lecture 3 - shoulder slides

7/31/2019 Lecture 3 - Shoulder Slides

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Radiological Anatomy of the

, ,and basics of Brachial Plexus


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De artment of Radiolo

Vancouver General Hospital

Dr. Savvas Nicolaou

Director of ER/Trauma Radiology

savvas.n co aou vc .ca


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Lecture Objectives

Be able to identify the following structures on a normal shoulder radiograph:

Clavicle

Acromial end- clavicle

Infraspinous fossa

Glenoid cavity

erna en - c av c e

Scapula

u scapu ar ossa

Supraglenoid tubercle

Infra lenoid tubercle , ,

Superior, medial and lateral borders

Humerus

Greater tuberosity

Spine

Acromion

Lesser tuberosity

Head

Coracoid process

Su ras inous fossa

Anatomical neck

Deltoid tuberosity


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Lecture Objectives

Be able to identify the following (rotator cuff muscles) structures on a shoulder

Supraspinatus muscle

Infras inatus muscle

Teres minor muscle

Subscapularis muscle


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Outline

Approach to Radiographs: AP, lateral and axillary view

Radiology Anatomy Atlas: glenohumeral region

This material is EXAMINABLE so pay attention!


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y v w

Glenohumeral region Clavicle, Scapula and Humerus


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Gross Anatomy of Glenohumeral region

3

3 Bones

2

1. Humerus

2. Scapula

1

3. Clavicle


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Gross Anatomy of Glenohumeral region

23

3 Joints1

1. Glenohumeral

2. Acromioclavicular

.


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Clavicle + Scapula - Anterior

Anterior

1: Clavicle, acromial end

2: Clavicle, sternal end

3: Scapula, superior border

,

5: Scapula, lateral border

6: Inferior angle of scapula

7: Acromion

8: Coracoid Process

: uper or ang e o scapu a10: Suprascapular notch

11: Su ra lenoid tubercle

12: Subscapular fossa


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Scapula - Posterior

Posterior

1: Spine of scapula

2: Lateral angle of scapula

3: Supraspinous fossa

5: Glenoid cavity

6: Infraglenoid tubercle

7: Lateral border of scapula

8: Medial border of scapula

: uper or or er o scapu a10: Acromion


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Glenohumeral region: Scapula + Clavicle

27 9

38

2: Clavicle acromial end

3: Superior border of scapula

4

4: Medial border of scapula

5: Lateral border of scapula

5: n er or ang e o scapu a

7: Acromion

8: Coracoid rocess

6

9: Suprascapular notch


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Scapula - Lateral

1: Supraspinous fossa

2: Spine

3: Subscapular fossa4: Glenoid cavity

5: n rasp nous ossa

6: Coracoid process

7. Acromion

8: Supraglenoid tubercle

9: Infraglenoid tubercle


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Humerus2

4

57

1: Deltoid tuberosity

3: Lesser Tuberosity

4: Head of humerus

5: Anatomical neck

6: Surgical neck

: v


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Glenohumeral joint

Very mobile flexion, extension,

abduction, adduction, lateral and

medial rotation

Price: instability

45% of all dislocations


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Glenohumeral joint stability

Joint stability depends:

1. Glenoid labrum

2. Joint capsule

.

Glenoid fossa, Acromion,

Coracoid


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Glenohumeral joint stability

Joint stability depends:

4. Glenohumeral ligaments

Superior, Middle, Inferior

.


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Gross Anatomy of Glenohumeral region Rotator cuff muscles

2

3

Posterior Anterior

1. Subscapularis

2. Supraspinatus

3. Infraspinatus

4. Teres minor


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Rotator cuff muscles

MuscleOrigin onscapula

Attachment onhumerus

Function Innervation

Supraspinatusmuscle supraspinousfossa

middle facet ofthe greatertuberosity

abducts the arm Suprascapularnerve (C5)

Infraspinatusmuscle

infraspinousfossa

posterior facetof the greater

tuberosity

externallyrotates the arm

Suprascapularnerve (C5-C6)

Teres minormuscle

middle half oflateral border

inferior facet ofthe greater

tuberosity

externallyrotates the arm

Axillary nerve(C5)

Subscapularismuscle

subscapularfossa

lesser tuberosity(60%) orhumeral neck

internally rotatesthe humerus

Upper andLowersubscapularnerve -


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AP View

Technique:

Cassette on patients

back, x-ray beam at

right angles to this

plane and centered on


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Lateral View

Technique:

plate, rotate, non-imaged shoulder

40 degrees out

x-ray tube is then placed

posteriorly along scapular spine


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Axillary View

Techni ue:

Cassette on patients

-,

shot through the axilla

Allows assessment

of humeral head

anteriorly and

osteriorl


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Glenohumeral region clavicle, scapula and humerus


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DeltoidTuberosity

DeltoidMuscle

Suprascapular

notch


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What is the arrow pointing at?

