Shoulder Girdle Flashcards
What is the shoulder girdle made up of?
-Scapula
-Clavicle
What does the shoulder girdle articulate with?
-head of humerus (shoulder joint)
-manubrium of sternum (sternoclavicular (SC) joint)
-each other (acromioclavicular {AC} joint)
What function does the shoulder girdle have?
To connect the upper limb to the trunk of the body
What is not considered to be part of the shoulder girdle?
Humerus
What type of joint is the shoulder classified as?
ball and socket joint
What type of bone is the clavicle?
long bone
What lies just above the first rib?
Clavicle
The acrominal extremity (lateral end) of the clavicle articulates with what?
Acromion on scapula (AC joint)
The sternal extremity (medial end) of the clavicle articulates with what?
manubrium of sternum (SC joint)
True or False
The clavicle has a curve more pronounced in males than in females?
True
What type of bone is the scapula?
flat bone
What forms the posterior portion of the shoulder girdle and is triangular in shape?
Scapula
What are the two surfaces of the scapula?
-costal (anterior) ribs
-dorsal (posterior) back
What are the three borders of the scapula?
-lateral border
-medial border
-superior border
What are the three angles of the scapula?
-superior angle
-inferior angle (T7)
-lateral angle
where is the scapular notch located?
Superior border
What is the lateral, thickened end of the scapula spine called?
Acromion
Essential Projections: Shoulder
AP Projections
-internal rotation
-external rotation
-neutral position
-AP oblique (Grashey method)
-Transthoracic lateral (Lawrence method)
-Inferosuperior axial (Lawrence method)
-PA oblique (scapular Y)
The thumb follows what?
The greater tubercle
What is the part position for AP projection of shoulder in (external rotation)
-rotate arm externally and supinate hand
-epicondyles are parallel to the IR
What is the distance for the AP projections of the shoulder?
40 inches
Where do you center for the AP Projection of shoulder (external rotation)
Enters perpendicular 1 inch inferior to coracoid process
What do you see in the AP projection shoulder (external rotation)?
-greater tubercle in profile on lateral aspect of humerus
-humeral head in profile
-scapulohumeral joint visualized with slight overlap of humeral head on glenoid cavity
-outline of lesser tubercle between the humeral head and greater tubercle
What is the part position for AP projection of shoulder (internal rotation)
-rotate arm internally, rest back of the hand on hip
-epicondyles are perpendicular
Where do you center for the AP projection of shoulder (internal rotation)
-CR is perpendicular
-Enters patient 1 inch inferior to coracoid process
What do you see in the AP projection of the shoulder (internal rotation)?
-lesser tubercle is in profile and pointing medially
-outline of greater tubercle superimposing humeral head
-collimated field includes superior scapula, lateral half of clavicle, and proximal humerus
-greater amount of humeral overlap of the glenoid cavity than in external and neutral positions
What is the part position for AP Shoulder (neutral rotation)?
-patient rest the palm of the hand against the thigh
-epicondyles are at a 45 degrees
Where do you center for the AP projection of shoulder (neutral position)
-CR is perpendicular
-Enters patient 1 inch inferior to coracoid process
What do you see in an AP projection of the shoulder (neutral position)?
-Neither the greater nor the lesser tubercle should appear in profile
-humeral head will be in partial profile
-greater tubercle will partially superimpose the humeral head
-some overlap of the humeral head and glenoid should be seen
What is the part position for the AP Oblique (Grashey) for shoulder?
-put patient 35 to 45 degrees posterior oblique position
-affected shoulder closer to iR
-head of the humerus in contact with IR
-scapula parallel to IR
-more rotation if patient is recumbent (60 degrees)?
-abduct arm slightly internally rotate
-place palm of hand on abdomen
Where do you center for the AP Oblique (Grashey)?
-perpendicular to glenoid cavity
-enters 2 inches medially and inferior to superolateral border of shoulder
-free joint space of humerus
What is the breathing technique for the humerus and shoulder?
Suspended breathing
What do you see in the AP Oblique (Grashey) for the shoulder?
-open joint space between the humeral head and glenoid cavity
-glenoid cavity in profile
-tip of coracoid is 0.25 inches on humeral head
What position do we do for trauma patients who cannot rotate or abduct arm?
Transthoracic Lateral (Lawrence method)
What is your position for the Transthoracic Lateral (lawrence)?
-Affectedside closer to IR
-Ensure elevated shoulder is higher than injured shoulder
-center at affected shoulder surgical neck
Where do you center for the Transthoracic lateral (Lawrence method)?
Perpendicular Center at the surgical neck of the humerus
What is the breathing technique for Transthoracic lateral (Lawrence method)?
Shallow breathing to blur out the ribs and lungs (exposure time of 3 to 5 seconds) if can’t do shallow do expiration instead
If the shoulders are in the same plane for the Transthoracic lateral (Lawrence method) what do you do?
angle tube 10-15 degrees cephalic
What distance is the Transthoracic lateral (Lawrence method) done?
