Humerus, Non-routine elbow, Shoulder, Clavicle, AC Joints
For the clavicle...How many degrees and in which direction should the central ray be directed for the AP axial projection with the patient upright in the lordotic position?
0 to 15 degrees cephalad
For the Fisk modification, a standing patient should lean forward or backward to place the vertical humerus at an angle of _____ to _____ degrees
10 to 15
What is the appropriate collimated field for the AP and lateral projection of the humerus
2 inches (5cm) distal to the elbow and superior to the shoulder and 1 inch (2.5cm) on the sides
What humeral processes should be palpated to ensure proper alignment when the humerus is being positioned?
Epicondyles
List some things that indicate that the humerus was correctly positioned for the AP projection.
Epicondyles are maximally seen and not rotated; Humeral head & greater tubercle are both seen in profile; Outline of the lesser tubercle is located between the humeral head and the greater tubercle
True or false. For the AP axial projection, the exposure should occur after the patient has been instructed to suspend respiration following full expiration
False
True or false. The AP and PA projections should demonstrate the entire clavicle free from superimposition with other bony structures.
False
True or false. The central ray should be directed perpendicularly to the affected AC joint for each image
False
True or false. The patient may be positioned either upright or supine to demonstrate AC joints.
False
For the axiolateral projection (Coyle method) of the elbow to demonstrate the coronoid process, the elbow is
Flexed 80 degrees
What is the roughened process of the humerus superior and lateral to the intertubercular groove?
Greater tubercle
What position is the hand in for the axiolateral projection (Coyle method) of the elbow?
Hand should be pronated
With reference to the plane of the IR, how should the humeral epicondyles be positioned for the AP projection of the shoulder with the shoulder in neutral rotation?
45 degrees medial oblique
What is the direction and amount of central ray angulation for the axiolateral projectjion (Coyle method) to demonstrate the radial head and capitulum?
45 degrees toward the shoulder
Pertaining to the PA oblique projection (scapular Y) what position would be used to examine a patient's injured left shoulder?
45 to 60 degree LAO
The recommended SID for radiography of the AC joint is _____
72"
With taking an image of the clavicle the AP and PA projections produce similar images, Identify which projection (AP or PA) produces the best spatial resolution and explain why.
PA because decreased OID
Which projection demonstrates the scapulohumeral joint space open and glenoid cavity in profile
AP oblique projection (Grashey method)
Which projection of the shoulder best demonstrates the greater tubercle of the humerus in profile?
AP projection with external rotation
Which projection of the shoulder best demonstrates the humeral head in profile?
AP projection with external rotation
Which projection of the shoulder is being performed when the patient is supine with the right shoulder centered on the IR, a vertical central ray is being directed perpendicular to the center of the IR, and the humeral epicondyles are parallel with the plane of the IR?
AP projection with external rotation
Which projection of the shoulder best demonstrates the lesser tubercle of the humerus in profile and pointing toward the glenoid cavity?
AP projection with internal rotation
What is the proper arm position for the Grashey method?
Abducted in slight internal rotaiton
What is the proper position of the humerus for the inferosuperior axial projection?
Abducted to a right angle and externally roatated
Which projection of the shoulder joint requires the patient to be rotated until the midcoronal plane forms an angle of 45 to 60 degrees with the plane of the IR?
PA oblique projection (scapular Y)
With reference from the thorax, where should the scapular body be demonstrated in the image of the PA oblique projection?
Along the lateral aspect but not superimposed
What specific anatomy is best demonstrated on the axiolateral projection (Coyle method) of the elbow when the central ray is directed 45 degrees toward the shoulder?
An open elbow joint between the radial head and capitulum
What should be adjusted from the regular procedure for the transthoracic lateral position (Lawrence method) of the humerus if the patient is unable to elevate the unaffected arm?
Central ray angulation
Which joint is a ball and socket joint?
Scapulohumeral
To what specific area of the humerus should the IR be centered for the transthoracic lateral projection (Lawrence method)?
Surgical neck
When performing the transthoracic lateral projection (Lawrence method) of the humerus, which breathing technique should be used to improve best the image contrast and decrease the exposure necessary to penetrate the body?
