Chapter 5 Upper Limbs Positioning/Situations

80-90 kV

What is the kV range using digital for a shoulder series on an average adult using a grid?

reduced OID

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

Garth method

What is the method name for the projection AP Apical Oblique Axial?

Grashey method

What is the method name for the projection Anterior Oblique for Glenoid Cavity?

Neer method

What is the method name for the projection Supraspinatus Outlet Tangential?

Fisk modification

What is the method name for the projection Tangential for Intertubercular (Bicipital) Sulcus?

Lawrence method

What is the method name for the projections Inferosuperior axial and Transthoracic lateral?

8-10 pounds

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 study?

suspected AC joint subluxation

What is the most come clinical indication to perform the Alexander method for the AC joints?

boomerang compensating filter

What is the name of the device that permits good visualization of soft-tissue and bony anatomy for adult shoulder

inferosuperior axial projection

What is the name of the projection shown in Fig 5.7

fracture of the clavicles

What must be ruled out before performing the weight-bearing study for acromioclavicular joints.

30 degrees caudad

What type of CR angle is required for the Apical AP Axial Shoulder projection?

none

What type of CR angle is required for the lateral scapula position?

25-30 degrees medially

What type of CR angle should be used for the inferosuperior axial projection for the scapulohumeral joint?

25-30 degrees medially

What type of CR angulation is required for the inferosuperior axial projection for the shoulder?

boomerang

What type of compensating filter is recommended for use on an AP shoulder projection for a hypersthentic patient?

internal rotation

What type of rotation is the arm in if the epicondyles are perpendicular to the IR, lesser tubercle is profiled medially, and proximal humerus is in a lateral position

neutral rotation

What type of rotation is the arm in if the humeral epicondyles angled 45 degrees to IR, and the palm of your hand is against your thighs

external rotation (Fig 5.9)

What type of rotation is the arm in if you can see the greater tubercle profiled laterally, the hand is supinated, epicondyles parallel to IR and proximal humerus is position for an AP projection

PA transaxillary projections (Hobbs modification)

Which of the following nontrauma projections can be performed erect to provide a lateral view of the proximal humerus in relationship to the scapulohumeral joint?

apical AP axial projection

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

tangential projection (neer method)

Which of the following projections best demonstrates the supraspinatus outlet region?

anterior oblique (grashey method)

Which of the following projections requires the CR to be centered 2 in (5 cm) inferior and medial from the superolateral border of the shoulder?

internal rotation (position)

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

posterior oblique (scapular Y) projection

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

neutral rotation (image)

Which projection of the proximal humerus is represented by Fig 5.2?

fisk modification

Which projection produces a tragential projection of the intertubercular sulucus (groove)?

external rotation

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

grashey method

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

AP Apical Oblique Axial projection

Which special projection of the shoulder requires that the affected side be rotated 45 degrees toward the cassette and uses a 45 degree caudad CR angle

superior angle of scapula and AC joint

Which two landmarks are placed perependicular to the IR for scapular Y lateral projection?

AP internal and AP external

Which two routine shoulder projection are routinely taken for a shoulder (with no traumatic injury) and proximal humerus

fractured clavicle

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

transthoracic lateral for humerus

With which of the following projections can an orthostatic (breathing) technique be used?

anterior margin of the humeral head is seen in profile. Humeral tubercles and the intertubercular sulcus is seen is profile

Fisk Modification is trying to demonstrate what type of anatomy?

perpendicular to IR

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

Hobbs Modification

PA Transaxillary Projection: Shoulder is also known as what?

lower kVp to 70-75

95 kV, 20 mAs, high-speed screens, 40 inch (102 cm) SID, grid, and suspended respiration where the techniques used on a AP shoulder projection. The image produces had poor contrast between soft tissue and bone, what could be done to fix this probelm?

The proximal 1/3 of the humerus nd upper scapula and the lateral 2/3 of the clavicle are shown

AP Projection- Neutral Rotation: Shoulder is trying to demonstrate what type of anatomy?

the medial portion of the scapula is seen through the thoracic structures

AP scapula projection is trying to demonstrate what type of anatomy.

