Humerus and Shoulder Girdle
The humerus is the largest and longest bone of the upper limb.
The shoulder girdle consists of two bones: The clavicle and the scapula.
The clavicle is a long bone with a double curvature that has three main parts: Two ends and a long central portion.
The female clavicle is usually shorter and less cured than the male clavicle.The male clavicle tends to be thicker and more curved, usually being most curved in heavenly muscled men.
The scapula, which forms the posterior of the shoulder girdle, is a flat trianglar bone its three borders, three angles, and two surfaces. The three borders are the medial border, superior border, and lateral border.
The humeral head articulates with the glenoid cavity of the scapula to form the scapula humeral joint, also known as the glenohumeral joint, or the shoulder joint.
The body of the scapula is arched for greater strength.
The arcomion is a long, curved process that extends laterally over the head of the humerus.
The coracoid process is a thick beaklike process that projects anteriorly beneath the clavicle.
Three joints or articulations are involved in the shoulder girdle; sternoclavicular joint, acromioclavicular joint, and scapulohumeral joint.
The scapulohumeral has movement type of a ball-and-socket (spherical) joint. These movements include flexión, extension, abduction, adduction, circumduction, and medial and lateral rotation.
The glenoid cavity is shallow.
Dislocations at the shoulder joint occur more frequently than at any other joint in the body.
The sternoclavicular joint is a double plane, or gliding joint.
The acromioclavicular joint is a plane, or gliding, movement type.
An External Rotation:
Is a true AP projection.
Positioning requires supination of the hand and external rotation of the elbow so that the interepicondylar line is parallel to the IR.
The Greater tubercle is now seen laterally in profile. The lesser tubercle is located anteriorly, just medial to the greater tubercle.
An Internal Rotation:
Perpendicular to the IR, placing the humerus in a true lateral position.
Perpendicular to the IR.
The greater tubercle is now rotated around the anterior and medial aspect of the proximal humerus. The lesser tubercle is seen in profile medially.
Neutral Rotation
A trauma patient when rotation is unacceptable.
Approximate 45 degrees angle to the IR
When the palm of the hand is facing inward toward the thigh.
kVp is 70-85; only use 80-85 kVp on bariatric patients or very muscular patients.
40-inch SID except for AC joints, which you would use 72-inch SID.
Clinical Indications:
AC joint separation: Partial or complete tear of the AC or coracoclavicular ligament or both ligaments. There are six classifications of AC joint separation, ranging from a sprain to a complete separation.
Acromioclavicular dislocation: Injury in which the distal clavicular is usually displaced surperiorly.
Bankart lesion: An inury of the glenoid labrum. Repeated dislocation may result in a small avulsion fracture in the anterionferior region of the glenoid rim.
Bursitis: Inflammation of the Bursae, or fluid-filled sacs enclosing the joints.
Hills-Sachs defect: is a compression fracture of the articular surface of the posterolateral aspect of te humeral head that is often associated with an anterior dislocation.
Idiopathic chronic adhesive capsulitis: (frozen shoulder) is caused by chronic inflammation characterized by pain and limitation of motion.
Impingement syndrome: Is impingement of the greater tuberosity and soft tissues and generally during abduction of the arm.
Osteoarthritis: also degenerative joint disease, is a noninflammatory joint disease characterized by gradual deterioration of the articular cartilage.
Osteaoporosis: Reduction in the quantity of bone or atrophy.
Rheumatoid arthritis: Inflammatory changes that occur throughout the connective tissues of the body.
Rotator cuff pathology: is an acute or a chronic traumatic injury to one or more.
Shoulder dislocation: is traumatic removal of the humeral head from the glenoid cavity. Of shoulder dislocations, 95% are anterior.
Tendonitis: an inflammatory of the tendon.
Projections:
AP PROJECTION: HUMERUS
Tech Factors - 40-inch SID, 14×17, 70-85kVp.
Know- epicondyles of the elbow are parallel and equidistant and AP projection shows the entire humerus, including the shoulder and elbow joints.
ROTATIONAL LATERAL-LATEROMEDIAL OR MEDIOLATERAL PROJECTIONS: HUMERUS
Same Tech factors
Know - epicondyles are perpendicular to IR
TRAUMA HORIZONTAL BEAM LATERAL - LATEROMEDIAL PROJECTIONS: MID-TO-DISTAL HUMERUS
Distal Humerus
Same tech factors
Know - Perform image as a horizontal beam lateral and flex elbow if possible.
TRANSTHORACIC LATERAL PROJECTIONS: HUMERUS (TRAUMA)
Same tech factors
Know
if orthostatic (breathing) lateral technique performed- minimum 3 seconds exposure time.
Place affected arm at patient’s side in neutral rotation
Opposite rm and place hand over top of head
If patient is in too much pain to drop nursed shoulder and elevate uninjured arm and shoulder high enough to prevent superimposition of shoulder, angle CR 10 to 15 degrees cephalad.
