Proximal Humerus Anatomy Quiz

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Questions and Answers

Which structures are primarily responsible for the attachment of the pectoralis major and supraspinatus muscles?

Greater tubercle (correct)

Coracoid process

Lesser tubercle

Deltoid tuberosity

What is the term for the deep groove located between the lesser and greater tubercles of the humerus?

Infraglenoid notch

Surgical neck

Epicondylar groove

Intertubercular groove (correct)

What is the anatomical position directly below the anatomic neck of the humerus called?

Capitulum

Radial groove

Surgical neck (correct)

Deltoid tuberosity

Which fat pad is located posteriorly at the elbow joint?

Posterior fat pad Signup and view all the answers

Which joint connects the scapula to the clavicle?

Acromio-clavicular joint Signup and view all the answers

What is the largest and longest bone in the upper extremity?

Humerus Signup and view all the answers

What is the name of the cavity on the scapula where the head of the humerus fits?

Glenoid cavity Signup and view all the answers

Which structure is primarily identified as the rough elevation on the body of the humerus?

Deltoid tuberosity Signup and view all the answers

What are the names of the two tubercles found on the proximal humerus?

Lesser and greater tubercles Signup and view all the answers

Which muscle attaches at the greater tubercle of the humerus?

Infraspinatus Signup and view all the answers

What is the anatomical landmark located directly below the head of the humerus called?

Anatomical neck Signup and view all the answers

Which projection of the shoulder is primarily requested to evaluate the scapula?

Transcapular view Signup and view all the answers

Which of the following is one of the angles of the scapula?

Inferior angle Signup and view all the answers

What is the recommended CR direction for the AP projection of the scapula?

Perpendicular to the midscapula Signup and view all the answers

Which action is necessary when performing the lateral projection of the scapula?

Have the patient grasp the opposite shoulder Signup and view all the answers

For optimal exposure factors during scapular imaging, which consideration is essential?

Include the entire scapula in the image Signup and view all the answers

What is the position of the patient when performing a lateral scapula projection in the recumbent position?

Supine and rotated until the scapula is parallel to IR Signup and view all the answers

Which projection is most effective for demonstrating coracoacromial arch?

Neer method Signup and view all the answers

What is the recommended body rotation for the posterior oblique position using the Grashey method?

10° to 15° Signup and view all the answers

Which structure of the humerus is located the farthest distally?

Surgical neck Signup and view all the answers

What is another term for the mid area of the costal surface of the scapula?

Subscapular fossa Signup and view all the answers

What is the primary function of the clavicle and scapula in the shoulder girdle?

To connect the upper limb to the trunk Signup and view all the answers

Which part of the scapula is referred to as the glenoid cavity?

Lateral angle (head) Signup and view all the answers

Which border of the scapula is nearest to the vertebrae?

Medial (Vertebral) border Signup and view all the answers

What is the significance of the costal (ventral) surface of the scapula?

It is the anterior surface of the scapula. Signup and view all the answers

What is the term for the thickened ridge of the spine on the posterior surface of the scapula?

Crest of spine Signup and view all the answers

Which angle of the scapula is located at the high medial corner?

Superior angle Signup and view all the answers

How many borders does the scapula have?

Three Signup and view all the answers

What does the term 'axillary border' refer to in terms of scapula anatomy?

Border nearest the axilla Signup and view all the answers

What is the location of the acromion in relation to the glenoid cavity?

Superior and posterior Signup and view all the answers

Which projection places the humerus in an AP position?

AP External Rotation Signup and view all the answers

What is the purpose of the 25-30˚ medial angle in the Inferosuperior Axial Projection?

To profile the humeral head Signup and view all the answers

Which structure is profiled medially during the AP Internal Rotation?

Lesser tubercle Signup and view all the answers

What positioning consideration is recommended when performing shoulder radiography?

Use a grid for all projections Signup and view all the answers

During the Grashey method, what is the angle of body rotation required?

35-45˚ Signup and view all the answers

What is the correct evaluation criterion for the Inferosuperior Axial Projection?

Lesser tubercle profiled anteriorly Signup and view all the answers

Which projection requires the patient to be in a 45-60˚ anterior oblique position?

PA Oblique (Scapular Y) Signup and view all the answers

What is the primary indication for performing a Supraspinatus Outlet projection?

To visualize the coracoacromial arch Signup and view all the answers

In the AP Neutral rotation, how is the arm positioned?