Deltoid tuberosity

Deltoid muscle

What muscle attaches to it?


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AP View 1. Clavicle acromial end2. Clavicle- sternal end

3. Acromion4. Coracoid process

34

2


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5. Glenoid cavity6. Humerus greater

tuberosit

AP View

7. Humerus lessertuberosity

8. Head of humerus

67

85


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9. Surgical neck ofhumerus

AP View

.humerus

11. Supraglenoidtubercle

. n rag eno tu erc e11

10

9

12


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AP View

1

13

24 4

1. Clavicle acromial end2. Clavicle- sternal end

3. Acromion4. Coracoid process


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AP View

855 8

7

5. Glenoid Cavity6. Humerus greater tuberosity

7. Humerus lesser tuberosity8. Head of Humerus


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AP View

1

99

9. Surgical neck of Humerus

10.Anatomical neck of Humerus

11.Supraglenoid tubercle

12.Infraglenoid tubercle


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1 borders of thescapula indicated

by the yellow

3

arrows

1. Lateral border2. Superior border

3 B) What are the

.

scapula indicatedby the green

arrows?

1 1. Superior angle2. Inferior angle3. Lateral angle

2


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Lateral View 1

23

7

4.

2. Acromion

3. Coracoid process

5

4. Spine of scapula

5. Head of humerus

6

6. Humerus

7. Superior angle of scapula

.

8


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1

23 43

47

5

6

1. Clavicle acromial end2. Acromion3. Coracoid process4. Spine of scapula5. Head of humerus6. Humerus

7. Superior angle of scapula8. Inferior angle of scapula

8


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Axillary View

1. Humerus

2. Coracoid Process3. Clavicle

5. Greater tuberosity6. Lesser tuberosity7. Intertubercular sulcus

9. Anatomical neck10. Surgical neck11. Acromion

. eno cav y 8. Head of humerus

5

1

3

8

6

9 4


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CT Images- Axial

*

.2. Humerus3. Coracoid Process

4. Glenoid Cavity5. Spine of Scapula6. Scapula

2

3

2

31

*

4

5

4

* 65

*


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CT Images- Coronal

1. Clavicle2. Acromion3. Head of Humerus.

2

23

344

Neck


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Lateral View

What fossa are here?

3. uprasp nous ossa

2. Infraspinous fossa

3. Subsca ular fossa

MRI of Muscles (Coronal)


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MRI of Muscles (Coronal)

2

13 3

4 41

1. Deltoid Muscle

2. Supraspinatous Muscle3. Subscapularis Muscle4. Teres Minor

MRI of Muscles (Axial Right Shoulder)


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MRI of Muscles (Axial, Right Shoulder)

55

1

4

23

2 466

1. Deltoid Muscle2. Supraspinatous Muscle3. Subsca ularis Muscle

Posterior

4. Infraspinatus Muscle5. Scapula

6. Spine of scapula

MRI of Muscles (Axial Right Shoulder)


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MRI of Muscles (Axial, Right Shoulder)

2 1

3 5

1

4 23

4

3

4

56

Posterior1. Deltoid Muscle2. Supraspinatous Muscle3. Subsca ularis Muscle4. Infraspinatus Muscle5. Scapula6. Spine of scapula


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Glenohumeral- scapular region


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Anterior shoulder dislocation

Humeral head displaces anteriorly (95%+)

Most often post-trauma

Repeat dislocation common, even with minor trauma

Mechanism: abduction and external rotation mostcommonly

Imaging: AP and Lateral views

Tx: conservative, shoulder reduction

What view is this?


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What view is this?

ew


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Anterior shoulder dislocation AP view

humeral head is abnormally

positioned

dis laced inferiorl andmedially on AP radiographs

Anterior dislocation of the shoulder in a 59-year old female. The AP view showsthe humeral head to be displaced inferiorly and medially in relation to the now

empty glenoid fossa (red arrow).


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What view is this?

Lateral view

posteriorly?

Anterior Shoulder Dislocation lateral view


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Anterior Shoulder Dislocation lateral view

Lateral view of the glenohumeral

jointdemonstrating anterior

dislocation of humerus (blue) and

the empty glenoid cavity (orange)

humeral head is abnormally

positioned

displaced anteriorly on

lateral radiograph


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Where is the fracturethrough?

Surgical neck of humerus


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Surgical neck of humerus fracture

Most common fracture of the proximal

humerus; more frequent than fracture of

anatomical neck

,

blood supply, thus, low risk of Avascular

Necrosis

Fracture in this area is very likely to

damage axillary nerve which supplies

deltoid muscle

Test b askin atient to ABDUCT

arm



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lecture 3 - shoulder slides

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