Surface anatomy of proximal UE

Question 1

What are the physical exam landmarks of the anterior shoulder you would palpate?

Answer 1

-Clavicle
-AC joint
-Acromion
-Greater tuberosity (tubercle)
-Coracoid process

Question 2

How would you palpate the clavicle?

Answer 2

The proximal to distal end which would lead you to the AC joint

Question 3

How would you palpate the AC joint?

Answer 3

Find the distal end of the clavicle, and the AC joint will be a little “bump” along the joint space (my not be easy to find)

Question 4

How would you palpate the acromion?

Answer 4

Distally to the AC joint, it will be a hard surface

Question 5

How would you palpate the greater tuberosity (tubercle)?

Answer 5

Palpate inferior to the acromion and joint soft tissue space, it will be a “large bump”
-the tubercle is the lateral part of the proximal humerus
-the lesser tuberosity is separated from the greater tuberosity by a groove

Question 6

How would you palpate the coracoid process?

Answer 6

It will be the hard bump the divot below the distal part of the clavicle

Question 7

What vessel would you need to locate to place a central line?

Answer 7

Infraclavicular subclavian vein

Question 8

How would you locate the infraclavicular subclavian vein for central line placement?

Answer 8

Use the clavicle as a guide: divide it into thirds: proximal 1/3, middle 1/3, distal 1/3

-subclavian vein runs under the cravicle at the junction between the proximal 1/3 and the middle 1/3
-place needle inferior to the clavicle at this landmark the enter the vein
*usually will have ultrasound guidelines

Question 9

What vessel is located posterior to the subclavian vein? What is the significance of this to a central line placement?

Answer 9

Subclavian artery, you don’t want to stick the needle in too far/deep during placement of a central line as you could poke the subclavian artery

Question 10

What is the physical exam landmark of the posterior shoulder/how would you palpate it? What procedure would this landmark be useful for?

Answer 10

Posterior/lateral border (back corner) of the acromion/top outer edge of the scalpula
-to find it: palpate laterally along the spine of the scapula (hard bump will be felt)
-under this bump, thee is soft tissue space which is the joint space
-the joint space is commonly used for shoulder injections