RAD POSI - SHOULDER GIRDLE

Scapular Y (PA Oblique Projection)

PP: Upright/recumbent; RAO/LAO; MCP 45-60 degrees to IR; scapular flat surface perpendicular to IR; RPO/LPO (for severely injured patient)

Shoulder Girdle

union of bones but may or may not have articulations between

Scapula, Clavicle, and Proximal Humerus

What are the body component of shoulder girdle

Shoulder Joints

union with articulation; synovial joint (ball and socket)

Proximal Humerus

consist of rounded portion; humeral head

Greater and Lesser Tubercle

What are the two process of proximal humerus?

Greater Tubercle

a process lateral to the humeral head and inferior to the anatomical neck; it is the attachement for the muscle of the upper back

Lesser Tubercle

process located anteriorly; attachement for the muscle of the upper back

Anatomic Neck

slightly constricted area directly below and lateral to the head of the humerus

Surgical Neck

common site for fractures of the humerus; it is the distal head

Intertubercular Groove / Bicipital Groove

a deep groove on the humerus that separates the greater tubercle from the lesser tubercle.

Deltoid Tuberosity

raised area on lateral surface of humerus to which deltoid muscle attaches

Greater Tubercle

superior, middle, and inferior section; sa section naka attached mga tendons

Supraspinatus Fossa

region of supraspinatus muscle that attached to the greater tubercle

Infraspinatus Fossa

region of infraspinatus muscle that attached to the greater tubercle

Subscapularis

attached to lesser tubercle

Rotator Cuff Muscle

ability to move the shoulder (eg. supra., infra., teres minor, subscapularis)

Clavicle

it is the fulcrum of shoulder that attaches to scapula (acromion) and sternum

Medial and Lateral Ends

What are the ends of clavicle?

More curvy

Male has a ____________ clavicle that indicates a stronger clavicle

Acromioclavicular Joint

the joint formed by the acromion of the scapula and the clavicle that is located laterally

Sternoclavicular / Manubrioclavicular Joint

the joint formed by the sternum and clavicle that is located medially

Superior, Lateral, Medial

What are the 3 borders of scapula?

Superior, Inferior, Lateral

What are the angles of scapula?

T7

the inferior angle of scapula is correspond to what bony landmarks?

Acromion Process

end of the clavicle; superior to coracoid (SUPEROPOSTERIORLY)

Coracoid Process

inferior (1.5 inches approx.) and anterior to acromion process

Glenoid Labrum

fibrocartilage ring that surrounds the glenoid fossa

Joint Capsule

fibrous sheet encloses the structure of the joint; covering of the joint

Synovial Bursa

it prevents the friction of shoulder joint particularly b/n humeral head and glenoid fossa of scapula

Bursa

sac filled with synovial fluid; this fluid acts as a cushion b/n tendon and other joint structure

Ball and Socket Synovial Joint

it permits wide range of movement (flexion, extension, abduction, adduction, internal rotation & external rotation); it is subjected to be disclocated

Anterior Dislocation

caused by excessive extension and lateral rotation of humerus (minsan present din ang hill sachs lesions)

Reverse Hill-Sachs Lesion

impaction fracture of anteromedial humeral head (posterior dislocation)

Reverse Bankart Lesions

deattachement of posteroinferior labrum (can be seen in posterior dislocation)

Rotator Cuff Muscle

for the stability of glenohumeral joints

Neutral, External, Internal Rotation

What are the rotations in the AP Projection of the Shoulder?

Upright (more comfortable) / supine; px rotated 15 degrees; scapula parallel to IR

What is the px position in AP Projection of Shoulder?

Neutral Rotation (AP Projection)

Palm of the hand placed against hip and epicondyles adjusted at about a 45 degree angle with the plane of the IR

External Rotation (AP Projection)

hand supinated; humeral epicondyle // to IR; arm abducted slightly

to open the subacromial bursa

Why do we need to abduct the arm slightly in the AP Projection External Rotation of Shoulder?

