Unit 1 ~ humerus and shoulder

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The three aspects of the clavicle are

(1) Acromial Extremity (2) Body (Shaft) (3) Sternal Extremity

The three angles of the scapula include the:

(1) Lateral Angle (head of the scapula) (2) Superior Angle (3) Inferior Angle

Where is the central ray center for an AP projection of the shoulder?

1 inch inferior to the coracoid process

Where is the central ray placed for an AP projection of the shoulder?

1 inch inferior to the coracoid process

What type of Central Ray angulation is required for the introsuperior axial projection of the shoulder?

25 to 30° medially

What type of central ray angulation is required for the inferior superior axial projection of the shoulder?

25 to 30° mediately

What type of CR angle is required for the apical AP axial shoulder projection?

30 degrees caudad

How much is a CR angled for the inferior superior axial projection Clements modification if the patient cannot fully abduct the arm 90°

5° to 15°

Which kV range should be used for shoulder series on an average adult?

70 to 80 kV

Which two basic shoulder projections (positions) are routinely taken for a shoulder and proximal humerus (with no traumatic injury)

AP and lateral

Which special projection of the shoulder requires that the effective side be rotated 45° toward the cassette and uses a 45° call Dad central ray angle?

AP apical oblique axial projection

Which two shoulder projections are taking routinely for a shoulder (with no traumatic injury) and proximal humerus?

AP external rotation, AP internal rotation

The___Projection of the shoulder produces an image of the glenoid process and profile. This is also referred to as the___method

AP oblique shoulder, Grashey method

Superior displacement of the distal clavicle

Acromioclavicular joint dislocation

Abnormal widening of acromioclavicular joint space

Acromioclavicular joint separation

Which structure of the scapula is most posterior

Acromion

On the anterior scapula this is the long curved process that extends laterally

Acromion process

List the movement types for the following joints; Scapula humoral: Sternoclavicular: Acromioclavicular:

Ball and socket plane plane

Avulsion fracture of the glenoid rim

Bankart lesion

Injury of the anterioinferior glenoid labrum

Bankart lesion

Injury of the anterior inferior glenoid labrum

Bankart lesion

Inferiorsuperior Axial Projection

Bernageau method

PA axial transaxillary projection

Bernageau method

What device permits good visualization of soft tissue and Bonnie anatomy for adult shoulder radiography?

Boomerang compensating filter

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

CR perpendicular to IR, directed to 1 inch (2.5 cm) inferior to coracoid process

The distal humerus contains a humoral Condyle that is divided into two parts:

Capitulum: located on the lateral aspect and articulates with the head of the radius Trochlea: located medially and articulates with the ulna.

On the anterior scapula this is the thick beak like process projecting anteriorly

Coracoid process

There are two anterior depressions of the distal humerus

Coronoid fossa: accepts coronoid process of ulna Radial fossa: accepts head of radius

Name the two surfaces of the scapula

Costal (anterior) dorsal (posterior)

Which basic projection of the shoulder requires that the humoral epicondyles be parallel to the IR?

External rotation AP

True or false rheumatoid arthritis is more prevalent in men over women

False

True or false the scapular why lateral position requires the body to be rotated 25° to 30° anteriorly toward the affected side

False

True or false: a 72 inch source image distance is recommended for most shoulder girdle studies

False

True or false: low MA with long exposure time should be used for adult shoulder studies

False

True or false: magnetic resonance imaging is an excellent modality for demonstrating boney injuries of the shoulder girdle

False

True or false: the affected our must be placed into external rotation for the transthoracic lateral projection

False

True or false: the PA axial transaxillary projection (Bernageau) requires no CR angle

False 30° caudad

Tangential for intertubercular (bicipital) groove Also known as what method

Fisk modification

Tangential for intertubercular (bicipital) groove sulcus

Fisk modification

What projection produces a tangential projection of the intertubercular Sulcus (groove)?

Fisk modification

True or false: large focal spot setting should be selected for most adult shoulder studies

Foss

True or false essential ray angle of 10° to 15° call dad maybe used for the transthoracic lateral shoulder projection if the patient is unable to elevate the uninjured arm and shoulder sufficiently

Foss 10° to 15° cephalad

AP apical oblique axial also known as what method

Garth method

AP apical oblique axial projection

Garth method

AP oblique for glenoid cavity also known as what method

Grashey method

Anterior oblique for glenoid cavity

Grashey method

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 and soft tissues on the coracoid acromion ligamentous and osseous arch

Impingement syndrome

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

Infraspinous fossa and supraspinous fossa

What are the three angles of the scapula?

