involves interpreting various imaging modalities to diagnose
and manage wrist disorders. Here's an overview:
Imaging Modalities:
X-ray (AP, lateral, oblique views), Computed Tomography (CT) scans, Magnetic Resonance Imaging
(MRI), Ultrasound Arthrography (joint injection with contrast)
Radiographic Views:
1. Anteroposterior (AP) view
2. Lateral view
3. Oblique views (45° and 90°)
4. Scaphoid view (for scaphoid fractures)

Wrist Radiographic Landmarks: these are the 8 bones that make up the wrist.
Scaphoid bone, Lunate bone, Triquetrum bone, Pisiform bone, Trapezium bone, Trapezoid bone,
Capitate bone, Hamate bone.

Common Wrist Pathologies:

1. Fractures (scaphoid, distal radius)
2. Carpal instability (scapholunate, lunotriquetral)
3. Osteoarthritis
4. Rheumatoid arthritis

MRI Findings:
1. Ligament sprains or tears
2. Tendinosis or tendon tears
3. Cartilage lesions
4. Bone marrow edema
5. Synovitis

CT Scan Findings:
1. Fracture detection
2. Bone fragmentation
3. Joint alignment
4. Loose bodies (bone or cartilage fragments)

Ultrasound Findings:
1. Tendinosis or tendon tears
2. Ganglion cysts
3. Synovitis
4. Nerve entrapment
Radiographic Measurements:
 1. Scapholunate angle (normal: 30-60°)
2. Lunotriquetral angle (normal: 10-30°)
3. Radial inclination (normal: 15-25°)
4. Ulnar variance (normal: -2 to +2 mm)

Limitations and Considerations:

1. Radiation exposure
2. Image quality and artifacts

Clinical Significance:
1. Injury to the radial or ulnar artery can compromise blood supply to the wrist.
2. Thrombosis or embolism can affect blood flow to the wrist.
3. Compromised blood supply can lead to ischemia, necrosis, or infection.