Ch. 5 Humerus & Shoulder Girdle

Lateral position: scapula (patient recumbent)

*borders of scapula superimposed *free of superimposition by ribs *arm elevated to demonstrate scapular body *body of scapula in profile in a true lateral position *body of scapula totally seperated, not superimposed by ribs *humerus not superimposed over area of interest *SUSPEND RESPIRATION*

Transthoracic lateral projection: proximal humerus (TRAUMA) lawrence method

*breathing technique *CR perpendicular to surgical neck *If patient can't drop injured shoulder & elevate uninjured arm & shoulder high enough to prevent superimposition of shoulders, ANGLE CR 10-15 DEGREES CEPHALAD.

AP PROJECTION: scapula

*breathing technique *CR to midscapula *entire scapula demonstrated *lateral border of scapula free of ribs and lungs *affected arm seen to be abducted 90 degrees and hand supinated, as evidenced by the lateral border of the scapula free of superimposition

Neutral rotation of the humerus

*epicondyles of the distal humerus appear at an approximate 45 degree angle to the IR * greater tuberacle(not in profile) * lesser tuberacle anteriorly (not in profile)

Internal Rotation of the humerus

*epicondyles of the distal humerus are perpendicular to the IR *greater tuberacle rotated anterior *lesser tuberacle is seen in profile medially

ROTATIONAL LATERAL- LATEROMEDIAL PROJECTION: humerus

*epidondyles perpendicular to the IR *CR to midhumerus *lesser tuberacle in profile *epicondyles superimposed *SUSPEND RESPIRATION*

Lateral position: scapula (patient erect)

*for body of scapula *CR to mid-vertebral border of scapula *palpate superior angle of the scapula & AC joint articulation *SUSPEND RESPIRATION*

Scapular Y lateral of the shoulder:

*for lateral shoulder & proximal humerus *CR to proximal humerus -- 2" below top of shoulder *body of scapula superimposed on end *acromion & coracoid process in profile *humeral head & glenoid cavity superimposed *SUSPEND RESPIRATION*

proximal humerus terms: -head -anatomic neck -lesser tubercle

*head- proximal part is the rounded head of the humerus *anatomic neck- slightly constricted area directly below and lateral to the head *lesser tuberacle- directly below the atomic neck on the anterior surface *greater tuberacle- larger lateral process; to which the pectoralis major and supraspinatus muscles attach.

proximal humerus terms: -intertubercular groove -surgical neck -body -deltoid tuberosity

*intertubercular groove- deep groove between the teo tuberacles *surgical neck- tapered area below the head and tuberacles *distal to the surgical neck, is the long BODY(shaft) of the humerus. *deltoid tuberosity - roughened raised triangular elevation along the anterolateral surface of the body, to which the deltoid muscle is attached

AP projection: of the scapula

*taken with arm abducted so it does not superimpose the scapula. pg. 177 image

SPECIAL: TRAUMA - Transthoracic lateral projection: humerus (trauma)

*unaffected limb raised over head * CR to mid-diaphysis *BREATHING TECHNIQUE* ----> 2 sec. exposure time

What anatomy is demonstrated on a radiograph of the humerus?

- head of humerus - greater tuberacle - intertubercular groove - lesser tuberacle -anatomic neck - surgical neck - body

upper limb: extremity SHOULDER GIRDLE

- humerus -clavicle -scapula

Scapula

-(shoulder blade) which forms the posterior part of the shoulder girdle, is a flat triangular bone with three boarders, three angles, and two surfaces.

COIL METHOD:

-45 degree angle toward shoulder -radial head fracture & coronoid process

Inferosuperior projection: of the proximal humerus & scapula (Lawrence Method)

-A lateral view of the head and neck of the humerus. Demonstrates the relationship of the humerus to the glenoid cavity, which makes up the scapulohumeral joint

SCAPULA ROUTINE:

-AP -Lateral * erect * recumbent

Humerus: routine

-AP -ROTATIONAL LATERAL -HORIZONTAL BEAM LATERAL

shoulder: nontrauma Special projections:

-inferior axial projection (Lawrence method) -posterior oblique position (Grashey method)

What anatomy is demonstrated on a radiograph of the clavicle?

