Chapter 5 Humerus & Shoulder Girdle
The anterior surface of the scapula is referred to as the _________ surface.
costal surface
The supine version of the tangential projection for the intertubercular groove requires that the CR be angled _______________ posteriorly from the horizontal plane.
10 to 15 degree
What CR angle is required for the AP axial projection (Alexander method) for AC joints?
15 degree cephalad
What type of CR angulation is required for the inferosuperior axial projection for the shoulder?
25 to 30 degree medially
How much is the CR angled for the inferosuperior axial projection (Clements modification) if patient cannot abduct the arm 90 degree?
5 to 15 degree
Which special projection of the shoulder requires that the affected side be rotated 45 degree toward the cassette & uses a 45 degree caudad CR angle?
AP apical oblique axial projection
Situation: A patient with a possible Bankart lesion comes to the radiology department. List three projections that can be performed that may demonstrate signs of this injury.
AP internal rotation Scapular Y Grashey
Situation: A patient with a clinical history of chronic shoulder dislocation comes to the radiology department. The orthopedic physician suspects that a Hill-Sachs defect may be present. Which specific position (s) may be used to best demonstrate this pathologic feature?
AP internal rotation, exaggerated external rotation
Situation: A patient with a possible fracture of the right proximal humerus from an automobile accident enters the ER. The patient has other injuries & is unable to stand or sit erect. Which positioning routine should be used to determine the extent of the injury?
AP of right shoulder & humerus without rotation (neutral position) & a supine horizontal beam, right transthoracic shoulder.
Which two routine shoulder projections are routinely taken for a shoulder (with no trauma injury) & proximal humerus?
AP, external rotation AP, internal rotation
Superior displacement of the distal clavicle
Acromioclavicular joint dislocation
Abnormal widening of acromioclavicular joint space
Acromioclavicular joint separation
Situation: A patient with possible right shoulder dislocation enters the ER. The tech attempts to perform a erect transthoracic lateral projection, but patient is unable to raise left arm & shoulder high enough. The resultant reveals that the shoulders are superimposed, & right shoulder & humeral head are not well visualized. What can be done to improve this image during repeat exposure?
Angle the CR 10 to 15 degree cephalad to separate the shoulders; roll patient back
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 of proximal humerus
Where is the CR centered for the AP scapula projection?
CR perpendicular midscapula, 2in(5cm) inferior to caracoid process, or level of axilla & approximately 2in(5cm) medial from lateral border
Specifically, where is the CR placed for an AP projection of the shoulder?
CR perpendicular to IR, directed to 1in (2.5cm) inferior to coracoid process.
Acromial extremity, Body, Sternal extremity; Acromioclavicular joint & Sternoclavicular joint; Jugular notch
Clavicle Anatomy
What type of CR angle is required for the lateral scapula position? A. 10 to 15 degree C. 10 to 15 degree caudad B. 5 to 15 caudad D. None
D. None CR perpendicular to IR
Which one of the following clinical indications requires a decrease in manual exposure factors? A. Impingement syndrome C. Bankart lesion B. Bursitis D. Osteoporosis
D. Osteoporosis
Which one of the following projections is best for demonstrating a possible dislocation of the proximal humerus? A. Grashey method B. Fisk modification C. Inferosuperior axial (Clements modification) projection D. Scapular Y projection
D. Scapular Y projection
Greater tubercle profiled laterally, Supination of hand, Epicondyles parallel to IR, & Proximal humerus in position for an AP projection
External rotation
True/False: A 72-inch (183-cm) SID is recommended for most shoulder girdle studies.
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 body injuries of the shoulder girdle.
False
True/False: Radiography is more sensitive than nuclear medicine for demonstrating 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 & 90 kV for analog & 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 to 40 degree anteriorly toward the affected side.
False
True/False: A CR angle of 10 to 15 degree caudad may be used for the transthoracic lateral projections if the patient is unable to elevate the uninjured arm & shoulder sufficiently.
False 10 to 15 degree cephalad
Tangential for intertubercular (bicipital) groove
Fisk modification
AP apical oblique axial
Garth method
Posterior oblique for glenoid cavity
Grashey method
A radiography of an AP axial clavicle projection reveals that the clavicle is projected below the superior border of the scapula. What can the technologist do to correct this problem during the repeat exposure?
Increase CR cephalad angle
A radiograph of AP oblique (Grashey method) taken as a 35 degree oblique projection reveals the borders of glenoid cavity are not superimposition of the cavity during the repeat exposure?
Increase rotation of affected shoulder toward IR to closer to 45 degree
Epicondyles perpendicular to IR, Lesser tubercle profiled medially, & Proximal humerus in a lateral position
Internal rotation
Inferosuperior axial & Transthoracic lateral
Lawrence method
AP projection of the shoulder: 85 kV, 20 mAs, high speed screens, 40 in SID, grid, & suspended respiration. The resultant radiograph demonstrated poor radiographic contrast between bony & soft tissue structures. Which of these factors can be altered during the repeat exposure to improve radiographic quality?
Lower to 75 kVp & double mass, which increases contrast
Situation: 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?
MRI
The Tangential projection is also referred to as the _________ method.
Neer Method
Supraspinatus outlet tangential
Neer method
Humeral epicondyles angled 45 degree to IR, & Palm of hand against thigh
Neutral rotation
Narrowing of joint space
Osteoarthritis
Atrophy of skeletal tissue
Osteoporosis
Thin bony cortex
Osteoporosis
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?
