May occur in association with. Bone metastases Primary tumours often metastasise to the proximal humerus, and it is important to search for any moth-eaten, lytic lesions, or areas of sclerosis. Potential lesions may be an incidental finding on a non-fractured humerus, or the fracture may be pathological in origin: Simple/Solitary/Unicameral bone cyst A benign lytic lesion that is often seen at the diametaphyseal region of the proximal humerus. Again, may be an incidental finding, however, will sometimes fracture. "Falling fragment sign" is sometimes seen, which refers to cortical fragments from the fracture, which fall through the fluid-filled lesion: - return to top.
The humerus is usually internally rotated, therefore the humeral head has a "light bulb" appearance on the. This is not always the case, however. There is widening of the joint ( 6mm) as the humeral head is displaced deschamps laterally; this is called the rim sign. On the axial, the humeral head will be displaced towards the acromion/away from the ribs: Associated with avulsion fractures of the lesser tuberosity. Also, a medial and anterior humeral head compression fracture may be evident (trough line). Acromioclavicular joint subluxation Width of the normal joint is less than 7mm in adults. Widening indicates moderate sprain with rupture of the acromioclavicular ligament. The inferior surfaces of the lateral clavicle and the acromion should be level. Subluxation is identified when the clavicle is elevated due to rupture of the coracoclavicular ligaments: Pseudo-subluxation Blood within the joint causes inferior subluxation of the humeral head, however, this is not a true dislocation. Look for a possible underlying fracture: Rotator cuff arthropathy causes superior elevation of the humeral head, with reduction in the subacromial space, often with erosions developing on the inferior surface of the acromion. Causes impingement of the supraspinatus tendon.
Shoulder dislocation and reduction - uptodate
Figure.2 Anterior glenohumeral ligaments. This drawing shows the anterosuperior, anteromedial, and anteroinferior glenohumeral ligaments. The anteromedial and anteroinferior glenohumeral ligaments are often avulsed from the glenoid or glenoid labrum in traumatic anterior melanoom instability. (From Grants Atlas of Anatomy. Baltimore: Williams wilkins; 1956.). Figure.3 Hill-Sachs lesion associated with anterior shoulder dislocation. On dislocation, the posterior aspect of the humeral head engages the anterior glenoid rim.
They may occur due to direct trauma or following anterior dislocation. Anterior glenohumeral dislocation Often occur due to sporting injuries. Humeral head lies under the coracoid on the. On the axial it is displaced towards the coracoid. On the modified axial and lateral scapula "Y" view, humeral head is displaced towards the ribs/coracoid. Important to identify associated fractures. Common fractures involve: the postero-lateral aspect of the humeral head (Hill-Sachs defect the anterior lip of the glenoid (Bankart lesion the greater tuberosity: afzuigkap Posterior glenohumeral dislocation Tend to occur due to muscle spasm during epileptic fits, or electric sway shock.
Common in older individuals. 40 years old: 35. Ultrasound may be considered in patients 40 years old with a first-time dislocation. 60 years old: may be as high. Beware of an inability to lift the arm in an older patient following a dislocation. Figure.1 views of the shoulder bony anatomy. (From Bucholz rw, heckman jd, court-Brown c,., eds. Rockwood and Greens Fractures in Adults. Philadelphia: Lippincott Williams wilkins; 2006.).
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It limits external kneuzen rotation at 45 to 90 degrees of abduction. Coracohumeral ligament: This is a secondary stabilizer to inferior translation. Bony restraints: acromion, coracoid, glenoid fossa. Scapular stabilizing muscles, coordinated shoulder motion involves:. Clavicular and sternoclavicular motion.
Acromioclavicular motion, pathoanatomy of shoulder dislocations: This involves a stretching or tearing of the capsule, usually off the glenoid, but occasionally off the humerus due to avulsion of the glenohumeral ligaments (hagl lesion). Labral damage: a bankart lesion refers to avulsion of anteroinferior labrum off the glenoid rim. It may be associated with a glenoid rim hond fracture (bony bankart). This is found in 40 of shoulders undergoing surgical intervention. Hill-Sachs lesion: A posterolateral head defect is caused by an impression fracture on the glenoid rim; this is seen in 27 of acute anterior dislocations and 74 of recurrent anterior dislocations (. Shoulder dislocation with associated rotator cuff tear.
