Bontrager Workbook: Chapter 5-Humerus and Shoulder Girdle

A patient with a clinical history of tendon injury in the shoulder region comes to the radiology department. The orthopedic physician needs a functional study of the shoulder joint performed to determine the extent of the tendon injury. Which of the following modalities would best demonstrate this injury? a. Arthography b. MRI c. Ultrasound d. Nuclear Medicine

c. Ultrasound

An injury of the anteroinferior aspect of the glenoid labrum is termed: a.) Hill-Sachs b.) Impingement syndrome c.) Bankart Lesion d.) Sunluxation

c.) Bankart Lesion

An injury of the anteroinferior aspect of the glenoid labrum is termed: a.) Hills-Sachs b.) Impingement syndrome c.) Bankart lesion d.) Subluxation

c.) Bankart lesion

Which of the following AP proximal shoulder projections will demonstrate the lesser tubercle in profile? a.) External rotation b.) Neutral rotation c.) Internal rotation d.) None of the above

c.) Internal rotation

What anatomy of the shoulder is best demonstrated with a tangential projection (Fisk method)? a.) Clavicle b.) Proximal humerus c.) Intertubercular groove d.) Glenoid cavity

c.) Intertubercular groove

The anterior surface of the scapula is referred to as the ___ surface.

costal

What CR angle is required for the AP axial projection (Alexander method) for AC joints? a. 25* cephalad b. 45* cauded c. 5-10* cauded d. 15* cephalad

d. 15* cephalad

What type of CR angle is required for the lateral scapula position? a. 10-15* cephalad b. 5-15* caudad c. 10-15* caudad d. None

d. None

Which one of the following clinical indications requires a decrease in manual exposure factors? a. Impingement syndrome b. Bursitis c. Bankart lesion d. Osteoporosis

d. Osteoporosis

The supine version of the tangential projection for the intertubercular groove requires that the CR be angled ___* posteriorly from the horizontal plane.

10-15*

Which special projection of the shoulder requires that the affected side be rotated 45* toward the cassette and uses a 45* caudad CR angle? A posterior dislocation of the humerus projects the humeral head ___(superior or inferior) to the glednoid cavity with the special projection described in the previous question.

AP apical oblique axial projection superior

Acromioclavicular joint separation

Abnormal widening of the acromioclavicular joint space

A patient with a possible right shoulder dislocation enters the ER. The technologist attempts to perform an erect transthoracic lateral projection, but the patient is unable to raise the left arm and shoulder high enough. The resultant radiograph reveals that the shoulders are superimposed , and the right shoulder and humeral head are not well visualized. What can be done to improve this image during the repeat exposure?

Angle the CR 10-15* cephalad to separate the shouler

The AP apical oblique axial projection (Garth method) is performed on a patient with a shoulder injury. The resultant radiograph demonstrates the proximal humeral head projected below the glenoid cavity. What type of trauma or pathology is indicated with this radiographic appearance?

Anterior dislocation

Osteoporosis

Atrophy of skeletal tissue

Bankart lesion

Avulsion fracture of the glenoid rim

Tendonitis

Calcified tendons

Where is the CR centered for the AP scapula projection?

Center CR perpendicular to midscapula. 2 in inferior to the coracoid process or level of axilla and approximately 2 in medial from the lateral border of patient.

location: Acromial extermity

Clavicle

Inferosuperior axial projection

Clements modification

Rheumatoid arthritis

Closed joint space

Impingement syndrome

Compression between the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch

Hill-Sachs defect

Compression fracture of the articular surface of the humeral head

Hill-Sachs defect

Compression fracture of the humeral head

True/False A 72in SID is recommended for most shoulder girdle studies

False

True/False A CR angle of 10-15* caudad may be used for the transthoracic lateral projections if the patient is unable to evaluate the uninjured arm and shoulder sufficently.

False

True/False Large focal spot setting should be selected for most adult shoulder studies.

False

True/False Low mA with short exposure times should be used for adult shoulder studies

False

True/False MRI is an excellent modality for demonstrating bony injuries of the shoulder girdle.

False

True/False Radiography is more sensitive than nuclear medicine for demonstrated physiologic aspects of the shoulder girdle

False

True/False The affected arm must be placed into external rotation for the transthoracic lateral projection.

False

True/False The kV range for adult shoulder projections is between 80 and 90 kV for analog and 100 to 110 kV for digital imaging systems

False

True/False The scapular Y lateral (anterior oblique) position requires the body to be rotated 30-40* anteriorly toward the affected side.

False

Tangential for intertubercular (bicipital) groove

Fisk modification

Tangential, intertubercular groove projection

Fisk modification

Bursitis

Fluid-filled joint space

AP apical oblique axial

Garth method

AP apical oblique, glenoid cavity projection

Garth method

Posterior oblique for glenoid cavity

Grashey method

Posterior oblique, glenoid cavity projection

Grashey method

A radiograph of the AP oblique (Grashey method) taken as a 35* oblique projection reveals that the borders of the glenoid cavity are not superimposed. The patient has large, rounded shoulders. What must be done to get better superimposition of the cavity during the repeat exposure?

