Bontrager chapter 5

Clavicle and scapula and proximal humerus

the shoulder girdle consists of

humerus

largest and longest bone of the upper limb

one-fifth

the humerus is approximately ______ of body height

head

most proximal part of the humerus

anatomic neck

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

lesser tubercle

process directly below the anatomic neck on the anterior surface of the humerus

greater tubercle

larger lateral process on the humerus

the greater tubercle

where do the pectoralis major and supraspinatus muscles attach?

intertubercular sulcus

the deep groove between these two tubercles

surgical neck

the tapered area below the head and tubercles

surgical neck

site of frequent fractures of the humerus

deltoid tuberosity

roughened raised triangular elevation along the anterolateral surface of the body (of the humerus)

neutral rotation

natural position of the arm without internal or external rotation

external rotation

position that places the humerus in a true AP or frontal position

lesser=anteriorly

greater=laterally

in a true AP projection, how are the tubercles located?

connect each upper limb to the trunk/axial skeleton

the function of the clavicle and scapula is to

muscles only

the scapula is connected to the trunk by

second posterior rib

upper margin of the scapula is at the level of the

seventh posterior rib

the lower margin of the scapula is at the level of the

lateral/ acromial end

medial/ sternal end

body

3 parts of clavicle

acromioclavicular joint (AC joint)

the joint between the acromial process and the clavicle

sternoclavicular joint (SC joint)

joint between sternum and clavicle

jugular notch

formed by the SC joints and manubrium

female clavicle

clavicle is usually shorter and less curved

male clavicle

clavicle tends to be thicker and more curved

medial border

superior border

lateral border (axillary border)

3 borders of the scapula

head of the scapula

the lateral angle of the scapula is sometimes called

scapulohumeral joint or the glenohumeral joint

the shoulder joint is also called

neck of the scapula

the constricted area between the head and the body of the scapula is the

superior and inferior angles

refer to the upper and lower ends of the medial or vertebral border of the scapula

wing or ala

the thin, flat, lower part of the scapular body sometimes is referred to as the

costal surface

the anterior surface of the scapula is called the

subscapular fossa

the middle area of the costal surface of the scapula that presents a large concavity or depression is known as the

acromion

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

coracoid process

a 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

crest of the spine

the posterior border or ridge of the spine of the scapula is thickened and called

infraspinous fossa and supraspinous fossa

posterior surface of the scapula is split into 2 fossas by the spine, called

SC joint

AC joint

Scapulohumeral joint (shoulder)

3 joints in the shoulder girdle

synovial joint/ diarthrodial

the 3 shoulder girdle joints are classified as

ball and socket (spheroidal)

shoulder joint type

dislocations of the shoulder

happens more frequently than at any other joint in the body

plane/ gliding joints

SC and AC joint types

AC joint separation

Refers to trauma to the upper shoulder region resulting in a partial or complete tear of the AC or coracoclavicular (CC) ligament or both ligaments.

nearly half of all athletic shoulder injuries

6 classifications

acromioclavicular (AC) dislocation

refers to an injury in which the distal clavicle usually is displaced superiorly

bankart lesion

an injury of the anteroinferior aspect of the glenoid labrum.

bursitis

an inflmmation of the bursae, or fluid filled sacs enclosing the joints

hill-sachs defect

a compression fracture of the articular surface of the posterolateral aspect of the humeral head that often is associated with an anterior dislocation of the humeral head

idiopathic chronic adhesive capsulitis

a disability of the shoulder joint that is caused by chronic inflammation in and around the joint

impingement syndrome

impingement of the greater tuberosity and soft tissues on the coracoacromial ligamentous and ossesous arch, generally during abduction of the arm

osteoarthritis (degenerative joint disease, DJD)

noninflammatory joint disease characterized by gradual deterioration of the articular cartilage with hypertrophic bone formation, most common type of arthritis and is considered part of the normal aging process

osteoporosis

due to a reduction in the quantity of bone or atrophy of skeletal tissue.

rheumatoid arthritis (RA)

chronic systemic disease characterized by inflammatory changes that occur throughout the connective tissues of the body. Inflammation begins in synovial membranes and can later involve the articular cartilage and bony cortex

rotator cuff pathology

acute or chronic traumatic injury to one or more of the rotator cuff muscles

teres minor, supraspinatus, infraspinatus, subscapularis

muscles of the rotator cuff

shoulder dislocation

traumatic removal of humeral head from the gelnoid cavity

tendonitis

An inflammatory condition of the tendon that usually results from a strain.