14.1 glenohumeral stability depends on both passive and active mechanisms, including: Passive:. Vacuum effect of limited joint volume. Adhesion and cohesion owing to the presence of synovial fluid. Scapular inclination: for 90 of shoulders, the critical angle of scapular inclination is between 0 and 30 degrees, below which the glenohumeral joint is considered unstable and prone to inferior dislocation. Ligamentous and capsular restraints (. Joint capsule: Redundancy prevents significant restraint, except at terminal ranges of motion.
The anteroinferior capsule limits anterior subluxation of the abducted shoulder. The posterior capsule and teres minor limit internal rotation. The anterior capsule and lower subscapularis restrain abduction and external rotation. Superior glenohumeral ligament: This is the primary restraint to inferior translation of the adducted shoulder. Middle glenohumeral ligament: This is variable, poorly defined, or absent. It limits external rotation at 45 degrees of abduction. Inferior glenohumeral ligament: This consists of three bands, the superior of which is of primary importance to prevent anterior dislocation of the shoulder.
Glenohumeral Instability - radsource
Glenohumeral Dislocation, epidemiology, the shoulder is the most commonly dislocated major joint of the body, accounting for up severe to 45 of dislocations. Anterior dislocations account for 96 of cases. Posterior dislocations, the second most common direction of dislocation, tijdens account for 2 to 4 of cases. Inferior (luxatio erecta) and superior shoulder dislocations are rare, accounting for approximately.5 of cases. The incidence of glenohumeral dislocation is 17 per 100,000 population per year. Incidence peaks for males in the 21 to 30 year age range and for women in the 61 to 80 year age range. Recurrence rate in all ages is 50 but rises to almost 89 in the 14 to 20 year age group.
humeral metaphysis should be examined. Ribs and lung particularly injury due to high velocity, eg, rta: Clavicle fractures Are usually easy to spot. If the fracture is minimally displaced and overlies the scapula/ribs, an angled up projection is helpful. Fractures of the middle third of the clavicle are most common (especially in 20 year olds). Fractures of the lateral third are more likely to be seen in an older age group. Fractures of the medial third are uncommon. Scapula fractures Will occur due to high velocity, eg, rta. Can be subtle due to overlying ribs/clavicle. If the mechanism of injury fits, then the scapula must be scrutinised, particularly the blade and spine of the scapula, and also the corocoid and acromion processes: Glenoid fractures Fractures to the anterior lip of the glenoid are usually very subtle and are therefore easily.
Identify normal paediatric anatomy and the development of secondary ossification centres. Recognise common pathological conditions seen around the shoulder girdle Fracture prevalence a fall onto the shoulder tends to result in specific injuries depending on the general age of the patient: Under 10 years Fractured clavicle 15-40 years Acromioclavicular joint subluxation Glenohumeral joint dislocation Under. The second image may be: Supero-inferior axial or infero-superior axial if the ap is normal, and the patient can easily abduct their arm. Modified axial, or lateral scapula "Y" view. The patient does not need to abduct their arm for these views and these projections can be easily obtained with the patient on a trolley. Normal paediatric anatomy In the unfused skeleton, definition the epiphyseal growth plate for the proximal humerus appears as two lucent lines. Commonly mistaken for fractures. Also, secondary ossification centres are often seen at the acromion and the coracoid processes: 12 years 14 years 15 years 17 years On the axial view, the ossification centre for the coracoid process may develop from the base or the tip.
Joint dislocation - wikipedia
Responsive menu by m, the, shoulder, fracture prevalence, projections. Normal paediatric anatomy, proximal humerus, clavicle, scapula. Glenoid, anterior dislocation, posterior dislocation, acromioclavicular joint subluxation, pseudo-subluxation. Rotator cuff arthropathy, bone metastases, simple bone cyst (hover over images to zoom, click to enlarge). Learning outcomes, assess skeletal radiographs using a systematic approach. Understand the different radiographic projections and how the anatomy changes with position. Understand what injuries will be demonstrated on different projections. Describe shoulder girdle anatomy, understand mechanisms of injury and the likely fractures/dislocations which may result. Recognise less common fractures to the individual bones of the shoulder girdle, accurately describe glenohumeral dislocations and associated fractures, gewrichten understand common eponyms, recognise potential ligament injuries.