Chapter 5 Shoulder Girdle

What additional maneuver must be added to the inferosuperior axial shoulder (Lawrence method) projection to best demonstrate a possible Hill- Sachs defect? a. Increase medial CR angulation. b. Angle the CR 10° to 15° downward or posteriorly in addition to the medial angle. c. Perform exaggerated external rotation of the affected upper limb. d. Increase abduction of the affected upper limb.

c. Perform exaggerated external rotation of the affected upper limb.

Which term describes the medial end of the clavicle? a. Acromial extremity b. Acromion c. Sternal extremity d. Acromial tuberosity

c. Sternal extremity

What is the name of the large fossa found within the anterior surface of the scapula? a. Supraspinous fossa b. Infraspinous fossa c. Subscapular fossa d. Glenoid fossa

c. Subscapular fossa

The AP oblique bilateral hands projection ("ball-catcher's position") is performed to evaluate for early signs of: a.gout. b. osteoporosis. c.rheumatoid arthritis. d.bursitis.

c. rheumatoid arthritis.

The inferosuperior axial projection (Clements modification) requires a CR angle of ____ toward axilla if a patient cannot fully abduct extremity 90°. a. 35° b. none c. 40° to 45° d. 5° to 15°

d. 5° to 15°

Which of the following projections can be performed using a breathing technique? a. Scapular Y lateral projection b. Inferosuperior axiolateral projection c. AP clavicle d. AP scapula

d. AP scapula

A patient enters the ED with multiple injuries. The physician is concerned about a dislocation of the left proximal humerus. The patient is unable to stand. Which of the following routines is advisable to best demonstrate this condition? a. AP shoulder and inferosuperior axiolateral projection b. AP shoulder and 35° to 45° LPO position (Grashey method) c. AP shoulder and Neer projection d. AP shoulder and recumbent AP oblique scapular Y projection

d. AP shoulder and recumbent AP oblique scapular Y projection

A patient enters the ED with a dislocated shoulder. The technologist attempts to position the patient into the transthoracic lateral projection, but the patient is unable to raise the unaffected arm over his head completely. What can the technologist do to compensate for the patient's inability to raise his arm completely? a. Perform the Grashey method instead. b. Use a breathing technique. c. Increase kV to penetrate through both shoulders. d. Angle the CR 10° to 15° cephalad.

d. Angle the CR 10° to 15° cephalad.

Which ionization chamber(s) for the AEC should be used for a tangential projection for an intertubercular groove? a. Center chamber b. Both outside chambers c. Left chamber d. Cannot use AEC with this projection

d. Cannot use AEC with this projection

A patient comes to radiology with a possible tear of the ulnar collateral ligament of the wrist. The patient complains of discomfort near the thumb region. Basic thumb projections do not demonstrate any type of fracture or dislocation. Which one of the following projections can be performed to confirm an injury to the ulnar collateral ligament? a.Norgaard method b.Modified Robert's method c.Gaynor-Hart method d.Folio method

d. Folio method

What is the common term for idiopathic chronic adhesive capsulitis? a. Bankart lesion b. Tendinitis c. Bursitis d. Frozen shoulder

d. Frozen shoulder

A patient with a history of carpal tunnel syndrome comes to radiology. The physician wants to rule out abnormal calcifications in the carpal sulcus. Which of the following projections would best demonstrate this region? a.Coyle method b.Jones method c.Carpal bridge d.Gaynor-Hart method

d. Gaynor-Hart method

A lateral elbow radiograph demonstrates about half of the radial head superimposed by the coronoid process of the ulna. Which of the following occurred? a.The hand was pronated rather than in a true lateral position. b.The hand and wrist were rotated laterally and not in a true lateral position. c.The shoulder was not dropped sufficiently to the tabletop level. d.No positioning errors occurred.

d. No positioning errors occurred.

Where is the CR centered for the bilateral acromioclavicular (AC) joint projection on a single 14- × 17-inch (35 × 43 cm) image receptor? a. At the affected AC joint b. 1 inch (2.5 cm) above jugular notch c. At the level of the thyroid cartilage d. At the sternal angle

b. 1 inch (2.5 cm) above jugular notch

Where is the CR centered for the posterior oblique position for the glenoid cavity? a. Acromion b. 2 inches (5 cm) medial and inferior to the superolateral border of shoulder c. Coracoid process d. 1 inch ( 2.5 cm) superior to the coracoid process

b. 2 inches (5 cm) medial and inferior to the superolateral border of shoulder

How much CR angulation is required for an asthenic patient for an AP axial projection of the clavicle? a. 15° b. 30° c. 45° d. No CR angulation should be used for this projection.

b. 30°

An inferosuperior axial projection (Clements modification) is performed on a patient with a nontraumatic shoulder injury. The patient cannot fully abduct the upper limb 90°. Which of the following modifications of the position should be performed for this patient? a. Angle CR 30° toward the axilla. b. Angle CR 5° to 15° toward the axilla. c. Angle CR 45° toward the elbow AC joint separation. d. Rotate shoulder slightly anterior to open joint space.

b. Angle CR 5° to 15° toward the axilla.

