Bony Landmark Chart
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Isolated Avulsion Fracture of the Lesser Tuberosity of The
(aspects of trauma) Isolated Avulsion Fracture of the Lesser Tuberosity of the Humerus in an Adult: Case Report and Literature Review Aman Dhawan, MD, Kevin Kirk, DO, Thomas Dowd, MD, and William Doukas, MD solated avulsion fractures of also describe our operative technique, comminuted 3-cm lesser tuberosity the lesser tuberosity of the including use of heavy, nonabsorb- fracture fragment retracted approxi- proximal humerus are rare. able suture. mately 2 cm from the donor site We report the case of a right- (Figures 1B–1D). No biceps tendon Ihand–dominant woman in her early ASE EPORT subluxation or injury and no intra- C R 30s who sustained such an injury, A right-hand–dominant woman in articular pathology were noted. with an intact subscapularis tendon her early 30s presented with right The lesser tuberosity fracture was attached to the lesser tuberosity frag- shoulder pain 1 day after a fall down surgically repaired less than 2 weeks ment. Treatment included surgery to a flight of stairs. During the acci- after injury. Through a deltopectoral restore tension to the subscapularis dent, as her feet slipped out from approach, the rotator interval and muscle and maintain the force couple underneath her and her torso fell the 3×2-cm fracture fragment were about the shoulder joint. One year after injury, the patient reported no pain, excellent range of motion, and “[To be diagnosed] this injury...requires... return to activities. This case demonstrates the diag- careful review of orthogonal radiographs nostic challenge of this injury, which requires a high index of suspicion and and advanced imaging.” careful review of orthogonal radio- graphs and advanced imaging. -
Considered a Bone of Both Shoulder Girdle and Shoulder Joint. the Shoulder Girdle Is Comprised of the Clavicle and the Scapula
Considered a bone of both shoulder girdle and shoulder joint. The shoulder girdle is comprised of the clavicle and the scapula. The shoulder joint consists of the scapula and the humerus. The primary function of the shoulder girdle is to position itself to accommodate movements of the shoulder joint. 1 Superior angle—top point Inferior angle—bottom point Vertebral border—side closest to vertebral column Axillary border—side closest to arm Subscapular fossa—anterior fossa Glenoid fossa, glenoid labrum, glenoid cavity --The glenoid fossa is the shallow cavity where the humeral head goes. The glenoid labrum is the cartilage that goes around the glenoid fossa. So the glenoid fossa and glenoid labrum together comprise the glenoid cavity. Supraspinous fossa—posterior, fossa above the spine Spine of the scapula—the back projection Infraspinous fossa—posterior depression/fossa below spine Coracoid process—anterior projection head Acromion process—posterior projection head above spine 2 Scapulothoracic “joint” = NOT a true joint; there are no ligaments or articular capsule. The scapula just rests on the muscle over top the rib cage, which allows for passive movements. Sternoclavicular joint=where the clavicle (collarbone) and the sternum (breastbone) articulate; movement is slight in all directions and of a gliding, rotational type Acromioclavicular joint = where the clavicle and scapula (acromion process) articulate; AKA: AC Joint; movement is a slight gliding when elevation and depression take place. Glenohumeral joint = the shoulder joint 3 4 All 3 true joints: Sternoclavicular, AC and glenohumeral (GH) all work together to move arm in all directions. The GH allows the arm to go out to the side and be abducted, then the AC and Sternoclavicular joints kick in to allow the arm to go above shoulder level by allowing the shoulderblade to move up to increase the range of motion (ROM). -
List: Bones & Bone Markings of Appendicular Skeleton and Knee
