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Shoulder anatomy . radiology training resource nchanaji nkeh keneth
- 1. RADIOLOGY TRAINING RESOURCE FOR MEDICAL IMAGING TECHNOLOGISTS/SONOGRAPHERS, NURSES, MIDWIVES AND RELATED MEDICS Module 14: Shoulder Anatomy Course lecturer Nchanji Nkeh Keneth Radiologic Technologist/Sonographer CSMRR: 001012016 +237 671459765 B.TECH/HPD in MDIRT (St. LOUIS UNIHEBS, Univ Buea) excellence660@gmail.com MedicalImagingTrainingResourceForMedicalImagTech, Nurses,MidwivesandMedics,NchanjiNkehKeneth 1 10/23/2020
- 2. 10/23/2020 5-2 The Shoulder Joint Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 3. 10/23/2020 5-3 The Shoulder Joint • Shoulder joint is attached to axial skeleton via the clavicle at SC joint • Scapula movement usually occurs with movement of humerus – Humeral flexion & abduction require scapula elevation, rotation upward, & abduction – Humeral adduction & extension results in scapula depression, rotation downward, & adduction – Scapula abduction occurs with humeral internal rotation & horizontal adduction – Scapula adduction occurs with humeral external rotation & horizontal abductionMedical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 4. 10/23/2020 5-4 The Shoulder Joint • Wide range of motion of the shoulder joint in many different planes requires a significant amount of laxity • Common to have instability problems – Rotator cuff impingement – Subluxations & dislocations • The price of mobility is reduced stability • The more mobile a joint is, the less stable it is & the more stable it is, the less mobile Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 5. 10/23/2020 5-5 Bones • Scapula, clavicle, & humerus serve as attachments for shoulder joint muscles – Scapular landmarks • supraspinatus fossa • infraspinatus fossa • subscapular fossa • spine of the scapula • glenoid cavity • coracoid process • acromion process • inferior angle From Seeley RR, Stephens TD, Tate P: Anatomy and physiology, ed 7, New York, 2006, McGraw-Hill Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 6. 10/23/2020 5-6 Bones • Scapula, clavicle, & humerus serve as attachments for shoulder joint muscles – Humeral landmarks • Head • Greater tubercle • Lesser tubercle • Intertubercular groove • Deltoid tuberosity Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 7. 10/23/2020 5-7 Bones • Key bony landmarks – Acromion process – Glenoid fossa – Lateral border – Inferior angle – Medial border – Superior angle – Spine of the scapula Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 8. 10/23/2020 5-8 Glenohumeral Joint • multiaxial ball- &-socket • enarthrodial Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 9. 10/23/2020 5-9 Glenohumeral Joint – Glenoid labrum slightly enhances stability Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 10. 10/23/2020 5-10 Glenohumeral Joint – Glenohumeral ligaments provide stability • especially anteriorly & inferiorly • inferior glenohumeral ligament Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 11. 10/23/2020 5-11 Glenohumeral Joint – Ligaments are quite lax until extreme ranges of motion reached due to wide range of motion involved – Stability is sacrificed to gain mobility Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 12. 10/23/2020 5-12 Glenohumeral Joint • Determining exact range of each movement is difficult due to accompanying shoulder girdle movement Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 13. 10/23/2020 5-13 Glenohumeral Joint – 90 to 95 degrees abduction – 0 degrees adduction, 75 degrees anterior to trunk Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 14. 10/23/2020 5-14 Glenohumeral Joint – 40 to 60 degrees of extension – 90 to 100 degrees of flexion Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 15. 10/23/2020 5-15 Glenohumeral Joint – 70 to 90 degrees of internal & external rotation Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 16. 10/23/2020 5-16 Glenohumeral Joint – 45 degrees of horizontal abduction – 135 degrees of horizontal adduction Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 17. 