Shoulder

Question 1

What are the axial skeleton and the appendicular skeleton?

Answer 1

The axial skeleton includes all the bones along the body’s long axis. The axial skeleton includes the bones that form the skull, laryngeal skeleton, vertebral column, and thoracic cage.
The bones of the appendicular skeleton (the limbs and girdles) “append” to the axial skeleton.

Question 2

Which bones make up the shoulder girdle?

Answer 2

Scapula
Humerus (proximal)
Clavicle

Question 3

What parts should you be able to identify on scapula?

Answer 3

spine, neck, angles, borders and fossa.
Corocoid process.
Acromion process.
Glenoid fossa/cavity & labrum

Question 4

What is the labrum?

Answer 4

The labrum is cartilage that surrounds the Glenoid fossa, so that the humerus can sit in the shoulder girdle more easily.

Question 5

What is the Corcoid process?

Answer 5

The corocoid process is the hook looking part of the scapula that you feel for when doing shoulder x-ray.

Question 6

What is the Acromion process?

Answer 6

The most medial part of the scapula sits above the humerus.

Top bit of the scapula

Question 7

The joints in the shoulder?

Answer 7

Acromio-clavicular joint (CAJ).
Gleno-humeral joint (GHJ).
Sterno-clavicular joint (SCJ)

Question 8

What is the Sterno-clavicular joint (SCJ)?

Answer 8

the articulation between
the manubrium of the sternum
and the medial end of the clavicle.

Synovial saddle joint.

Question 9

What is the Acromio-clavicular joint (ACJ)?

Answer 9

The articulation between-
the acromion process (scapula)
and the lateral end of the clavicle.

Synovial plane joint.

Question 10

What is the Gleno-humeral joint?

Answer 10

The articulation between:
the head of humerus
and the glenoid cavity of the scapula.
Synovial ball and socket joint.

Question 11

What are the shoulder joint movements?

Answer 11

FLEX / EXTEND
ABDUCT / ADDUCT
ROTATE
CIRCUMDUCT

The most flexible and versatile joint.
Compromise – it’s also one of the weakest and most prone to injury!

Question 12

What parts of the humerus do you need to know?

Answer 12

Humerus (proximal):

head, anatomical & surgical necks, greater and lesser tuberosity’s.

Question 13

What parts of the clavicle do you need to know?

Answer 13

Clavicle:

medial (sternal), lateral (acromial), tubercle.

Question 14

What is the conoid tubercle?

Answer 14

Part of the clavicle, that you feel for, so its near the lateral end, on the inferior side of the clavicle.

Question 15

ANTERO-POSTERIOR HUMERUS, how do you do it?

Answer 15

Patient position:
Standing with back to detector
Positioning criteria:
Arm extended, abducted slightly & supinated.
Posterior aspect of upper arm in contact with the detector
Humeral epicondyles equidistant to the detector
Centering:
Midway between shoulder & elbow joints with a horizontal central ray (HCR)
Additional info:
100/115cm SID

Question 16

LATERAL HUMERUS, how do you do it?

Answer 16

Patient position:
Standing with anterior aspect of shoulder in contact with the detector
Positioning criteria:
Arm abducted slightly, elbow flexed & palm placed on abdomen.
Lateral aspect of humerus in contact with the detector
Humeral epicondyles superimposed
Centering:
Midway between shoulder & elbow joints with a HCR
Additional info:
100/115cm SID

Question 17

Antero-posterior AP Shoulder, how do you do it?

Answer 17

Patient core position:
Patient standing erect
Positioning criteria:
Posterior aspect of shoulder in contact with the detector
MSP perpendicular to the detector, with the humeral heads equidistant to the detector
Arm externally rotated with palmer aspect facing anteriorly.
Centring:
To the palpable corocoid process. Horizontal central ray parallel to MSP and perpendicular to the detector (can be modified to use VCR for supine pt).
Collimation:
Collimate to include shoulder girdle, including medial end of clavicle, inferior angle of scapula, and proximal 1/3rd of humerus
Other info:
100/115cm SID. Usually with grid in erect bucky (centre chamber AED), but can be ‘direct’ for smaller anatomy.

Question 18

Why AP shoulder and not turned AP?

Answer 18

Right Shoulder
MSP parallel to central ray.
MSP & central ray perpendicular to IR.

• Clavicle and shoulder girdle not distorted
• Glenoid is oblique and with humeral head overlapping.
• ACJ demonstrated.

Preferred for TRAUMA

Question 19

Why turned AP shoulder and not normal AP shoulder?

Answer 19

Right Shoulder
MSP rotated 25 degrees to affected (R) side.
Central ray parallel to IR.

• Demonstrates GHJ more effectively
• Clavicle is foreshortened.
• ACJ oblique = not clear.

Preferred for assessment of chronic joint pain (you can see the joint space)

Question 20

Turned ‘true’ AP for GHJ, how do you do it?

Answer 20

Patient core position: Patient standing erect
Positioning criteria:
Posterior aspect of shoulder in contact with vertical detector.
Patient’s MSP rotated approx. 30’ towards affected side (30’posterior oblique)
Arm externally rotated with palmer aspect facing anteriorly.
Centring:
To the palpable corocoid process. Horizontal central ray perpendicular to detector(can be modified to use VCR for supine pt).
Collimation:
Collimate to include shoulder girdle, including medial end of clavicle, inferior angle of scapula and proximal 1/3rd of humerus. (some protocols collimate to GHJ only.
Other info:
100/115cm SID. Usually with grid in erect bucky (centre chamber AED), but can be ‘direct’ for smaller anatomy.

Question 21

Supero-Inferior Axial Shoulder, how do you do it?

Answer 21

Patient core position:
Patient sitting with affected side
nearest table.
Positioning criteria:
Affected humerus abducted with anterior/inferior aspect/elbow in contact with the detector. Patient leans trunk towards the affected side. Palm down.
Centring:
Over the acromion process / humeral head. Vertical central ray may be angled towards elbow to help include GHJ).
Collimation:
Collimate to include GHJ, proximal 1/3rd humerus, coronoid process and distal clavicle.
Other info:
100/115cm SID

Question 22

Lateral scapula projection, how do you do it?

Y view

Answer 22

Patient core position:
Patient stands in anterior-oblique position with affected side in contact with erect dectector
Positioning criteria:
Medial & lateral borders of scapula are superimposed. Arm is abducted and elbow flexed
Centring:
Midpoint of medial border of the scapula. Horizontal Central ray.
Collimation:
Collimate to include entire scapula, proximal humerus and lateral chest wall
Other info:
100/115cm SID. Grid preferred

Question 23

Clavicle AP projection, how do you do it?

Answer 23

Patient core position:
Same as AP shoulder.
Positioning criteria:
Posterior aspect of shoulder in contact with the detector. MSP perpendicular and humeral heads equidistant to the detector
Centring:
Middle of clavicle. Central ray (usually HCR).
Collimation:
Collimate to include clavicle, ACJ & SCJ with superior soft tissue margin.
Other info:
100/115cm SID

Question 24

Clavicle AP 30 Cranial, how do you do it?

Axial clavicle

Answer 24

Patient core position:
Same as AP Shoulder.
Positioning criteria:
Posterior aspect of shoulder in contact with the detector. MSP perpendicular and humeral heads equidistant to detector.
Centring:
Middle of clavicle. Central ray angled 30’ cranially & perpendicular to long axis of clavicle.
Collimation:
Collimate to include clavicle, ACJ & SCJ with superior soft tissue margin.
Other info:
100/115cm SID.