Alexander Method

Alternative AP Axial Projection: AC Joints is also known as what?

wrong direction of CR angle

An AP apical oblique axial (garth method) image demonstrates poor visibility of the shoulder joint. These are the following x-ray factors: patient erect, facing the x-ray tube, 45 degree rotation of affected shoulder toward the iR, 45 degree cephalad angle, and CR centered to the scapulohumeral joint. Which of the factors lead to the bad image.

more

An asthenic patient requires ............................ CR angle for an AP axial clavicle projection than a hypersthenic patient

possible subacromial spurs

Supraspinatus Outlet; Neer method, Apical AP axial projections also help detect what?

Fisk Modification

Tangential Projection- Intertubercular (Bicipital) Sulcus: Shoulder is also known as what?

Neer Method

Tangential Projection- Supraspinatus Outlet: Shoulder is also known as what.

Lateral Position: Scapula (pateint erect)

This erect position as the clincal indicators of horizontal fracture of the scapula.

posterior dislocation

This is a less common type of dislocation that can be seen with scapular Y lateral where the humeral head is demonstrated inferior to acromion process

AP Projection: Humerus

This is a non trauma projection with clinical indications of looking for fracture and dislocation of the humerus, and pathologic process including osteoporosis. What position is this?

Transthoracic Lateral Projection: Humerus

This is a trauma view of the humerus that has clinical indications of fractures of the diaphysis of the humerus.

Horizontal Beam-Lateromedial Projections: Mid-to-Distal Humerus

This is a trauma view of the humerus that has the clinical indicators of fracture/dislocation of the midhumerus/distal humerus and pathologic process including osteoporosis, what position is this?

Alternative AP Axial Projection: AC Joints

This is an alternative AC joint projection thats trying to possible see suspected AC joint subluxation or dislocation

Lawrence Method (transthoracic)

Transthoracic Lateral Projections: Proximal Humerus is also known as what?

False (MRI)

True or False Magnetic resonance imaging (MRI) is an excellent modality for demonstrating bony injuries of the shoulder girdle

False (SID)

True or False: A 72 in (183 cm) source image distance (SID) is recommended for most shoulder girdle studies

True (AC joint)

True or False: A 72 in (183 cm)is recommended for adult acromioclavicular joint studies

False (10-15 degrees cephalad)

True or False: A CR angle of 10-15 degrees caudad may be used for the transthoracic lateral shoulder projection if the patient is unable to elevate the uninjuried arm and shoulder sufficiently

False (PA axial)

True or False: A PA axial projection of the clavicle requires a 35-45 degree caudal CR angle

True (high-speed)

True or False: A high-speed screen-IR system is recommended for analog shoulder studies when using a grid

True (contrast)

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

True (obese)

True or False: It is recommended to perform shoulder position on obese patients in the erect position when possible

False (large)

True or False: Large focal spot setting should be selected for most adult shoulder studies

False (low)

True or False: Low mA with short exposure times should be used ofr adult shoulder studies

True (bone scanes)

True or False: Nuclear medicine bone scans can demonstrate signs of osteomyelitis and cellulitis

False (physiologic)

True or False: Radiography is more sensitive than nuclear medicine for demonstrating physiologic aspects of the shoulder girdle

True (dynamic)

True or False: Sonography (ultrasound) can provide a functional (dynamic) evaluation of joint movement that MRI cannot

True (PA)

True or False: The PA transaxillary projection (Hobbs modification) requires no CR angle.

False (arm)

True or False: The affected arm must be placed into external rotation for the transthoracic lateral projection

False (kV)

True or False: The kV range for an adult shoulder projection is between 60 and 70 kV for analong and 100 to 110 kV for digital imaging systems

False: arm location along with CR centering are different

True or False: The lateral scapula and posterior oblique (Scapular Y) projection are the same projection

False (Y)

True or False: The scapular Y lateral (posterior oblique) position requires the body to be rotated 25 to 30 degrees anteriorly toward affected side

True (lateral)

True or False: The transthoracic lateral projection can be performed for possible fractures or dislocation of the proximal humerus

True (breathing)

True or False: The use of a breathing technique can be performed for the transthoracic lateral humerus projection.

