A practical guide to diagnostic imaging of the upper extremity

Imaging of the upper extremities can be challenging and rewarding. Newer imaging modalities, including MRI and CT, have greatly expanded the ability of the radiologist to define soft-tissue abnormalities in the wrist, especially triangular fibrocartilage tears and carpal and radioulnar instability. MRI of the shoulder has almost replaced the arthrogram for diagnosing rotator cuff tears. The plain film, however, remains the mainstay of bone imaging and is the most efficacious first step in the diagnostic work-up. The radionuclide scan, although nonspecific, may provide a map for the radiologist to locate occult lesions. Dialogue between the surgeon and radiologist is essential to effective upper extremity evaluations. The radiologist can maximize his or her effectiveness by performing a brief history and physical examination of the patient.