Humerus and Shoulder Anatomy and Positioning

Radius

lateral bone of the forearm, aligns with 1st digit

head of radius

radial notch

proximal radioulnar joint

neck of radius

radial tuberosity

body or shaft of radius

Ulna

Medially bone of forearm, aligns with 5th digit

olecranon process of ulna

trochlear notch (semilunar notch) of ulna

coronoid process of ulna

coronoid tubercle

Humerus

Largest & longest bone in the upper extremity About 1/5 of an adult's height Articulates with the scapula at the shoulder joint

Lateral epicondyle

Capitulum

Trochlea

Medial epicondyle

Humeral condyle

Expanded distal end of the humerus

Coronoid Fossa

Radial Fossa

Olecranon Fossa

Concentric Arches

1st and smallest arc - Trochlear sulcus

2nd intermediate arc double lined -

smallest of the 2 - Capitulum

Largest of the 2 - Trochlea

3rd arc - Trochlear notch of the ulna

Elbow joint

hinge joint formed by humerus, ulna, and radius

body or shaft of humerus (diapysis)

deltoid tuberosity of humerus

rough raised elevation along the anterolateral surface of the body (Deltoid muscle attaches here)

surgical neck of humerus

greater tubercle (tuberosity)

Larger lateral process, Pectoralis major and supraspinatus muscles attach

Intertubercular groove (bicipital groove)

Deep groove between the two tubercles

Lesser tubercle (tuberosity)

The process directly below the anatomic neck on the anterior surface

Anatomic neck

Head of humerus

articulates with glenoid cavity of scapula, Most proximal part of the humerus

Scapulohumeral joint (glenohumeral joint)

The humeral head articulate with the glenoid cavity of the scapula

Neutral rotation of humerus

natural arm position without internal or external rotation, proximal humerus in an oblique position (looks like 2 eye balls).

Internal rotation of humerus

dorsal aspect of hand on hip with entire humerus rolled inward. Humerus in true lateral position. Greater tubercle "A" and lesser tubercle is "B".

External rotation of humerus

Arm abducted and supinated with the greater tubercle "A" and lesser tubercle "B".

Internal

How is the humerus rotated? External, Internal, or Neutral?

Neutral

How is the humerus rotated? External, Internal, or Neutral?

External

How is the humerus rotated?

A=greater tubercle B=lesser tubercle

Head of humerus

A?

greater tubercle (tuberosity)

B?

Intertubercular groove (bicipital groove)

C?

Lesser tubercle (tuberosity)

D?

Anatomic neck

E?

surgical neck of humerus

F?

body or shaft of humerus (diapysis)

G?

Hill Sachs defect

Compression fracture of the articular surface of the humeral head

radiopaque objects, clothing removed placed in gown , long hair, oxygen tubing, and pacemaker leads to avoid reduced detail/scatter

During patient preparation, what must be removed?

1. Limit the number of exposures

2. Collimation

3. shielding (led apron)

4. Position correctly

What 4 things help protect you and the patient against radiation?

BEFORE the examination

When must the anatomical marker be placed?

kVp: 70-85

grid: use if greater than 4in (10cm)

mA: dependent

What technical factors are needed for a good Humerus (kVp, grid, mA)?

AP

Lateral (Lateromedial and mediolateral)

Routine projections of Humerus?

What is the evaluation criteria and procedure for a AP Humerus Xray?

SID: 40inches

Grid: yes if bigger than 4in

kVp: 70-85

CR: Midpoint of humerus

Patient position: Erect or supine, rotate body to affected side to bring shoulder and proximal humerus onto IR, extend hand and forearm, supinate hand pinky on hip

Breathing instructions: suspend respiration during exposure

Evaluation criteria: Entire humerus including shoulder and elbow, no motion, greater tubercle is seen laterally, humeral head is partially seen in profile medially, lateral and medial epicondlyes, Minimal superimposition of the glenoid cavity

What is the evaluation criteria and procedure for a Mediolateral Humerus (true lateral) Xray?

