Shoulder Girdle
Download
Report
Transcript Shoulder Girdle
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 & 1st costal
cartilage
Scapula
Flat Bone
2 surfaces
3 borders
3 angles
Anterior
Scapula
Proximal Humerus
Posterior Greater Tubercle
Attachments
Superior:
Supraspinatus
Middle:
Infraspinatus
Inferior: Teres
Minor
Lesser Tubercle
Attachments
Biceps
Tendon
Subscapularis
Muscles
Muscles
Biceps Brachii
Long Head
Tendon
Short Head
Tendon
Arises from
superior margin
of glenoid cavity
Arises from
coracoid process
Muscle inserts
into the radial
tuberosity
Bursa
Small
Subcoracoid
Bursa
Supraspinatus
Muscle
Long head of biceps
muscle
synovial filled
sacs
Relieves
pressure and
reduces
friction
Injury or age
causes
calcium
deposits seen
on x-rays
Shoulder Girdle Articulations
Scapulohumeral
Ball and
Socket
Acromioclavicular
Gliding
Sternoclavicular
Double
Gliding
AP Projection
Shoulder (Anatomic Position, External Rotation)
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)
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)
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
Humerus
Coracoid
Process
Acromioclavicular
Joint
•Lesser Tubercle in
profile
•Coroacoid
Process pointing
anteriorly
Acromion
Scapulohumeral
Joint
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
CR 35
degrees
Demonstrates relationship of humeral head to
the glenoid cavity
Useful in diagnosing posterior dislocation
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
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
35-45 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: 10-15
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