Internal Rotation (AP Projection)

Posterior aspect of hand may be placed against hip and epicondyles adjusted perpendicular to the plane of the IR (para mag lateral yung shoulder)

1 inch inferior to coracoid process

What is the RP of AP Projection of Shoulder?

- Greater tubercle

- Site of insertion of supraspinatus tendon

- Places the shoulder in true AP Proximal Humerus

- demonstrates the glenohumeral joint relationship and the region of subacromial bursa

What are the SS of AP Projection External Rotation of Shoulder?

- Greater Tubercle partially superimposing humeral head

- posterior part of supraspinatus insertion

- oblique proximal humerus

- Small calcifications

What are the SS of AP Projection Neutral Rotation of Shoulder?

- lesser tubercle

- site of insertion of the subscapular tendon

- proximal humerus in true lateral position

- demonstrates the subdeltoid bursa

What are the SS of AP Projection Internal Rotation of Shoulder?

Lawrence Method (Transthoracic Humerus)

can be use as an alternative for lateral projection of humerus; ONLY THE PROXIMAL PART OF THE HUMERUS CAN BE SEEN

level of surgical neck

What is the RP of Lawrence Method Transthoracic Lateral Projection?

horizontal or 10-15 degrees cephalad (if px cannot elevated unaffected shoulder)

What is the CR of Lawrence Method Transthoracic Lateral Projection?

Proximal humerus (projected thru thorax)

What is the SS of Lawrence Method Transthoracic Lateral Projection?

- trauma exist and the arm cannot be rotated or abducted due to injury

- demonstrates proximal humerus in 90 degrees from AP Projection

- shows its relationship to the scapula and clavicle

What is the ER of Lawrence Method Transthoracic Lateral Projection?

Patient Position of Lawrence Method Transthoracic Lateral Projection

Right/Left ; Upright (more comfortable) or supine; px in lateral position; uninjured arm raised; forearm rested on head; midcoronal plane perpendicular to IR; full inspiration (improves contrast & reduces exposure) or breathing technique (slow, deep breathing)

Lawrence Method (Inferosuperior Axial Projection)

PP: Supine; head, shoulder & elbow elevated (3 in.); arm abducted 90 degrees; humerus rotated externally; IR placed against the neck; head turn away from side of interest.

Axilla

What is the RP of Lawrence Method (Inferosuperior Axial Projection) ?

Horizontal; 15-30 degrees medially (greater abduction, greater angle)

What is the CR of Lawrence Method (Inferosuperior Axial Projection) ?

- proximal humerus

- lateral portion of coracoids process

- acromioclavicular articulations

- insertion site of subscapular tendon

- point of insertion of teres minor tendon

What is the SS of Lawrence Method (Inferosuperior Axial Projection) ?

Rafert-Long Method (Inferosuperior Axial Projection)

PP: supine; head, shoulder, and elbow elevated (3inches); arm abducted 90 degrees; exaggerated external rotation of arm; hand 45 degrees to IR; thumb pointing downward; IR placed against neck; head turn away from side of interest

Axilla

What is the RP of Rafert-Long Method (Inferosuperior Axial Projection) ?

Horizontal; 15 degrees medially (passing AC Joint)

What is the CR of Rafert-Long Method (Inferosuperior Axial Projection) ?

- coracoid process pointing anteriorly

- lesser tubercle in profile

What is the SS of Rafert-Long Method (Inferosuperior Axial Projection) ?

Hill-Sachs compression fracture (defect)

What is the ER of Rafert-Long Method (Inferosuperior Axial Projection) ?

West Point Method (Inferosuperior Axial Projection)

used if the px in a Rafert-Long method cannot be used

West Point Method (Inferosuperior Axial Projection)

PP: Prone; shoulder elevated (3inches); head turn away from side of interest; arm abducted 90 degrees; forearm rested over the edge of table; IR placed vertically

Axilla; 5 inch inferior and 1.5 inch medial to acromial edge

What is the RP of West Point (Inferosuperior Axial Projection) ?