List: Bones & Bone markings of Appendicular skeleton and Knee joint Lab: Handout 4 Superior Appendicular Skeleton I. Clavicle (Left or Right?) A. Acromial End B. Conoid Tubercle C. Shaft D. Sternal End II. Scapula (Left or Right?) A. Superior border (superior margin) B. Medial border (vertebral margin) C. Lateral border (axillary margin) D. Scapular notch (suprascapular notch) E. Acromion Process F. Coracoid Process G. Glenoid Fossa (cavity) H. Infraglenoid tubercle I. Subscapular fossa J. Superior & Inferior Angle K. Scapular Spine L. Supraspinous Fossa M. Infraspinous Fossa III. Humerus (Left or Right?) A. Head of Humerus B. Anatomical Neck C. Surgical Neck D. Greater Tubercle E. Lesser Tubercle F. Intertubercular fossa (bicipital groove) G. Deltoid Tuberosity H. Radial Groove (groove for radial nerve) I. Lateral Epicondyle J. Medial Epicondyle K. Radial Fossa L. Coronoid Fossa M. Capitulum N. Trochlea O. Olecranon Fossa IV. Radius (Left or Right?) A. Head of Radius B. Neck C. Radial Tuberosity D. Styloid Process of radius E. Ulnar Notch of radius V. Ulna (Left or Right?) A. Olecranon Process B. Coronoid Process of ulna C. Trochlear Notch of ulna Human Anatomy List: Bones & Bone markings of Appendicular skeleton and Knee joint Lab: Handout 4 D. Radial Notch of ulna E. Head of Ulna F. Styloid Process VI. Carpals (8) A. Proximal row (4): Scaphoid, Lunate, Triquetrum, Pisiform B. Distal row (4): Trapezium, Trapezoid, Capitate, Hamate VII. Metacarpals: Numbered 1-5 A. Base B. Shaft C. Head VIII. Phalanges A. Proximal Phalanx B. Middle Phalanx C. Distal Phalanx ============================================================================= Inferior Appendicular Skeleton IX. Os Coxae (Innominate bone) (Left or Right?) A. -
Chapter 5 Upper Limb Anatomy Bones and Joints
Chapter 5 Upper limb anatomy Bones and joints Scapula Costal Surface The costal (anterior) surface of the scapula faces the ribcage. It contains a large concave depression over most of its surface, known as the subscapular fossa. The subscapularis (rotator cuff muscle) originates from this fossa. Originating from the superolateral surface of the costal scapula is the coracoid process. It is a hook-like projection, which lies just underneath the clavicle. Three muscles attach to the coracoid process: the pectoralis minor, coracobrachialis, the short head of biceps brachii. Acromion Coracoid process Glenoid fossa Subscapular fossa © teachmeanatomy Lateral surface • Glenoid fossa - a shallow cavity, located superiorly on the lateral border. It articulates with the head of the humerus to form the glenohumeral (shoulder) joint. • Supraglenoid tubercle - a roughening immediately superior to the glenoid fossa. The place of attachment of the long head of the biceps brachii. • Infraglenoid tubercle - a roughening immediately inferior to the glenoid fossa. The place of attachment of the long head of the triceps brachii. Supraglenoid tubercle Glenoid fossa Infraglenoid tubercle gn teachmeanatomy Posterior surface • Spine - the most prominent feature of the posterior scapula. It runs transversely across the scapula, dividing the surface into two. • Acromion - projection of the spine that arches over the glenohumeral joint and articulates with the clavicle at the acromioclavicular joint. • Infraspinous fossa - the area below the spine of the scapula, it displays a convex shape. The infraspinatus muscle originates from this area. • Supraspinous fossa - the area above the spine of the scapula, it is much smaller than the infraspinous fossa, and is more convex in shape.The supraspinatus muscle originates from this area. -
Body Mechanics As the Rotator Cuff Gether in a Cuff-Shape Across the Greater and Lesser Tubercles the on Head of the Humerus
EXPerT CONTENT Body Mechanics by Joseph E. Muscolino | Artwork Giovanni Rimasti | Photography Yanik Chauvin Rotator Cuff Injury www.amtamassage.org/mtj WORKING WITH CLieNTS AFFecTED BY THIS COmmON CONDITION ROTATOR CUFF GROUP as the rotator cuff group because their distal tendons blend and attach to- The four rotator cuff muscles are gether in a cuff-shape across the greater and lesser tubercles on the head of the supraspinatus, infraspinatus, the humerus. Although all four rotator cuff muscles have specific concen- teres minor, and subscapularis (Fig- tric mover actions at the glenohumeral (GH) joint, their primary functional ure 1). These muscles are described importance is to contract isometrically for GH joint stabilization. Because 17 Before practicing any new modality or technique, check with your state’s or province’s massage therapy regulatory authority to ensure that it is within the defined scope of practice for massage therapy. the rotator cuff group has both mover and stabilization roles, it is extremely functionally active and therefore often physically stressed and injured. In fact, after neck and low back conditions, the shoulder is the most com- Supraspinatus