True (grid)

True or False: The use of a grid is not required for shoulder studies that measure less than 10 cm

True (shields)

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

inferosuperior axial projection (Fig 5.12)

What is the correct term and method for the projection seen in Fig 5.12.

tangential projection (fisk modification)

A patient comes to the radiology deoartment with a history of tendonitis of the bicep tendon. Whichof the following projectionswill best demonstrate calcification of the tendon within the intertubercular sulcus?

transthoracic lateral projection (ER)

A patient enters the ER with a definite fracture to the midhumerus. Because of other trauma the patient is unable to stand. Which lateral projection would demonstrate the entire humerus?

neutral AP, transthorax, and lateral Y

A patient enters the ER with a possible humerus from an automobile accident. The patient has other injuries and is unable to stand or sit erect, which positioning routine should be used to determine the extent of the injury?

angle CR 10-15 degrees cephalad to seperate the shoulder

A patient enters the ER with a possible right shoulder dislocation. An erect transthoracic lateral projection is attempted but the patients is unable to raise the left arm and shoulder high enough. The resulting x-rays shows that the shoulders are superomposed, and the right shoulder and humeral head are not visualized, what can be done to fix this image?

AP and transthoracic lateral of humerus

A patient enters the ER with a proximal and midhumeral fracture. The patient is in extreme pain. Which projection positions routines would demosntrates the entire humerus without excessive movement of the limb?

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

A patient is referred to radiology for a nontrauma shoulder sereis. The routine calls for a PA 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?

inferior axial projection (lawrence method), inferosuperior axial projection (clements modification), and AP aoical oblique axial projection (garth method)

A patient with a clinical history of chronic shoulder dislocated comes in. The orthopedic physician suspects that a Hill-Sachs defect may be present. Which specific position(s) may be used to best demonstrate this pathologic feature?

ultrasound

A patient with a clinical history of tendon injury in the shoulder region comes to the radiology department. The orthopedic physician needs a functional study of the shoulder joint performed to determine the extend of the tendon injury. which modalilty would best demonstrate this injury?

acromioclavicular joint series: non-weight bearing and weight-bearing projections

A patient with a possible right-shoulder separation enters the ER. Which of the following routines should be used?

MRI

A patient with a possible rotator cuff tear comes to the radiology department. Which of the following imaging modalities would best demonstrate this injury?

AP apical oblique axial (garth method)

A patient with a possible shoulder dislocation enters the ER. A neutral AP projection of the shoulder has been taken, confirming a dislocation. Which additional projection should be taken?

AP internal rotation, posterior oblique (scapular Y) lateral, anterior oblique (grashey method)

A patient with possible Bankart lesion comes to the radiology department. List 3 projections that can be performed that may demonstrate signs of this injury?

superior

A posterior dislocation of the humerus projects the humeral head .......................... to the glenoid cavity in the AP Apical Oblique Axial Projection.

increase CR angulation

A radiiograph of an AP axial clavicle taken on an asthenic-type patient shows that the clavicle is projected in the lung field below the top of the shoulder.The fallin positioning factors were used: erect position, CR angled 15-degrees cephalad, 40-inch (102 cm) SID, and respiratory suspended at end of expiration. What can be done to fix this x-ray?

breathing instruction to blur the ribs and lungs

A radiograpg of a transthoraciic lateral projection demonstrates considerable superimposition of lung markings and ribs over the region of the proximal shoulder. What can the technologist do to minimize this problem?

increase CR cephalad angle

A radiograph of an AP axial clavicle projection reveals that the clavicle is projected below the superior border of the scapula. What can be done to correct this problem?

make sure condyles are parallel to IR and supinate the hand

A radiograph of an AP projection (with external rotation) of a shoulder (with no traumatic injury) reveals that neither the greater nor lesser tubercles are profiled. What must be done to correct this mistake?

epicondyles not parallel to IR

A radiograph of an AP projection with external rotation of the shoulder does not demonstrate either the greater or lesser tubercle in profile. What is the most likely cause for this radiographic outcome?

