THE SHOULDER GIRDLE

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THE SHOULDER GIRDLE

• Technique
• Denise Ogilvie
• October 2006

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Learning Objectives

• Describe anatomy, physiology and pathology of the
  shoulder girdle
• Bony and soft tissue anatomy
• Muscles of rotator cuff
• Pathology-OA,Rotator cuff tears,
  shoulder dislocation/subluxation,
  joint impingement, tendonitis
• Identify and explain the radiographic appearances
  of anatomy of the shoulder girdle including soft
  tissue revolving around the rotator cuff

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Learning Objectives

• Demonstrate a capability to produce, and
  technically evaluate, high quality radiographs of
  the shoulder girdle in a range of clinical and
  patient presentations
• Identify AP, GH, Axial, Neers, Lateral Scapula
  views

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Learning Objectives

• List and describe projections used to image the
  following
• Chronic shoulder
• Trauma shoulder
• Sterno-clavicular joints
• Acromio-clavicular joints
• Clavicle

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Basic Anatomy

• AP View

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Basic Anatomy

• PA View

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Basic Anatomy

• Lateral View

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Basic Anatomy

• Muscles
• AP View

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Basic Anatomy

• Muscles
• PA View

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AP

• Erect or supine
• Internal or external rotation
• Ext-hand supinated
• Int-back of hand against thigh
• Suspended respiration
• IR- 24 x 30-landscape
• CP- 2.5cm inferior to coracoid process
• CR-perpendicular

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AP Image Critique

• External Rotation
• Bony and soft tissue structures shown
• Entire clavicle
• Proximal humerus
• Greater tubercle visible
• GH jt seen with slight overlap of humeral
• head

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AP Image Critique

• Internal Rotation
• Lesser Tubercle in profile

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Gleno-Humeral Joint

• Erect or supine
• Rotate patient 35-45 degrees to affected side
• Humeral head in contact with IR
• Int or ext rotation
• Int-back of hand against thigh
• IR 18 x 24 portrait
• CP- to GH jt
• Can angle 15-20 degrees caudad to show acromian
  space

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Gleno-Humeral Joint Image Critique

• Jt space between Glenoid humeral head clearly
  visible
• Glenoid cavity in profile
• Bony soft tissue
• If ext-greater tubercle in profile
• If int Lesser tubercle in profile medially
• Clear view of acromian space

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Lateral Shoulder (scapula or Y)

• Trauma-? or dislocation
• Preferably erect
• Patient facing IR (PA)
• Rotate body 45-60 degrees to IR
• Body of scapula perpendicular to IR
• CR-humeral head perpendicular to mid medial
  scapular border
• IR 24 x 30 portrait

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Lateral Shoulder (scapula or Y) Image Critique

• Humeral head superimposed over junction of Y of
  scapula
• Scapula not overlying the thorax
• Medial lateral borders superimposed
• Inferior angle of scapula at lower edge of film
  and acromian at top
• Glenoid cavity seen on end at meeting point of
  arms leg of Y

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Lateral Shoulder (scapula or Y) Image Critique
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Supero-Inferior (SI) or Axial

• Can be seated or standing so arm can be abducted
  out
• Patient leans laterally adjusting arm out over IR
• IR placed on table under shoulder jt
• Elbow flexed 90degrees and rested on table-hand
  pronated
• Head tilted away from affected side

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Supero-Inferior (SI) or Axial

• Patients body needs top be vertical so as not to
  rotate shoulder forward or backward
• CR- 5-10 degrees toward elbow through the
  shoulder joint
• IR needs to be displaced appropriately so the
  shoulder is centre of film
• IR 18 x 24 crosswise

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Supero-Inferior (SI) or Axial Image Critique

• Shows relationship of humeral head and glenoid
• AC jt, coracoid process seen under humeral head
• Lesser tubercle in profile seen anteriorly
• Bony soft tissue detail

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Neers View

• Erect facing Erect bucky
• Affected shoulder touching bucky same as lateral
  scapula view
• Scapula perpendicular to IR-body rotated 45-60
  degrees
• Arm by side
• CR-angled 10-15 degrees caudad to the humeral
  head
• IR-18 x 24

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Neers View

• Used to demonstrate the coraco-acromial arch or
  outlet to diagnose impingement
• Shows posterior surface of acromion and
  acromio-clavicular joint

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Neers View Image Critique

• Humeral head projected below AC jt
• AC jt in vertical line with Y
• Lateral and medial borders of scapula
  superimposed
• Lateral clavicle and acromion seen 1.25cm
  superior to the humeral head

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References

• Merrills Atlas of Radiographic Positions
  Radiologic Procedures Vol1 10th edn
• Radiographic Image Analysis McQuillen Martensen
  2nd edn
• Skeletal Radiography Sheila Bull 1st edn