How much posterior CR angulation is required for the supine version of the tangential projection for the intertubercular (bicipital) groove? a. 20° to 30° b. 30° to 40° c. 10° to 15° d. No angle is used for this projection.

c. 10° to 15°

What medial central ray (CR) angle is required for the inferosuperior axial shoulder (Lawrence method)? a. 5° to 10° b. 40° to 45° c. 25° to 30° d. 10° to 15°

c. 25° to 30°

A radiograph for an AP projection with external rotation of the proximal humerus reveals that the greater tubercle is profiled laterally. What should be changed to improve this image for a repeat exposure? a. Rotate epicondyles so they are perpendicular to the image receptor. b. Move the patient obliquely 10° to 15° toward the affected side. c. Rotate the arm to place palm of the patient's hand against the thigh. d. Positioning is acceptable; do not repeat it.

d. Positioning is acceptable; do not repeat it.

A radiograph of a PA projection of the hand reveals that the distal radius and ulna and the carpals were cut off. What should the technologist do to correct this problem? a.Accept the radiograph. Carpals and distal radius and ulna are not part of a hand study. b.Make sure the carpals, distal radius, and ulna are included on the lateral projection. c.If the injury to the patient did not involve the carpal region and distal forearm, do not repeat it. d.Repeat the PA projection to include all the carpals and about 1 inch (2.5 cm) of the distal radius and ulna.

d. Repeat the PA projection to include all the carpals and about 1 inch (2.5 cm) of the distal radius and ulna.

Which of the following joints is considered to have a spheroidal type of movement? a. Acromioclavicular joints b. Sternoclavicular joints c. Bicipital joint d. Scapulohumeral joint

d. Scapulohumeral joint

What is a possible radiographic sign for impingement syndrome of the shoulder? a. Calcified tendons b. Fluid-filled joint space c. Fracture of the glenoid rim d. Subacromial spurring

d. Subacromial spurring

A patient enters the ER with a possible Bennett's fracture. Which of the following routines should be performed to confirm this diagnosis? a.Finger b.Wrist c. Forearm d.Thumb

d. Thumb

Increase, Decrease, or No Change in technique for the following pathologies.

1. Advanced Paget's disease Increase 2. Bursitis No change 3. Advanced osteoporosis Decrease 4. Bone tumors No change 5. Osteomyelitis No change 6. Carpal tunnel syndrome No change 7. Small joint effusion No change 8. Advanced rheumatoid arthritis Decrease

A patient with a fractured forearm had the fracture reduced and a fiberglass cast placed on the extremity. The orthopedic surgeon orders a post-reduction study. The original technique was 60 kV with 3 mAs. Which of the following techniques should be selected for the post- reduction study? a.64 kV, 3 mAs b.64 kV, 6 mAs c.60 kV, 6 mAs d.70 kV, 3 mAs

a. 64 kV, 3 mAs

Which of the following shoulder positions is considered a trauma projection (can be performed safely for a possible fracture or dislocation)? a. AP apical oblique axial (Garth method) projection b. Inferosuperior axial (Clements modification) projection c. AP projection-internal rotation d. None of the above

a. AP apical oblique axial (Garth method) projection

What type of CR angle is required for the superoinferior axial projection (Hobbs modification)? a. CR is perpendicular to IR b. 5° to 15° toward axilla c. 25° away from axilla d. 10° toward shoulder

a. CR is perpendicular to IR

A radiograph of a scapular Y lateral position reveals that the scapula is slightly rotated (the vertebral and axillary borders are not superimposed). The axillary border of the scapula is determined to be more lateral compared with the vertebral border. Which of the following modifications should be made for the repeat exposure? a. Decrease rotation of thorax. b. Decrease CR angle. c. Increase rotation of thorax. d. Abduct the arm more and flex it at the elbow.

a. Decrease rotation of thorax.

