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The muscles surrounding the shoulder girdle, including the clavicle and scapula, primarily stabilize the scapula. This stable base allows other muscles to move the humerus effectively. Scapular movements often mirror those of the humerus and extend its range of motion. For instance, raising the arm above the head would not be feasible without simultaneous upward rotation of the scapula.
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The upper limb consists of the arm, forearm, wrist, and hand bones. The humerus is the single bone of the upper arm region. Proximally, it has a large, spherical, smooth head that articulates with the glenoid cavity of the scapula to form the glenohumeral or shoulder joint. The margin of the head is the anatomical neck, a residual epiphyseal plate. Laterally it extends to form bony projections called the greater tubercle and the lesser tubercle. Next to the tubercles is the surgical neck, a...
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Bones of the Upper Limb: Radius01:09

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Bones of the Upper Limb: Ulna01:15

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The ulna and radius are parallel bones of the antebrachium or the forearm. The ulna lies medially and consists of a bony tip called the olecranon process at its proximal end. This hook-like projection articulates with the olecranon fossa of the humerus and forms the "hinged" ulnohumeral part of the elbow joint. This joint facilitates forearm extension and flexion while preventing its hyperextension. Similarly, the coronoid process, another bony projection on the proximal/anterior side...
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The hyoid bone is a small U-shaped bone located in the upper neck at the level of the inferior mandible, with its tips pointing posteriorly. It does not directly articulate with any other bone in the body. The hyoid acts as the attachment site for the tongue, the larynx, and the pharynx. It is held in position by a series of small muscles attached from above or below. These muscles help to move the hyoid up/down or forward/back in coordination with movements of the tongue, larynx, and pharynx...
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Nine muscles are involved in arm movements. Two of these, the pectoralis major and latissimus dorsi, originate from the axial skeleton and are called axial muscles. The other seven originate from the scapula and are called the scapular muscles.
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Updated: Aug 8, 2025

Measuring 3D In-vivo Shoulder Kinematics using Biplanar Videoradiography
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Shoulder Abduction While Using the Bougie: A Common Mistake.

John J Horky1, Andrew P Pirotte1, Bailee R Wilson2

  • 1University of Kansas Medical Center, Department of Emergency Medicine, Kansas City, Kansas.

Clinical Practice and Cases in Emergency Medicine
|March 1, 2023
PubMed
Summary
This summary is machine-generated.

Proper shoulder positioning is crucial for successful bougie use during endotracheal intubation. Adducting the shoulder corrects left posterolateral bougie malposition, improving airway access and patient outcomes.

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Area of Science:

  • Emergency Medicine
  • Anesthesiology
  • Critical Care

Background:

  • Endotracheal intubation is a critical procedure in emergency and critical care settings.
  • The bougie is a commonly used device to facilitate endotracheal tube placement.
  • Technical challenges can arise during bougie-assisted intubation, potentially leading to failed attempts.

Purpose of the Study:

  • To highlight a common technical error in bougie use during endotracheal intubation.
  • To demonstrate how correcting shoulder mechanics can improve bougie success rates.
  • To provide guidance on optimal bougie technique for intubating clinicians.

Main Methods:

  • Case report of a challenging endotracheal intubation in a patient with chronic obstructive pulmonary disease and congestive heart failure.
  • Utilized video laryngoscopy with a Macintosh 3 blade and bougie for endotracheal tube delivery.
  • Identified and corrected shoulder abduction as a cause of bougie malposition.

Main Results:

  • Despite a grade 2a Cormack-Lehane view, the bougie repeatedly failed to enter the airway due to left posterolateral deviation.
  • Readjusting the intubating clinician's shoulder from abduction to adduction facilitated successful passage of the bougie through the vocal cords.
  • Successful endotracheal intubation was achieved after correcting the shoulder mechanics.

Conclusions:

  • The bougie is an effective endotracheal tube introducer when utilized with proper technique.
  • Optimal body mechanics, specifically shoulder adduction, are essential for successful bougie use.
  • Shoulder abduction is a frequent error leading to bougie malposition; correcting this improves intubation success.