Transcript MODULE 4 - RollaNet

MODULE 4
SHOULDER
NORMAL ANATOMY
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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
LINES OF MENSURATION
• Axial angle of humerus in AP with external
rotation
• Humeral shaft line
• Humeral head line
– greater tubercle
– medial/inferior articular surface
LINES OF MENSURATION
• Humeral angle
– average 60o in men
– average 62o in female
• Changes in angles could be due to fracture,
dysplasia, or SLE
Humeral angle=HA
Fig 2.68
Humeral shaft line=A
Humeral head line=B
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
Glenohumeral joint
in AP with external rotation
Fig 2.69
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
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)
Acromiohumeral joint space
Fig 2.70
LINES OF MENSURATION
• Decrease (<7.0mm) indicative of rotator
cuff tear, degenerative tendonitis
• Increase (>11.0mm) indicative of posttraumatic subluxation, dislocation, joint
effusion, stroke, brachial plexus lesion
(drooping shoulder)
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 2.5-4.1
• Females average 2.9 with a range of 2.1-3.7
Acromioclavicular joint space
Fig 2.71a
Good
Acromioclavicular joint space
Fig 2.71b
Bad DJD Bad dog!!!
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
COMMON CONDITIONS
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Degenerative joint disease
Rotator cuff tear
Calcific tendonitis
Dislocation and humerus fracture
Clavicle fracture
CLINICAL DIAGNOSIS
• Impingement
• Adhesive capsulitis
• Tendonitis/bursitis
SLIDES
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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
MENTION
• Adhesive capsulitis
• Tendonitis/bursitis