25 degrees anteriorly and medially

What is the CR of West Point (Inferosuperior Axial Projection) ?

- humeral head projected free of the coracoid process

What is the SS of West Point (Inferosuperior Axial Projection) ?

West Point Method (Inferosuperior Axial Projection)

used when chronic instability of shoulder is suspected; to demonstrate Bankart's Lesion and Associated hill-sachs defect

Clements Modification (Inferosuperior Axial Projection)

when prone (west point) or supine (rafert-long) position is not possible

Clements Modification (Inferosuperior Axial Projection)

less arm abduction and less manipulation of x-ray tube

Clements Modification (Inferosuperior Axial Projection)

PP: Lateral recumbent; unaffected side against IR; abduct arm 90 degrees; IR against superior aspect of shoulder

midaxillary region

What is the RP of Clements Modification (Inferosuperior Axial Projection)?

horizontal or 5-15 degrees medially (px cannot abduct arm 90 degrees)

What is the CR of Clements Modification (Inferosuperior Axial Projection)?

- AC Joint

- scapulohumeral joint

What is the SS of Clements Modification (Inferosuperior Axial Projection)?

Superoinferior Axial Projection

used as an alternative for clements modifications

- Relationship of the proximal end of the humerus to the glenoid cavity.

- AC articulation

- Outer portion of the coracoid process

- Points of insertion of the subscapularis muscle & teres minor muscle.

- Coracoid process above clavicle.

- Lesser tubercle in profile.

What is the SS of Superoinferior Axial Projection?

Superoinferior Axial Projection

PP: Seated; patient lean laterally; elbow flexed 90 degrees & rested on table; hand pronated; humeral epicondyles perpendicular to table

Shoulder Joint

What is the RP of Superoinferior Axial Projection?

5-15 degrees towards the elbow

What is the CR of Superoinferior Axial Projection?

little bit increase in OID

What is the disadvantage of Superoinferior Axial Projection

AP Axial Projection

PP: Upright/supine; scapulohumeral joint centered to IR

- Relationship of the head of humerus to the glenoid cavity.

- Scapula humeral joint

- Proximal humerus

- Clavicle projected above the superior angle of scapula

What is the SS of AP Axial Projection?

AP Axial Projection

Useful in diagnosis cases of posterior dislocation

scapulohumeral joint

What is the RP of AP Axial Projection?

35 degrees cephalad

What is the CR of AP Axial Projection?

Rolled Film Axial Projection

rolled film put in axilla; for px who cannot perform abductio

CR: perpendicular / vertical

SS: distorted image of shoulder

Scapular Y (PA Oblique Projection)

useful in evaluation of suspected shoulder dislocations

perpendicular

What is the CR of Scapular Y?

scapulohumeral joint

What is the RP of AP Axial Projection?

Anterior / Subcoracoid Dislocation

head beneath the coracoid process

Posterior / Subacromial Dislocation

head projected beneath acromion process

anteriorly

where does coracoid process located?

posteriorly

where does acromion process located?

humeral head b/n acromion and coracoid

how do you describe a normal shoulder?

body of scapula

The _______ forms the vertical component of the Y

acromion and coracoid

Forms the slanted portion of Y

- scapular body and acromion & coracoid form the upper limbs

- superimposed humeral head & glenoid cavity

- superimposed humeral shaft and scapular body

- coracoid process superimposed or projected below clavicle

What is the SS of Scapular Y (PA Oblique Projection)?

Stryker Notch (AP Axial Projection)

useful for demonstration of Hill-Sach Defect

Stryker Notch (AP Axial Projection)

PP: Supine; arm flexed slightly beyond 90 degrees; palm of hand on top of head w/ fingertips resting on head (places humerus in a slight internal rotation); body of humerus // to MSP of body.

coracoid process

What is the RP of Stryker Notch?

10 degrees cephalad

What is the CR of Stryker Notch?