Chapt. 5 Humerus and Shoulder Girdle

Radiographic images of the acromioclavicular articulations are normally performed.

With the patient holding weights Bilaterally

Radiograph AP Shoulder internal rotation

Internal rotation is evident by lesser tubercle visualized in full profile on the medial aspect of humerus. Greater tubercle is superimposed over humeral head.

What is the SID for a AP Projection: AC Joints?

72"

AP Axial Clavicle

AP Axial position the correct angle = projects most of the clavicle above the scapula, 2nd & 3rd ribs with the medial end superimposed over 1st & 2nd ribs.

Which radiographic projection of the shoulder will demonstrate the humerus in true anatomic position?

AP projection with external rotation

A radiographic image is taken on a supine patient with their arm abducted to a right angle and the elbow flexed. This best describes: A. An AP projection of the scapula B. An PA oblique projection of the scapula C. A tangential projection of the elbow D. A lateral projection of the elbow

A. An AP projection of the scapula

In evaluating a radiographic image of the scapula in the true lateral projection, which of the following structures should be superimposed? A. The vertebral and axillary borders B. The acromion and Coracoid process C. The scapular body and axillary ribs D. The humeral head and glenoid fossa

A. The vertebral and axillary borders

What is the CR for a AP Clavicle and AP Axial Clavicle?

AP = Perpendicular to midclavicle. AP Axial = 15* to 30* cephalad to midclavicle.

Evaluation criteria for AP and AP Axial Clavicle

Anatomy shown for both: Entire clavicle shown including both AC & SC joints & acromion. AP position the clavicle shouldn't be foreshortened & midclavicle is superimposed over scapula.

Evaluation Criteria of AP Projection: AC Joints

Anatomy shown: Both AC and SC joints and both clavicles. No rotation evident by symmetric appearance of the SC joints on each side of the vertebral column.

Evaluation criteria for a AP Humerus

Anatomy shown: Entire humerus, including the shoulder & elbow joints. True AP is evident when the greater tubercle is in profile & humeral head is in partial profile (proximal end). The lateral & medial epicondyles are visualized in profile or parallel to the film (distal end).

Evaluation criteria for Lateral Scapula

Anatomy shown: Entire scapula in a lat position evident by direct superimposition of vertebral and lateral borders. Free of superimposition by ribs. Humerus should superimpose area of interest.

Evaluation criteria for the Grashey Method

Anatomy shown: Glenoid cavity s/b in profile w/o superimposition of humeral head. Scapulohumeral joint s/b open & the anterior & posterior rims superimposed.

Evaluation criteria of AP Scapula

Anatomy shown: Lat portion of the scapula is free of superimposition & medial scapula is seen through the thoracic structures. Affected arm seen to be abducted 90* and supinated as evidence by the lat border of scapula free of superimposition.

Evaluation criteria for a Rotation Lateral Humerus

Anatomy shown: Lateral projection of entire humerus, including elbow and shoulder joints. True lat is evident by epicondyles being directly superimposed & the lesser tubercle is shown in profile medially.

Evaluation criteria Transthoracic Lateral (Lawrence Method) Humerus

Anatomy shown: Lateral view of entire humerus and glenohumeral joint s/b visualized through the thorax without superimposition of unaffected humerus. Outline of shaft of humerus shown anteriorly to the Tspine, humeral head and glenoid cavity relationship demonstrated.

Evaluation criteria of a Scapular Y

Anatomy shown: Proximal 1/3 of humerus & scapula, & the lat 2/3 of the clavicle, including the relationship of the humeral head to the glenoid cavity. Thin body is seen on end w/o rib superimposition, the acromion & coracoid processes appear nearly symmetric upper limbs of the "Y". The humeral head should appear superimposed over the base of the Y if humerus in not dislocated.

Evaluation criteria of a Neutral Rotation Shoulder

Anatomy shown: Proximal 1/3 of humerus, upper scapula & 2/3 of clavicle. Greater & lesser tubercule is superimposed by humeral head. Epicondyles are 45* angle to IR thus placing the humerus at a 45* oblique. Suspend respirations.

