Chapter 5 Shoulder Girdle

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

2 inches medial and inferior to the superolateral border of shoulder

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

Arthrography

T/F 51. The arm should be abducted about 45° for an AP scapula.

False-90 degrees

62. 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? Fisk modification Garth method Grashey method Pearson method

Fisk modification

69. What is the common term for idiopathic chronic adhesive capsulitis? Bankart lesion Tendinitis Bursitis Frozen shoulder

Frozen shoulder

2. Which term describes the medial end of the clavicle? Acromial extremity Acromion Sternal extremity Acromial tuberosity

Sternal extremity

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

Subacromial spurring

5. What is the name of the large fossa found within the anterior surface of the scapula? Supraspinous fossa Infraspinous fossa Subscapular fossa Glenoid fossa

Subscapular fossa

Fisk modification

Tangential, intertubercular groove projection

Neer method

Tangential, supraspinatus outlet projection

T/F 13. Part 3 refers to the greater tubercle.

True

T/F 16. The use of a grid during shoulder radiography will result in higher patient dose over nongrid procedures.

True

T/F 28. The PA transaxillary projection (Hobbs modification) is performed to rule out possible shoulder dislocation.

True

T/F 3. The female clavicle is usually shorter and less curved than that of the male.

True

T/F 49. The recommended SID for AC joints is 72 inches (183 cm).

True

T/F 52. An orthostatic (breathing) technique can be performed for the AP projection of the scapula.

True

T/F 56. 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.

True

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

5-15

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

AP scapula

46. 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? AP shoulder and inferosuperior axiolateral projection AP shoulder and 35° to 45° LPO position (Grashey method) AP shoulder and Neer projection AP shoulder and recumbent AP oblique scapular Y projection

AP shoulder and recumbent AP oblique scapular Y projection

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

CR is perpendicular to IR

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

Cannot use AEC with this projection

9. Which view and projection of the proximal humerus is represented in the figure? External rotation, anteroposterior (AP) projection Neutral rotation, AP projection Internal rotation, AP projection External rotation, lateral projection

External rotation, AP projection

T/F 12. Part 10 refers to the vertebral border of the scapula.

False

T/F 21. A radiograph of the inferosuperior axial projection (Lawrence method) demonstrates the acromion process of the shoulder to be located most superiorly (anteriorly).

False

T/F 22. For a Grashey method projection of the shoulder, the CR is centered to the acromion.

False

T/F 32. PA transaxillary (Hobbs modification) requires a 5° to 15° CR cephalic angle.

False

T/F 50. The Hill-Sachs defect is a fracture of the articular surface of the glenoid cavity.

False

T/F 54. A posterior dislocation of the shoulder occurs more frequently than an anterior dislocation.

False

41. 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? Decrease rotation of thorax. Decrease CR angle. Increase rotation of thorax. Abduct the arm more and flex it at the elbow.

Increase rotation of thorax.

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

Increase the cephalic CR angle during repeat exposure

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

Inferosuperior axial (Clements modification)

Clements modification

Inferosuperior axial projection

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

Internal rotation

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

Internal rotation

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

Level of the surgical neck

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

No CR angle should be used

45. 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? PA scapular Y lateral with 10° to 15° caudal angle PA scapular Y lateral with 10° to 15° cephalad angle AP oblique shoulder with 45° caudal angle AP shoulder with 10° to 15° caudal angle

PA scapular Y lateral with 10 to 15 degrees caudal angle

Hobbs modification

PA transaxillary projection

T/F 55. The Alexander method for AC joints requires a 15° cephalic CR angle.

True

T/F 67. Sonography is an effective diagnostic tool in studying the shoulder joint.

True

T/F 7. All of the joints of the shoulder girdle are diarthrodial.

True freely movable

38. 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? Make the exposure on second inspiration. Use a compression band to prevent patient movement. Use a 72-inch (183 cm) SID. Use an orthostatic (breathing) technique.

Use an orthostatic breathing technique

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

25 to 30

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

30

59. 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? AP neutral shoulder rotation and carefully rotated internally proximal humerus AP shoulder as is; show radiograph to the ED physician before attempting a rotational lateral projection AP and horizontal beam transthoracic lateral shoulder projection AP and apical oblique shoulder without any arm rotation

AP and horizontal beam transthoracic lateral shoulder projection

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

AP apical oblique axial (Garth method)

Garth method

AP apical oblique axial projection

63. 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? Angle CR 30° toward the axilla. Angle CR 5° to 15° toward the axilla. Angle CR 45° toward the elbow AC joint separation. Rotate shoulder slightly anterior to open joint space.

Angle CR 5 to 15 degrees to the axilla

61. 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? Perform the Grashey method instead. Use a breathing technique. Increase kV to penetrate through both shoulders. Angle the CR 10° to 15° cephalad.

Angle the CR 10-15 cephalad

43. 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 midshaft of the clavicle is discovered. What should the technologist do in this situation? Perform the weight-bearing phase as ordered. Reduce the amount of weight that would normally be given to the patient and perform the weight- bearing study. Consult with the ED physician before continuing with the AC joint study. Slowly give the patient more weight to hold until he begins to complain and then complete the AC joint study.

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

4. The anterior surface of the scapula is referred to as the: scapular surface. dorsal surface. supraspinous and infraspinous fossa. costal surface.

Costal surface

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

Deltoid tuberosity

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

Glenoid process

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

Grashey method

37. 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? Angle CR 5° to 10° caudad. Angle CR 5° to 10° cephalad. Increase rotation of the body. Abduct the arm slightly.

Increase rotation of the body

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

Inferior

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

Lateral scapula projection

33. Which of the following best demonstrates the coracoacromial arch? Neer method West Point method Fisk method Garth method

Neer method

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

Neutral rotation

47. 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? Non-weight-bearing and weight-bearing type of projections performed with the patient recumbent by pulling down on the shoulders Recumbent AP and AP axial projection of the clavicles to include AC joints AP projections of shoulders with external and internal rotation performed recumbent AP and AP apical oblique projection of the shoulder performed recumbent

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

10. Part 5 refers to the coracoid process. superior border of scapula. lateral angle of scapula. none of the above.

None of the above

57. Which of the following AP shoulder projections demonstrates the greater tubercle in profile medially? External rotation Internal rotation Neutral rotation None of the above

None of the above

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

Parallel

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

Perform exaggerated external rotation of the affected upper limb

39. 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? Rotate epicondyles so they are perpendicular to the image receptor. Move the patient obliquely 10° to 15° toward the affected side. Rotate the arm to place palm of the patient's hand against the thigh. Positioning is acceptable; do not repeat it.

Positioning is acceptable, do not repeat it

42. 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? Posterior oblique (Grashey method) Scapular Y lateral Transthoracic lateral AP projection-neutral rotation

Posterior oblique (Grashey)

Grashey method

Posterior oblique, Glenoid cavity projection.

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

Scapulohumeral joint

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

1 inch above the jugular notch

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

10 to 15

48. A patient enters the ED with a possible bony defect of the midwing 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? Take an apical oblique projection of the shoulder. Take a transthoracic lateral projection of the shoulder region. Have the patient reach across the chest and grasp the opposite shoulder for a lateral scapula projection. Have the patient drop the affected arm behind him or her and take a lateral scapula projection.

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

44. A patient enters the ED with a midshaft 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? Scapular Y lateral-AP oblique projection Apical oblique projection Horizontal beam transthoracic lateral projection for humerus Rotational lateral projection for humerus

Horizontal beam transthoracic lateral projection for humerus

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

Repeat the AP projection and correct collimation.