Shoulder- Anatomy and Roentgenogram

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Chapter 1  shoulder shoulder joint

The shoulder area has a complex three-dimensional structure, so it takes time to get used to the picture. Please read this book considering that different doctors take pictures in very different ways. If you're an emergency room doctor, it's good to know what views other doctors in your hospital usually take.
I mainly shoot shoulder trauma series. This is shoulder AP/scapular Lateral/shoulder axillary view.

It is good to know how the various structures look in the AP view.
The groove between the GT and the LT is called the bicipital groove because the tendon of the biceps muscle passes through it.

GT greater tubercle

LT lesser tubercle

 

 

Scapular Lat pictures are particularly difficult to understand, due to the unique structure of the scapular.
When viewed from the side, it resembles a Y shape, so it is also called a Y projection view, and a scapular outlet view.
The red dotted line is the coracoid process and the blue dotted line is the spine of the scapular.
At the end there is an acromion (blue straight line). A long black straight line corresponds to the body of the scapular.
The white circle is the head of the humerus, and it should be in the center of this Y, but it will be slightly different depending on the position where it is taken.
When dislocated, it will come out in front or back. 

 

 

The axillary view is also taken from the armpit and looks complicated due to the scapular.
The clavicle is represented by a blue dotted line, which should be easy to find.

The red dotted line shows the acromion. This acromion is an extension of the spine protruding on the back of scapular

The acromion and clavicle meet each other.
The white dot in front is the coracoid process.

The green dotted line shows the humerus, and if there is an anterior or posterior dislocation, the position change will be obvious. The green arrow shows the bicipital groove.
For practice, draw lines while looking at various X-ray photos in your hospital.
If you know anatomy, you can see the picture, and if you keep looking at the picture, the anatomical structure will come inside your eye and head.

There are many structures of particular importance in the surface anatomy of the shoulder. The acromion is corresponding to the peak of the shoulder
The acromion is not covered muscles between the trapezius muscles and deltoid muscles, so it is easy to touch.
It also connects to the clavicle, so it's easy to find. Since the clavicle is most apparent in appearance, you can also find it by touching. Also, the scapular spin can be touched from the back of the shoulder.
As if it corresponds to the clavicle, along the scapular spine, the acromion is also palpable.

The acromioclavicular joint (AC joint), the joint between the acromion and the clavicle, may also have arthritis and dislocation.
This is the structure you should be able to find.
The bicipital groove is wrapped under the muscle, so it is palpable for slender people.
When the elbow is bent 90 degrees, it is located about 20 degrees outward compared to the forearm. 

When you moves the forearm like a joy stick and rotates the humerus externally/internally, and if you put your anather hand on the area, you can feel it better.
Since biceps tendonitis is common, it is also a site that must be found on the surface.
It is also the first place to see because it is the most clearly visible area when viewed with ultrasound.

The coracoid process, located on the medial side of the shoulder, is curved in the shape of a crow's beak.
 Although it is an important landmark, sometimes obese people are not easily touched.
also do.
When the patient's hand is in the back pocket, the greater tubercle (GT abbreviated) under the acromion is more pronounced, and especially the insertion of the supraspinatus is exposed.

If there is a supraspinatus muscle rupture, there may be tenderness, so the area should be touched. It is a must-see structure when viewing ultrasound. Some patients find it difficult to stay in this back pocket position for a long time.

Ultrasound :

Perhaps the most effective area for ultrasound is the shoulder.
In the case of the shoulder, ultrasound is helpful when giving injections while performing a physical examination at the same time, and the effect of reducing damage to other structures through ultrasound is also evident.

In my case, when giving an injection while watching an ultrasound, the most common place for diagnosis is the biceps brachii.
For biceps tendinitis, without stabbing the tendon, spraying the medicine right on top is easy. This is the advantage of ultrasound only. 

The next ommon place is the subacromial space, it helps diagnose and treat impingement syndrome. It is also a great advantage to be able to give the medicine directly above without damaging the supraspinatus.

In the case of a frozen shoulder, after injection for the coracohumeral ligament connecting the cocacoid and humerus, immediately , the patient's satisfaction is high as it reduces the pain and increases the external rotation angle.

Ultrasound has the advantage of observing other lesions and has the advantage that it can be safely injected into the desired area.
There is a lot of treatment, but there are some parts that cannot be explained with books.
Fortunately, there have been many academic conferences recently for Ultrasound.