MODULE 4

SHOULDER

NORMAL ANATOMY

• Positioning slides

• Discuss three views versus four view series

• AP - internal rotation

• AP - external rotation

• Abduction - baby arm, 90o/90o view– at least one view should demonstrate lung

apices, usually baby arm

LINES OF MENSURATION

• Axial angle of humerus in AP with external rotation

• Humeral shaft line

• Humeral head line– greater tubercle– medial/inferior articular surface

LINES OF MENSURATION

• Humeral angle– average 60o in men– average 62o in female

• Changes in angles could be due to fracture, dysplasia, or SLE

Humeral angle=HAFig 2.68

Humeral shaft line=AHumeral head line=B

LINES OF MENSURATION

• Glenohumeral joint in AP with external rotation

• Measure superior, middle, and inferior

• Add and divide by three and report average (mobility versus stability)

• 4-5 mm essential normal

Glenohumeral joint in AP with external rotationFig 2.69

LINES OF MENSURATION

• Increased measure indicative of infection, inflammatory arthritide, acromegaly, posterior dislocation

• Decreased measure indicative of degenerative joint disease, calcium pyrophosphate dihydrate (CPPD), inflammatory arthritide, septic arthritis

LINES OF MENSURATION

• Acromiohumeral joint space

• AP shoulder (or external rotation)

• Measure inferior surface of acromion to humeral head

• Average 9.0mm (range 7-11mm)

Acromiohumeral joint spaceFig 2.70

LINES OF MENSURATION

• Decrease (<7.0mm) indicative of rotator cuff tear, degenerative tendonitis

• Increase (>11.0mm) indicative of post-traumatic subluxation, dislocation, joint effusion, stroke, brachial plexus lesion (drooping shoulder)

LINES OF MENSURATION

• Acromioclavicular joint space

• AP, PA, external view

• Measure superior and inferior surfaces and average the measurements

• Males average 3.3 with a range of 2.5-4.1

• Females average 2.9 with a range of 2.1-3.7

Acromioclavicular joint spaceFig 2.71a

Good

Bad DJD Bad dog!!!

Acromioclavicular joint spaceFig 2.71b

LINES OF MENSURATION

• Decrease measure (<2.5/2.1) indicative of degenerative joint disease

• Increase measure (>4.1/3.7) indicative of traumatic separation, resorption (osteolysis), HPT, rheumatoid arthritis, backpacking syndrome

• May require weighted and non-weighted comparison study

COMMON CONDITIONS

• Degenerative joint disease

• Rotator cuff tear

• Calcific tendonitis

• Dislocation and humerus fracture

• Clavicle fracture

CLINICAL DIAGNOSIS

• Impingement

• Adhesive capsulitis

• Tendonitis/bursitis

SLIDES

• Normal positioning• Text measure• Gross specifications• Degenerative joint

disease• Calcified tendonitis• Rotator cuff tear

• Acromioclavicular separation Osteolysis

• Scapula fracture• Clavicular fracture• Surgical sign of

clavicle removal• Ischemic necrosis• Impingement

MENTION

• Adhesive capsulitis

• Tendonitis/bursitis