SID: 40inches

Grid: yes if bigger than 4in

kVp: 70-85

CR: Midpoint of humerus, rotate to humerus angle

Patient position: Face patient towards IR, oblique as needed to allow close contact of humerus to IR, flex elbow 90°

Breathing instructions: suspend respiration during exposure

Evaluation criteria: Includes both joints, True Lateral Projection, Epicondyles superimposed, Lesser tubercle in profile medially

What is the evaluation criteria and procedure for a Lateromedial Humerus Xray?

SID: 40inches

Grid: yes if bigger than 4in

kVp: 70-85

CR: Midpoint of humerus

Patient position: Patients back to IR ,Elbow partially flexed, internally rotate arm so epicondyles are perpendicular to IR, abduct arm slightly

Breathing instructions: suspend respiration during exposure

Evaluation criteria: entire humerus including elbow and shoulder joints, epicondyles superimposed, lesser tubercle is shown in profile medially, partial superimposition by lower portion of glenoid cavity

Horizontal beam lateral

Transthoracic Lateral

AP neutral rotation

Special projections of Humerus?

What is the evaluation criteria and procedure for a Horizontal beam Lateral Xray?

SID: 40inches

Grid: yes if bigger than 4in

kVp: 70-85

CR: distal 2/3 of humerus

Patient position: With patient recumbent, place support under patients' arm, Flex elbow to 90° if possible, Place IR between arm and thorax

Breathing instructions: suspend respiration during exposure

Evaluation criteria: elbow flexed to 90°, includes elbow joining and distal humerus

What is the evaluation criteria and procedure for a transthoracic lateral (trauma) projection Xray?

MUST INCLUDE AP NEUTRAL ROTATION

SID: 40inches

Grid: yes if bigger than 4in

kVp: 70-85

CR: mid diaphysis directed through thorax

Patient position: position affected arm in a neutral rotation, raise opposite arm (unaffected) above head, thorax in true lateral

Breathing instructions: Orthostatic breathing (gently and short)

Evaluation criteria: entire humerus and glenohumeral joint demonstrated

What is the evaluation criteria and procedure for a AP Neutral Xray?

SID: 40inches

Grid: yes if bigger than 4in

kVp: 70-85

CR: midpoint of humerus

Patient position: leave arm in a neutral position (No rotating) • "AS IS"

Breathing instructions: suspend respiration during exposure

Shoulder girdle

Scapula

Forms the posterior part of the shoulder girdle, Flat triangular bone

Superior border of scapula

Lateral (axillary) border of scapula

Medial (vertebral) border of scapula

superior angle

inferior angle

Lateral angle (head of scapula)

Thickest part of scapula, ends laterally in a shallow depression called the glenoid cavity (fossa)

Glenohumeral joint

Neck of scapula

Body (blade) of scapula

Arched in shape for greater strength, Thin flat lower portion of the body is referred to as the Wing or ala

Costal or ventral surface of scapula (subscapular fossa)

Anterior surface of scapula, closest to ribs

Acromion

Long, curved process that extends laterally over the head of the humerus

Coracoid process

Thick, beaklike process that projects anteriorly beneath the clavicle

Subscapular notch

notch on the superior border that is partially formed by the base of the coracoid process

Dorsal surface of scapula

Crest of spine

Supraspinous fossa

infraspinous fossa

Acromion

Coracoid process

Body

Which structures from the "Y" on the scapula?

Acromion

8?

Coracoid process

10?

Glenohumeral joint

7?

Lateral (axillary) border of scapula

15?

inferior angle

14?

Medial (vertebral) border of scapula / Body (blade) of scapula

13?

Acromion

A?

Coracoid process

B?

inferior angle

C?

Medial (vertebral) border of scapula / Body (blade) of scapula AND Lateral (axillary) border of scapula

E?

AP External rotation

AP Internal rotation

Routine projections of the (NONTRAUMA) shoulder?

