Trauma Radiography “The Shoulder Girdle”

Abdul Nizam Bin DuimJuru X-ray U29 SGH Kuching

The Basic Anatomy of The Shoulder

GirdleUpper 3rd of the Humerus /

The Head of Humerus

Glenoid Process of the Scapula

Clavicle

The BasicRadiography Of The Shoulder

Girdle

Ap Shoulder (External / Internal

Rotation)

Lateral Scapula / Transthoracic / “Y View”

Axilary View/Supero-Inferior

AP Shoulder (Supine/Erect)

Internal Rotation External Rotation

“External Vs Internal”

AP Shoulder External Rotation

AP Shoulder Internal Rotation

Ap Shoulder ?Straight

Body Oblique 30-40 DegGrasheys View

Grashey’s View/AP Glenohumeral Joints

True AP of GH joint space/no overlap

Profile position of Humeral Head and Glenoid

Bankart’s Lesion/Fracture appear as Chip Fracture of Glenoid Rim (Labrum Tear)

Ap ShoulderStraight AP Int Rotation

Oblq 30-40 deg Ext Rotation/Grasheys View

True Ap Shoulder (Grashey’s View) Grashey view taken with patient in

posterior oblique position with scapular spine parallel to film plane, creating true AP projection of shoulder. Compare more tangential appearance of the glenoid in this view with the typical AP shoulder

“Shoulder surgery” By Nikolaus Wülker, Michel Mansat, Freddie H. Fu

Published by Informa Health Care, 2001,ISBN 1853175633, 9781853175633

“Rockwood and Green's fractures in adults”

By Charles A. Rockwood, David P. Green, Robert W. Bucholz, James D. Heckman, Charles M. Court-Brown, Kenneth J. Koval, Paul Tornetta

Published by Lippincott Williams & Wilkins, 2006

Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.

Lateral/Transthoracic Scapula/”Y” View

Axial/SuperoInferior Shoulder

Supine Sitting

Axial/SuperoInferior Shoulder

Audit on Radiographs of Shoulder

The radiographs of 115 anterior shoulder dislocations (100 patients; 74 males, 26 females, mean age 35 ± 18 years) were reviewed to assess the radiographic views used in the management of this dislocation. Eighty-eight patients (88%) had only the anteroposterior (AP) view , 10 patients had 2 radiographic views taken and only 2 patients had three radiographic views.

Hill-Sachs Lesions were found in 18%, asociated with glenoid rim fractures in 3%(Bankart’s Lesion) of the patients. A greater tuberosity fracture was found in 18% of the patients.

Therefore, the current practice in the management of an acute anterior shoulder dislocation appears to be to perform a single view (AP) pre-reduction radiograph to confirm the diagnosis and a single view (AP) post reduction radiograph to confirm reduction after a close manipulative reduction has been performed. This practice is likely to result in an underestimate of associated Hill Sachs Lesion,Bankart’s Lesion and glenoid rim fractures, but not greater tuberosity fractures.

Medical Journal of Malaysia, 60 (1). pp. 15-20. ISSN 0300-5283

Lee, D.J.K., and Yeap, J.S., and Fazir M., and Muhd Borhan T.A., and Kareem B.A., (2005)

TraumaFracture /Pathology

Anteror/Posterior DislocationBankart’s LesionHill Sachs LesionGH ArthritisRotator Cuffs InjuryFracture-Humeral Head/Glenoid Scapula/

Clavicle/Joints AC etc.

Anterior / Posterior Dislocation of The Shoulder

A shoulder dislocation occurs when the head of the humerus (upper arm bone) pops out of the shallow shoulder socket of the scapula (called the glenoid). This can happen when a strong force pulls the shoulder upward or outward, or from an extreme external rotation of the humerus.

Glenohumeral dislocations are generally classified by the direction of dislocation of the humerus.(Anterior / Posterior-Seizure/Intense elctrical shock)

Dislocation can be full or partial, partial dislocation (also called subluxation)—the head of the humerus slips out of the socket momentarily and then snaps back into place.Full dislocation—the head of the humerus comes completely out of the socket

Shoulder dislocations can also be associated with fractures—one can have a fracture and dislocation at the same time. Nerves and blood vessels can sometimes be injured with a severe shoulder dislocation, requiring immediate medical attention.

Anterior-GT# Posterior LT#

Anterior / Posterior Dislocation of The Shoulder

(GH Joint)

GlenoHumeral /ShoulderArthritis

glenohumeral arthritis or shoulder arthritis is an inflammatory process of the shoulder that

is usually accompanied by pain, swelling, and stiffness resulting from infection, trauma,

degenerative changes, metabolic disturbances, or other causes. It occurs in various forms,

such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis.

AP Shoulder Of GH Arthritis

Lesion / Fracture / Deformity

Bankart’s (Bone / Cartilage Lesion)

Is a specific injury to a part of the shoulder joint called the labrum (a cuff of cartilage that forms a cup for the end of the arm bone (humerus) to move within) When the labrum of the shoulder joint is torn, the stability of the shoulder joint is compromised. A specific type of labral tear is called a Bankart lesion, and is due to dislocation of the shoulder causing the tear.

Hill Sach’s (Bone Lesion) Is an injury that causes damage to the head of the humerus (arm

bone).When the shoulder dislocates, the smooth cartilage surface of the humerus hits against the rim of the scapula (glenoid). The Hill-Sachs injury is caused when the humeral head is impinged against the glenoid of the shoulder joint.

Both are Complication becouse of Shoulder Dislocation

Rotator Cuffs Tear/InjuryRotator cuff tears are tears

of one, or more, of the four tendons of the rotator cuff muscles.

The tendons of the rotator cuff supraspinatus, infraspinatus, teres minor and subscapularis.

Soft Tissue Injury-MRIXrays wont show any

tear,provide indirect evidence

Fractures-Head Of Humerus

Fracture Greater/Lasser Tuberosity

Greater tuberosity fracture-

usually associated with anterior dislocation

Lesser tuberosity fracture-

usually associated with posterior dislocation

Facture of The ScapulaRareMost common between

40-60 yearsImportance occur only

in severe traumaClassified based on

location/anatomical structure

“Y View”

Fracture Of The ClavicleFracture proximal (medial)

third- 5%Fracture middle third- 85%Fracture distal third- 15%

If displacement is present , the proximal fragment is usually elevated and distal fragment is displaced medially and caudally.

RecommendationsAP Shoulder-Anterior/Posterior Dislocation,Fracture

Clavicle

External Rotaion-Greater Tubercle

Internal Rotation-Lasser Tubercle,Hill Sach’s LesionGrashey’s View(30-40 deg)-GHArthritis,Glenoid(Rim)

Fracture/Bankart’s Lesion,Anterior/Posterior DislocationLateral/Tranthoracic/Y View-Scapula

Fracture,Choracoid/Acromion FractureAxial/SuperoInferior-Ext view for Anterior/Posterior

Dislocations