Shoulder Girdle Tanya Nolan

Shoulder Girdle Formed by 2 bones Scapula Clavicle Function Connect upper limb to trunk

Clavicle Long Bone Horizontal oblique plane Doubly curved for strength Function Fulcrum for movements of the arm Acromial Extremity Articulates with acromion process of scapula Sternal Extremity Articulates with the manubrium of sternum & 1 st costal cartilage

Scapula Flat Bone 2 surfaces 3 borders 3 angles Anterior

Scapula

Proximal Humerus Greater Tubercle Attachments Superior: Supraspinatus Middle: Infraspinatus Inferior: Teres Minor Lesser Tubercle Attachments Subscapularis Posterior Biceps Tendon

Muscles

Biceps Brachii Long Head Tendon Arises from superior margin of glenoid cavity Short Head Tendon Arises from coracoid process Muscle inserts into the radial tuberosity

Bursa Small synovial filled sacs Relieves pressure and reduces friction Injury or age causes calcium deposits seen on x-rays Subcoracoid Bursa Supraspinatus Muscle Long head of biceps muscle

Shoulder Girdle Articulations Scapulohumeral Ball and Socket Acromioclavicular Gliding Sternoclavicular Double Gliding

AP Projection Shoulder ( Anatomic Position, External Rotation )

Greater tubercle and Humeral head in profile Supraspinatus tendon insertion visualized

AP Projection Shoulder ( Neutral Rotation, palm against hip )

Greater Tubercle partially superimposing the humeral head Posterior part of supraspinatus insertion demonstrated Profiles calcific deposits not otherwise visualized

AP Projection Shoulder ( Internal Rotation, posterior hand against hip )

Lesser Tubercle in profile Proximal humerus in true lateral position Insertion site of subscapular tendon demonstrated

Transthoracic Lateral Projection Shoulder (Lawrence Method) What do you do if the patient cannot sufficiently elevate the unaffected shoulder?

Transthoracic Lateral Shoulder

Inferosuperior Axial Projection Lawrence Method Degree of angulation of CR depends on abduction of arm

Inferosuperior Axial Projection Lawrence Method Lesser Tubercle Coracoid Process Acromioclavicular Joint Scapulohumeral Joint Acromion Humerus Lesser Tubercle in profile Coroacoid Process pointing anteriorly

Superoinferior Axial Projection Alternative to Supine Lawrence Method Place the patient in a chair at the end of the exam table and have them extend the shoulder over the table. Shoulder should be over midpoint of IR Tilt head away from IR Humeral epicondyles should be vertical CR 5-15 degrees toward elbow

AP Axial Projection Trauma Shoulder Demonstrates relationship of humeral head to the glenoid cavity Useful in diagnosing posterior dislocation CR 35 degrees

Scapular Y PA Oblique Projection The position of the arm is unimportant because it does not change the relationship of the humeral head to the glenoid cavity

Scapular Y

Useful in demonstrating dislocations Anterior Subcoracoid dislocation Head beneath the coracoid process Posterior Subacromial dislocation Head projected beneath acromion process

AP Oblique Projection Glenoid Cavity (Grashy Method) RPO / LPO Position degrees toward affected side Scapula parallel with the plane of the IR CR 2 in. medial and 2 in. inferior to superolateral border of the shoulder Open Glenoid Cavity in Profile

Intertubercular Groove Tangential Projection CR: degrees posterior Hand supinated Profiles the intertubercular groove free from superimposition of the surrounding shoulder structures.

Acromioclavicular Articulations AP Projection: Bilateral SID: 72 inches Upright Position With and Without weights Demonstrates dislocation, separation, and the function of joints

Acromioclavicular Articulations AP Projection: Bilateral What pathology does this image demonstrate? How do you know a patient is not rotated or favoring the injured side?

Acromioclavicular Articulations Alexander Method AC Joint and Clavicle projected above the Acromion CR 15 degrees cephalic

Clavicle AP Projection

Clavicle PA Projection What would be the advantage of doing a PA Projection?

AP Axial Projection Lordotic Position Thinner patients require more angulation to project the clavicle off of the scapula and ribs. Which position is easier for the patient?

AP Axial Projection Lordotic Position How do you treat a fractured clavicle?

Scapula AP Projection

Scapula Lateral Projection Patient flexes elbow and places hand on posterior thorax Delineates the acromion and coracoid process Adjust body of scapula to be perpendicular to the IR

Scapula Lateral Projection Arm brought across the chest grasping opposite shoulder Position of the arm determines what portion of the scapula will be superimposed by the humerus

Scapula Lateral Projection Extending the arm upward demonstrates the body of the scapula best.

Shoulder Arthrography Examination of a joint after the injection of contrast material that outlines soft tissue and joint structures. The most common purpose of shoulder arthrography is to rule out bursitis