Situations: Humerus & Shoulder Girdle

A radiograph of an AP scapula reveals that the scapula is within the lung field and difficult to see. Which two things can the technologist do to improve the visibility of the scapula during the repeat exposure?

Ensure that the affected arm is abducted 90 degrees and use a breathing technique.

A pt. comes to radiology dept. with a hx. of tendonitis of the bicep tendon. Which projection will best demonstrate calcification of the tendon within the intertubecular grove?

Tangential projection-Fisk method

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

Transthoracic lateral projection for humerus

A pt. with clinical hx. of tendon injury in the shoulder region comes to radiology dept. The orthopedic physician needs a FUNCTIONAL study of the shoulder joint performed to determine the extent of the tendon injury. Which of the following modalities would best demonstrate this injury?

Ultrasound

A pt. with a possible Bankart lesion comes to the radiology dept. List three projections that can be performed that may demonstrate signs of an injury?

A. AP-internal rotation B. Scapular Y lateral C. Posterior Oblique ( Grashey method)

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

Acromioclavicular joint series: Non-weight bearing and weight bearing

A pt. with a possible right shoulder dislocation enters the ER. The tech. attempts to perform an erect transthoracic lateral projection, but the pt. is unable to raise the left arm and shoulder high enough. The resultant radiograph reveals that the shoulders are superimposed and the rt. shoulder and humeral head are not well visualized. What can be done to improve this image during repeat exposure?

Angle the CR 10-15 degree cephalad to separate the shoulders.

A pt. 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?

Garth Method

A radiograph of an AP axial clavicle taken on an asthenic type pt. reveals that the clavicle is projected in the lung field below the shoulder. The following positioning factors were used. Erect positioning, Cr angled 15degrees cephalad, 40" SID and respiration suspended at end of expiration. Which modification should be made during exposure?

Increase CR angulation

A radiograph of an Axial clavicle projection reveals that the clavicle is projected below the superior border of the scapula. What can the technologist do to correct this problem during repeat exposure?

Increase central ray cephalad angle

A radiograph of the AP oblique ( Grashey Method) taken at 35 degree oblique projection reveals that the borders of the glenoid cavity are superimposed. The pt. has large, rounded shoulders. What must be done to get better superimposition of the cavity during repeat exposure?

Increase rotation of affected shoulder toward IR to closer to 45 degrees

A pt. with a possible rotater cuff comes to the radiology dept. Which modality would best demonstrate this injury?

MRI

The following factors were used to produce a radiograph of an AP projection of the shoulder: 80Kv, 20 mAs, high speed screens, 40" SID, grid and suspended respiration. The resultant radiograph demonstrated poor radiographic contrast between the bony and soft tissue structures. Which of these factors can be altered during repeat exposure to improve radiographic quality?

Lower to 75kv and double mAs to 40 which increases radiographic contrast

A radiograph of a lateral scapula position reveals that it is not a true lateral projection. ( Separation exists between the axillary and vertebral borders) The projection was taken using the following factors: Erect position, 40" SID, 45 degree rotation toward cassette from PA, central ray centered to midscapula and no central ray angulation. Based on these factors, how can this position be improved during repeat exposure?

Palpate the superior angle of the scapula and AC joint and articulation and ensure that the imaginary plane between these points is perpendicular to the IR.

A pt. is referred to radiology for a nontrauma shoulder series. The routine calls for a PA transaxillary projections be included. But the pt. is unable to stand and is confined to wheelchair. What should the technologist do at this point?

Perform the projection with the pt.s upper chest prone on the table

A pt. with a clinical hx. of chronic shoulder dislocation comes to the radiology dept. The orthopedic physician suspects that a HIll-Sachs defect may be present.

Possible positioning options: Inferosuperior axial projection with exaggerated external rotation. Inferosuperior axial projection (clements modification) and AP apical oblique axial projection (Garth method)

A radiograph of a posterior oblique (grashey ) reveals that the anterior and posterior glenoid rims are not superimposed. The following positioning factors were used: erect position, body rotated 25-30 degrees toward the affected side, CR perpendicular to scapulohumeral joint space and affected arm slightly abducted in neural roatation. What modifications will superimpose the glenoid rims during repeat exposure?

Rotate body 35-45 degrees toward affected side

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 during the repeat exposure?

Supinate the hand and ensure that the epicondyles are parallel to the IR for a true AP

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

The humeral epicondyles were not placed parallel to the plane of the IR

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

The routine includes an AP of right shoulder and humerus without rotation (neutral rotation)and a supine, horizontal beam, right transthoracic shoulder. Note: in those cases in which the opposite arm cannot be elevated or extended, a supine posterior oblique scapular Y lateral projection could be used as a second option for a lateral shoulder position.

A radiograph of a transthoracic lateral projection demonstrates considerable superimposition of lung markings and ribs over the region of the proximal shoulder. What can the tech. do to minimize this problem during the repeat exposure?

Use breathing exposure technique to create blurring of ribs and lung markings