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