Merrills Chapter 5
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
10 to 15 degrees
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
10 to 15 degrees cephalad
how many articulations does the shoulder girdle have
3
what patient position would be required if the patients right shoulder is to be examined
35 to 45 degress RPO
what position would be used to examine a patient's injured left shoulder
45 to 60 degrees LAO
the recommended SID for radiography of the AC joints is
72 inches
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 the clavicle is at the level of first or second rib
the AP and PA projections produce similar images. Identify which projection produces the best spatial resolution and explain why
PA. decreased OID
what is the proper arm position for the Grasley method
abducted in slight internal rotation
lateral end of clavicle
acromial
lateral extension of scapular spine
acromion
scapular spinal process of shoulder girdle
acromion
what is the name of the lateral end of the scapular spine
acromion
what structure of the scapula articulates with the lateral end of the clavicle
acromion
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
the portion of the humerus located between the tubercles and the head is called the ___ neck
anatomic
narrow constriction superior to the tubercles
anatomic neck
which surface of the scapula is the costal surface
anterior
with reference to the long axis of the body, how should the affected arm be positioned
as close as possible to right angle
which area of the body should the central ray enter
axilla of the affected arm
identify the joint type for each articulation of the shoulder girdle
ball and socket for scapulohumeral gliding for the AC and SC
small, synovial fluid filled sacs that relieve pressure and reduce friction in tissue are called
bursae
inflammation of the bursa
bursitis
malignant tumor arising from cartilage cells
chondrosarcoma
anterior part of shoulder girdle
clavicle
what bone forms the anterior part of the shoulder girdle
clavicle
how does the appearance of the clavicle differ in the axial projections compared with the AP/PA projections
clavicle is more horizontal and projected free of bony superimposition in axial projections
anterior scapular process
coracoid
slender, finger-like projection extending anteriorly and laterally from near the lateral angle
coracoid process
what is the most anterior bony projection of the scapula
coracoid process
anterior scapular surface
costal
anterior aspect of scapula
costal surface
scapular spine ridge
crest
displacement of a bone from the joint space
dislocation
into which rotational position should the humerus be placed
external
for the AP axial projection, the exposure should occur after the patient has been instructed to suspend respiration following full expiration
false
for the AP projection the patient should be rotated toward the affected side for best placement of the scapula parallel with the IR
false
the AP and PA projections should demonstrate the entire clavicle free from superimposition with other bony structures
false
the central ray should be directed perpendicularly to the affected AC joints for each image
false
the patient may be positioned either upright or supine to demonstrate AC joints
false
bone classification for scapula
flat
what bone classification is the scapula
flat
For the fisk modification, the IR is supported on the patients
forearm
disruption in the continuity of bone
fracture
cavity for humeral head
glenoid
a properly positioned AP oblique image will demonstrate the _ in profile
glenoid cavity
large fossa at lateral angle
glenoid cavity
what type of joints are SC and AC joints
gliding
bony process on the lateral surface of the bone
greater tubercle
large, rounded eminence that articulates with the glenoid cavity
head
articulates with scapula
humerus
what bones articulates with the glenoid cavity
humerus
most distal angle of shoulder girdle
inferior
the junction of the medial and lateral borders
inferior angle
list the names of the scapular angles
inferior angle, superior angle, lateral angle
posterior-inferior scapular fossa
infraspinous
large, broad area below the spine on dorsal surface
infraspinous fossa
for the lateral projection, how should the affected arm be placed for best demonstration of the acromion and coracoid proces
instruct the patient to flex the elbow
deep depression that separates the two tubercles
intertubercular (bicipital) groove
at what level is the clavicle
just above the first rib
Which end of the clavicle articulates with part of the scapula
lateral
scapular border
lateral
which scapular border should be demonstrated free from superimposition with the ribs for the AP projection
lateral
extends from the glenoid cavity to the inferior angle
lateral border
bony process on the anterior surface of the shaft, inferior from the anatomic neck
lesser tubercle
bone classification for humerus
long
What classification of bone is the clavicle?
