252
EQUINE VETERINARY EDUCATION / AE / MAY 2015
a)
b)
c)
*
*1. * * Lat
Cr
2. 3.
* *
*
*
d)
e)
f)
*
* * * * *
Fig 1: Key: Pink/green asterisk = cranial/caudal prominence of the lateral tubercle. DT = Deltoid tuberosity. IT = infraspinatus tendon. BT = biceps brachii tendon. a) Lateral view of the scapulohumeral joint. The biceps brachii and infraspinatus muscles depicted by blue arrows. The biceps brachii originates from the supraglenoid process of the scapular passing over the tubercles of the humerus and inserting on the proximal antebrachium. Arrowheads = infraspinatus tendon insertion site. Arrows = boundary of infraspinatus bursa overlying caudal prominence of the lateral tubercle. Insert: Dorsal view of scapulohumeral joint. Highlighting the tuberosities of the humerus. Lateral (1), intermediate (2) and medial (3) tubercles. b) Lateral view of scapulohumeral joint with skin and subcutaneous tissue reflected cranially to expose brachiocephalicus muscle overlying the intertubercular and infraspinatus bursae. c) Lateral view of scapulohumeral joint with brachiocephalicus muscle reflected crainially to expose biceps brachii and infraspinatus muscles. Infraspinatus muscle inserts on distal aspect of the lateral tubercle of the humerus. d) Craniolateral view of the scrapulohumeral joint. Forceps inserted into intertubercular (bicipital bursa) via a lateral approach just proximal to the deltoid tuberosity. e) Craniolateral view of the scapulohumeral joint. The biceps brachii muscle transected distally and reflected proximally to expose the intertubercular bursa and humeral tuberocities. f) Lateral view of the scapulohumeral joint. The infraspinatus muscle has been transected and reflected distally to expose the under side of the infraspinatus tendon and infraspinatus bursa.
evaluation of the ‘tendon surface’ of the humeral tubercles (depicted in the insert of Fig 1a), permitting identification of fractures or osteomyelitic lesions of the tubercles. With suspicion of lameness originating from the proximal
humerus, a deltoid tuberosity fracture is a possible differential diagnosis and craniomedial-caudalateral oblique views of the tuberosity have be shown to be the most effective in identifying the fracture line (Fiske-Jackson et al. 2010).
© 2015 EVJ Ltd
Ultrasonographic evaluation of the intertubercular and infraspinatus bursa permits identification of bursal distension, provides information on the nature of the fluid within the bursa and has been shown to be useful in guiding synoviocentesis (Schumacher et al. 2007; Schneeweiss et al. 2012). Ultrasound augments radiography allowing evaluation of the contour of ‘flexor surface’ humeral tubercules and the integrity of the overlying bicipital tendon (Pugh et al. 1994). Ultrasound has
IT
IT
IT
DT
Deltoideus Deltoideus
Deltoideus
BT
BT
Infraspinatus
DT
Biceps brachii
Infraspinatus
Biceps brachii
Biceps brachii
Supraspinatus
Supraspinatus
Supraspinatus
Biceps brachii
Supraspinatus
Brachiocephalicus
Brachiocephalicus
Infraspinatus
Brachiocephalicus
Infraspinatus
Infraspinatus
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84