Suspended full inspiration
When taking an AP or PA projection for the clavicle what breathing instructions should be given to the patient?
Suspended respiration after expiration
Which classification of joint are sternoclavicular (SC) joints and acromioclavicular (AC) joints?
Synovial
Which projection of the shoulder girdle is performed with the patient supine, an IR placed vertically against the superior surface of the shoulder, and the central ray angled 10 to 15 degrees posteriorly (downward from horizontal )
Tangential for the intertubercular (bicipital) groove
Which projection of the upper limb should be performed to demonstrate a fracture of the proximal humerus when the arm cannot be abducted?
Transthoracic lateral projection (Lawrence method) of the humerus
Which structure articulates with the ulna to form the humeroulnar joint?
Trochlea
True or false. In an image of a normal shoulder, the humeral head, should be directly superimposed over the junction of the scapular Y
True
True or false. The entire clavicle should be demonstrated with either AP or PA projection
True
Describe the Intertubercular (bicipital) groove of the humerus
Deep depression that separates the two tubercles
What bone articulates with the glenoid cavity?
Humerus
List the names of each shoulder girdle articulation
- Scapulohumeral - Acromioclavicular - Sternoclavicular
Identify the joint type for each articulation of the shoulder girdle.
-Ball & socket for the scapulohumeral articulation -Gliding for the AC & SC articulations
When performing AP projections of the shoulder, where should the central ray be directed?
1 inch (2.5 cm) inferior to the coracoid process
How many degrees and in which direction should the central ray be directed if it cannot be directed perpendicular to the IR because the patient is unable to elevate the unaffected shoulder? (pertaining to Lawrence method)
10 to 15 degrees cephalad
How many degrees and in which direction should the central ray be directed for the PA axial projection of the clavicle
15 to 30 degrees caudad
How many degrees and in which direction should the central ray be directed for the AP axial projection of the clavicle with the patient supine?
15 to 30 degrees cephalad
How many articulations does the humerus have?
3
How many articulations does the shoulder girdle have?
3
What patient position would be required if the patient's right shoulder is to be examined (pertaining to the AP oblique projection *Grashey method* for the glenoid cavity)
35 to 45 degree RPO
What would be the require patient position to demonstrate the left shoulder using the AP oblique projection (Grashey) method
35 to 45 degrees LPO
Which projection for the humerus requires the patient's hand to be supinated?
AP
If the patient's condition permits, which joint should be demonstrated with the patient in an upright position?
Acromioclavicular
The portion of the humerus located between the tubercles and the head is called the ________ neck.
Anatomic
What is the CR orientation for the axiolateral projection of the elbow (Coyle method) to demonstrate the coronoid process?
Angled 45 degrees away from the shoulder
What is the central ray orientation for the axiolateral projection of the elbow (Coyle method) to demonstrate the coronoid process when the patient is seated?
Angled 45 degrees away from the shoulder
Which of the following should be used to image the radial head on a trauma patient?
Axiolateral projection (Coyle method) of elbow joint
Where is the humeral head usually seen on a PA oblique (scapular Y) image if the shoulder is anteriorly dislocated
Beneath the coracoid process
Describe the Lesser tubercle of the humerus
Bony process on the anterior surface of the shaft, inferior from the anatomic neck
Describe the Greater tubercle of the humerus
Bony process on the lateral surface of the bone
What criterion is used to determine if the CR angle was sufficient for the axial projections of the clavicle?
CR angle is sufficient if the medial end of clavicle is at the level of the 1st or 2nd ribs
Which structure articulates with the radius to form the humeroradial joint
Capitulum
What bone forms the anterior part of the shoulder girdle?
Clavicle
Describe the surgical neck of the humerus
Constriction of the shaft inferior to the tubercles
Into which rotational position should the humerus be placed for a inferosuperior axial projection (lawrence method)
External
A properly positioned AP oblique (Grashey) image will demonstrate the _______________ in profile
Glenoid cavity
Which type of joint are SC joints and AC joints?
Gliding
Which projection of the shoulder requires that a horizontal central ray be directed 15 to 30 degrees medially and enter the axilla of the affected arm?