long bone
what gender of adults has more sharply curved clavicles
males
scapula border
medial
which end of the clavicle articulates with the manubrium
medial
extends from the superior angle to inferior angle
medial border
list the names of the scapular borders
medial border, lateral border, superior
transfer of a cancerous lesion from one area to another
metastases
where on the scapula is the scapular notch located
near the lateral end of the superior border
on superior border
notch
form of arthritis marked by progressive cartilage deterioration in synovial joints and vertebrae
osteoarthritis
increased density of atypically soft bone
osteopetrosis
loss of bone density
osteoporosis
for the fisk modification how should the central ray be directed
perpendicular to the IR
for the lateral projection what is the significance of arm placement
placement of the arm determines what part of the scapula is demonstrated in superimposition with the humerus
the _ should be parallel with the plane of the IR
plane of superior angle and acromion
what positioning maneuver should be avoided if the patient possibly has a fractured humerus or dislocation of the scapulohumeral joint
rotation of the arm
posterior shoulder girdle bone
scapula
deep depression on superior border
scapular notch
what structures separates the two fossae on the posterior surfaces of the scapula
scapular spine
ball and socket joint
scapulohumeral
list the names of each shoulder girdle articulation
scapulohumeral, acromioclavicular, sternoclavicular
what positioning consideration determines how much the x-ray tube should be angled for AP axial and PA axial projections
size of patient
which type of respiration should the patient use to obliterate lung detail
slow breathing
large protrusion on dorsal surface
spine
medial end of clavicle
sternal
what bone articulates with the medial end of the clavicle
sternum
what breathing instructions should be given to the patient
stop breathing for the exposure
anterior scapular fossa
subscapular
what muscle covers and attaches to the costal surface of the scapula
subscapular
large depression on the costal surface
subscapular fossa
top scapular border
superior
the junction of the medial and superior borders
superior angles
extends from superior angle to coracoid process
superior border
the transthoracic lateral projection may be performed with the patient positioned upright or
supine
posterior-superior scapular fossa
supraspinous
name the two fossae located on the posterior surface of the scapula
supraspinous and infraspinous fossa
area above the scapular spine on dorsal surface
supraspinous fossa
how many surfaces, borders, and angles does a scapula have
surfaces: 2 borders: 3 angles:3
constriction of the shaft inferior to the tubercles
surgical neck
to what specific area of the humerus should the IR be centered for the transthoracic lateral projection
surgical neck
for AP projections, the patient's respiration should be
suspended
what classification of joints are sternoclavicular joints and acrominoclavicular joints
synovial
the lateral end of the clavicle is also known as
the acromial extremity
what positioning of the body should the central ray enter
the degree of abduction of the affected arm
The medial end of the clavicle is also known as
the sternal extremity
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 weights? why?
the weights should be fixed to the patients wrists. Attaching the weights prevents the patients from tensing muscles, making demonstration of a small dislocation more difficult
what is the purpose of abducting the upper limb for the AP projection
to pull scapula laterally from the thorax
AP projection images of scapula should demonstrate the acromoin and inferior angle
true
AP projection images should demonstrate the area of the scapula, including the glenoid cavity and coracoid process, without superimposition of the ribs
true
in an image of a normal shoulder, the humeral head should be directly superimposed over the junction of the scapular Y
true
the acromion and the inferior angle should be demonstrated in the lateral projection
true
the entire clavicle should be demonstrated with either AP or PA
true
the lateral projection image should demonstrate the lateral and medial borders superimposed
true
the lateral projection image should demonstrate the scapular body free from superimposition with the ribs
true
when the patient is recumbent, the head and upper torso should be elevated 3 inches
true
when using a horizontally directed central ray, the patient should be placed in the supine body position
true
new tissue growth where cell proliferation is uncontrolled
tumor
what procedures should be performed to demonstrate both AC joints on a patient who has wide shoulders
two IR's should be used and exposed simultaneously
which change to radiographic exposure factors should be used to aid effectively the blurring of long detail by the action of the heart when the patient is able to hold his or her breath for a sustained period
use a low mA/long exposure time combination with the usual mAs factor