At the side in 'as is' position Signup and view all the answers

Study Notes

Proximal Humerus Anatomy

Largest and longest bone in the upper extremity
Approximately 1/5 of an adult's height
Articulates with the scapula at the shoulder joint
'
The most proximal part of the humerus is a rounded portion called the head '
' Slightly constricted portion below the head is the anatomic neck
The process directly below the anatomic neck on the anterior surface is the lesser tubercle
Larger lateral process is the greater tubercle where the pectoralis major and supraspinatus muscles attach
Deep groove between the two tubercles is the intertubercular groove (bicipital groove)
The area below the head and tubercles is the surgical neck
Distal to the surgical neck is the body (shaft)
Deltoid tuberosity is a rough raised elevation along the anterolateral surface of the body where the deltoid muscle attaches

Joints

Scapulohumeral joint (glenohumeral or shoulder joint) 'h
Elbow joint '

Learning Outcomes

Identify the following joints on an image of the upper extremity:
- Acromioclavicular joint
- Shoulder joint
- Sternoclavicular joint
Identify the following parts and prominences on an image or skeleton:
- Scapula
  - Head
  - Neck
  - Body
  - Glenoid cavity
  - Spine
  - Acromion
  - Coracoid process
  - Angles: Medial, Superior, and Inferior
  - Borders: Superior, Axillary, and Vertebral
  - Scapular Notch

Let's Review – Proximal Humerus

The two neck names and where they are located are:
- Anatomical neck: Located below the head
- Surgical neck: Located below the lesser and greater tubercle
Lesser tubercle is the smaller more medial tubercule
Greater tubercle is the larger more lateral tubercule
Intertubercular sulcus/groove (bicipital groove) is the groove that separates the tubercules
Deltoid tuberosity is the name of the rough elevation on the body of the humerus
Deltoid muscle attaches to the deltoid tuberosity
Pectoralis major and supraspinatus muscles attach to the greater tubercle
The other two names that refer to the shoulder joint are glenohumeral joint and scapulohumeral joint

Shoulder Girdle

Consists of 2 bones:
- Clavicle
- Scapula
Function of the two bones is to connect the upper limb to the trunk (axial skeleton)

Scapula Anatomy - Borders

Forms the posterior part of the shoulder girdle
Flat, triangular bone
The scapula has 3 borders:
- Superior border: Uppermost margin
- Lateral (Axillary) border: Border nearest axilla
- Medial (Vertebral) border: Border near the vertebrae

Scapula Anatomy - Angles

The three corners of the scapula are called angles:
- Superior angle: High - medial corner of the scapula
- Inferior angle: Most inferior portion of the scapula
- Lateral angle (head): Sometimes called head of the scapula, thickest part, ends laterally in a shallow depression called the glenoid cavity (fossa)

Shoulder Joint – Glenohumeral Joint

Formed by the:
- Glenoid cavity (fossa) of the scapula
- Head of the humerus

Scapula Anatomy – Anterior View

Neck: Constricted area between the head and body of the scapula
Body (blade): Arched in shape for greater strength, thin flat lower portion of the body is referred to as the Wing or ala
Costal (Ventral) Surface: Anterior surface of the scapula
Subscapular fossa: Large depression on the anterior side

Scapula Anatomy – Anterior View

Acromion: Long, curved process that extends laterally over the head of the humerus
Coracoid process: Thick, beaklike process that projects anteriorly beneath the clavicle
Suprascapular notch: Is on the superior border that is partially formed by the base of the coracoid process

Scapula Anatomy – Posterior View

Posterior surface: Aka dorsal surface
Spine: Prominent structure on the dorsal surface, starts at the vertebral border as a smooth area and continues laterally to end at the acromion
Crest of spine: Thickened ridge of the spine
Spine separates the posterior surface into the:
- Infraspinous fossa
- Supraspinous fossa

Scapula Anatomy

The lateral view of the scapula looks like the letter Y
The Y is formed by the acromion and coracoid:
- Acromion extends superior and posteriorly in relation to the glenoid cavity
- Coracoid is located anteriorly in relation to the joint or glenoid cavity
Lower portion of Y is the body

Proximal Humerus Rotation

External Rotation
Internal Rotation
Neutral Rotation

Positioning Considerations

40 SID
Grid (greater than 10cm)
Remove anything that could cause artifacts
Suspend respiration

Clinical Indications – Shoulder/Scapula

Degenerative conditions:
- Osteoporosis
- Osteoarthritis
Hill-Sachs defect
Fractures & Dislocations
Bursitis

Routine ( Nontrauma) Projections

AP External Rotation (AP)
AP Internal Rotation (Lateral)

AP Shoulder: External Rotation

40 SID
GRID
Patient erect or supine
Abduct extended arm slightly
Externally rotate arm (supinate hand) until epicondyles are parallel to IR
CR – 1 inch inferior to coracoid process

Evaluation Criteria (External Rotation)

Greater tubercle profiled laterally
Scapulohumeral joint centered
Proximal humerus, upper scapula, and clavicle visualized
Optimal exposure factors

AP Shoulder – Internal Rotation

40 SID
Grid
Patient erect or supine
Internally rotate arm (Pronate hand) until epicondyles are perpendicular to IR
CR – 1 in inferior to coracoid process