A radiograph of an AP oblique elbow with medial rotation reveals that the radial head is superimposed over part of the coronoid process. What positioning error has been committed? a. Excessive medial rotation b. Flexion of the elbow c. Excessive lateral rotation d. Incorrect CR angulation

a. Excessive medial rotation

A radiograph of a PA oblique of the hand reveals that the mid-aspect of the fourth and fifth metacarpals are superimposed. What specific positioning error has been committed? a.Excessive rotation of the hand and/or wrist b.Insufficient rotation of the hand and/or wrist c.Incorrect CR angulation d.Fingers of the hand are not parallel to IR

a. Excessive rotation of the hand and/or wrist

Which of the following AP shoulder projections demonstrates the greater tubercle in profile? a. External rotation b. Internal rotation c. Neutral rotation d. None of the above

a. External rotation

A patient is scheduled for an arthrogram. During the course of the study, the radiologist requests a projection to demonstrate the intertubercular groove. Which one of the following projections would best demonstrate this structure? a. Fisk modification b. Garth method c. Grashey method d. Pearson method

a. Fisk modification

Which of the following shoulder projections best demonstrates the glenoid cavity in profile? a. Grashey method b. Clements modification c. Garth method d. AP shoulder, neutral rotation

a. Grashey method

Which rotation of the humerus will result in a lateral position of the proximal humerus? a. Internal rotation (epicondyles perpendicular to image receptor) b. Neutral rotation (epicondyles 45° to the image receptor) c. External rotation (epicondyles parallel to the image receptor) d. None of the above

a. Internal rotation (epicondyles perpendicular to image receptor)

Which of the following best demonstrates the coracoacromial arch? a. Neer method b. West Point method c. Fisk method d. Garth method

a. Neer method

How much CR angulation should be used for a scapular Y projection? a. No CR angle should be used. b. 10° to 15° c. 20° to 30° d. 35° to 45°

a. No CR angle should be used.

A patient enters the ED with a possible AC joint separation. The patient is paraplegic; therefore, the study cannot be done erect. Which of the following routines would be performed to diagnose this condition? a. Non-weight-bearing and weight-bearing type of projections performed with the patient recumbent by pulling down on the shoulders b. Recumbent AP and AP axial projection of the clavicles to include AC joints c. AP projections of shoulders with external and internal rotation performed recumbent d. AP and AP apical oblique projection of the shoulder performed recumbent

a. Non-weight-bearing and weight-bearing type of projections performed with the patient recumbent by pulling down on the shoulders

A referring physician suspects that a subacromial spur may be the cause for a patient's arm numbness. She asks the technologist for a projection that would best demonstrate any possible spurs. Which of the following projections would accomplish this objective? a. PA scapular Y lateral with 10° to 15° caudal angle b. PA scapular Y lateral with 10° to 15° cephalad angle c. AP oblique shoulder with 45° caudal angle d. AP shoulder with 10° to 15° caudal angle

a. PA scapular Y lateral with 10° to 15° caudal angle Neer method

A patient comes to radiology for treatment of an arthritic condition of the right shoulder. The radiologist orders AP internal/external rotation projections and an inferosuperior axiolateral projection of the scapulohumeral joint. However, the patient cannot abduct the arm for this projection. Which other projection will best demonstrate the scapulohumeral joint space? a. Posterior oblique (Grashey method) b. Scapular Y lateral c. Transthoracic lateral d. AP projection-neutral rotation

a. Posterior oblique (Grashey method)

A radiograph of an AP clavicle reveals that the sternal extremity is partially collimated off. What should the technologist do? a. Repeat the AP projection and correct collimation. b. Make sure the sternal extremity is included on the AP axial projection. c. Only repeat it if the patient's pain/symptoms involve the sternal extremity. d. Ask the radiologist whether he or she wants the projection repeated.

a. Repeat the AP projection and correct collimation.

A radiograph of a tangential, inferosuperior projection of the carpal canal reveals that the hamate is superimposed over the pisiform. Which of the following measures will correct this problem? a. Rotate the wrist and hand 10° internally. b.Increase the CR angle. c.Decrease the CR angle. d.Increase the extension of the hand and/or wrist.

a. Rotate the wrist and hand 10° internally.