Inferosuperior axial projection (Lawrence method)
Which depression is located between the lesser and greater tubercles of the proximal humerus
Intertubercular groove
At what level is the clavicle (with reference to the ribs)?
Just above the 1st rib
Describe the head of the humerus
Large, rounded eminence that articulates with the glenoid cavity
Which end of the clavicle (medial or lateral) articulates with part of the scapula?
Lateral
In which body position should the patient be placed to demonstrate the left shoulder with the PA oblique projection (scapular Y)
Left anterior oblique
One way that the lateral image of a humerus, produced with the patient in the lateral decubitus position and the IR placed between the arm and thorax, appears different from the lateral position with the patient standing is that the former demonstrates:
Less than the entire humerus
Which bony process is located on the anterior surface of the proximal humerus?
Lesser tubercle
Which gender of adults (males or females) has more sharply curved clavicles?
Males
Which end of the clavicle (medial or lateral) articulates with the manubrium?
Medial
Describe the Anatomic neck of the humerus
Narrow constriction superior to the tubercles
Which depression is located on the anterior surface of the distal humerus?
Olecranon fossa
With reference to the plane of the IR, how should the humeral epicondyles be positioned for the AP projection of the shoulder with the shoulder in external rotation?
Parallel
With reference to the plane of the IR, how should the humeral epicondyles be positioned for the AP projection of the shoulder with the shoulder in internal rotation?
Perpendicular
For the Fisk modification, how should the central ray be directed?
Perpendicular to the IR
How should the central ray be directed for the PA oblique projection (scapular Y) of the shoulder?
Perpendicular to the IR
Describe best how to position the IR for the lateral projection of the humerus if the AP projection mage clearly shows a fracture 2 inches superior to the elbow.
Place the IR between the humerus and the thorax
What positioning maneuver should be avoided if the patient possibly has a fractured humerus or dislocation of the scapulohumeral joint?
Rotation of the arm
What bone articulates with the medial end of the clavicle
Sternum
Pertaining to the PA oblique projection (scapular Y) what breathing instructions should be given to the patient
Stop breathing for the exposure
Where is the humerus generally demonstrated on a PA oblique shoulder (scapular Y) image if the shoulder is normal?
Superimposed on the junctionof the acromion and coracoid process
How should the hand be placed for the AP projection of the humerus?
Supinated
The transthoracic lateral projection may be performed with the patient positioned upright or:
Supine
The humerus can be examined with the patient in either the _____________ or ____________ position
Supine or upright
Which positioning characteristic best indicates that the humerus is properly positioned for the AP projection of the humerus?
The humeral epicondylar coronal plane is parallel with the IR
With reference to the plane of the IR, how is it determined that the humerus is properly positioned in true lateral position
The humeral epicondylar coronal plane is perpendicular
Which evaluation criterion indicates that the humerus was properly positioned for the AP projection?
The humeral head and greater tubercle are both seen in profile
Which evaluation criterion indicates that the humerus was properly positioned for the lateral projection
The lesser tubercle is seen in profile
What is the purpose of the weight-bearing projections for the AC joints?
The weights enable better demonstration of a separation of an AC joint
What is the proper method to attach the weights? why?
The weights should be fixed to the patient's wrists. Attaching the weights to the wrist prevents the patient from tensing muscles, making demonstration of a small dislocation more difficult.
How many AP projections are necessary for the best demonstration of the elbow without distortion when an injury prevents full extension of the elbow?
Two
What procedure should be performed to demonstrate both AC joints on a patient who has wide shoulders?
Two IRs should be used and exposed simulataneously
Which change to radiographic exposure factors should be used to aid effectively the blurring of lung detail by the action of the heart when the patient is able to hold his or her breath for a sustained period? (Lawrence method)
Use a low mA/long exposure time combination with the usual mAs factor
The lateral end of the clavicle is also known as the _______ extremity
acromial
What structure of the scapula articulates with the lateral end of the clavicle
acrominon
For the Fisk modification, the IR is supported on the patient's ___________
forearm
What classification of bone is the clavicle?
long
Which classification of bone is the clavicle
long
The medial end of the clavicle is also known as the__________ extremity.
sternal
For AP projections of humerus, the patient's respiration should be_______________
suspended