monly injured joint of the human body. ROTATOR CUFF PATHOLOGY The three most common types of rotator cuff pathology are tendinitis, tendinosus, and tearing. Excessive physi- cal stress placed on the rotator cuff tendon can cause ir- ritation and inflammation of the tendon, in other words, tendinitis. If the physical stress is chronic, the inflam- matory process often subsides and degeneration of the fascial tendinous tissue occurs; this is referred to as tendinosus. The degeneration of tendinosus results in weakness of the tendon’s structure, and with continued Teres minor physical stress, whether it is overuse microtrauma or a macrotrauma, a rotator cuff tendon tear might occur. -
The Critical Shoulder Angle As a Diagnostic Measure for Osteoarthritis and Rotator Cuff Pathology
Open Access Original Article DOI: 10.7759/cureus.11447 The Critical Shoulder Angle as a Diagnostic Measure for Osteoarthritis and Rotator Cuff Pathology Zak Rose-Reneau 1 , Amanda K. Moorefield 1 , Derek Schirmer 1 , Eugene Ismailov 1 , Rob Downing 2 , Barth W. Wright 1 1. Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, USA 2. Graduate Medical Education, University of Missouri-Kansas City (UMKC), Kansas City, USA Corresponding author: Amanda K. Moorefield, [email protected] Abstract The purpose of this study was to correlate critical shoulder angle (CSA), a measurement that takes into account both glenoid tilt and the acromial index (AI), with shoulder pathologies as presented in an earlier study by Moor et al. (2013). Based on Moor et al.’s predicted normal CSA range of 30-35°, we hypothesized that a greater-than-normal CSA would be correlated to or associated with rotator cuff pathology, while a smaller-than-normal CSA would be associated with osteoarthritis (OA). Following Moore et al., we utilized Grashey radiographic imaging because it provides the clearest view of the entire glenoid fossa and acromion. We analyzed 323 anterior-posterior (AP) radiographs to identify and measure the CSA, classifying each patient into one of five groups [none reported (n=94), mild OA (n=156), moderate OA (n=36), severe OA (n=37), and rotator cuff pathology (n=40)]. Our results were statistically significant, supporting the association of smaller CSAs with OA and larger CSAs with rotator cuff pathology. CSA measurements could provide a new means for identifying shoulder pathology and thereby reduce the need for costly and timely imaging techniques. -
Scapular Motion Tracking Using Acromion Skin Marker Cluster: in Vitro Accuracy Assessment
Scapular Motion Tracking Using Acromion Skin Marker Cluster: In Vitro Accuracy Assessment Andrea Cereatti, Claudio Rosso, Ara Nazarian, Joseph P. DeAngelis, Arun J. Ramappa & Ugo Della Croce Journal of Medical and Biological Engineering ISSN 1609-0985 J. Med. Biol. Eng. DOI 10.1007/s40846-015-0010-2 1 23 Your article is protected by copyright and all rights are held exclusively by Taiwanese Society of Biomedical Engineering. This e- offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com”. 1 23 Author's personal copy J. Med. Biol. Eng. DOI 10.1007/s40846-015-0010-2 ORIGINAL ARTICLE Scapular Motion Tracking Using Acromion Skin Marker Cluster: In Vitro Accuracy Assessment Andrea Cereatti • Claudio Rosso • Ara Nazarian • Joseph P. DeAngelis • Arun J. Ramappa • Ugo Della Croce Received: 11 October 2013 / Accepted: 20 March 2014 Ó Taiwanese Society of Biomedical Engineering 2015 Abstract Several studies have recently investigated how estimated using an AMC combined with a single anatom- the implementations of acromion marker clusters (AMCs) ical calibration, the accuracy was highly dependent on the method and stereo-photogrammetry affect the estimates of specimen and the type of motion (maximum errors between scapula kinematics. -
Spontaneous Fracture of the Scapula Spines in Association with Severe Rotator Cuff Disease and Osteoporosis