AP PROJECTION-EXTERNAL ROTATION: SHOULDER (NONTRAUMA)
Same tech factors
Know
externally rotate arM until epicondyles of distal humerus are parallel to IR
Full external rotation is evidence by greater tubercle visualized in full profile on the lateral aspect.
AP PROJECTION - INTERNAL ROTATION: SHOULDER (NONTRAUMA)
Lateral proximal humerus
Same tech factors
Know - Full internal rotation position is evidenced by lesser tubercle visualized in full profile
INFEROSUPERIOR AXIAL PROJECTIONS: SHOULDER (NONTRAUMA)
Lawrence Method
Same tech factors
Know
Hill-Sachs defect with exaggerated rotation of affected limb
Move patient toward the front edge of tabletop and place a cart or other arm support against front edge or table to support abducted arm.
Rotate head toward opposite side, place verticle cassette on table as close to neck as possible.
Direct R medially 25 to 30 degrees, centered horizontally to axilla and humeral head.
An alternative position is exaggerate external rotation.
IFEROSUPERIOR AXIAL PROJECTION: SHOULDER (NONTRAUMA)
Clements method
Same tech factors
Know
Hill-sachs defect with exaggerated rotation of affected limb
Direct horizontal CR perpendicular to IR
If patient cannot abduct the arm 90 degrees, angle tube 5 to 15 degrees toward the axilla.
PA AXIAL TRANSAXILLARY PROJECTION: SHOULDER (NONTRAUMA)
Modified Bernageau Method
Same tech factors
Know
The arm is raised superiorly to 160 to 180 degrees flexión
CR is directed 30 degrees causally
AP OBLIQUE PROJECTION - GLENOID CAVITY: SHOULDER (NONTRAUMA)
Grashey Method
Same tech factors
Know
Rotate body 35 to 45 degrees onward affected side
Glenoid cavity should be seen in profile
APICAL AP AXIAL PROJECTION: SHOULDER
Same tech factors
Know
demonstrate narrowing of acromiohumeral space
CR is angled 30 degrees cauded
TANGENTIAL PROJECTION - INTERTUBERCULAR (BICIPITAL) SULCUS: SHOULDER (NONTRAUMA)
Fish Method
Same tech factors
Know
Pathologies of intertubercular sulcus (groove)
CR 10 to 15 degrees posteriors from horizontal
AP PROJECTION-NEUTRAL ROTATION: SHOULDER (TRAUMA)
Same tech factors
Same as our lab projections just not rotated.
TRANSTHORACIC LATERAL PROJECTION: PROXIMAL HUMERUS (TRAUMA)
Lawrence Method
Same tech factors
Know
surgical neck
PA OBLIQUE PROJECTION-SCAPULAR Y LATERAL: SHOULDER (TRAUMA)
Same tech factors
Know
Humeral head is demonstrated inferior to coracoid process with anterior dislocations; less common posterior dislocations, humeral head is demonstrated inferior to acromiohumeral process.
The amount of body obliquely may range from 45 to 60 degrees.
The humeral head should appear superimposed over the Y if the humerus is not dislocated.
TANGENTIAL PROJECTION - SUPRASPINATUS OUTLET: SHOULDER (TRAUMA)
Neer Method
Same tech factors but no AEC
Know
Caracoacromial arch for suprasinatus outlet
AP APICAL OBLIQUE AXIAL PROJECTIONS: SHOULDER (TRAUMA)
GARTH METHOD
Same tech factors
Know
“Garth brooks likes pickles and has friends in low places”
CR angled 45 degrees cauded
Patient is rotated 45 degrees
AP AND AP AXIAL PROJECTIONS: CLAVICLE
Same tech factors
Know
Department routines commonly include both AP and AP axial projections
AP - CR perpendicular to mid clavicle
AP axial - CR 15 to 30 degrees cephalad to midclavicle
Thin (asthenic) patients require 25 to 30 degrees CR angle; Patients with thick shoulders and chest (hypersthenic) require 15 to 20 CR angle.
AP PROJECTIONS (PEARSON METHOD): AC JOINTS
BILATERAL WITH AND WITHOUT WEIGHTS
Tech Factors:
72 inches, 14×17, include with weight or without weight.
CR perpendicular to midpoint between AC joints, 1 inch above juglar notch
AP PROJECTION: SCAPULA
Same tech factors
Know
There is a breathing technique
Gently abduct arm 90 degrees
LATERAL POSITION: SCAPULA-PATIENT ERECT
Same tech factors
Know
Have patient reach across front of chest and grasp opposite shoulder to demonstrate body of scapula.
LATERAL POSITION: SCAPULA- PATIENT RECUMBENT
Same tech factors
Know
perpendicular to the IR