1. MODULE 4
SHOULDER

2. NORMAL ANATOMY Positioning slides
Discuss three views versus four view series
AP - internal rotation
AP - external rotation
Abduction - baby arm, 90o/90o view
at least one view should demonstrate lung apices, usually baby arm

3. LINES OF MENSURATION
Axial angle of humerus in AP with external rotation
Humeral shaft line
Humeral head line
greater tubercle
medial/inferior articular surface

4. LINES OF MENSURATION Humeral angle
average 60o in men
average 62o in female
Changes in angles could be due to fracture, dysplasia, or SLE

5. Humeral shaft line=A
Humeral head line=B
Humeral angle=HA
Fig 2.68

6. LINES OF MENSURATION Glenohumeral joint in AP with external rotation
Measure superior, middle, and inferior
Add and divide by three and report average (mobility versus stability)
4-5 mm essential normal

7. Glenohumeral joint
in AP with external rotation
Fig 2.69

8. LINES OF MENSURATION
Increased measure indicative of infection, inflammatory arthritide, acromegaly, posterior dislocation
Decreased measure indicative of degenerative joint disease, calcium pyrophosphate dihydrate (CPPD), inflammatory arthritide, septic arthritis

9. LINES OF MENSURATION Acromiohumeral joint space
AP shoulder (or external rotation)
Measure inferior surface of acromion to humeral head
Average 9.0mm (range 7-11mm)

10. Acromiohumeral joint space
Fig 2.70

11. LINES OF MENSURATION
Decrease (<7.0mm) indicative of rotator cuff tear, degenerative tendonitis
Increase (>11.0mm) indicative of post-traumatic subluxation, dislocation, joint effusion, stroke, brachial plexus lesion (drooping shoulder)

12. LINES OF MENSURATION Acromioclavicular joint space
AP, PA, external view
Measure superior and inferior surfaces and average the measurements
Males average 3.3 with a range of
Females average 2.9 with a range of

13. Acromioclavicular joint space
Fig 2.71a
Good

14. Acromioclavicular joint space
Fig 2.71b
Bad DJD Bad dog!!!

15. LINES OF MENSURATION
Decrease measure (<2.5/2.1) indicative of degenerative joint disease
Increase measure (>4.1/3.7) indicative of traumatic separation, resorption (osteolysis), HPT, rheumatoid arthritis, backpacking syndrome
May require weighted and non-weighted comparison study

16. COMMON CONDITIONS Degenerative joint disease Rotator cuff tear
Calcific tendonitis
Dislocation and humerus fracture
Clavicle fracture

17. CLINICAL DIAGNOSIS
Impingement
Adhesive capsulitis
Tendonitis/bursitis

18. SLIDES Normal positioning Text measure Gross specifications
Degenerative joint disease
Calcified tendonitis
Rotator cuff tear
Acromioclavicular separation Osteolysis
Scapula fracture
Clavicular fracture
Surgical sign of clavicle removal
Ischemic necrosis
Impingement

19. MENTION
Adhesive capsulitis
Tendonitis/bursitis