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

Greater Tubercle Attachments Superior:

Supraspinatus Middle:

Infraspinatus Inferior: Teres

Minor

Lesser Tubercle Attachments Subscapularis

Posterior

Biceps Tendon

Muscles

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 ProjectionShoulder (Anatomic Position, External Rotation)

AP ProjectionShoulder (Anatomic Position, External Rotation)

Greater tubercle and Humeral head in profile

Supraspinatus tendon insertion visualized

AP ProjectionShoulder (Neutral Rotation, palm against hip)

AP ProjectionShoulder (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 ProjectionShoulder (Internal Rotation, posterior hand against hip)

AP ProjectionShoulder (Internal Rotation, posterior hand against hip)

Lesser Tubercle in profile

Proximal humerus in true lateral position

Insertion site of subscapular tendon demonstrated

Transthoracic Lateral ProjectionShoulder (Lawrence Method)

What do you do if the patient cannot sufficiently elevate the unaffected shoulder?

Transthoracic Lateral Shoulder

Inferosuperior Axial ProjectionLawrence Method

Degree of angulation of CR depends on abduction of arm

Inferosuperior Axial ProjectionLawrence Method

Lesser Tubercle

Coracoid Process

Acromioclavicular Joint

Scapulohumeral Joint

Acromion

Humerus

•Lesser Tubercle in profile

•Coroacoid Process pointing anteriorly

Superoinferior Axial ProjectionAlternative 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 ProjectionTrauma Shoulder

Demonstrates relationship of humeral head to the glenoid cavity

Useful in diagnosing posterior dislocation

CR 35 degrees

Scapular YPA 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 ProjectionGlenoid 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 GrooveTangential Projection

CR: 10-15 degrees posterior

Hand supinated

Profiles the intertubercular groove free from superimposition of the surrounding shoulder structures.

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

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

Acromioclavicular ArticulationsAlexander Method

AC Joint and Clavicle projected above the Acromion

CR 15 degrees cephalic

ClavicleAP Projection

ClaviclePA Projection

What would be the advantage of doing a PA Projection?

AP Axial ProjectionLordotic 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 ProjectionLordotic Position

How do you treat a fractured clavicle?

ScapulaAP 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

ScapulaLateral 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