rotate body more toward affected side

A radiograph of an anterior oblique (grashey method) shows that the anterior and posterior glenoid rims are not superimposed. The patient was erect, body rotated 25-30 degrees towardaffected side, CR perpendicular to scapulohumeral joint space, and affected arm slightly abducted in neutral rotation. What needs to be fixed for the next X-ray?

increase rotation so scapula is parallel to the IR

A radiograph of the AP oblique (grashey method) taken with a 30 dgree rotation of the affected shoulder toward the IR reveals that the borders of the glenoid cavity are noy superimposed. Patients has large rounded shoulders, what must be done to fix this image?

arm at a 90 degree angle and breathing technique

A radiography of an AP scapula reveals that the scapula is within the lung field and difficult to see. Which two things can be done to improve the visiablity of the scapula?

rotate patient more to get scapula perpendicular to IR

A radiogrpah of a lateral scpula position reveals that it is not a true lateral projections.With the projection taken with the following factors: erect position, 40 inch (102 cm), 45 degree rotation toward IR for a PA, CR centered to midscapula and no CR angulation, what can be done to fix this image?

Garth Method

AP Apical Oblique Axial Projection: Shoulder is also known as what?

Grashey Method

AP Oblique Projections- Glenoid Cavity: Shoulder is also known as what?

Lawrence Method

Another way of calling Inferosuperior Axial Projection: Shoulder is what?

the anteroinferior aspect of the acromion process and acromiohumeral joint space is open

Apical AP Axial Projection: Shoulder is trying to demonstrate what type of anatomy.

perpendicular

Are the epicondyles in FIg 5.5 of the distal humerus parallel or perpendicular to the IR on this projection?

lateral perspective

Does Fig 5.5 represent an AP or lateral perspective of the proximal humerus?

10-15 degrees (erect)

For the erect version of the tangential projection for the intertubercular sulcus, the patient leans forward .......................................... from vertical

90 degrees

How much (at what angle) should the affected arm be abducted from the body for a Inferosuperior Axial Projection?

5-15 degrees

How much is the CR angled for the inferosuperior axial projection (Clements modification) if the patient cannot fully abduct the arm 90 degrees?

parent or guardain

If physical immobilization is required, what indvidual shouldbe asked to restrain a child for a shoulder series?

internal rotation (image)

In Fig 5.5 is this an internal or external rotation AP projection of the proximal humerus and shoulder

Clements Modification

Inferosuperior Axial Projection: Shoulder is also known as what?

entire scaplua shpulde be visualized in a lateral postion.

Lateral Position (patient recumbent) is trying to demonstrate what type of anatomy?

Body of scapula should be seen in profile free of superimposition by ribs

Lateral Position: Scapula (pateint erect) is trying to demonstrate what type of anatomy?

1 in inferior to coracoid process with CR perpendicular

Specifically, where is the CR placed for an AP projection of the shoulder?

tangential

The ......................... projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs, which create shoulder impingment sympyoms

anterior oblique

The ............................................ projection of the shoulder produces an image of the glenoid process in profile.

the entire humerus, including the shoulder and elbow joint (AP)

The AP Projection: Humerus is looking at demonstrateing what anatomy?

AP projection of proximal humerus and lateral 2/3 of clavile and upper scapula, including the relationship of the glenoid cavity with the humeral head

The AP Proximal humerus is trying to demonstrate what type of anatomy?

entire clavicle visualized including both AC and Sternoclavicular joints and acromion.

The AP and AP Axial projections trys to demonstrate waht anatomy?

dislocated shoulder

The AP apical oblique axial projection (garth method) is performed on a patient with a shoulder injury. The resultant radiograph demonstrates the proximal humeral head projected below the glenoid cavity. What type of trauma or pathology is indicated with this radiographic aooearance?

the entire humerus, including the shoulder and elbow joint is visible as well as the distal 2/3 of the humerus should be seen

The Horizontal Beam (proximal humerus) is looking to demonstrated what anatomy?