40 inches
What do you see in the Transthoracic lateral (Lawrence method)?
-proximal humerus, scapula, clavicle seen through the lung field
-scapula superimposed over the thoracic spine
-unaffected clavicle and humerus projected above
What is the part position for the Inferosuperior Axial Projection (Lawrence Method)?
-supine
-head turned away from CR
-abduct arm to right angle 90 degrees
What is the central ray for the Inferosuperior Axial Projection (Lawrence Method)?
-CR is horizontal
-Medial angulation of 15 to 30 degrees
-Enters axilla (armpit) passes through the AC joint
-angle depends on abduction of humerus
-more abduction=more angle
When the hand is supinated in the Inferosuperior Axial Projection (Lawrence Method) what happens?
-epicondyles are parallel
-lesser tubercle in profile anteriorly
What do you see in the Inferosuperior Axial (Lawrence Method)?
-scapulohumeral joint with slight overlap
-coracoid process pointing anteriorly
-epicondyles are parallel
What happens when you externally rotate the hand (thumb pointing to the floor) for the Inferosuperior Axial Projection?
-epicondyles are at a 45-degree
-demonstrates the Hill-Sacs defect (posterolateral aspect of the humeral head dislocation)
If you can’t lay the patient on the table for the Inferosuperior Axial projection what do you do instead?
Superoinferior Axial Projection
What is the position and centering for the Superoinferior Axial Projection?
-5 to 10 degrees toward the elbow through shoulder joint
-keep head out of the way
What makes up the “Scapular Y”?
Your ABC
-Acromion
-Body
-Coracoid Process
An anterior dislocation of the shoulder where will the head of the humerus be located?
Located under the coracoid
An posterior dislocation of the shoulder where will the head of the humerus be located?
Located below acromion
What is the part position for the PA Oblique (Scapular Y)? for shoulder
-upright, 45 to 60 degrees anterior oblique
-affected shoulder closer to IR
-RAO or LAO
-side down being demonstrated
Where do you center for the PA Oblique (Scapular Y)?
-CR perpendicular
-Enters the vertebral (medial) border and exits the axillary (lateral ) border
In a “Scapular Y “ what should you see?
A space between the ribcage and body of the scapula
In the PA Oblique (Scapular Y) what do you see?
-humeral head and glenoid cavity sumperimposed
-humeral shaft and scapular body superimposed
-acromion projected laterally and free of superimposition
-scapula in lateral profile with lateral and vertebral borders superimposed
-coracoid possibly superimposed or projected below the clavicle
What is the part position for the AP Oblique (Scapular Y)?
-upright, 45 to 60 degrees posterior oblique
-rotate patient away from affect side
-unaffected shoulder closer to IR
-RPO or LPO
-side up being demonstrated
Where do we center for the AP Oblique (Scapular Y)?
-CR perpendicular
-Enters the lateral border and exits the medial border
What is the part position for the Supraspinatus “Outlet” Neer Method?
-rotate body 45 to 60 degreess
-RAO or LAO
-CR angle 10 to 15 degrees caudad
Where do we center for the Neer Method?
Enter superior aspect of humeral head
-looking at the Y
Why do we do the Tangenital projection (fisk modification)?
To demonstrate the intertubercular groove
What is the part position for AP AC joints (Pearson)?
-upright required
-arms to the side
-bilateral image
-with/without weights
What is the distance for the AP AC Joint (Pearson)?
72 inches (divergence of the beam)
Where do we center for the AP AC joints (pearson)?
perpendicular to midline of body at level of AC joint
If doing a unilateral AC joint what is the distance?
40 inches
What is the distance used for the clavicle?
40 inches
Where do you center for the clavicle?
Perpendicular to midshaft of the clavicle
In the PA clavicle
What two joints must you get on for the projection of the clavicle?
AC and SC
What is the breathing technique for AC joints?
expiration
What is the degree of angulation for the AP axial for the clavicle?
15-30 degrees cephalic (throw clavicle off the ribcage)
What is the angulation for the PA axial for the clavicle?
15-30 degrees caudal
For AP you angle
Up
For PA you angle
Down
Essential projections: Scapula
-AP
-Lateral
What is the part position for the AP Scapula?
-abduct arm to right angle (90 degrees)
-flex elbow
-draws scapula laterally clear from the thoracic structures(off the ribcage)
-supinate hand
-scapula is parallel to the IR
Where do you center for the AP Scapula?
Perpendicular to point 2 inches (5cm) inferior to coracoid process
What is the breathing technique for AP Scapula?
expiration
What do you see in the lateral scapula?
-humerus is not align over the body of the scapula
-lateral and medial border superimposed
-inclusion of the acromion and inferior angle
What do you do for the lateral scapula?
-y method
-put hand behind your back
-hand over the head
