CT Upper Extremity (Shoulder/Elbow/Wrist/Hand)

Indications

• Complex/occult fracture characterization (scaphoid, distal radius, scapula, elbow)
• Fracture-dislocation, intra-articular extension, hardware/nonunion assessment
• Preoperative planning

Patient prep

• Remove jewelry, watches, removable hardware
• Position part as still as possible; splint may need removal if not metallic-artifact-free
• No contrast for routine osseous indication (CT arthrogram is a separate fluoroscopy/injection protocol)

Contrast

Technique

• Wrist/hand/elbow: prone, arm extended overhead ('superman') to move part out of torso for low dose and fewer artifacts when tolerated; otherwise at side
• Shoulder: supine, arm at side in neutral; scan affected side
• 120 kV (lower for distal small parts), thin sub-mm collimation
• Bone and soft tissue recon; isotropic 0.5-0.625 mm data
• Multiplanar and 3D reformats; for wrist, align reformats to anatomy of interest

Series / Sequences

Key points

• Isotropic thin data enables reformats in any plane; align to the bone of interest (e.g., scaphoid long axis)
• Position extremity away from torso when feasible to reduce dose and improve image quality
• Use metal artifact reduction (MAR/IMAR) recon for hardware
• Add soft tissue windows for foreign body, abscess, or soft tissue mass
• CT arthrogram (intra-articular dilute iodinated contrast) is used for labral/ligament/cartilage assessment when MRI contraindicated

References