Lateral- thickest portion sometimes called the head; ends at the glenoid cavity and excepts the head of the humerus to form the scapulohumeral joint Inferior - lower end of medial (vertebral) boarder Superior - upper end of medial (vertebral) boarder

Inferiosuperior axial also known as what method

Lawrence method

Transthoracic lateral also known as what method

Lawrence method

The___ (male or female) clavicle tends to be thicker and more curved in shape.

Male

An aesthetic patient requires___more or less CR angle for an AP axial clavicle projection and a hypersonic patient

More CR angle

Supraspinatus outlet tangential

Neer method

Supraspinatus outlet tangential Also known as what method

Neer method

What is the posterior depression of the distal humerus?

Olecranon fossa: accepts the olecranon process of the ulna

Which of the following clinical indication requires a decrease in manual exposure factors A: impingement syndrome B: bursitis C: Bankart lesion D: osteoporosis

Osteoporosis

What non-trauma projection can be performed erect to provide a lateral perspective of the proximal humerus in relationship to the scapulohumeral joint

PA axial transaxillary projection (Bernageau method)

Physical immobilization is required, which individual should be asked to restrain a child for a shoulder series?

Parent or guardian

How are the humoral epicondyles aligned for a rotation lateralomedial projection of the humerus?

Perpendicular to the IR

What projection of the shoulder produces an image of the glenoid process and profile

Posterior oblique (Grashey method)

Which projection is best for demonstrating a possible dislocation of the proximal humerus

Posterior oblique (Scapular Y) projection

To best demonstrate a possible hill Sachs defect, which additional positioning technique can be added to the the inferiosuperior axial (Lawrence method) projection?

Rotate affected arm externally approximately 45°

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

Rotator cuff tear

Which projection would be best for demonstrating a possible dislocation of the proximal humerus?

Scapular Y

On the anterior scapula, this is the notch on the superior border partially formed by the base of the coracoid

Scapular notch

Which non-trauma projection can be performed erect to provide a lateral view of the proximal humerus in relationship to the glenohumeral joint?

Superioinferior axial projection (Hobbs modification)

Which two landmarks are placed perpendicular to the IR for the scapular why lateral projection?

Superior angle of the scapula and the AC joint articulation

What are the three borders of the scapula?

Superior, medial (vertebral) lateral (axillary)

The most common injury to the rotator cuff is to the___tendon

Supraspinatus tendon

Special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs. Which create shoulder impingement symptoms

Tangential projection Supraspinatus outlet Near method or apical AP axial projection

Calcified tendons

Tendonisitis

With which projection is a breathing technique recommended?

Trans thoracic lateral for humerus

Which lateral projection can be performed to demonstrate the entire humorous for a patient with mid humeral fracture?

Transthoracic lateral projection for humorous

True or false call Lynn the use of a grid is not required for shoulder studies that measure less than 10 cm

True

True or false the shoulder is the most common joint to develop bursitis do too repetitive motion

True

True or false: CT arthrography of the shoulder joint often requires the use of iodinated contrast media injected into the joint space

True

True or false: nuclear medicine bone scans can demonstrate signs of osteomyelitis and cellulitis

True

True or false: shoulder projections are best performed erect when possible

True

True or false: sonography can provide a functional evaluation of joint movement that MRI cannot

True

True or false: the transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus

True

True or false: the use of a breathing technique can be performed for the transthoracic lateral humorous projection

True

True or false: the use of contact shields over the breast, long, and thyroid regions is recommended for most shoulder projections

True

True or false: it is recommended to perform shoulder positions on obese patients in the erect position when possible

True (to reduce OID and part distortion)

What is the anatomical name for the armpit?

axillary

Fluid filled joint space

bursitis

Which structure of the scapula extends most anteriorly

coracoid process

The anterior surface of the scapula is referred to as the

costal surface

True or false radiography is more sensitive than nuclear medicine for demonstrating physiologic aspects of the shoulder girdle

false

True or false: the KVP range for adult shoulder projections is between 100 to 110 KVP

false

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

fracture of the clavicle

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

impingement syndrome

Subacromial spurs

impingement syndrome

Narrowing of joint space

osteoarthritis

Atrophy of skeletal tissue

osteoporosis

Thin bony cortex

osteoporosis

The shoulder girdle consists of

proximal humerus, scapula, clavicle

Closed joint space

rheumatoid arthritis

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

rotator cuff tear

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

synovial, diarthrodial

Inflammatory condition of the tendon

tendonitis


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