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    1. 1. Trauma Radiography “The Shoulder Girdle” Abdul Nizam Bin Duim Juru X-ray U29 SGH Kuching
    2. 2. The Basic Anatomy of The Shoulder Girdle <ul><li>Upper 3 rd of the Humerus / The Head of Humerus </li></ul><ul><li>Glenoid Process of the Scapula </li></ul><ul><li>Clavicle </li></ul>
    3. 3. The Basic Radiography Of The Shoulder Girdle <ul><li>Ap Shoulder </li></ul><ul><li>(External / Internal Rotation) </li></ul><ul><li>Lateral Scapula / </li></ul><ul><li>Transthoracic / </li></ul><ul><li>“ Y View” </li></ul><ul><li>Axilary View/Supero-Inferior </li></ul>
    4. 4. AP Shoulder (Supine/Erect) <ul><li>Internal Rotation </li></ul><ul><li>External Rotation </li></ul>
    5. 5. “ External Vs Internal”
    6. 6. AP Shoulder External Rotation
    7. 7. AP Shoulder Internal Rotation
    8. 8. Ap Shoulder ? <ul><li>Straight </li></ul><ul><li>Body Oblique 30-40 Deg </li></ul><ul><li>Grasheys View </li></ul>
    9. 9. Grashey’s View/AP Glenohumeral Joints <ul><li>True AP of GH joint space/no overlap </li></ul><ul><li>Profile position of Humeral Head and Glenoid </li></ul><ul><li>Bankart’s Lesion/Fracture appear as Chip Fracture of Glenoid Rim (Labrum Tear) </li></ul>
    10. 10. Ap Shoulder <ul><li>Straight AP Int Rotation </li></ul><ul><li>Oblq 30-40 deg Ext Rotation/Grasheys View </li></ul>
    11. 11. True Ap Shoulder (Grashey’s View) <ul><li>Grashey view taken with patient in posterior oblique position with scapular spine parallel to film plane, creating true AP projection of shoulder . Compare more tangential appearance of the glenoid in this view with the typical AP shoulder </li></ul><ul><li>“ Shoulder surgery” By Nikolaus Wülker, Michel Mansat, Freddie H. Fu </li></ul><ul><li>Published by Informa Health Care, 2001,ISBN 1853175633, 9781853175633 </li></ul><ul><li>“ Rockwood and Green's fractures in adults” </li></ul><ul><li>By Charles A. Rockwood, David P. Green, Robert W. Bucholz, James D. Heckman, Charles M. Court-Brown, Kenneth J. Koval, Paul Tornetta </li></ul><ul><li>Published by Lippincott Williams & Wilkins, 2006 </li></ul><ul><li>Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA. </li></ul>
    12. 12. Lateral/Transthoracic Scapula/”Y” View
    13. 13. Axial/SuperoInferior Shoulder <ul><li>Supine </li></ul><ul><li>Sitting </li></ul>
    14. 14. Axial/SuperoInferior Shoulder
    15. 15. Audit on Radiographs of Shoulder <ul><li>The radiographs of 115 anterior shoulder dislocations (100 patients; 74 males, 26 females, mean age 35 ± 18 years) were reviewed to assess the radiographic views used in the management of this dislocation. Eighty-eight patients (88%) had only the anteroposterior (AP) view , 10 patients had 2 radiographic views taken and only 2 patients had three radiographic views. </li></ul><ul><li>Hill-Sachs Lesions were found in 18%, asociated with glenoid rim fractures in 3%(Bankart’s Lesion) of the patients. A greater tuberosity fracture was found in 18% of the patients. </li></ul><ul><li>Therefore, the current practice in the management of an acute anterior shoulder dislocation appears to be to perform a single view (AP) pre-reduction radiograph to confirm the diagnosis and a single view (AP) post reduction radiograph to confirm reduction after a close manipulative reduction has been performed. This practice is likely to result in an underestimate of associated Hill Sachs Lesion,Bankart’s Lesion and glenoid rim fractures , but not greater tuberosity fractures. </li></ul><ul><li>Medical Journal of Malaysia, 60 (1). pp. 15-20. ISSN 0300-5283 </li></ul><ul><li>Lee, D.J.K., and Yeap, J.S., and Fazir M., and Muhd Borhan T.A., and Kareem B.A., (2005) </li></ul>
    16. 16. Trauma Fracture /Pathology <ul><li>Anteror/Posterior Dislocation </li></ul><ul><li>Bankart’s Lesion </li></ul><ul><li>Hill Sachs Lesion </li></ul><ul><li>GH Arthritis </li></ul><ul><li>Rotator Cuffs Injury </li></ul><ul><li>Fracture-Humeral Head/Glenoid Scapula/ </li></ul><ul><li>Clavicle/Joints AC etc. </li></ul>
