Chapter 5 shoulder girdle positioning

For internal rotation of the shoulder you want the CR perpendicular to IR and ____ inch Inferior to the coracoid process

1

Where is the central ray center for an AP projection- external rotation of the shoulder

1 inch inferior to Coracoid process

When performing an AP projection of the shoulder, to where should essentially be directed

1 inch inferior to the coracoid process

For the correct version of the tangential projection for the intertubercular sulcus, The patient leans forward _________________________ from vertical

10 to 15 degrees

What central ray angulation is required for the tangential projection supraspinatus outlet (Neer method)

10 to 15 degrees caudad

Outlet projection (neer method) and scapular Y lateral are very similar projections. Both are centered at the scapulohumeral joint while the Neer method CR is _____ - ______ degrees while the scapular Y CR is perpendicular

10, 15

When angling for the AP axial projections of the clavicle you would angle ____- ____ degrees for hypersthenic patients and ____-____ degrees for asthenic patients

15, 20; 25, 30

Inferosuperior axial projection you want the shoulder raised how much from table top

2 inches

Obese patients the AC joint can be identified by going ____ inches inferior and ____ inch medial to locate the scpulohumeral joint

2, 1/2

Posterior dislocation which is uncommon ____-_____% results in the humeral head being demonstrated posteriorly beneath the acromion

2, 4

During a shoulder projection how much of the clavicle and scapula do you want Shown

2/3 of clavicle and upper scpula

What type of Central right angle should be used for the inferosuperior axial projection of the scapulohumeral joint space

25 to 30 degrees medially

With reference to the plane of the image receptor, how should the humeral epicondyles be positioned for the AP projection of the shoulder with the shoulder in neutral rotation

45 degrees medial oblique

When performing a lateral projection of the scapula with the patient positioned right anterior oblique (RAO) or left anterior oblique (LAO)Approximately how much body rotation is necessary for the average patient

45 to 60 degrees

If the patient cannot fully abductee affected arm 90° for the inferosuperior axial projection (clements modification) The technologist can angle the CR ___________________ towards the axilla

5 to 15 degrees

What is the minimum amount of weight a large adult should have strapped to each wrist for the weight-bearing phase of an AC joint and study

8 to 10lbs

For an AP projection of the AC joints bilaterally with weights A large Person would hold ____- _____ lbs while a smaller person would hold ____-_____ lbs

8,10; 5,8

Anterior dislocation is more common _____% result in humeral head being demonstrated anteriorly beneath the coracoid

95

Situation: A patient with a possible shoulder dislocation enters the emergency room. A neutral AP projection of the shoulder has been taken, confirming a dislocation. Which additional projection should be taken

AP apical oblique axial (Garth method)

Which projection of the shoulder best demonstrates the humeral head in profile

AP projection with external rotation

Which projection of the shoulder is being performed when the patient is supine with the right shoulder centered on the cassette, a vertical central ray is being directed perpendicular to the IR and directed 1 inch inferior to the coracoid process and the humeral epicondyles are parallel with the plane of the cassette

AP projection with external rotation

Which projection of the shoulder best demonstrates the lesser tubercle of the humerus in profile and pointing toward the glenoid cavity (fossa)

AP projection with internal rotation

Superior displacement of distal clavicle

Acromioclavicular joint dislocation

Situation:A patient with a possible right shoulder separation enters the emergency room. Which of the following routine should be used

Acromioclavicular joint series: Nonweightbearing in weight-bearing projections

What is the difference in the apical ap axial projection vs an ap

Acromiohumeral space is more open compared to an AP projection and proximal humerus is in neutral rotation position

Which of the following scapular structures as most posterior

Acromion

Which of the following structures is considered the most posterior

Acromion

Boomerang filter is a specially effective in demonstrating what...? While allowing for optimal visualization of the denser shoulder joint region

Acromion and AC joint regions

Which of the following projections requires the CR to be Centered 2 inches inferior and medial from the superolateral border of the shoulder

Anterior oblique (grashey method)

What projection demonstrates narrowing of acromiohumeral space in possible spurring of the anteromedial aspect of acromion

Apical AP axial projection

Which of the following projections and/or positions best demonstrates signs of impingement syndrome in the acromiohumeral space

Apical AP axial projection

What modality procedure requires the use of contrast medium injected into a joint capsule

Arthrography

What is seen in over 85% of cases after traumatic anterior dislocation of the shoulder

Bankart fracture

Injury to the anterioinferior glenoid labrum

Bankart lesion

What type of compression filter is recommended for the use on an AP shoulder projection for the hyperesthetic patient

Boomerang

What is the hill Sachs defect caused from

Caused by soft base of humeral head impacting hard anterior glenoid

What is an alternative a CR centering technique for an AP shoulder projection on an obese patient if unable to palpate the coracoid process

Center 2 inches below AC joint

Hill-Sachs defect

Compression fracture of the articular surface of the posterolateral aspect of the humeral head. Often associated with an anterior dislocation of humeral head

What modality procedure is used to evaluate soft tissue and skeletal involvement of lesions and soft tissue injuries