Evaluation criteria AP Projection - External Rotation vs. Internal Rotation Shoulder

Anatomy shown: Proximal humerus and lateral 2/3 of clavicle and upper scapula, including relationship of the humeral head to the glenoid cavity. External rotation is evident by greater tubercle visualized in full profile on the lateral aspect of humerus. Lesser tubercle is superimposed over humeral head. Internal rotation is evident by lesser tubercle visualized in full profile on the medial aspect of humerus. Greater tubercle is superimposed over humeral head.

When radiographing the proximal humerus using the transthoracic (Lawrence) position, the plane of the epicondyles should be: A. Parallel to the plane of the image receptor B. Perpendicular to the plane of the image receptor C. 45 degrees to the plane of the image receptor D. 70 degrees to the plane of the image receptor

B. Perpendicular to the plane of the image receptor

In order to visualize the glenoid fossa on radiographic image of the humerus in the AP oblique (Grashey) projection, the patient is medially rotated: A. 10-20 degrees B. 20-30 degrees C. 35-45 degrees D. 60-70 degrees

C. 35-45 degrees

In order to obtain a radiographic image of the humerus (non-trauma) in the lateral projection, the arm should be placed in: A. Neutral rotation B. Counter rotation C. Internal rotation D. External rotation

C. Internal rotation

A radiographic image of the shoulder is obtained in the AP projection with a medial rotation. This will place the humerus in the: A. Anatomic position B. 25-degree oblique position C. Lateral position D. 45-degree oblique position

C. Lateral position

A radiographic image of the scapula is obtained in the lateral projection. The upper portion of the scapula is demonstrated as the letter Y. The superior aspect of the letter Y is formed by: A. The glenoid and humeral heads B. The scapular spine and vertebral border C. The acromion and coracoid processes D. The vertebral and axillary borders

C. The acromion and coracoid processes

A radiographic image of the shoulder in the PA oblique (scapular Y) projection is obtained to rule out a dislocation of the humeral head. The patient should be rotated so that the midcoronal plane forms an angle of: A. 5-10 degrees to the plane of the image receptor B. 15-25 degrees to the plane of the image receptor C. 55-75 degrees to the plane of the image receptor D. 45-60 degrees to the plane of the image receptor

D. 45-60 degrees to the plane of the image receptor

A radiographic image of the humerus is obtained in the AP projection. This will require that a plane passing between the epicondyles be placed parallel to the plane of the image receptor in order to obtain a profile view of the: A. Acromion B. Lesser tuberosity C. Glenohumeral joint D. Greater tuberosity

D. Greater tuberosity

What is the CR for a Lateral Scapula?

Midvertebral border of Scapula

In a AP Projection -External Rotation Shoulder the epicondyles are __________to the IR?

Parallel

In a AP Projection - Internal Rotation Shoulder the epicondyles are _________ to the IR?

Perpendicular

What is the CR for a Transthoracic Lateral (Lawrence Method) Humerus

Perpendicular to IR & centered to mid humerus of affected humerus (thorax m/b in a true lat).

What is the CR for a Rotational Lateral Humerus

Perpendicular to IR & centered to the midpoint of humerus.

What is the CR of a Neutral Rotation Shoulder?

Perpendicular to IR directed to scapulohumeral joint, which is 1" inferior and lateral to corocoid process.

What is the CR for the Grashey Method

Perpendicular to IR, centered to scapulohumeral joint (s/b 2" below shoulder & 2" from lateral border of shoulder).

What is the CR for a AP Projection - External & Internal Rotation Shoulder

Perpendicular to IR, directed to 1" inferior to corocoid process (3/4" inferior to lateral portion of clavicle).

What is the CR for a AP Projection of the Humerus

Perpendicular to IR, directed to midpoint of Humerus.

What is the CR of a AP Scapula?

Perpendicular to mid scapula or 2" inf. to corocoid process and 2" medial from lateral borders of pt.