-sternoclavicular joint -sternal extremity -body -acromial extremity -AC joint

The shoulder girdle consists of two bones: CLAVICLE & SCAPULA

-the function of the clavicle and scapula is to connect each upper limb to the trunk or axial skeleton. - each clavicle is located over the upper anterior rib cage - each scapula is situated over the upper posterior rib cage * The upper margin of the scapula is at the level of the 2nd posterior rib, and the lower margin is at the level of the 7th posterior rib(T7).

What are the 3 boarders of the scapula?

3 boarders: -superior: uppermost margin of the scapula -medial(vertebral): long edge or boarder near the vertebrae -lateral(axillary): the boarder nearest the axilla

The AP humerus is the same position as:

AP of the shoulder, with external rotation

Which position is the same as the Rotational Lateral projection of the humerus?

AP shoulder with internal rotation

Which of the following humeral structures is the most distal? A) anatomic neck B) greater tuberacle C) lesser tuberacle D) surgical neck

D. surgical neck

After taking an AP shoulder projection, what determines the next lateral position?

Dislocation= scapular Y lateral Fracture of a surgical neck= thransthoracic lateral

In a true AP projection of the proximal humerus:

The lesser tuberacle is located anteriorly and the greater tubercle is located latterly.

What is the joint classification for the scapulohumeral joint?

spherodial (ball & socket)

ROUTINE: Clavicle: AP & AP AXIAL PROJECTIONS:

(AP) *CR perpendicular = CR to midclavicle (AP axial) *CR 15-30 degrees cephalad= CR to midclavicle *entire clavicle demonstrated *AP AXIAL= more of clavicle seen above ribs *ON INSPARATION- to elevate clavicles

classification & mobility type of joints

* All 3 are SYNOVIAL JOINTS (characterized by a fibrous capsule that contains synovial fluid * Diarthrodial (freely movable)

Lateral Projection: of the scapula

* The scapular Y lateral projection is taken with the patient in an anterior oblique position & with the upper body rotated until the scapula is seperated from the rib cage in a true lateral projection -"Y" shape= acromion and coracoid process make up the upper legs of the "Y" and the body makes the lower leg.

Lateral View: Scapula -acromion -coracoid process

* The upper parts of the "Y" are the acromion and the coracoid process -acromion: expanded distal end of the spine that extends superiorly and posteriorly to the glenoid fossa. -Coracoid process: located more anteriorly in relationship to the glenoid cavity or shoulder joint.

External rotation of the humerus

* represents a true AP projectionof the humerus in the anatomic position *interepicondylar line is parallel to the IR - greater tuberacle is laterally in profile -lesser tuberacle located anteriorly

AC JOINTS: AP PROJECTION: bilateral: with & without weights

* weights held by straps around wrists *CR to midpoint between AC joints *72" SID *both AC joints demonstrated *no motion *SUSPEND RESPIRATION*

posterior oblique position: shoulder (non trauma) GRASHEY METHOD

*35-45 degrees oblique *CR perpendicular *CR 2" below & medial from the superolateral border of humerus *scapulohumeral joint centered *SUSPEND RESPIRATION*

AP shoulder with external

*CR 1" below coracoid process *epicondyles parallel *greater tuberacle profiled latterally *scapulohumeral joint centered *proximal humerus, upper scapula,and clavicle visualized *SUSPEND RESPIRATION*

AP PROJECTION: INTERNAL ROTATION: shoulder: non trauma

*CR 1" below coracoid process *lesser tuberacle profiled medially *scapulohumeral joint centered *promixal humerus, upper scapula, & clavicle visualized *SUSPEND RESPIRATION*

Inferiosuperior axial projection: shoulder: (Lawrence Method)

*CR 25-30 degrees medial to axilla *arm supinated, abducted 90 degrees *demonstrates possible HILL-SACHS DEFECT *lesser tuberacle ptofiled anteriorly *humeral head & glenoid fossa profiled *suspend respiration*

AP PROJECTION: HUMERUS

*CR to mid-humerus *include both shoulder and elbow joints (entire humerus demonstrated) *greater tuberacle in profile *medial epicondyles in profile * SUSPEND RESPIRATION*

AP PROJECTION: neutral rotation: shoulder trauma

*CR to scapulohumeral joint *greater tuberacle superimposed *scapulohumeral joint centered *SUSPEND RESPIRATION*

Anterior View: Scapula -costal surface -subscapular fossa

*Costal surface- anterior surface of the scapula, termed the costal surface because of its proximity to the ribs *subscapular fossa- a large, concavity or depression in the middle area of the costal surface

Movement type: joints of shoulder girdle:

