Ch. 5- Shoulder Girdle

• Clavicle is shorter and less curved in females
• Clavicle is thicker and more curved in males
• Clavicle has 2 joints:

  • Acromioclavicular
  • Sternoclavicular
• Scapulas 3 borders:

  • Superior
  • Medial (vertebral)
  • Lateral (axillary)
• Articulations in the shoulder girdle:

  • Acromioclavicular Joint
  • Sternoclavicular Joint
  • Glenohumeral Joint
• The intertubercular groove is aka the bicipital groove
• Clavicle: Long bone with double curvature
• The clavicles acromial extremity articulates with the scpaulas acromion
• The clavicles sternal extremity articulates with the sternum
• 3 angles of scapula:

  • Superior
  • Inferior
  • Lateral (head)

  
• The posterior of the scapula has a supraspinous fossa and infraspinous fossa
• Scapula Lateral Y includes:

  • Acromion
  • Coracoid process
  • Inferior angle
  • Scapular spine
  • Body of scapula

  
• Movement types of shoulder joints:

  • Glenohumeral: Spheroidal (Ball and Socket)
  • Sternoclavicular: Plane (gliding)
  • Acromioclavicular: Plane (gliding)
• The acromion is the most posterior structure on the scapula
• Basic Shoulder Routine:

  • AP External Rotation
  • AP Internal Rotation
  • Alternate 3rd view
• Alternate 3rd views in shoulder routines:

  • Scapular Y Lateral
  • Inferosuperior (axillary)
  • Superoinferior axial
  • Grashey (AP Oblique Glenoid)
• AP External Rotation:

  • CR 1" inferior to coracoid process
  • Epicondyles parallel to IR
  • Greater tubercle laterally profiled
• AP Internal Rotation:

  • CR 1" inferior to the coracoid process
  • Epicondyles perpendicular to IR
  • Lesser tubercle profiled medially
• Inferosuperior Axial (Lawrence Method):

  • CR 25 to 30 degrees medial to axilla
  • Arm supinated and abducted 90 degrees
  • Lesser tubercle profiled anteriorly
  • Humeral head and glenoid fossa profiled
• An alternate position of the Lawrence Method is done with exaggerated rotation to demonstrate a possible Hill-Sachs defect (a compression fracture)
• Superoinferior Axial Projection:

  • Place scapulohumeral joint in center of IR
  • CR: 5 to 15 degree and towards elbow
• AP Oblique Projection (Grashey Method):

  • Rotate body 35 to 45 degrees towards the affected side
  • CR: Perpendicular to IR, 2" inferior and medial from superolateral border of humerus
  • Glenoid cavity profiled
  • Demonstrates Bankkart lesion and fx of glenoid labrum or brim
• Bankkart Lesion: Injury of the anteroinferior aspect of the glenoid labrum
• Fisk Method (Tangential Intertubercular Groove):

  • 8 x 10 CW
  • Place humerus 10 to 15 degrees from vertical
  • Pathology of intertubercular sulcus (groove) including bony spurs of the humeral tubercles
  • CR is perpendicular to intertubercular groove
• Shoulder Trauma Routine:

  • AP Neutral Rotation
  • Scapular Y Trauma
  • Transthoracic Lateral
• Shoulder trauma special views:

  • Neer Method
  • AP Apical Oblique Axial
• AP Neutral Rotation:

  • CR to glenohumeral joint; 1" inferior to coracoid
  • Epicondyles are approx 45 degrees to IR
  • Neither tubercle in profile
• Scapula Y Lateral Trauma:

  • Rotate into anterior oblique 45 to 60 degrees towards IR
  • CR to proximal humerus; 2" below top shoulder
  • Humerus in image
• Transthoracic Lateral Prox Humerus:

  • CR perpendicular to surgical neck
  • Breathing Technique: Minimum 3 seconds exposure time with orthostatic breathing
• Neer Method (Supraspinatus Outlet):

  • CR 10 to 15 degrees caudad
  • Demonstrates coracoacromial arch for supraspinatus outlet region for shoulder impingement

  
• Routine Scapula:

  • AP
  • Lateral Y
• AP Scapula:

  • CR to midscapula
  • Abduct arm 90 degrees and supinate hand
  • Optional breathing technique
  • Lateral border free or ribs and lung

  
• Lateral Y Scapula:

  • For BODY of Scapula
  • Cross arm across chest
  • CR to mid vertebral border of scapula
  • From PA rotate 45 to 60 degrees until imaginary line between superior angle and AC joint is perpendicular to IR

  
• Lateral Y Scapula:

  • For UPPER Scapula (acromion or coracoid)
  • Let arm hang down by side or slightly behind lower back

  
• AP Clavicle:

  • CR perpendicular to midclavicle
  • 10 x 12 CW IR
  • Expose on suspended inspiration to elevate clavicle
• AP Axial Clavicle:

  • CR 15 to 30 degrees cephalic and perpendicular to midclavicle
  • 10 x 12 CW IR
  • Expose on suspended inspiration to elevate clavicle
• AC Joints (Pearson Method):

  • CR to midpoint between AC joints ( 1" above jugular notch)
  • Without and with weights
  • 72" SID
  • 14 x 17 CW
  • On expiration
  • 8 to 10 lbs or 5 to 8 lbs on asthenic pt