Lateral view of proximal humerus in relationship to scapulohumeral cavity. Coracoid process of scapula and lesser tubercle are seen in profile. Spine of scapula is seen on edge below the scapulohumeral joint

The Lawrence Method is looking to demonstrate what type of anatomy?

Lateral view of proximal half of the humerus and scapulohumeral joint should be visualized through thorax without superimposition of the opposite shoulder

The Lawrence Method of the proximal humerus is tring to demonstrate what anatomy

Proximal humerus is superimposed over thing body of scapula, which should be seen on end without rib superimposition

The Neer Method is tring to demonstrate what type of anatomy?

the entire humerus, including the shoulder and elbow joint (lateral)

The Rotational Lateral humerus is looking at demonstrateing what anatomy?

the grashey method

The anterior oblique projection is also referred to as what?

lateral view of the proximal humerus in relationship to scapulohumeral cavity is shown

The clements modification is looking to demonstrate what type of anatomy?

humeral head and glenoid cavity and neck and head of the scapula are well demonstrated free of superimpostion

The garth method is trying to demonstrate what type of anatomy.

glenoid cavity should be seen in profile without superimpostion of hemeral head.

The grashey method is tring to demonstrate what type of anatomy?

Lateral view of proximal humerus in relationship to scapulohumeral (glemohumeral) articulation. The coracoid process of scapula is seen on end.

The hobbs modification is tring to demonstrate what type anatomy

lateral view of proximal humerus and lateral 2/3 of clavicle and upper scapula is demonstrated,including the relationship of the humeral head with the glenoid cavity

The lateral proximal humerus is looking at demonstrating what type of anatomy?

both AC joints, entire clavicels and SC joints are demonstrated

The pearson method is trying to demonstrated what type anatomy

True lateral view of the scapula, proximal humerus and scapulohumeral joint

The scapular Y view is tring to demonsrtate what antomy.

10-15 degrees

The supine version of the tangential projection for the intertubercular sulcus requires that the CR be angled ............................ posteriorly from the horizontal plane

AP and AP Axial Projections: Clavicle

These two projections have clincal indication of a fractured or dislocated clavicle and department routines commonly include both AP and AP Axial.

AP Projection- Internal Rotation: Shoulder

This lateral non trauma shoulder view has clinical indication of fractures or dislocations of proximal humerus and shoulder girdle, calcium deposits in muscle, tendons, or bursal structures, and degenerative conditions including osteoporsis and osteoarthritis

Rotational Lateral- Lateromedial or Mediolateral Projection: Humerus

This non trauma projection is the lateral view of the humerus with clinical indications looking for fracture and dislocation of the humerus, pathologic process including osteoporosis, what projection is this?

Inferosuperior Axial Projection: Shoulder (recumbent)

This non trauma shoulder view has the clinical indications of degenerative conditions including osteoporosis and osteoarthritis and Hill-Sachs defect with exaggerated rotation of affected limb and is done recumbent.

AP Oblique Projections- Glenoid Cavity: Shoulder

This non trauma view has the clincial indications of fractures or dislocation of proximal humerus, fractures of glenoid labrum or brim, and brankart lessions, erosion of glenoid rim, the integrity of the scapulohumeral joint and other degenerative conditions.

Inferosuperior Axial Projection: Shoulder

This non truama shoulder view as the cinical indication of degenerative conditions including osteoporosis and osteoarthritis, Hill-Sachs defect with exaggerated rotation of affected limb.

Tangential Projection- Intertubercular (Bicipital) Sulcus: Shoulder

This non truama view has the clinical indications of pathologies of intertubercular sulcus (groove) including bony spurs of the humeral tubercles.

PA Transthoracic Projection: Shoulder

This nontruama projection of the shoulder has clincal indications of fractures or dislocations of the proximal humerus and bursitis, shoulder impingement, osteoporosis, osteoarthritism and tendonitis

AP Projection: AC Joints

This projection has clincal indication of possible AC joint seperation, widening of one joint space compared with the other view with weights usually inficated AC joint seperation.

AP Projection: Scapula

This projection has the clincal indications of fractures and other pathology of the scapula.

