Procedure-oriented sectional anatomy of the elbow.

This is the second in a series of papers related to procedure-oriented joint anatomy. This article will review the anatomy of the elbow and its relationship to procedures in the clinical setting. Needle procedures of the elbow joint include medial and lateral epicondyle injections, olecranon bursa injection, elbow joint aspiration, phlebotomies in the antecubital fossa, and intramuscular injections such as trigger point and botulinum toxin injections. Complications related to these procedures include infection, skin atrophy, injuries to peripheral nerves, tendon rupture associated with the use of corticosteroids, iatrogenic vascular injuries, and chronic local pain. This article provides anatomically accurate schematics of the elbow anatomy relevant to needle procedures. Cross-sectional anatomical schematics of the elbow were drawn as they appear on axial and coronal projections. Superficial and deep landmarks are highlighted as well as sources of potential complications. These schematics allow for safer and more accurate needle procedures in the elbow area, for both nonguided and musculoskeletal ultrasound-guided techniques.

Procedure-oriented sectional anatomy of the shoulder.

This is the first in a series of papers on procedure-oriented joint anatomy. This paper will review anatomy of the shoulder joint and focus on non-imaging-guided procedures. Needle procedures of the shoulder include glenohumeral, subacromial, and acromioclavicular joint injections; electromyography; trigger point and other intramuscular injections; bicipital tendon sheath injection; suprascapular nerve blocks; and botulinum toxin injections. The accuracy of these non-imaging-guided procedures is reviewed. Complications of these procedures include infection, damage to tendon, and local or systemic response to medication. This paper provides anatomically accurate schematics of the shoulder anatomy relevant to needle procedures. Cross-sectional schematics of the shoulder were drawn as they appear on axial and sagittal projections. Superficial and deep landmarks are highlighted and sources of potential complications. The schematics allow for safer and more accurate non-image-guided needle procedures in the shoulder region.

Neuroimaging in posttraumatic hypopituitarism.

Posttraumatic hypopituitarism is the failure of the hypothalamic-pituitary axis secondary to traumatic brain injury. It can clinically present as decreased muscle mass, concentration, libido, and fertility. It can also present as increased fatigue, depression, and cognitive deficits. In addition, electrolyte abnormalities such as hyponatremia can occur in hypopituitarism. As a result of heightened awareness of posttraumatic hypopituitarism, it is a phenomenon that is becoming more commonly diagnosed. Posttraumatic hypopituitarism is a diagnosis based on clinical evaluation, laboratory testing, and neuroimaging. Of the radiological techniques, magnetic resonance imaging is the preferred technique to image the pituitary gland. This article contains coronal and sagittal magnetic resonance imaging of the posterior fossa, illustrating the normal hypothalamus and pituitary gland as well as adjacent structures. The sequential enhancement pattern of the normal pituitary gland is consistent with its vascular supply. A colored illustration was created to display the vascular supply to the hypothalamus, pituitary stalk, and pituitary gland.

Sectional neuroanatomy of the lower thoracic spine and chest.

This is the fourth in a series of articles on the spine. The first reviewed the anatomy of the neck; the second reviewed the upper thoracic spine and chest (T1-T4); and the third reviewed the middle thoracic spine and chest (T5-T8). The procedures performed in the lower thoracic spine include percutaneous biopsies of the liver and kidneys, percutaneous nephrolithotomy, spinal injections, radiofrequency ablations, electromyography of the diaphragm, trigger point injections, chemodenervation with botulinum toxin, acupuncture, aneurysm repair, and, occasionally, chest tube placement in the lower lung fields. Complications include subcapsular hematomas, infections, pneumothorax, hemothorax, spinal cord ischemia and resultant paraplegia, and, rarely, nephropleural fistulas. This article provides anatomically accurate schematics of innervations of the lower thoracic chest and spine (T9-T12) that can be used to interpret the magnetic resonance images of the muscles and the nerves. Cross-sectional schematics of the lower thoracic chest and spine were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the lower thoracic chest and spine allows the physician to increase the accuracy and the efficacy of interventional procedures. This could also assist the electromyographer in correlating the clinical and electrophysiological findings with magnetic resonance images.

Sectional neuroanatomy of the middle thoracic spine (t5-t8) and chest.

This is the third in a series of articles on the spine. The first reviewed the anatomy of the neck. The second reviewed the upper thoracic spine and chest (T1-T4). A fourth article is planned for the lower thoracic spine. Procedures in the midthoracic spine include chest tube placement, trigger point injections, chemodenervation with botulinum toxin, video-assisted thoroscopic surgery, and spinal injections. Complications include pneumothorax, hemothorax, diaphragmatic irritation, sympathetic trunk irritation, postthoracotomy pain, and intradural abscesses. This article provides anatomically accurate schematics of innervations of the middle thoracic chest and spine (T5-T8) that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the middle thoracic chest and spine were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the middle thoracic chest and spine allows the physician to increase the accuracy and efficacy of interventional procedures. This could also assist the electromyographer in correlating the clinical and electrophysiologic findings with magnetic resonance images.