10/23/2020 5-17 Glenohumeral Joint • Frequently injured due to anatomical design – shallowness of glenoid fossa – laxity of ligamentous structures – lack of strength & endurance in muscles – anterior or anteroinferior glenohumeral subluxations & dislocations – common – posterior dislocations – rare – posterior instability problems somewhat common Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 18. 10/23/2020 5-18 Glenohumeral Joint • Rotator cuff is frequently injured – Subscapularis, supraspinatus, infraspinatus, & teres minor muscles – attach to the front, top, & rear of humeral head – point of insertion enables humeral rotation – vital in maintaining humeral head in correct approximation within glenoid fossa while more powerful muscles move humerus through its wide range of motion Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 19. 10/23/2020 5-19 Pairing of shoulder girdle & shoulder joint movements Shoulder joint Shoulder girdle Abduction Upward rotation Adduction Downward rotation Flexion Elevation/upward rotation Extension Depression/downward rotation Internal rotation Abduction (protraction) External rotation Adduction (retraction) Horizontal abduction Adduction (retraction) Horizontal adduction Abduction (protraction) Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 20. 10/23/2020 5-20 Movements • Abduction – upward lateral movement of humerus out to the side, away from body • Adduction – downward movement of humerus medially toward body from abduction Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 21. 10/23/2020 5-21 Movements • Flexion – movement of humerus straight anteriorly • Extension – movement of humerus straight posteriorly Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 22. 10/23/2020 5-22 Movements • Horizontal adduction (transverse flexion) – movement of humerus in a horizontal or transverse plane toward & across chest • Horizontal abduction (transverse extension) – movement of humerus in a horizontal or transverse plane away from chest Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 23. 10/23/2020 5-23 Movements • External rotation – movement of humerus laterally around its long axis away from midline • Internal rotation – movement of humerus medially around its long axis toward midline Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 24. 10/23/2020 5-24 Movements • Diagonal abduction – movement of humerus in a diagonal plane away from midline of body • Diagonal adduction – movement of humerus in a diagonal plane toward midline of body Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 25. 10/23/2020 5-25 Muscles • Intrinsic glenohumeral muscles – Originate on scapula & clavicle – Deltoid, Coracobrachialis, Teres major – Rotator cuff group • subscapularis, supraspinatus, infraspinatus, & teres minor • Extrinsic glenohumeral muscles – latissimus dorsi & pectoralis major Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 26. 10/23/2020 5-26 Muscles • Anterior – Pectoralis major – Coracobrachialis – Subscapularis • Superior – Deltoid – Supraspinatus From Shier D, Butler J, Lewis R: Hole’s essentials of human anatomy and physiology, ed 9, New York, 2006, McGraw-Hill. Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 27. 10/23/2020 5-27 Muscles • Superior – Deltoid – Supraspinatus • Posterior – Latissimus dorsi – Teres major – Infraspinatus – Teres minor From Shier D, Butler J, Lewis R: Hole’s essentials of human anatomy and physiology, ed 9, New York, 2006, McGraw-Hill. Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 28. 10/23/2020 5-28 Nerves • All shoulder joint muscles are innervated from the brachial plexus • Lateral pectoral nerve arising from C5, C6, & C7 – Pectoralis major (clavicular head) • Medial pectoral nerve arising from C8 & T1 – Pectoralis major (sternal head) • Thoracodorsal nerve arising from C6, C7, & C8 – Latissimus dorsi Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 29. 10/23/2020 5-29 Nerves • Axillary nerve branching from C5 & C6 – Deltoid – Teres minor – Sensation to lateral patch of skin over deltoid region of arm • Upper subscapular nerves arising from C5 & C6 – SubscapularisMedical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 30. 10/23/2020 5-30 Nerves • Lower subscapular nerve arising from C5 & C6 – Subscapularis – Teres major • Suprascapula nerve originating from C5 & C6 – Supraspinatus – Infraspinatus Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 31. 