AP Projection-External Rotation: Shoulder

This projection of the shoulder has clinical indications of fracture/dislocation of the proximal humerus and shoulder girlde, calcium deposits in muscles, tendons, or bursal structures, and degreneration condition including osteoporosis and osteoarthritis.

Lateral Position (patient recumbent)

This recomebnt position as the clincal indicators of fractures of scapula and usually increases image magnifications becasue of increase OID

Apical AP Axial Projection: Shoulder

This shoulder view has the clinical indications of demonstrating narrowinf of acromiohumeral space and possible spurring of the anteroinferior aspect of acromion that may lead to partial or complete tear of a tendon.

The entire humerus and glenohumeral joint space should be visualized through the thorax without superimposition of the opposite humerus

This transthoracic view of the humerus is looking at demonstrateing what type of anatomy?

Transthoracic Lateral Projections: Proximal Humerus

This trauma shoulder view has the clincal indication of fractures or dislocations of proximal humerus

AP Apical Oblique Axial Projection: Shoulder

This trauma view has clincial indications of optimal trauma projection for possible scapulohumeral dislocation especially posterior dislocation and glenoid process fractures, Hill-Sachs lesions, and soft tissue calcifications

Tangential Projection- Supraspinatus Outlet: Shoulder

This trauma view has the clincal indication of fractures or dislocation of proximal humerus and scapula and SPECIFICALLY demonstrates coracoacromial arch for supraspinatus outlet region for possible shoulder impingement.

PA Oblique Projection- Scapular Y Lateral: Shoulder

This trauma view has the clinical indication of fractures or dislocation of proximal humerus and scapula and humeral head is demonstrated inferior to coracoid prociess with anterior dislocation.

AP Projection- Neutral Rotation: Shoulder

This truame shoulder view has clincial indications of fractures or dislocation of proximal humerus and shoulder girdle and calcium deposits in muscles, tendons, or bursal structures may be evident along with degenerative diseases

rotate affected arm externally approximately 45 degrees

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

use exaggerated external rotation

To best demonstrate the Hill-Sachs defect on the inferosuperior axial projection, which additional positioningmaneuver must be used?

True (shielding)

True or Flase: Even though the amount of radiations exposre is minimal for most shoulder projections, gonadal shielding should be used for children and adults of childbearing age.

true (breathing)

True or Flase: Orthostatic (breathing) technique is recommended for the AP projection of scapula.

True (motion)

True or Flase: The greatest technical concern during a pediatric shoulder study is voluntary motion.

scapular Y posterior oblique projection

What is the correct term to discribe the projection shown in Fig 5.6

15 degrees cephalad

What CR angle is required for the AP axial projection (Alexander method) for AC joints?

10-15 degrees caudad

What CR angulation is required for the tangential projection-supraspinatus outlet (neer method)?

Pearson Method and Bilateral with and without weights

What are the two other names for the AP Projection: AC Joints?

center 2 inches (5 cm) below AC joint

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

nuclear medicine

Which of the different imaging modalities or procedures provides a functional, or dynamic, study of the shoulder joint?

1 in (2.5 cm) inferior to coracoid process

Where is the CR centered for an AP projection-external rotation of the shoulder?

CR perpendicular, 1 inch in from AC joint, 3 inches down from clavicle (2 inchs down from coracoid)

Where is the CR centered for the AP scapula projections?

superior angle and AC joint

Which 2 positioning landmarks are aligned perpendicularly to the IR for the lateral scapula projection?

AC joints

Which anatomy is best demonstrated by the alexander method?

scapulohumeral joint space

Which anatomy of the shoulder is best demonstrated with a PA transaxillary projection (hobbs method)

osteoporosis

Which cilincial indications requires a decrease in manual exposure factors?

scapulohumeral dislocations

Which clinical indication is best demonstrated with the Garth method?

transthoracic lateral projection

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

nongrid

Which of the different analog technics does not apply for an adult shoulder radiography?

ultrasound (osteomyelitis)

Which of the different imaging modalities or procedures best demonstrates osteomyelitis?