What is the evaluation criteria and procedure for a AP external rotation Xray?

SID: 40inches

Grid: depends

kVp: 70-85

CR: 1 inch inferior to coracoid process

Patient position: abduct and externally rotate arm, erect or supine

Breathing instructions: suspend respiration during exposure

Evaluation criteria: proximal humerus and 2/3 clavicle and upper scapula and glenoid cavity included, Greater tubercle profiled laterally

What is the evaluation criteria and procedure for a AP Internal rotation Xray?

SID: 40inches

Grid: depends

kVp: 70-85

CR: 1 inch inferior to coracoid process

Patient position: abduct and internally rotate arm

Breathing instructions: suspend respiration during exposure

Evaluation criteria: proximal humerus and 2/3 clavicle and upper scapula , Scapulohumeral joint centered, Lesser tubercle profiled medially

Inferosuperior axial projection (Lawrence method)

AP oblique projection (Grashey Method)

Special Projections of (NONTRAUMA) shoulder?

What is the evaluation criteria and procedure for a Inferosuperior axial projection (Lawrence method) Xray?

SID: 40inches

Grid: depends

kVp: 70-85

CR: medially 25-30° horizontal to axilla/humeral head for 90° abducted arm, less than 90° CR decreased to 15-20° (more arm abduction greater CR angle)

Patient position: supine, shoulder raised 2in to line up to IR,

Breathing instructions: suspend respiration during exposure

Evaluation criteria: Lesser tubercle profiled anteriorly, Humeral head and glenoid fossa profiled, Optimal exposure factors

What is the evaluation criteria and procedure for a AP oblique projection (Grashey Method) Xray?

SID: 40inches

Grid: depends

kVp: 70-85

CR: scapulohumeral joint (2in inferior and 2in medial from superolateral border of shoulder)

Patient position: erect or supine, rotate body 35-40° toward affected side, arm slightly flexed in neutral rotation, LPO/RPO

Breathing instructions: suspend respiration during exposure

Evaluation criteria: Glenoid Cavity should be visualized, Scapulohumeral joint centered, Optimal exposure factors

AP Neutral Rotation

PA Oblique (scapular Y lateral)

Routine TRAUMA projections of shoulder?

What is the evaluation criteria and procedure for a AP Neutral Rotation Xray?

SID: 40inches

Grid: depends

kVp: 70-85

CR: midscapulohumeral joint (3/4in inferior and 2in slightly lateral to corcoid process)

Patient position: erect or supine, rotate body if necessary to place body on IR

Breathing instructions: suspend respiration during exposure

Evaluation criteria: Greater tubercle superimposed ,Scapulohumeral joint centered, Optimal exposure factors

What is the evaluation criteria and procedure for a PA Oblique (scapular Y lateral) Xray?

SID: 40inches

Grid: depends

kVp: 70-85

CR: scapulohumeral joint (palpate superior angle of scapula and AC joint)

Patient position: erect or recumbent, rotate patient until imaginary line between AC and superior angle is perpendicular to IR, angle may be 45-60° LAO/RAO

Breathing instructions: suspend respiration during exposure

Evaluation criteria: Body of scapula superimposed on end, Acromion and coracoid processes in profile, Humeral head and glenoid cavity superimposed, Optimal exposure factors

Supraspinatous outlet (Neer Method)

Special TRAUMA projections of shoulder?

What is the evaluation criteria and procedure for a Supraspinatous outlet (Neer Method) Xray?

SID: 40inches

Grid: depends

kVp: 70-85

CR: 10-15° caudal angle, centered posteriorly to pass through humeral head (1in above midscapula)

Patient position: erect or recumbent, rotate patient until imaginary line between AC and superior angle is perpendicular to IR, angle may be 45-60° LAO/RAO

Breathing instructions: suspend respiration during exposure

Evaluation criteria: Supraspinatus outlet open and in profile ,Demonstrates coracoacromial arch, Optimal exposure factors

AP

Lateral

Routine Scapula Projections?