All of the joints of the shoulder girdle are diarthrodial. a. True b. False

a. True

An orthostatic (breathing) technique can be performed for the AP projection of the scapula. a. True b. False

a. True

For AC joint weight-bearing studies, patients should not be asked to hold on to the weights with their hands; rather, the weights should be attached to the wrists. a. True b. False

a. True

Sonography is an effective diagnostic tool in studying the shoulder joint. a. True b. False

a. True

The Alexander method for AC joints requires a 15° cephalic CR angle. a. True b. False

a. True

The female clavicle is usually shorter and less curved than that of the male. a. True b. False

a. True

The recommended SID for AC joints is 72 inches (183 cm). a. True b. False

a. True

The use of a grid during shoulder radiography will result in higher patient dose over non-grid procedures. a. True b. False

a. True

Which of the following modalities best demonstrates shoulder joint pathology such as rotator cuff tears using dynamic evaluation techniques during joint movements? a. Ultrasound b. Magnetic resonance imaging (MRI) c. Computed tomography (CT) d. Arthrography

a. Ultrasound

A patient enters the ER with an elbow injury. The partially flexed AP and lateral positions reveal a possible fracture of the coronoid process. The patient's elbow is partially flexed and he refuses to extend it further. Which one of the following positions should be performed to confirm the fracture of the coronoid process? a.Jones method b.Coyle method with 80° flexion, CR angled 45° away from shoulder d.Coyle method with 90° flexion, CR angled 45° toward the shoulder e.Gaynor-Hart method

b. Coyle method with 80° flexion, CR angled 45° away from shoulder C

A radiograph of the inferosuperior axial projection (Lawrence method) demonstrates the acromion process of the shoulder to be located most superiorly (anteriorly). a. True b. False

b. False

For a Grashey method projection of the shoulder, the CR is centered to the acromion. a. True b. False

b. False - 2 inches inferior and medial from the superolateral border of the scapula

The arm should be abducted about 45° for an AP scapula. a. True b. False

b. False - 90 degrees

A posterior dislocation of the shoulder occurs more frequently than an anterior dislocation. a. True b. False

b. False - 95% of all shoulder dislocations are anterior

PA transaxillary (Hobbs modification) requires a 5° to 15° CR cephalic angle. a. True b. False

b. False - CR perpendicular to IR, & axilla & humeral head

The Hill-Sachs defect is a fracture of the articular surface of the glenoid cavity. a. True b. False

b. False - it is a compression fracture of the articular surface of the posteriolateral aspect of the humeral head that is often associated with anterior dislocation of the humeral head

The PA transaxillary projection (Hobbs modification) is performed to rule out possible shoulder dislocation. a. True b. False

b. False - should never be attempted with trauma

Which of the following structures is not part of the proximal humerus? a. Lesser tubercle b. Glenoid process c. Intertubercular groove d. Anatomic neck

b. Glenoid process

A radiograph of the PA scaphoid projection reveals extensive superimposition of the scaphoid and adjacent carpals. Which of the following factors can lead to this problem? a.Elevation of the hand and wrist b.Insufficient ulnar deviation c.Insufficient CR angle distally d.Slight flexion of the phalanges

b. Insufficient ulnar deviation C

Which of the following AP shoulder projections demonstrates the lesser tubercle in profile medially? a. External rotation b. Internal rotation c. Neutral rotation d. None of the above

b. Internal rotation

A patient enters the ER in severe pain with a possible dislocation of the elbow. The patient has the elbow flexed more than 90°. Which one of the following routines should be performed to confirm the diagnosis? a.Partially flexed AP and limited lateral projections b.Jones method and limited lateral projection c.Coyle method and limited lateral projection d.Lateral elbow only

b. Jones method and limited lateral projection

Which AP projection of the shoulder and proximal humerus is created by placing the affected palm of the hand facing inward toward the thigh? a. Internal rotation b. Neutral rotation c. External rotation d. AP axial

b. Neutral rotation

An AP apical oblique projection for an anteriorly dislocated scapulohumeral joint will project the humerus _____ to the glenoid cavity. a. superior b. inferior c. lateral d. medial

b. inferior

The AP humerus requires that the humeral epicondyles are _____ to the IR. a. set at a 45° angle b. parallel c. perpendicular d. slightly oblique

b. parallel

A patient enters the ED with multiple injuries including a possible fracture of the left proximal humerus. Which positioning rotation should be performed to determine the extent of the humerus injury? a. AP neutral shoulder rotation and carefully rotated internally proximal humerus b. AP shoulder as is; show radiograph to the ED physician before attempting a rotational lateral projection c. AP and horizontal beam transthoracic lateral shoulder projection d. AP and apical oblique shoulder without any arm rotation

c. AP and horizontal beam transthoracic lateral shoulder projection

A patient comes to the emergency department (ED) with a possible right AC joint separation. Right clavicle and AC joint exams are ordered. The clavicle is taken first, and a small linear fracture of the mid-shaft of the clavicle is discovered. What should the technologist do in this situation? a. Perform the weight-bearing phase as ordered. b. Reduce the amount of weight that would normally be given to the patient and perform the weight-bearing study. c. Consult with the ED physician before continuing with the AC joint study. d. Slowly give the patient more weight to hold until he begins to complain and then complete the AC joint study.

c. Consult with the ED physician before continuing with the AC joint study.