*Scapulohumeral Joint= spheroidal/ ball and socket *Sternoclavicular joint= plane/gliding joint *Acromioclavicular joint= plane/gliding joint

Anterior view: Scapula -lateral angle -scapulohumeral joint -neck -superior & inferior angles

*The lateral angle- (head of scapula) is the thickest part and end latterally in a shallow depression, called the glenoid fossa. *Scapulohumeral joint-where the humeral head articulates with the glenoid cavity of the scapula *neck- constricted area between the head and the body of the scapula *superior & inferior angles- refer to the upper and lower ends of the medial or vertebral border.

trauma lateral scapular Y of the shoulder

*palpate scapular borders *20-30 degree rotation *CR cross-angled if required *grid crosswise

*Radiographs of the proximal humerus (pg.179)

*reveals calcium deposits or other pathologies ( osteoporosis) *By the position of the greater and lesser tuberacle you can determine the rotational position of the arm.

posterior view: -spine -acromion

*spine- a prominent structure on the dorsal or posterior surface of the scapula .. the elevated spine of the scapula starts at the vertebral boarder as the smooth, triangular area and continues latterly to the end at the acromion. *acromion- overhangs the shoulder joint posteriorly

TRAUMA HORIZONTAL BEAM LATERAL: lateromedial projection: humerus

*unaffected limb raised over head *CR to midpoint of distal two-thirds of humerus *SUSPEND RESPIRATION* *patient recumbent, horizontal beam lateral; flex elbow (90 degree from AP) - place cassette between arm and thorax

The lateral: ACROMIAL EXTREMITY (end) : Clavicle

- The lateral: ACROMIAL EXTREMITY of the clavicle articulates with the acromion of the scapula -This joint or articulation is called the acromioclavicular joint and generally can be readily palpated

Shoulder (trauma) routine:

-AP (neutral rotation) -Transthoracic lateral or -Scapular Y lateral

shoulder: routine

-AP external rotation(AP) -AP internal rotation(lateral)

What's the difference in a Male & Female clavicle?

-The female clavicle is usually shorter and less curved -most curved in heavily muscled men

Anterior view: Scapula -acromion -coracoid process -scapular notch

-acromion- a long curved proces that extends latterly over the head of the humerus -coracoid process- thick, beaklike process that projects anteriorly beneath the clavicle -scapular notch- a notch on the superior border that is partially formed by the base of the coracoid process

posterior view: -crest -infraspinous fossa & supraspinous fossa

-crest: where posterior border or ridge of the spine is thickened -the spine seperates the posterior surface into an INFRASPINOUS FOSSA and a SUPRASPINOUS FOSSA. Both of these fossae serve as surfaces of attachment for shoulder muscles.

SHOULDER GIRDLE TECHNICAL FACTORS:

-kV range: analog 70-75; digital 85 -grid: ( >10cm ) -high mA (short exposure time) -small FS -AEC (center chamber) -40" SID (except AC JOINTS)

humerus

-largest and longest bone of the upper limb -The humerus articulates with the scapula at the glenoid fossa

Which 3 joints are involved in the shoulder girdle?

-sternoclavicular joint -acromioclavicular joint -scapulohumeral joint

Which of the following scapular structures is most posterior? A: coracoid process B: glenoid cavity C: scapular notch D: acromion

D. acromion

What is another term for the mid area of the costal surface of the scapula?

subscapular fossa

The body: (clavicle)

the body(shaft) of the clavicle is the elongated portion between the two extremities. -The acromial end of clavicle is flattened & attaches to the acromion -The sternal end is more triangular in shape and is directed downward to the sternum

The medial: Sternal Extremity(end): Clavicle

Sternal Extremity(end) articulates with the manubrium, which is the upper part of the sternum. - this articulation is called the sternoclavicular joint. Also, easily palpated, and the combination of the sternoclavicular joints on either side of the manubrium helps to form an important positioning landmark called the jugular notch.

Lateral view: Scapula -dorsal surface -spine -ventral surface -lateral boarder -glenoid cavity -inferior angle

The bottom of the "Y" is the body of the scapula. -DORSAL SURFACE: posterior surface (back portion) of the thin body portion of the scapula. -SPINE: extends from the dorsal surface, to its upper margin -VENTRAL SURFACE: anterior surface of the body - LATERAL BORDER: thicker edge or border that extends from the GLENOID CAVITY to the INFERIOR ANGLE