10/23/2020 5-31 Nerves • Musculotaneous nerve branching from C5, C6, & C7 – Coracobrachialis – Sensation to radial aspect of forearm Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 32. 10/23/2020 5-32 Deltoid Muscle Anterior fibers: abduction, flexion, horizontal adduction, & internal rotation Middle fibers: abduction Posterior fibers: abduction, extension, horizontal abduction, & external rotation Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 33. 10/23/2020 5-33 Pectoralis Major Muscle Upper fibers (clavicular head): internal rotation, horizontal adduction, flexion, abduction (once arm is abducted 90 degrees, upper fibers assist in further abduction), & adduction (with arm below 90 degrees of abduction) Lower fibers (sternal head): internal rotation, horizontal adduction, extension, & adduction Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 34. 10/23/2020 5-34 Latissimus Dorsi Muscle Adduction Extension Internal rotation Horizontal abduction Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 35. 10/23/2020 5-35 Coracobrachialis Muscle Flexion Adduction Horizontal adduction Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 36. 10/23/2020 5-36 Rotator cuff muscles • Supraspinatus – attach to greater tubercle from above (Abduct) • Infraspinatus – attach to greater tubercle posteriorly (Ext. Rot.) • Teres Minor – attach to greater tubercle posteriorly (Ext. Rot.) • Subscapularis – attach to lesser tubercle anterior (Int. Rot.) Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 37. 10/23/2020 5-37 Rotator cuff muscles • not very large • must possess strength & muscular endurance • conducting repetitious overhead activities (throwing, swimming, & pitching) with poor technique, muscle fatigue, or inadequate warm- up & conditioning leads to failure of rotator cuff muscle group in dynamically stabilizing humeral head in glenoid cavity • leads to further rotator cuff problems such as tendinitis & rotator cuff impingement within subacromial spaceMedical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 38. 10/23/2020 5-38 Subscapularis Muscle Adduction Extension Stabilization of the humeral head in glenoid fossa Internal rotation Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 39. 10/23/2020 5-39 Supraspinatus Muscle Abduction Stabilization of the humeral head in glenoid fossa Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 40. 10/23/2020 5-40 Infraspinatus Muscle External rotation Horizontal abduction Extension Stabilization of humeral head in the glenoid fossa Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 41. 10/23/2020 5-41 Teres Minor Muscle External rotation Horizontal abduction Extension Stabilization of humeral head in the glenoid fossa Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 42. 10/23/2020 5-42 Teres Major Muscle Extension, particularly from the flexed position to the posteriorly extended position Internal rotation Adduction, particularly from the abducted position down to the side & toward midline of body Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 43. 10/23/2020 5-43 Glenohumeral Flexion • Agonists – Anterior Deltoid – Upper Pectoralis Major Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 44. 10/23/2020 5-44 Glenohumeral Extension • Agonists – Teres Major – Latissimus Dorsi – Lower Pectoralis Major Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 45. 10/23/2020 5-45 Glenohumeral Abduction • Agonists – Deltoid – Supraspinatus – Upper Pectoralis Major Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 46. 10/23/2020 5-46 Glenohumeral Adduction • EX. Lat. Pull - pull down weights • Agonists – Latissimus Dorsi – Teres Major – Lower Pectoralis Major Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 47. 10/23/2020 5-47 Glenohumeral Internal Rotation • Agonists – Latissimus Dorsi – Teres Major – Subscapularis – Pectoralis Major • All attach anteromedially on humerusMedical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 48. 10/23/2020 5-48 Glenohumeral External Rotation • Agonists – Infraspinatus – Teres Minor • Both attach posteriorly on greater tubercle Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 49. 