A young child comes to radiology with an elbow injury. The basic elbow projections demonstrate a possible nondisplaced fracture of the coronoid process. Beyond the medial oblique projection, what additional projection(s) can be performed to demonstrate the coronoid process in profile? a.Coyle method with 45° CR angle toward shoulder b.Radial head lateral projections c.Coyle method with 45° CR angle away from shoulder d.Acute flexion projection

c. Coyle method with 45° CR angle away from shoulder C

What is the name of the insertion point for the deltoid muscle located on the anterolateral surface of the humerus? a. Surgical neck b. Deltoid protuberance c. Deltoid tuberosity d. Intertubercular groove

c. Deltoid tuberosity

A radiograph of an AP projection of the elbow reveals that there is complete separation of the proximal radius and ulna. What positioning error has been committed? a.Excessive medial rotation b.Partial flexion of the joint c.Excessive lateral rotation d.Incorrect CR location and angle

c. Excessive lateral rotation Co

A patient enters the ED with a possible bony defect of the mid-wing area of the scapula. The patient is able to stand and move the upper limb freely. In addition to the routine AP scapula projection with the arm abducted, which of the following would best demonstrate the involved area? a. Take an apical oblique projection of the shoulder. b. Take a transthoracic lateral projection of the shoulder region. c. Have the patient reach across the chest and grasp the opposite shoulder for a lateral scapula projection. d. Have the patient drop the affected arm behind him or her and take a lateral scapula projection.

c. Have the patient reach across the chest and grasp the opposite shoulder for a lateral scapula projection.

A patient enters the ED with a mid-shaft humeral fracture. The AP projection taken on the cart demonstrates another fracture near the surgical neck of the humerus. The patient is unable to stand or rotate the humerus because of the extent of the trauma. What other projection should be taken for this patient? a. Scapular Y lateral-AP oblique projection b. Apical oblique projection c. Horizontal beam transthoracic lateral projection for humerus d. Rotational lateral projection for humerus

c. Horizontal beam transthoracic lateral projection for humerus

A radiograph of an AP oblique projection for the glenoid cavity reveals that the anterior and posterior rims of the glenoid process are not superimposed. Which of the following modifications should produce a more acceptable image? a. Angle CR 5° to 10° caudad. b. Angle CR 5° to 10° cephalad. c. Increase rotation of the body. d. Abduct the arm slightly.

c. Increase rotation of the body.

A radiograph of an AP axial projection of the clavicle demonstrates that the clavicle is within the mid-aspect of the lung apices. What should the technologist do to correct this error? a. Do nothing; this is an acceptable AP axial clavicle projection. b. Increase the caudal CR angle during repeat exposure. c. Increase the cephalic CR angle during repeat exposure. d. Make the exposure upon complete inspiration.

c. Increase the cephalic CR angle during repeat exposure.

Which one of the following projections/positions should NOT be performed for a possible shoulder dislocation? a. AP axial oblique (Garth method) b. Transthoracic lateral (Lawrence method) c. Inferosuperior axial (Clements modification) d. Scapular Y

c. Inferosuperior axial (Clements modification)

Which projection of the shoulder requires that the patient be rotated 45° to 60° toward the IR from a PA position? a. Inferosuperior axiolateral projection b. AP oblique projection c. Lateral scapula projection d. None of the above

c. Lateral scapula projection

Where is the CR centered for a transthoracic lateral projection for proximal humerus? a. 1 inch (2.5 cm) inferior to the acromion b. Level of the greater tubercle c. Level of surgical neck d. Midaxilla

c. Level of surgical neck

A patient enters the ER with a possible scaphoid fracture. The patient is unable to assume the ulnar deviation position. Which of the following positions should be performed to confirm the diagnosis? a.Gaynor-Hart b.Jones c.Modified Stecher d.Coyle

c. Modified Stecher

A radiograph of a transthoracic lateral projection reveals that it is difficult to visualize the proximal humerus due to the ribs and lung markings. The following analog exposure factors were used: 75 kV, 30 mAs, 40-inch (102 cm) SID, grid, and suspended respiration. Which of the following changes will improve the visibility of the proximal humerus? a. Make the exposure on second inspiration. b. Use a compression band to prevent patient movement. c. Use a 72-inch (183 cm) SID. d. Use an orthostatic (breathing) technique.

d. Use an orthostatic (breathing) technique.

The anterior surface of the scapula is referred to as the: a. scapular surface. b. dorsal surface. c. supraspinous and infraspinous fossa. d. costal surface.

d. costal surface.