    17. 17. Anterior / Posterior Dislocation of The Shoulder <ul><li>A shoulder dislocation occurs when the head of the humerus (upper arm bone) pops out of the shallow shoulder socket of the scapula (called the glenoid). This can happen when a strong force pulls the shoulder upward or outward, or from an extreme external rotation of the humerus. </li></ul><ul><li>Glenohumeral dislocations are generally classified by the direction of dislocation of the humerus.( Anterior / Posterior-Seizure/Intense elctrical shock) </li></ul><ul><li>Dislocation can be full or partial, partial dislocation (also called subluxation)—the head of the humerus slips out of the socket momentarily and then snaps back into place.Full dislocation—the head of the humerus comes completely out of the socket </li></ul><ul><li>Shoulder dislocations can also be associated with fractures—one can have a fracture and dislocation at the same time. Nerves and blood vessels can sometimes be injured with a severe shoulder dislocation, requiring immediate medical attention. </li></ul><ul><li>Anterior-GT# Posterior LT# </li></ul>
    18. 18. Anterior / Posterior Dislocation of The Shoulder (GH Joint)
    19. 19. GlenoHumeral /Shoulder Arthritis <ul><li>glenohumeral arthritis or shoulder arthritis is an inflammatory process of the shoulder that </li></ul><ul><li>is usually accompanied by pain, swelling, and stiffness resulting from infection, trauma, </li></ul><ul><li>degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, </li></ul><ul><li>such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. </li></ul>
    20. 20. AP Shoulder Of GH Arthritis
    21. 21. Lesion / Fracture / Deformity <ul><li>Bankart’s (Bone / Cartilage Lesion) </li></ul><ul><li>Is a specific injury to a part of the shoulder joint called the labrum (a cuff of cartilage that forms a cup for the end of the arm bone (humerus) to move within) When the labrum of the shoulder joint is torn, the stability of the shoulder joint is compromised. A specific type of labral tear is called a Bankart lesion, and is due to dislocation of the shoulder causing the tear. </li></ul><ul><li>Hill Sach’s (Bone Lesion) </li></ul><ul><li>Is an injury that causes damage to the head of the humerus (arm bone).When the shoulder dislocates, the smooth cartilage surface of the humerus hits against the rim of the scapula (glenoid). The Hill-Sachs injury is caused when the humeral head is impinged against the glenoid of the shoulder joint. </li></ul><ul><li>Both are Complication becouse of Shoulder Dislocation </li></ul>
    22. 23. Rotator Cuffs Tear/Injury <ul><li>Rotator cuff tears are tears of one, or more, of the four tendons of the rotator cuff muscles. </li></ul><ul><li>The tendons of the rotator cuff supraspinatus, infraspinatus, teres minor and subscapularis. </li></ul><ul><li>Soft Tissue Injury- MRI </li></ul><ul><li>Xrays wont show any tear,provide indirect evidence </li></ul>
    23. 24. Fractures-Head Of Humerus
    24. 25. Fracture Greater/Lasser Tuberosity <ul><li>Greater tuberosity fracture- </li></ul><ul><li>usually associated with anterior dislocation </li></ul><ul><li>Lesser tuberosity fracture- </li></ul><ul><li>usually associated with posterior dislocation </li></ul>
    25. 26. Facture of The Scapula <ul><li>Rare </li></ul><ul><li>Most common between 40-60 years </li></ul><ul><li>Importance occur only in severe trauma </li></ul><ul><li>Classified based on location/anatomical structure </li></ul><ul><li>“ Y View” </li></ul>
    26. 27. Fracture Of The Clavicle <ul><li>Fracture proximal (medial) third- 5% </li></ul><ul><li>Fracture middle third- 85% </li></ul><ul><li>Fracture distal third- 15% </li></ul><ul><li>If displacement is present , the proximal fragment is usually elevated and distal fragment is displaced medially and caudally. </li></ul>
    27. 28. Recommendations <ul><li>AP Shoulder-Anterior/Posterior Dislocation,Fracture Clavicle </li></ul><ul><li>External Rotaion-Greater Tubercle </li></ul><ul><li>Internal Rotation-Lasser Tubercle,Hill Sach’s Lesion </li></ul><ul><li>Grashey’s View(30-40 deg)-GHArthritis,Glenoid(Rim) Fracture/Bankart’s Lesion,Anterior/Posterior Dislocation </li></ul><ul><li>Lateral/Tranthoracic/Y View-Scapula Fracture,Choracoid/Acromion Fracture </li></ul><ul><li>Axial/SuperoInferior-Ext view for Anterior/Posterior Dislocations </li></ul>