10/23/2020 5-49 Glenohumeral Horizontal Abduction • Agonists – Posterior Deltoid – Middle Deltoid – Infraspinatus – Teres Minor Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 50. 10/23/2020 5-50 Glenohumeral Horizontal Adduction • Agonists – Anterior Deltoid – Pectoralis Major – Coracobrachialis Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 51. 10/23/2020 5-51 Glenohumeral Diagonal Abduction • Agonists – Posterior Deltoid – Infraspinatus – Teres Minor – Triceps Brachii (Long Head) Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 52. 10/23/2020 5-52 Glenohumeral Diagonal Adduction • Agonists - both low & high – Anterior Deltoid – Coracobrachialis – Biceps Brachii (short head) – Pectoralis Major - Upper & Lower Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 53. 10/23/2020 5-53 Web Sites Radiologic Anatomy Browser http://radlinux1.usuf1.usuhs.mil/rad/iong/index.html – This site has numerous radiological views of the musculoskeletal system. University of Arkansas Medical School Gross Anatomy for Medical Students http://anatomy.uams.edu/anatomyhtml/grossresources.html – Dissections, anatomy tables, atlas images, links, etc. Loyola University Medical Center: Structure of the Human Body www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/GA.html – An excellent site with many slides, dissections, tutorials, etc., for the study of human anatomy Wheeless’ Textbook of Orthopaedics www.wheelessonline.com/ – This site has an extensive index of links to the fractures, joints, muscles, nerves, trauma, medications, medical topics, lab tests, and links to orthopedic journals and other orthopedic and medical news. Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 54. 10/23/2020 5-54 Web Sites Premiere Medical Search Engine http://www.medsite.com/Default.asp?bhcp=1 – This site allows the reader to enter any medical condition and it will search the net to find relevant articles. Arthroscopy.Com www.arthroscopy.com/sports.htm – Patient information on various musculoskeletal problems of the upper and lower extremity Virtual Hospital www.vh.org – Numerous slides, patient information, etc. Medical Multimedia Group www.healthpages.org/AHP/LIBRARY/HLTHTOP/CTD/ – A Patient's Guide to Cumulative Trauma Disorder (CTD) Baseball Almanac www.baseball-almanac.com/chapters/cap-ch8.shtml – Coaching Adult PitchersMedical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 55. 10/23/2020 5-55 Web Sites Lecture Topics in Kinesiology http://moon.ouhsc.edu/dthompso/namics/shoulder.htm – Shoulder articulations, movements, and muscles that are within the shoulder girdle The Physician and Sportsmedicine www.physsportsmed.com/issues/2003/0703/depalma.htm – Detecting and Treating Shoulder Impingement Syndrome: The Role of Scapulothoracic Dyskinesis Southern California Orthopedic Institute www.scoi.com/sholanat.htm – Anatomy of the Shoulder FamilyDoctor.org http://familydoctor.org/268.xml – Shoulder Pain Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 56. 10/23/2020 5-56 Web Sites MedlinePlus www.nlm.nih.gov/medlineplus/tutorials/shoulderarthroscopy/htm/ index.htm – Shoulder arthroscopy interactive tutorial MedlinePlus www.nlm.nih.gov/medlineplus/tutorials/rotatorcuffinjuries/htm/ind ex.htm – Rotator cuff injuries interactive tutorial American Physical Therapy Association www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/ CM/HTMLDisplay.cfm&CONTENTID=20448 – Taking Care of Your Shoulder American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/category.cfm?topcategory=Shoulder – Patient Education Library on the Shoulder Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth
- 57. 10/23/2020 5-57 Web Sites Orthopaedic Research Institute http://www.ori.org.au/bonejoint/shoulder/contents.htm – Several web pages, text, and graphics on glenohumeral instability American Sports Medicine Institute www.asmi.org/asmiweb/mpresentations/mmp.htm – Biomechanics of the Shoulder during Throwing American Sports Medicine Institute http://www.asmi.org/SportsMed/throwing/thrower10.html – Throwers Ten Exercises Washington Musculoskeletal Tumor Center www.sarcoma.org/main.php?page=shoulder – Shoulder girdle surgery Medical Imaging Training Resource For Medical Imag Tech, Nurses, Midwives and Medics , Nchanji Nkeh Keneth