Computed tomography in magnetic resonance imaging

MOST clavicles are heavily what...? In heavily muscled men

Curved

AP apical oblique axial projection shoulder trauma (Garth method) especially demonstrates, posterior _____________

Dislocations

Shoulder and upper arm abnormalities, traumatic and pathologic in origin, or extremely painful. For this reason, the ___________ position of the patient should be used whenever possible for radiographic examinations of these parts

Erect

Two best demonstrate the hill Sachs defect on the infernosuperior axial projection, which additional positioning maneuver must be used

Exaggerated external rotation

Which routine projection of the shoulder requires that the humeral epicondyles be parallel to the IR

External rotation

True or false:The male clavicle is shorter and less curved than the female clavicle

False

True or false a posteroanterior (PA) axial projection of the clavicle requires a 35 to 45° caudal central ray angle

Flase

Which special projection of the shoulder places the glenoid cavity in profile for an "open" scapulohumeral joint

Grashey method

Compression fracture of humeral head

Hill-Sachs defect

For the lateral projection RAO or LAO of the scpula patient reaches across the front of the chest and grabs the opposite shoulder. The reason that we do this is is so that the _________ doesn't superimpose the body of the scapula

Humerus

What is the largest and longest bone of the other limb

Humerus

Disability of the shoulder joint caused by chronic inflammation in and around the joint

Idiopathic chronic adhesive capsulitis

When your hand is supinated in AP projection how is the humerus

In external rotation

A radiograph of an AP axial clavicle taken on an asthenic type patient shows that the clavicle is projected in the lung fields below the top of the shoulder. The following positioning factors were used:Erect position, Central right angle to 15° cephalad, 40 inch S ID, and respiration suspended at end of expiration. Which of the following modification should be made during the repeat exposure

Increase central ray angulation

When performing the AP projection of the scapula, The central ray should be directed toward a point 2 inches __________ to the Coracoid process

Inferior

AP apical oblique axial projection shoulder trauma (Garth method) with anterior dislocation's which of the most common the humerus is projected ______________

Inferiorly

Which position of the shoulder and proximal humerus projects the lesser tubercle in profile medially

Internal rotation

With reference to the body of the scapula, where is the coracoid process located

Lateral and superior

In a true AP projection the greater tubercle will be in profile __________

Laterally

Why would you ever do a PA projection of the clavicle

Less OID

Which two borders of the scapula unite to form the superior angle

Medial and superior

Which of the following is not an eagle found on the scapula

Medial angle

For the trauma horizontal beam lateral medial projection of the humerus where should the central ray enter the humerus

Midpoint of distal 2/3 of humerus to include elbow joint in proximal humerus

For the lateral projection RAO or LAO of the scapula where is the CR centered

Midvertebral border of the scapula

When your hand is placed against ur hip naturally humerus is in what position

Neutral position

What modality procedure is used to demonstrate osteomyelitis, metastatic bone lesions and cellulitis

Nuclear medicine

Which of the following imaging modalities or procedures best demonstrates osteomyelitis

Nuclear medicine

What can you use that will help blur out the surrounding pulmonary structures

Orthostatic breathing

Which of the following pathological conditions often reduces narrowing of the joint space

Osteoarthritis

Which projection of the shoulder joint requires the patient to be rotated 45 to 60° until the scapula is in a true lateral position

PA oblique projection (scapular Y)

Situation: The patient is referred to Radiology for non-trauma shoulder series. The routine calls for a P a transaxillary projection (Hobbs modification) To be included. But the patient is unable to stand and is confined to a wheelchair.What should the technologist do?

Perform the projection with the patient's upper chest prone on the table

With reference to the plane of the IR, how should the humeral epicondyles be positioned for the AP projection of the shoulder internal rotation

Perpendicular

How are the humeral epicondyles aligned for a rotational lateralmedial projection of the humerus

Perpendicular to IR

Where on the scapula is the supraspinous fossa located

Posterior surface, above the scapular spine

Where on the scapula is the infraspinous fossa located

Posterior surface, below the scapular spine

What is the major advantage of the supine, tangential version of the intertubercular Sulcus projection over the erect version

Reduced OID

Chronic systemic disease with arthritic information changes throughout the body

Rheumatoid arthritis

Which of the following pathological conditions may require a reduction in manual exposure factors

Rheumatoid arthritis

A radiograph of an anterior oblique (Grashey method)Shows that the anterior and posterior glenoid rams are not superimpose. The following positioning factors were used: Erect position, body rotated 25 to 30° toward the affected side, central ray perpendicular to a scapulohumeral joint space, and affected arm slightly abducted in neutral position. Which of the following modifications will super impose the glenoid rims during the repeat exposure

Rotate body more toward affective side

Traumatic injury to one or more muscles of the shoulder joint

Rotator cuff tear

For an AP projection of the neutral shoulder trauma where do you center

Scapulohumeral Joint Centered to IR

What correctly describes the shoulder joint

Scapulohumeral and Glenohumeral

Which clinical indication is best demonstrated with the Garth method

Scapulohumeral dislocations

Where do you center for an AP oblique projection of the glenoid cavity

Scapulohumeral joint

Where do you center for the scapular Y PA oblique projection shoulder trauma

Scapulohumeral joint

Which anatomy of the shoulder is best demonstrated with a PA transaxillary projection (Hobbs modification)

