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