Central Annals of Musculoskeletal Disorders Case Report *Corresponding author Hans Van der Wall, CNI Molecular Imaging & University of Notre Dame, Sydney, Australia, Tel: +61 2 9736 1040; Spontaneous Fracture of the FAX: +61 2 9736 2095; Email: [email protected] Submitted: 25 March 2020 Scapula Spines in Association Accepted: 07 April 2020 Published: 10 April 2020 ISSN: 2578-3599 with Severe Rotator Cuff Copyright © 2020 Robert B, et al. Disease and Osteoporosis OPEN ACCESS 1 2 3 Breit Robert , Strokon Andrew , Burton Leticia , Van der Wall Keywords H3* and Bruce Warwick3 • Scapular fracture • Rotator cuff arthropathy 1CNI Molecular Imaging, Australia • Osteoporosis 2Sydney Private Hospital, Australia • Scintigraphy 3CNI Molecular Imaging & University of Notre Dame, Sydney, Australia • SPECT/ CT 4Concord Hospital, Australia Abstract We present the case of a 74 year-old woman with diabetes mellitus and established osteoporosis who initially presented with increasing pain and disability of the shoulders. Investigations showed severe rotator cuff disease. This was treated conservatively with physiotherapy and corticosteroid injection into both joints with good pain relief but no improvement in function. She subsequently presented with increasing posterior thoracic pain with plain films reporting no evidence of rib fracture. Bone scintigraphy showed severe rotator cuff disease and degenerative joint disease at multiple sites. The single photon emission computed tomography (SPECT)/ x-ray Computed Tomography (CT) showed bilateral scapula spine fractures of long standing with a probable non-union on the left side. These fractures are rare and difficult to treat when associated with rotator cuff disease. INTRODUCTION Fractures of the scapula spine are rare, with a reported level of dysfunction remained significant with marked restriction frequency of less than twenty cases in the literature [1-8]. -
Distal Clavicle Resection
www.ashevilleortho.com Distal Clavicle Resection Impingement syndrome and associated rotator cuff tears are commonly encountered shoulder problems. This condition is caused when the rotator cuff tendons rub the underside of the acromion bone. Chronic rubbing can lead to a weakening and even tearing of the rotator cuff. Symptoms include pain, weakness and loss of motion. Whether this procedure is done using a scope or through a small incision is dependent on the severity of the tear and the doctor’s preference. The method shown in these animations is with a scope. This content is for informational purposes only. It is not intended to represent actual surgical technique or results. The information is not intended to be a substitute for professional medical advice, diagnosis, treatment or care. Always seek the advice of a medical professional when you have a medical condition. Do not disregard professional medical advice or delay in seeking advice if you have read something in this printout. Copyright © 2013, Understand.com, LLC, All Rights Reserved. Asheville Orthopaedic Associates • (828) 252-7331 www.ashevilleortho.com Distal Clavicle Resection Introduction Impingement syndrome and associated rotator cuff tears are commonly encountered shoulder problems. This condition is caused when the rotator cuff tendons rub the underside of the acromion bone. Chronic rubbing can lead to a weakening and even tearing of the rotator cuff. Symptoms include pain, weakness and loss of motion. Whether this procedure is done using a scope or through a small incision is dependent on the severity of the tear and the doctor’s preference. The method shown in these animations is with a scope. -
By the Authors. These Guidelines Will Be Usefulas an Aid in Diagnosing
Kroeber Anthropological Society Papers, Nos. 71-72, 1990 Humeral Morphology of Achondroplasia Rina Malonzo and Jeannine Ross Unique humeral morphologicalfeatures oftwo prehistoric achondroplastic adult individuals are des- cribed. Thesefeatures are compared to the humerus ofa prehistoric non-achondroplastic dwarfand to the humeri ofa normal humanpopulation sample. A set ofunique, derived achondroplastic characteris- tics ispresented. The non-achondroplastic individual is diagnosed as such based on guidelines created by the authors. These guidelines will be useful as an aid in diagnosing achondroplastic individualsfrom the archaeological record. INTRODUCTION and 1915-2-463) (Merbs 1980). The following paper describes a set of humeral morphological For several decades dwarfism has been a characteristics which can be used as a guide to prominent topic within the study of paleopathol- identifying achondroplastic individuals from the ogy. It has been represented directly by skeletal archaeological record. evidence and indirectly by artistic representation in the archaeological record (Hoffman and Brunker 1976). Several prehistoric Egyptian and MATERIALS AND METHODS Native American dwarfed skeletons have been recorded, indicating