Scapulohumeral joint space

Before completing an AC joint projection ____________ and ____________ projection should be completed first to rule out fracture, or this radiograph may be taken without weights first and checked before it is taken with weights

Shoulder, clavicle

What modality procedure is used to evaluate soft tissues within the joint for possible rotor cuff tears; bursa injuries or disruption and damage to nerves, tendons, or ligaments

Sonography

Of which part of the scapula is the acromion an extension

Spine

On which border of the scapula is the scapular notch located

Superior

Which two positioning landmarks are aligned perpendicularly to the IR for the lateral scapular projection

Superior angle in AC joint

AP apical oblique axial projection shoulder trauma (Garth method) with the posterior dislocation, humerus is projected __________

Superiorly

Which of the following human structures is most distal anatomic neck Greater tubercles Lesser tubercles Surgical neck

Surgical neck

Situation: A patient comes into the radiology department with a history of tendinitis of the bicep tendon. Which of the following projections are best demonstrate calcification of the tendon within the intertubercular sulcus

Tangential projection (Fisk modification)

Male clavicle tends to be

Thicker and more curved

True or false the greatest Technical concern during a pediatric shoulder study is voluntary motion

True

True or false: Even though the amount of radiation exposure is minimal from the shoulder projections, Gonadal shielding should be used for children and adults of childbearing age

True

Which of the following imaging modalities are procedures provides a functional, or dynamic, study of the shoulder joint

Ultrasound

What are the three main parts of the clavicle

acromial extremity, sternal extremity, body

Tangential projection- supraspinatus Outlet: shoulder trams is used specifically to demonstrate the __________________ _______ for the supraspinatus outlet

coracoacromial arch

Which border of the scapula extends from the glenoid cavity to the inferior angle

lateral

In which body position should the patient be placed to demonstrate the left shoulder with the PA oblique projection (scapular Y)

left anterior oblique

Reduction in the quantity of bone

osteoporosis

Female clavicle is

shorter and less curved

An Ap apical oblique axial (Garth method) radiographic image demonstrates poor visibility of the shoulder joint. The technologist used the following factors: patient erect, facing the x-ray tube, 45 degree of roation of affected shoulder toward the IR, 45 degree cephalad angle, and the CR centered to the scapulohumeral joint. What factor would have contributed to this poor Garth psoition

wrong direction of CR angle

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

30 degrees caudad

Bankart fracture

A fracture of the anteroinferior glenoid rim

Which anatomy is best demonstrated by the Alexander method

AC joints

What projections is the boomerang filter typically used for

AP

Situation: A patient enters the ER with a proximal in midhumeral fracture. The patient is an extreme pain. Which of the following positioning routines with demonstrate the entire humerus without excessive movement of the limb

AP and transthoracic lateral of humerus

What projection would you do to see the glenoid cavity in profile without super imposition of humeral head

AP oblique projection

Which projection of the shoulder best demonstrates the greater tubercle of the humerus in profile

AP projection with external rotation

Which specific joints are found on the lateral end of the clavicle

Acromioclavicular

How many degrees and in which direction should the central ray be directed for the AP axial projection of the clavicle

Cephalically 15 to 30 degrees

Which of the following structures of the scapula extend the most interiorly

Coracoid process

Never attempt rotating an arm if _____________ or _______________ is suspected

Fracture, dislocation

Which type of injury must be ruled out before the weight-bearing phase of an AC joint study

Fractured clavicle

Which projection of the shoulder requires that a horizontal central ray be directed 25 to 30° immediately and enter the axilla of the affected arm

Inferosuperior axial projection (Lawrence method)

When the back of your hand is placed against hip what position is the humerus in

Internal rotation

Which two borders of the scapula unite to form the inferior angle

Medial and lateral

With reference to the plane of the IR, how should the humeral epicondyles be positioned for the AP projection of the shoulder with the shoulder in neutral rotation

Parallel

How should the central ray be directed for the PA oblique projection (scapular Y) of the shoulder?

Perpendicular to the cassette

Or shoulder trauma you would either use transthoracic lateral (Lawrence method) ORRRRR

Scapular Y: PA oblique projection

Which bony structure separates the supraspinatus and infraspinatus fossae

Scapular spine

What is the name of the fossa on the anterior surface of the scapula

Subscapular

What is another term for the middle area of the costal of surface of the scapula

Subscapular fossa

Which of the following projections best demonstrates the supraspinatus outlet region

Tangential projection (Neer method)

During the transthoracic lateral projection of the humerus the central ray should be directed through what

Thorax to mid diaphysis

With which of the following projections canon orthostatic breathing technique used

Transthoracic lateral for humerus

True or false a 72 inch SID is recommended for adults acromioclavicular joint studies

True

What is the type of joint movement for the scapulohumeral joint

ball and socket