What is the CR of a AP Projection: AC Joints

Perpendicular to midpoint between AC joints, 1" above jugular notch.

What is the CR for a Scapular Y?

Perpendicular to the IR directed to scapulohumeral joint which is 2"-2 1/2" below the top of the shoulder.

AP Projection Humerus position

Position pt. erect or supine. Do not attempt if fx or dislocation is suspected!! Rotate body toward affected side so shoulder & upper humerus is in contact with IR, align long axis of humerus with IR. Extend hand & forearm & abduct arm with hand supinated, this places epicondyles of elbow equidistant from IR elbow s/b included in lower margin of IR. Suspend respiration.

Rotational Lateral -Lateromedial of Humerus

Position pt. with back to IR and elbow partially flexed, with body rotated toward affected side bringing humerus and shoulder in contact with IR. Internally rotate arm as needed for lat position, epicondyles are perpendicular to IR. Suspend respiration.

AP Scapula position

Pt. erect or supine. Center mid scapular area to center of IR with top of IR 2" above shoulders and the lateral border is 2" from the lateral margin of the ribs. Abduct arm 90* and supinate hand (I'm feeling faint...LOL)

Neutral Rotation Shoulder (Trauma) position

Pt. erect or supine. Rotate body toward affected side. Position to center scapulohumeral joint to IR. Place pt. arm at their side or "as is" Eepicondyles are at a 45* to plane of IR. Suspend respiration.

Scapular Y anterior oblique position

Pt. faces IR & body will be rotated 45-60* angle with IR to get scapula in lateral position.

Lateral Scapula postion

Pt. in erect position should reach around chest and grasp opposite shoulder, drop affected arm flex elbow and place arm behind back. Palpate borders of scapula and rotated body until scapula is in a true lateral (35-45* rotation) Align pt. to center midvertebral border to CR & to IR Suspend Respiration

AP and AP Axial Clavicle positon

Pt. position is erect or supine with arms at sides, chin raised & looking straight ahead. Posterior shoulder is in contact with IR. Center clavicle and IR to CR (clavicle can be located with medial aspect at jugular notch & laterally portion at AC joint above shoulder). Suspend respiration at end of inhalation.

Transthoracic Lateral (Lawrence Method) Humerus position

Pt. s/b erect if possible with affected side against IR & at their side. Before raising unaffected arm determine CR.. Orthostatic breathing technique used (shallow breathing, short gentle breathes w/o moving shoulders)

AP Projection-External Rotation vs. Internal Rotation Positioning Shoulder

Pt. s/b erect or supine, rotate slightly to affected side. For external; abduct arm slightly; externally rotate arm until epicondyles of distal humerus are parallel to IR, hand s/b supinated. For internal; abduct arm slightly, internally rotate arm, epicondyles of distal humerus are perpendicular to IR, hand s/b pronated. Suspend respiration.

Post. Oblique position-Grashey Method position

Rotate body 35* to 45* toward affected side and center to midscapulohumeral joint (s/b 2" below shoulder & 2" from lateral border of shoulder). Suspend respirations.

Is the greater tubercle visual or superimposed on a AP Projection - Internal Rotation Shoulder?

Superimposed over humeral head.

What are the differences between a AP Projection- External Rotation vs. Internal Rotation Shoulder?

The arms are rotated either externally or internally. The hands are supinated (external) or pronated (internal). The epicondyles for external are parallel to the IR where as the epicondyles are perpendicular in a internal rotation of the shoulder.

What s/b evident in a radiograph for a true AP Projection of the Humerus?

The greater tubercle is in profile & humeral head is in partial profile (proximal end).

AP Projection: AC Joints position

This position is done w/o weights until fx is ruled out. Pt. is in erect position, posterior shoulders against IR, = wght both feet, arms at side, looking straight ahead. Position pt. to direct CR to midway between AC joints.

The greater tubercle is ____________over the humeral head in a AP Projection - External Rotation Shoulder.

Visualized in full profile on the lateral aspect of the humerus.