that this pathology is not A comparative population sample, housed by linked solely with modem society (Brothwell and the Lowie Museum of Anthropology (LMA) at Sandison 1967; Hoffman and Brunker 1976; the University of California at Berkeley, was Niswander et al. 1975; Snow 1943). Artifacts derived from a random sample forming a total of such as paintings, tomb illustrations and statues sixty adult individuals (thirty males and thirty of dwarfed individuals have been discovered in females) from six different prehistoric ar- various parts of the world. However, interpreta- chaeological sites within California. Two tions of such artifacts are speculative, for it is achondroplastic adult individuals from similar necessary to allow artistic license for individualis- contexts, specimen number 6670 (spc. -
Subacromial Decompression in the Shoulder
Subacromial Decompression Geoffrey S. Van Thiel, Matthew T. Provencher, Shane J. Nho, and Anthony A. Romeo PROCEDURE 2 22 Indications P ITFALLS ■ Impingement symptoms refractory to at least • There are numerous possible 3 months of nonoperative management causes of shoulder pain that can ■ In conjunction with arthroscopic treatment of a mimic impingement symptoms. All potential causes should be rotator cuff tear thoroughly evaluated prior to ■ Relative indication: type II or III acromion with undertaking operative treatment clinical fi ndings of impingement of isolated impingement syndrome. Examination/Imaging Subacromial Decompression PHYSICAL EXAMINATION ■ Assess the patient for Controversies • Complete shoulder examination with range of • Subacromial decompression in motion and strength the treatment of rotator cuff • Tenderness with palpation over anterolateral pathology has been continually acromion and supraspinatus debated. Prospective studies • Classic Neer sign with anterolateral shoulder have suggested that there is no difference in outcomes with and pain on forward elevation above 90° when without subacromial the greater tuberosity impacts the anterior decompression. acromion (and made worse with internal rotation) • Subacromial decompression • Positive Hawkins sign: pain with internal rotation, performed in association with a forward elevation to 90°, and adduction, which superior labrum anterior- causes impingement against the coracoacromial posterior (SLAP) repair can potentially increase ligament postoperative stiffness. ■ The impingement test is positive if the patient experiences pain relief with a subacromial injection of lidocaine. ■ Be certain to evaluate for acromioclavicular (AC) joint pathology, and keep in mind that there are several causes of shoulder pain that can mimic impingement syndrome. P ITFALLS IMAGING • Ensure that an axillary lateral ■ Standard radiographs should be ordered, view is obtained to rule out an os acromiale. -
Phty 101 – Week 1
PHTY 101 – WEEK 1 1.7 Classify the shoulder (glenohumeral) joint and identify and/or describe its: • The glenohumeral joint is a multiaxial, synovial, ball and socket joint • Movements: o Flexion and extension- transverse axis o Abduction and adduction- anteroposterior axis o Internal and external rotation- longitudinal axis • Greatest amount of motion and most unstable joint in body • Function: positions and directs humerus, elbow and hand in relation to trunk (radioulnar joint deal with palm and fingers) • Combines with scapulothoracic, acromioclavicular and sternoclavicular joints • Articular surfaces: o Humeral head- ½ sphere, faces medially o Glenoid fossa- very shallow, faces laterally o Only 25-30% contact between articular surfaces o Shallower and smaller surface compared to hip • Glenoid labrum o Glenoid labrum- fibrous structure around glenoid fossa (adheres to edges), central part avascular and edges not greatly vascularised à doesn’t heal well, labrum functions to; - Facilitate mobility - Increase glenoid concavity- increasing mobility - Provide attachment for joint capsule, ligaments and muscles • Joint capsule o Very thin and lax- doesn’t compromise ROM o Attaches to glenoid labrum o Reflected (folded) inferiorly onto medial shaft of humerus o Reinforced by; - Rotator cuff tendons- supraspinatus, infraspinatus, teres minor, subscapularis - Rotator cuff tendons- action: internal or external rotation, function: pull humerus head in against fossa - Glenohumeral and coracohumeral ligaments (capsular) • Synovial membrane o Lines