axilla

atomic name for the armpit

***coronoid and condylar processes are not part of the shoulder girdle***

***coronoid and condylar processes are not part of the shoulder girdle***

external rotation

correct proximal humerus position for the greater tubercle being profiled laterally

neutral rotation

correct proximal humerus position for humeral epicondyles angled 45 degrees to IR

internal rotation

correct proximal humerus position for epicondyles perpendicular to IR

external rotation

correct proximal humerus position for supination of the hand

neutral rotation

correct proximal humerus position for palm of hand against thigh

external rotation

correct proximal humerus position for epicondyles parallel to IR

internal rotation

correct proximal humerus position for lesser tubercle profiled mediallyl

internal rotation

correct proximal humerus position for proximal humerus in lateral position

external rotation

correct proximal humerus position for proximal humerus in position for AP

true

t/f the use of a grid is not required for shoulder studies that measure less than 10 cm

false

t/f the kV range for adult shoulder projections is between 60 -70 kV for analog and 100-110 kV for digital

false

t/f low mA with short exposure times should be used for adult shoulder studies

false

t/f large focal spot setting should be selected for most adult shoulder studies

true

t/f a high-speed screen-IR system is recommended for analog shoulder studies when using a grid

false

t/f a 72-inch SID is recommended for most shoulder girdle studies

true

t/f the use of contact shields over the breast, lung, and thyroid regions is recommended for most shoulder projections

boomerang compensating filter

device permits good visualization of soft-tissue and boy anatomy for adult shoulder radiography

parent or guardian

if physical immobilization is required, which individual should be asked to restrain a child for a shoulder series

true

t/f it is recommended to perform shoulder positions on obese patients in the erect position when possible

CR perpendicular to IR directed to 1 inch (2.5 cm) inferior to coracoid process

specifically, where is the central ray placed for an AP projection of the shoulder

transthoracic lateral projection for the humerus

which lateral projection can be performed to demonstrate the entire humerus for a patient with a midhumeral fracture

rotate affected arm externally approximately 45 degrees

to best demonstrate a possible Hill-Sachs defect, which additional positioning technique can be added to the inferosuperior axial (lawrence method) projection

25-30 degrees

what type of central ray angulation is required for the inferosuperior axial projection for the shoulder?

anterior oblique aka grashey

this projection of the shoulder produces an image of the glenoid process in profile

fisk modification

which projection produces a tangential projection of the intertubercular sulcus or groove

10-15 degrees

the supine version of the tangential projection for the intertubercular sulcus requires that the CR be angled how many degrees posteriorly from the horizontal plane

posterior oblique (scapular Y) projection

which projection is best for demonstrating a possible disloaction of the proximal humerus

tangential projection-supraspinatus outlet; neer method or apical AP axial

this projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for the possible subacromial spurs, which creater shoulder impingement symptoms

30 degrees caudad

what type of CR angle is required for the apical AP axial shoulder projection

PA transaxillary projection (Hobbs modification)

which of the nontrauma projections can be performed erect to provide a lateral view of the proximal humerus in relationsihp to the scapulohumeral joint

5-15 degrees

how much is the CR angled for the inferosuperior axial projection (clements) if the patient cannot fully abduct the arm 90 degrees

15 degrees cephalad

what CR angle is required for the AP axial projection (alexander) for AC joints

true

t/f the PA transaxillary projection (Hobbs) requires no CR angle

true

t/f the transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus

true

t/f the use of a breathing technique can be performed for the transthoracic lateral humerus projection

false

t/f the affected arm must be placed into external rotation for the transthoracic lateral projection

false

t/f a central ray angle of 10-15 degrees caudad may be used for the transthoracic lateral shoulder projection if the patient is unable to elevate the uninjured arm and shoulder sufficiently

flase

t/f the scapular Y lateral (posterior oblique) position requires the body to be rotated 25-30 degrees anteriorly toward the affected side

superior angle of the scapula and the AC joints articulation

which 2 landmarks are placed perpendicular to the IR for the scapular Y lateral projection

AP apical oblique axial projection

which special projection of the shoulder requires that the affected side be rotated 45 degrees toward the cassette and uses a 45 degree caudad CR angle

fracture of clavicle

what must be ruled out before performing the weight-bearing study for acromioclavicular joints