Shoulder Girdle
Tanya Nolan
Shoulder Girdle
 Formed by 2 bones


Scapula
Clavicle
 Function

Connect upper limb
to trunk
Clavicle
 Long Bone
 Horizontal oblique
plane
 Doubly curved
for strength
 Function
 Fulcrum for movements of the arm
 Acromial Extremity
 Articulates with acromion process of scapula
 Sternal Extremity
 Articulates with the manubrium of sternum & 1st costal
cartilage
Scapula
 Flat Bone



2 surfaces
3 borders
3 angles
Anterior
Scapula
Proximal Humerus
Posterior Greater Tubercle
Attachments



Superior:
Supraspinatus
Middle:
Infraspinatus
Inferior: Teres
Minor
 Lesser Tubercle
Attachments

Biceps
Tendon
Subscapularis
Muscles
Muscles
 Biceps Brachii
 Long Head
Tendon


Short Head
Tendon


Arises from
superior margin
of glenoid cavity
Arises from
coracoid process
Muscle inserts
into the radial
tuberosity
Bursa
 Small
Subcoracoid
Bursa
Supraspinatus
Muscle
Long head of biceps
muscle
synovial filled
sacs
 Relieves
pressure and
reduces
friction
 Injury or age
causes
calcium
deposits seen
on x-rays
Shoulder Girdle Articulations
 Scapulohumeral

Ball and
Socket
 Acromioclavicular

Gliding
 Sternoclavicular

Double
Gliding
AP Projection
Shoulder (Anatomic Position, External Rotation)
AP Projection
Shoulder (Anatomic Position, External Rotation)
 Greater tubercle
and Humeral
head in profile
 Supraspinatus
tendon insertion
visualized
AP Projection
Shoulder (Neutral Rotation, palm against hip)
AP Projection
Shoulder (Neutral Rotation, palm against hip)
 Greater Tubercle
partially
superimposing
the humeral
head
 Posterior part of
supraspinatus
insertion
demonstrated

Profiles calcific
deposits not
otherwise
visualized
AP Projection
Shoulder (Internal Rotation, posterior hand against hip)
AP Projection
Shoulder (Internal Rotation, posterior hand against hip)
 Lesser Tubercle
in profile
 Proximal
humerus in true
lateral position
 Insertion site of
subscapular
tendon
demonstrated
Transthoracic Lateral Projection
Shoulder (Lawrence Method)
 What do you do if the patient cannot sufficiently
elevate the unaffected shoulder?
Transthoracic Lateral Shoulder
Inferosuperior Axial Projection
Lawrence Method
Degree of angulation of CR
depends on abduction of arm
Inferosuperior Axial Projection
Lawrence Method
Lesser Tubercle
Humerus
Coracoid
Process
Acromioclavicular
Joint
•Lesser Tubercle in
profile
•Coroacoid
Process pointing
anteriorly
Acromion
Scapulohumeral
Joint
Superoinferior Axial Projection
Alternative to Supine Lawrence Method
 Place the patient in a chair at
the end of the exam table
and have them extend the
shoulder over the table.
 Shoulder should be over
midpoint of IR
 Tilt head away from IR
 Humeral epicondyles should
be vertical
CR 5-15 degrees
toward elbow
AP Axial Projection
Trauma Shoulder
CR 35
degrees
 Demonstrates relationship of humeral head to
the glenoid cavity
 Useful in diagnosing posterior dislocation
Scapular Y
PA Oblique Projection
 The position of the arm is unimportant because it does not change
the relationship of the humeral head to the glenoid cavity
Scapular Y
Scapular Y
 Useful in demonstrating
dislocations


Anterior Subcoracoid
dislocation
 Head beneath the
coracoid process
Posterior Subacromial
dislocation
 Head projected
beneath acromion
process
AP Oblique Projection
Glenoid Cavity
(Grashy Method)
 RPO / LPO Position


35-45 degrees toward
affected side
Scapula parallel with
the plane of the IR
 CR 2 in. medial and 2 in.
inferior to superolateral
border of the shoulder
Open Glenoid
Cavity in Profile
Intertubercular Groove
Tangential Projection
CR: 10-15
degrees
posterior
Hand supinated
Profiles the intertubercular groove free
from superimposition of the surrounding
shoulder structures.
Acromioclavicular Articulations
AP Projection: Bilateral




SID: 72 inches
Upright Position
With and Without weights
Demonstrates dislocation, separation, and the function of joints
Acromioclavicular Articulations
AP Projection: Bilateral
 What pathology does this image demonstrate?
 How do you know a patient is not rotated or favoring the injured side?
Acromioclavicular Articulations
Alexander Method
 AC Joint
and
Clavicle
projected
above the
Acromion
CR 15
degrees
cephalic
Clavicle
AP Projection
Clavicle
PA Projection
 What would
be the
advantage of
doing a PA
Projection?
AP Axial Projection
Lordotic Position
 Thinner
patients
require more
angulation to
project the
clavicle off of
the scapula
and ribs.
 Which
position is
easier for the
patient?
AP Axial Projection
Lordotic Position
 How do you treat a fractured clavicle?
Scapula
AP Projection
Scapula
Lateral Projection
 Patient flexes
elbow and
places hand on
posterior thorax

Delineates the
acromion and
coracoid
process
 Adjust body of
scapula to be
perpendicular to
the IR
Scapula
Lateral Projection
 Arm brought
across the chest
grasping opposite
shoulder
 Position of the arm
determines what
portion of the
scapula will be
superimposed by
the humerus
Scapula
Lateral Projection
 Extending the
arm upward
demonstrates
the body of
the scapula
best.
Shoulder Arthrography
 Examination of a joint
after the injection of
contrast material that
outlines soft tissue and
joint structures.
 The most common
purpose of shoulder
arthrography is to rule
out bursitis