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MODULE 4 PowerPoint PPT Presentation


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MODULE 4. SHOULDER. NORMAL ANATOMY. Positioning slides Discuss three views versus four view series AP - internal rotation AP - external rotation Abduction - baby arm, 90 o /90 o view at least one view should demonstrate lung apices, usually baby arm. LINES OF MENSURATION.

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MODULE 4

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Module 4 l.jpg

MODULE 4

SHOULDER


Normal anatomy l.jpg

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


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LINES OF MENSURATION

  • Axial angle of humerus in AP with external rotation

  • Humeral shaft line

  • Humeral head line

    • greater tubercle

    • medial/inferior articular surface


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LINES OF MENSURATION

  • Humeral angle

    • average 60o in men

    • average 62o in female

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


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Humeral shaft line=A

Humeral head line=B

Humeral angle=HA

Fig 2.68


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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


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Glenohumeral joint

in AP with external rotation

Fig 2.69


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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


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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)


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Acromiohumeral joint space

Fig 2.70


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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)


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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


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Acromioclavicular joint space

Fig 2.71a

Good


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Acromioclavicular joint space

Fig 2.71b

Bad DJD Bad dog!!!


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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


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COMMON CONDITIONS

  • Degenerative joint disease

  • Rotator cuff tear

  • Calcific tendonitis

  • Dislocation and humerus fracture

  • Clavicle fracture


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CLINICAL DIAGNOSIS

  • Impingement

  • Adhesive capsulitis

  • Tendonitis/bursitis


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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

SLIDES


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MENTION

  • Adhesive capsulitis

  • Tendonitis/bursitis


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