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The shoulder - Interactive Atlas of Cross-Sectional Anatomy

Atlas-MR

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Method

This atlas of cross sectional anatomy of the glenohumeral joint (shoulder) is based on imagery by magnetic resonance (MRI). Each anatomical structure is labeled in an interactive way. This tool is at the same time useful for the training and teaching of the anatomy, but also with the experts to illustrate a course or an explanation of pathology to a patient, in particular within the framework of rotator cuff tendon injury and joint disease.
This software is open and free for any public curious about anatomy, but it was particularly conceived for the radiologists, the rheumatologists, the orthopedic surgeons, the general practitioners, the medical students, and the radiologic technologists.

Cross-sectional anatomy: MR of the shoulder

A MRI of the shoulder from a healthy subject was performed in the 3 plans of space (coronal, axial, sagittal) commonly used in osteoarticular imagery, with two weightings most commonly used to explore the musculo-skeletal pathology of the shoulder: spin-echo T1 and proton-density with fat saturation sequences.
The images obtained were exported in JPEG starting from data DICOM stored on the PACS (Picture Archiving and Communicating System).
The images were post processed with Adobe Photoshop (realignment, reduction of size in order to adapt to the electronic format).
The interactive and dynamic contents were added with Macromedia Flash.

Illustrations

We used a 3D volume rendering (CT-scan) of the shoulder. A numeric illustration was secondly painted to show bone anatomy, muscles attachments, ligaments and muscle layers of the rotator cuff.
These illustrations allow basic anatomical recalls in anatomy of the shoulder and make it possible to be located more easily on an MRI by using the cross-references.

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X-rays

In this anatomic tool, we added a new kind of images :

Radiography of the shoulder (AP and “Y” view)

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Arteriography (angiography) of the right axillary artery.

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Anatomy of the shoulder: how to use anatomic labels

The menu “anatomical structures” allows the user to visualize only the chosen types of labels :
- Bones
- Joints
- Ligaments
- Muscles
- Tendons
- Lymph nodes
- Arteries
- Veins
- Nerves

The menu “weightings” makes it possible to choose the type of MR sequence to be viewed: spin-echo T1 or proton-density with fat saturation sequences.
The menu “plans” allows to choose the visualization of the shoulder in one of the 3 plans of space: axial, coronal, sagittal and to reach the illustrations and x-rays.
The left side menu provides cross-references to help for a better orientation in space for the user. This one moreover is facilitated by the medical illustrations.
We have added a new horizontal menu at the bottom, which allows the user to access more quickly to the MR slices or other images (anatomic pictures and x-rays).

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Labeled anatomical structures

List of labels (languages = English, French and Latin (terminologia anatomica)):

Subscapular fossa
Spine of scapula
Supraspinous fossa
Infraspinous fossa
Acromion
Acromial angle
Medial border
Lateral border
Superior border
Suprascapular notch
Inferior angle
Superior angle
Glenoid cavity
Supraglenoid tubercle
Infraglenoid tubercle
Neck of scapula
Coracoid process
Scapula
Clavicle
Head
Anatomical neck
Surgical neck
Greater tubercle
Lesser tubercle
Intertubercular sulcus; Bicipital groove
Crest of greater tubercle; Lateral lip
Crest of lesser tubercle; Medial lip
Humerus
Acromioclavicular joint
Acromioclavicular ligament
Trapezoid ligament
Conoid ligament
Coracoacromial ligament
Superior transverse scapular ligament
Glenoid labrum
Glenoid labrum
Glenohumeral ligaments (Superior)
Glenohumeral ligaments (Middle)
Glenohumeral ligaments (Inferior)
Coracohumeral ligament
Transverse humeral ligament
Subdeltoid bursa + Subacromial bursa
Glenohumeral joint; Shoulder joint
Subtendinous bursa of subscapularis
Deltoid (Clavicular part)
Deltoid (Acromial part)
Deltoid (Spinal part)
Supraspinatus
Supraspinatus (Tendon)
Deltoid
Infraspinatus
Infraspinatus (Tendon)
Teres minor (Tendon)
Teres minor
Teres major (Tendon)
Teres major
Subscapularis (Tendon)
Subscapularis
Biceps brachii -Long head (Tendon)
Biceps brachii -Long head
Biceps brachii -Short head (Tendon)
Biceps brachii -Short head
Coracobrachialis (Tendon)
Coracobrachialis
Triceps brachii - Long head
Triceps brachii - Lateral head
Triceps brachii - Medial head
Brachialis
Trapezius
Latissimus dorsi
Rhomboid major
Rhomboid minor
Levator scapulae
Serratus anterior
Pectoralis major
Pectoralis major (Tendon)
Pectoralis minor
Pectoralis minor (Tendon)
Subclavius
Axillary artery
Brachial artery
Subclavian artery
Superior thoracic artery
Posterior circumflex humeral artery
Anterior circumflex humeral artery
Subscapular artery
Thoracodorsal artery
Circumflex scapular artery
Lateral thoracic artery
Suprascapular artery
Thoracoacromial artery (Clavicular branch)
Thoracoacromial artery (Acromial branch)
Thoracoacromial artery (Deltoid branch)
Thoracoacromial artery (Pectoral branches)
Thoracoacromial artery
Profunda brachii artery; Deep artery of arm
Cephalic vein
Basilic vein
Axillary vein
Brachial vein
Dorsal scapular artery
Suprascapular nerve
Suprascapular nerve
Thoracodorsal nerve
Medial pectoral nerve
Lateral pectoral nerve
Musculocutaneous nerve
Long thoracic nerve
Axillary nerve
Superior lateral brachial cutaneous nerve
Brachial plexus
Ulnar nerve - Median nerve - Radial nerve - Medial cutaneous nerve of forearm - Medial cutaneous nerve of arm
Supraclavicular nodes
Axillary lymph nodes (Central nodes)
Axillary lymph nodes (Pectoral nodes; Anterior nodes)
Axillary lymph nodes (Apical nodes)
Axillary lymph nodes (Subscapular nodes; Posterior nodes)
Axillary lymph nodes (Humeral nodes; Lateral nodes)
Brachial nodes
Interpectoral nodes
Deltopectoral nodes; Infraclavicular nodes
Paramammary nodes