Evaluation Criteria (Internal Rotation)

Lesser tubercle profiled medially
Scapulohumeral joint centered
Proximal humerus, upper scapula, and clavicle visualized
Optimal exposure factors

Special (nontrauma) Projections

Inferosuperior Axial Projection (Lawrence Method)
AP oblique projection (Grashey method)

Inferosuperior Axial Projection: Shoulder (Lawrence Method)

40 SID
Position patient supine & shoulder raised about 2 inches from tabletop
Rotate head toward opposite side
Abduct arm 90 degrees from body
Externally rotate arm with palm up
CR – Directed medially 25-30˚, Centered to axilla & humeral head

Evaluation Criteria (Inferosuperior Axial Projection)

Lesser tubercle profiled anteriorly
Humeral head and glenoid fossa profiled
Optimal exposure factors

AP Oblique Projection: Grashey method

Glenoid Cavity should be visualized
40 SID
Grid
Erect or Supine
Rotate body 35-45˚ toward affected side (posterior oblique)
CR – Centered to scapulohumeral joint

Evaluation Criteria: Grashey Method (Posterior Oblique)

Glenoid cavity profiled
Scapulohumeral joint centered
Optimal exposure factors

Routine (trauma) Projections

AP Neutral rotation
PA Oblique (Scapular Y Lateral)

AP Neutral: Shoulder (Trauma)

40 SID
Grid
Erect or Supine
Arm at side in “as is” position
CR – Mid-scapulohumeral joint

Evaluation Criteria (AP Neutral)

Greater tubercle superimposed
Scapulohumeral joint centered
Optimal exposure factors

PA Oblique-Scapular Y Lateral: Shoulder (Trauma)

40 SID
Grid
Erect or supine
Rotate patient into anterior oblique position 45-60˚
Palpate the superior angle of the scapula & AC joint articulation
Rotate patient until two points are perpendicular to IR

Evaluation Criteria (Scapular Y Lateral)

Body of scapula superimposed on end
Acromion and coracoid processes in profile
Humeral head and glenoid cavity superimposed
Optimal exposure factors

Special (Trauma) Projections

Supraspinatus outlet (Neer method)

Supraspinatus Outlet: Shoulder (Trauma) ’

Neer Method
Specifically demonstrates coracoacromial arch for supraspinatus outlet region for possible shoulder impingement
40 SID
Rotate patient into anterior oblique 45-60˚
CR – angle 10-15˚ caudal centered to pass through humeral head

Evaluation Criteria (Neer Method vs. Scapular Y Lateral Projection:

Supraspinatus outlet (Neer method) open and in profile
Demonstrates coracoacromial arch
Optimal exposure factors

Routine Scapula Projections

AP
Lateral

AP Projection: Scapula

40 SID
Erect or supine
Abduct arm 90˚ and supinate hand
CR – perpendicular to midscapula, (level of axilla and 2 inches medial from lateral border of patient)
Orthostatic breathing technique preferred

Evaluation Criteria (AP Projection)

Entire scapula demonstrated
Lateral border of scapula free of ribs and lungs
Optimal exposure factors

Lateral: Scapula - Erect

Have patient reach a crossed chest and grasp opposite shoulder to demonstrate body of scapula
Let arm hang by patients' side to demonstrate acromion and coracoid processes
Rotate patient 45-60˚
CR – Midvertebral border of scapula

Lateral Scapula- Recumbent

Patient supine
Rotate patient till AC joint articulation and superior border of scapula are perpendicular to IR
CR- midscapula lateral border

Body of Scapula in Profile (Lateral Scapula)

Borders of scapula superimposed
Free of superimposition by ribs
Arm elevated to demonstrate scapular body

Quiz Me

The projection that would best demonstrate a possible Hill-Sachs defect is the A.Inferosuperior axial projection with exaggerated external rotation

Quiz Me

The body rotation for a posterior oblique position (Grashey method) is D. 35° to 45°

Quiz Me

The most distal humeral structure is D. Surgical neck

Quiz Me 2

The mid area of the costal surface of the scapula is the A. Subscapular fossa

Clavicle & AC Joints

Chapter 5 Continued

Learning Objectives

Identify the following joints on an image of the upper extremity:
- AC - Acromioclavicular Joint
- SC - Sternoclavicular Joint
Describe the anatomy and positioning of the shoulder girdle and upper extremity
Identify the following parts and prominences on an image or skeleton:
- Clavicle
  - Body
  - Sternal end
  - Acromial end

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Description

Test your knowledge of the proximal humerus anatomy, including its structure and associated joints. This quiz covers important features such as the head, neck, tubercles, and major muscle attachments. Evaluate your understanding of this essential component of the upper extremity.