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MODULE 4

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  1. MODULE 4 SHOULDER

  2. 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

  3. LINES OF MENSURATION • Axial angle of humerus in AP with external rotation • Humeral shaft line • Humeral head line • greater tubercle • medial/inferior articular surface

  4. LINES OF MENSURATION • Humeral angle • average 60o in men • average 62o in female • Changes in angles could be due to fracture, dysplasia, or SLE

  5. Humeral shaft line=A Humeral head line=B Humeral angle=HA Fig 2.68

  6. 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

  7. Glenohumeral joint in AP with external rotation Fig 2.69

  8. 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

  9. 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)

  10. Acromiohumeral joint space Fig 2.70

  11. 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)

  12. 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

  13. Acromioclavicular joint space Fig 2.71a Good

  14. Acromioclavicular joint space Fig 2.71b Bad DJD Bad dog!!!

  15. 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

  16. COMMON CONDITIONS • Degenerative joint disease • Rotator cuff tear • Calcific tendonitis • Dislocation and humerus fracture • Clavicle fracture

  17. CLINICAL DIAGNOSIS • Impingement • Adhesive capsulitis • Tendonitis/bursitis

  18. 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

  19. MENTION • Adhesive capsulitis • Tendonitis/bursitis