PA transaxillary projection (Hobbs modification)
A radiograph of a lateral scapula position reveals it is not a true lateral projection. Erect position, 40 in(102cm) SID, 45 degree rotation toward cassette from PA, CR centered to midscapula, & no CR angulation. How can this position be improved during the repeat exposure?
Palpate the superior angle of the scapula & AC joint articulation & ensure that the imaginary plan between these points is perpendicular to the IR
Coracoid process, Crest of spine, Dorsal & Costal surface, Scapular notch, Acromion, Neck, Body; Superior, Medial, & Lateral Borders; Scapulohumeral joint
Scapula Anatomy
Scapulohumeral
Spheroidal movement
A radiography of an AP projection (with external rotation) of a shoulder (with no traumatic injury) reveals that neither the greater not lesser tubercles are profiled. What must be done to correct this during the repeat exposure?
Supinate the hand & ensure that the epicondyles are parallel to the IR for true AP
The _______________ projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs, which create impingement symptoms.
Tangential projection
Calcified tendons
Tendonitis
Inflammatory condition of the tendon
Tendonitis
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?
The humeral epicondyles were not placed parallel to the plane of the IR.
Which lateral projection can be performed to demonstrate the entire humerus for a patient with a midhumeral fracture?
Transthoracic lateral projection for humerus
A patient enters the ER with a definite fracture to midhumerus. Because of other trauma the patient is unable to stand. Which lateral projection would demonstrate the entire humerus?
Transthoracic lateral projection of humerus
True/False: A high-speed screen-IR system is recommended for analog shoulder studies when using a grid.
True
True/False: CT arthrography 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 & cellulitis.
True
True/False: Sonography (ultrasound) can provide a functional (dynamic) evaluation of joint movement that MRI cannot.
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 dislocations 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 10 cm.
True
True/False: The use of contact shields over the breast, lung, & thyroid regions is recommended for most shoulder projections.
True
Situation: A patient with clinical history of tendon injury in the shoulder region comes to the radiology department. The orthopedic physician needs a functional study of the study of the shoulder joint performed to determine the extent of tendon injury. Which of the following modalities would best demonstrate this injury?
Ultrasound
A radiograph of a transthoracic lateral projection demonstrates considerable superimposition of lung markings & ribs over the region of proximal shoulder. What can the tech do to minimize this problem during the repeat exposure?
Use breathing exposure technique to create blurring of ribs & lung markings
What is the anatomic name for the armpit?
axilla
The three angles of the scapula include the
lateral angle, superior angle, & inferior angle
The ________ clavicle tends to be thicker & more curved in shape.
male clavicle
A thin-shouldered patient requires _______ CR angle for an AP axial clavicle projection than a large-shoulder patient.
more CR angle
The shoulder girdle consists of:
proximal humerus, scapula, & clavicle
The three aspects of the clavicle are:
sternal extremity, body, & acromial extremity
A posterior dislocation of the humerus projects the humeral head __________ to the glenoid cavity with the special projection above.
superior
Which two landmarks are placed perpendicular to the IR for the scapular Y lateral projection?
superior angle of scapula & AC joint articulation
All the joints of the shoulder girdle are classified as being
synovial joint (diarthrodial)
What are the names of the two fossae located on the posterior scapula?
infraspinous fossa & supraspinous fossa
Which one of the following kV ranges (analog) should be used for a shoulder series on an average adult? A. 70 to 80 kV C. 80 to 90 kV B. 55 to 60 kV D. 65 to 75 kV
A. 70 to 80 kV
Which one of the following projections produces a tangential projection of the intertubercle groove. A. Fisk modification C. Hobbs modification B. Grashey method 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 C. RAD student B. Radiologic tech. D. Nurse aid
A. Parent or guardian
Fluid-filled joint space
Bursitis
To best demonstrate a possible Hill-Sachs defect, which additional positioning technique can be added to the inferosuperior axial projection? A. Angle CR 10 to 15 degree caudad B. Rotate affected arm externally, approximately 45 degree C. Angle CR 3 to 5 degree caudad D. Place humeral epicondyles parallel to IR
B. Rotate affected arm externally, approximately 45 degree
Avulsion fracture of the glenoid rim
Bankart lesion
Injury of the anteroinferior glenoid labrium
Bankart lesion
A radiography of an AP scapula reveals that the scapula is within the lung field & difficult to see. Which 2 things can the technologist do to improve the visibility of the scapula during repeat exposure?
Breathing technique & ensure affective arm at 90 degree
Compression fracture of humeral head
Hill-Sachs defect
Compression fracture of the articular surface of the humeral head
Hill-Sachs defect
Compression between the greater tuberosity & soft tissues on the coracoacromial ligamentous & osseous arch
Impingement syndrome
Subacromial spurs
Impingement syndrome
Sternoclavicular & Acromioclavicular
Plane
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 Projection Grashey method
Greater tubercle, Intertubercular groove, Surgical neck, Head, Anatomic neck, Lesser tubercle, deltoid tuberosity & Body
Proximal Humerus
Closed joint space
Rheumatoid arthritis
Traumatic injury to one or more of the supportive muscles of the shoulder girdle
Rotator cuff tear
What must be ruled out before performing the weight-bearing study for acromioclavicular joints?
fracture of clavicle