Increase rotation of the affected shoulder toward the IR closer to 45*.

A radiograph of an AP axial clavicle projected below the superior border of the scapula. What can the technologist do to correct this problem during the repeat exposure?

Increase the CR cephalad angle

A patient with a clinical history of chronic shoulder dislocation comes to the radiology department. The orthopedic physician suspects that Hill-Sachs defect may be present. Which specific position(s) may be used to best demonstrate this pathologic feature?

Inferosuperior axial projection with exaggerated external rotation. Inferosuperior axial projection (Clements) and Ap apical oblique axial projection (Garth)

Tendonitis

Inflammatory condition of the tendon

Bankart lesion

Injury of the anteroinferior glenoid labrum

Inferosuperior axial Transthoracic lateral

Lawrence method

The following factors were used to produce a radiograph of an AP projection of the shoulder: 85 kV, 20 mAs, high-speed screens, 40 in SID, grid, and suspended respiration. The resultant radiograph demonstrated poor radiographic contrast between bony and soft tissue structures. Which of these factors can be altered during the repeat exposure to improve radiographic quality?

Lower the kV to 75 and double the mAs to 40 mAs. This will increase the radiographic contrast.

A thin-shouldered patient requires ___ ( more or less) CR angle for an AP axial clavicle projection that a large-shouldered patient.

More

Osteoarthritis

Narrowing of the joint space

Supraspinatus outlet tangential

Neer method

Tangential, supraspinatus outlet projection

Neer method

location: Coronoid process Condylar process

Not a part of the shoulder girdle

A radiograph of a lateral scapula position reveals that it is not a true lateral projection. (Considerable separation exists between that axillary and vertebral borders.) The projection was taken using the following factors: erect position, 40 in SID, 45* rotation toward cassette from PA, CR centered to midscapula, and no CR angulation. Based on these factors, how can this position be improved during the repeat exposure?

Palpate the superior angle of the scapula and AC joint articulation and ensure the imaging plane between these points is perpendicular to the IR.

A patient with a possible fracture of the right proximal humerus from an automobile accident enters the ER. The patient has other injuries and is unable to stand or sit erect. Which positioning routine should be used to determine the extent of the injury.

Routine includes AP of the right shoulder and humerus without rotation and supine, horizontal beam, right transthoracic shoulder (Y lateral could be used as 2nd option for lateral shoulder).

location: Coracoid process Crest of spine

Scapula

Impingement syndrome

Subacromial space

Acromioclavicular joint dislocation

Superior displacement of the distal clavicle

A radiograph of an AP projection (with external rotation) of a shoulder (no traumatic injury) reveals that neither the greater now lesser tubercles are profiled. What must be done to correct this during the repeat exposure?

Supinate the hand and ensure that epicondyles are parallel to the IR for a true AP.

Osteoporosis

Thin bony cortex

A patient enters the ER with a definite fracture to the midhumerus. Because of other trauma the patient is unable to stand. Which lateral projection would demonstrate the entire humerus?

Transthoracic lateral projection for humerus

Which lateral projection can be performed to demonstrate the entire humerus for a patient with a midhumeral fracture?

Transthoracic lateral projection for humerus

Rotator cuff tear

Traumatic injury to one or more of the supportive muscles of the shoulder girdle

True/False A high-speed screen-IR system is recommended for analog shoulder studies when using a grid.

True

True/False CT arthography of the shoulder joint often requires the use of iodinated contrast media injected into the joint space

True

True/False Nuclear medicine bone scans can demonstrate signs of osteomyelitis.

True

True/False The PA transaxillary projection (Hobbs modification) requires no CR angle.

True

True/False The transthoracic lateral projection can be performed for possible fractures or dislocation of the proximal humerus

True

True/False The use of a breathing technique can be performed for the transthoracic lateral humerus projection.

True

True/False The use of a grid is not required for shoulder studies that measure less than 10cm.

True

True/False The use of automatic exposure control (AEC) is not recommended for the AP projection of the scapula.

True

True/False The use of contact shields over the breast, lung, and thyroid regions is recommended for most shoulder projections

True

True/False Ultrasound can provide a functional (dynamic) evolution of joint movement that MRI cannot.

True

A radiograph of a transthoracic lateral projection demonstrates considerable superimposition of lung markings and ribs over the region of the proximal shoulder. What can the technologist do to minimize this problem during the repeat exposure?

Use breathing exposure technique to create blurring of ribs and lung markings

Which of the following projections will best demonstrate a possible Hill-Sachs defect? a.) Inferosuperior axial projection with exaggerated external rotation b.) PA transaxillary (Hobbs modification) c.) Posterior oblique (Grashey method) d.) Tangential projection (Fisk modification)

a.) Inferosuperior axial projection with exaggerated external rotation

What is another term for the mid area of the costal surface of the ribs? a.) Subscapular fossa b.) Infraspinous fossa c.) Scapulohumeral fossa d.) Scapulohumeral surface

a.) Subscapular fossa

What is the anatomic name for armpit?

axilla

Which one of the following projections is best for demonstrating a possible dislocation of the proximal humerus? a. Posterior Oblique (Grashey method) b. Fisk modification c. Inferosuperior axial (Clements modification) projection d. Scapular Y projection

d. Scapular Y projection

The ___(male/female) clavicle tends to be thicker and more curved in shape.

male

Which 2 landmarks are placed perpendicular to the IR for the scapular Y lateral projection?

superior angle of the scapula and AC joint articulation

All of the joints of the shoulder girdle are classified as being:

synovial (diarthrodial)

The ___ projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs, which create shoulder impingement symptoms. This projection is also referred to as the ___ method.

tangential Neer

The three angles of the scapula:

1. lateral angle 2. superior angle 3. inferior angle

The shoulder girdle consists of

1. proximal humerus 2. scapula 3. clavicle

The three aspects of the clavicle are the:

1. sternal extremity 2. body/shaft 3. acromial extremity

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Which 2 routine shoulder projections are routinely taken for a shoulder (no traumatic injury) and proximal humerus?

1. AP external rotation 2. AP internal rotation

A patient with a possible Bankart lesion comes to the radiology department. List 3 projections that can be performed that may demonstrate signs of this injury.

1. AP internal rotation 2. Scapular Y lateral 3. Posterior oblique (Grashey method)

List the movement types for the following joints: 1. Scapulohumeral 2. Sternoclavicular 3. Acromioclavicular

1. Spheroidal 2. plane 3. plane

What are the names of the two fossae located on the posterior scapula?

1. infraspinous fossa 2. supraspinous fossa

Superoinferior axial projection

Hobbs modification

A radiograph of an AP projection with external rotation of the shoulder does not demonstrate either the greater or lesser tubercle in profile. What is the most likely cause for this radiographic outcome?

Humeral epicondyles were not placed parallel to the plane of the IR.

Specifically, where is the central ray placed for an AP projection of the shoulder?

Perpendicular to IR, 1 in inferior to the coracoid process

The ___ projection of the shoulder produces an image of the glenoid process in profile. This projection is also referred to as the ___ method.

Posterior Oblique Grashey

location: Greater tubercle Intertubercular groove Surgical neck

Proximal humerus

What type of CR angulation is required for the inferosuperior axial projection for the shoulder? a. 25-30* medially b. 35-45* medially c. 25* anterior and 25* medially d. CR perpendicular to IR

a. 25-30* medially

How much is the CR angled for the inferosuperior axial projection (Clements modification) if the patient cannot fully abduct the arm 90*? a. 5-15* b. 45* c. 25-30* d. 20*

a. 5-15*

Which one of the following kV ranges should be used for a shoulder series on an average adult? a. 70-80 kV b. 55-60 kV c. 80-90 kV d. 65-75 kV

a. 70-80 kV

Which on of the following projections produces a tangential projection of the intertubercular groove? a. Fisk modification b. Grashey method c. Hobbs modification d. Lawrence method

a. Fisk modification

If physical immobilization is required, which individual should be asked to restrain a child for a shoulder series? a. Parent or guardian b. Radiologic technologist c. Radiography student d. Nurse aide

a. Parent or guardian

A patient with a possible rotator cuff tear comes to the radiology department. Which one of the following imaging modalities would best demonstrate this injury? a. Arthography b. MRI c. Nuclear Medicine d. Radiography

b. MRI

To best demonstrate a possible Hill-Sachs defect, which additional positioning technique can be added to the inferosuperior axial projection? a. Angle CR 10-15* caudad b. Rotate affected arm externally approximately 45* c. Angle CR 3-5* caudad d. Place humeral epicondyles parallel to IR

b. Rotate affected arm externally approximately 45*

Which of the following nontrauma projections can be performed erect to provide a lateral view of the proximal humerus in relationship to the glenohumeral joint? a. Tangential projection (Fisk modification) b. AP projection- neutral rotation c. PA transaxillary projection (Hobbs modification) d. Posterior Oblique position (Grashey method)

c. PA transaxillary projection (Hobbs modification)

How much should the CR be angled for an AP axial projection of the clavicle on an asthenic patient? a.) 5* b.) 10* c.) 20* d.) 30

d.) 30

How much is the body rotation for a posterior oblique position (Grashey method)? a.) 5-8* b.) 10-15* c.) 20-25* d.) 35-45*

d.) 35-45*

Which of the following scapular structures is most posterior? a.) Coracoid process b.) Glenoid cavity c.) Scapular notch d.) Acromion

d.) Acromion

What is the joint classification for the scapulohumeral joint? a.) Trochoidal b.) Plane c.) Bicondylar d.) Spheroidal

d.) Spheroidal

Which of the following humeral structures is most distal and inferior? a.) Anatomic neck b.) Greater tubercle c.) Lesser tubercle d.) Surgical neck

d.) Surgical neck

Which of the following humeral structures is most distal and inferior? a.) anatomical neck b.) Greater tubercle c.) Lesser tubercle d.) Surgical neck

d.) Surgical neck

What must be ruled out before performing the weight-bearing study for acromioclavicular joints?

fracture of the clavicle