Test Review: Chapter 5 Shoulder Girdle

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

1 inch (2.5 cm) above jugular notch

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

10° to 15°

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

2 inches (5 cm) medial and inferior to the superolateral border of shoulder

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

25° to 30°

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

30°

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

5° to 15°

Which of the following projections can be performed using an orthostatic or breathing technique? a. Scapular Y lateral projection b. Inferosuperior axiolateral projection c. AP clavicle d. AP scapula

AP scapula

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

AP shoulder and recumbent AP oblique scapular Y projection

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

Angle CR 5° to 15° toward the axilla.

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

Angle the CR 10° to 15° cephalad.

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

CR is perpendicular to IR

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

Cannot use AEC with this projection

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

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

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

Deltoid tuberosity

Which of the following AP shoulder projections demonstrates the greater tubercle in profile? a. External rotation b. Internal rotation c. Neutral rotation d. None of the above

External rotation

For a Grashey method projection of the shoulder, the CR is centered to the acromion. a. True b. False

False **2 inches inferior and medial from the superolateral border of the scapula

The arm should be abducted about 45° for an AP scapula. a. True b. False

False **90 degrees

A posterior dislocation of the shoulder occurs more frequently than an anterior dislocation. a. True b. False

False **95% of all shoulder dislocations are anterior

The Hill-Sachs defect is a fracture of the articular surface of the glenoid cavity. a. True b. False

False **it is a compression fracture of the articular surface of the posteriolateral aspect of the humeral head that is often associated with anterior dislocation of the humeral head

For lateral scapula - RAO or LAO projection the CR enters mid humerus. a. True b. False

False **mid vertebral border of scapula

The PA transaxillary projection (Hobbs modification) is performed to rule out possible shoulder dislocation. a. True b. False

False **should never be attempted with trauma

A patient is scheduled for a shoulder 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? a. Fisk modification b. Garth method c. Grashey method d. Pearson method

Fisk modification

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

Glenoid process

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

Grashey method

A patient enters the ED with a possible bony defect of the mid-wing 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? a. Take an apical oblique projection of the shoulder. b. Take a transthoracic lateral projection of the shoulder region. c. Have the patient reach across the chest and grasp the opposite shoulder for a lateral scapula projection. d. 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.

A patient enters the ED with a mid-shaft 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? a. Scapular Y lateral-AP oblique projection b. Apical oblique projection c. Horizontal beam transthoracic lateral projection for humerus d. Rotational lateral projection for humerus

Horizontal beam transthoracic lateral projection for humerus

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? a. Decrease rotation of thorax. b. Decrease CR angle. c. Increase rotation of thorax. d. Abduct the arm more and flex it at the elbow.

Increase rotation of thorax.

A radiograph of an AP axial projection of the clavicle demonstrates that the clavicle is within the mid-aspect of the lung apices. What should the technologist do to correct this error? a. Do nothing; this is an acceptable AP axial clavicle projection. b. Increase the caudal CR angle and repeat exposure. c. Increase the cephalic CR angle and repeat exposure. d. Make the exposure upon complete inspiration.

Increase the cephalic CR angle and repeat exposure.

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

Inferosuperior axial (Clements modification)

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

Internal rotation

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

Internal rotation (epicondyles perpendicular to image receptor)

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

Lateral scapula projection

Where is the CR centered for a transthoracic lateral projection for proximal humerus? a. 1 inch (2.5 cm) inferior to the acromion b. Level of the greater tubercle c. Level of surgical neck d. Mid-axilla

Level of surgical neck

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

Neutral rotation

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

No CR angle should be used.

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

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? a. Rotate epicondyles so they are perpendicular to the image receptor. b. Move the patient obliquely 10° to 15° toward the affected side. c. Rotate the arm to place palm of the patient's hand against the thigh. d. Nothing image is acceptable; do not repeat it.

Nothing image is acceptable; do not repeat it.

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? a. PA scapular Y lateral with 10° to 15° caudal angle Neer method b. PA scapular Y lateral with 10° to 15° cephalad angle c. AP oblique shoulder with 45° caudal angle d. AP shoulder with 10° to 15° caudal angle

PA scapular Y lateral with 10° to 15° caudal angle Neer method

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

Parallel

all of the above.

Part 7 refers to the: a. scapulohumeral joint. b. glenohumeral joint. c. glenoid cavity or fossa. d. all of the above.

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? a. Posterior oblique (Grashey method) b. Scapular Y lateral c. Transthoracic lateral d. AP projection-neutral rotation

Posterior oblique (Grashey method)

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

Repeat the AP projection and correct collimation.

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

Scapulohumeral joint

Which term describes the medial end of the clavicle? a. Acromial extremity b. Acromion c. Sternal extremity d. Acromial tuberosity

Sternal extremity

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

Subacromial spurring

What is the name of the large fossa found within the anterior surface of the scapula? a. Supraspinous fossa b. Infraspinous fossa c. Subscapular fossa d. Glenoid fossa

Subscapular fossa

Fisk modification

Tangential, intertubercular groove projection

Neer method

Tangential, supraspinatus outlet projection

All of the joints of the shoulder girdle are diarthrodial. a. True b. False

True

An orthostatic (breathing) technique can be performed for the AP projection of the scapula. a. True b. False

True

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. a. True b. False

True

Sonography is an effective diagnostic tool in studying the shoulder joint. a. True b. False

True

The Alexander method for AC joints requires a 15° cephalic CR angle. a. True b. False

True

The CR enters 2 inches inferior to coracoid process, or to the level of axilla, and approximately 2 inches medial from lateral border for AP scapula. a. True b. False

True

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

Ultrasound

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

Use an orthostatic (breathing) technique.

External rotation, anteroposterior (AP) projection

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

PA transaxillary (Hobbs modification) requires a 5° to 15° CR cephalic angle. a. True b. False

b. False **CR perpendicular to IR, & axilla & humeral head

The anterior surface of the scapula is referred to as the: a. scapular surface. b. dorsal surface. c. supraspinous and infraspinous fossa. d. costal surface.

costal surface.

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

inferior

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

AP and horizontal beam transthoracic lateral shoulder projection

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

AP apical oblique axial (Garth method) projection

Garth method

AP apical oblique axial projection

A radiograph of the inferosuperior axial projection (Lawrence method) demonstrates the acromion process of the shoulder to be located most superiorly (anteriorly). a. True b. False

False

What is the common term for idiopathic chronic adhesive capsulitis? a. Bankart lesion b. Tendinitis c. Bursitis d. Frozen shoulder

Frozen shoulder

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? a. Angle CR 5° to 10° caudad. b. Angle CR 5° to 10° cephalad. c. Increase rotation of the body. d. Abduct the arm slightly.

Increase rotation of the body.

Clements modification

Inferosuperior axial projection of the shoulder

Which of the following best demonstrates the coracoacromial arch? a. Neer method b. West Point method c. Fisk method d. Garth method

Neer method

Hobbs modification

PA transaxillary projection

False

Part 10 refers to the vertebral border of the scapula. a. True b. False

True

Part 3 refers to the greater tubercle. a. True b. False

coracoid process.

Part 6 refers to the: a. coracoid process. b. superior border of scapula. c. lateral angle of scapula. d. none of the above.

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

Perform exaggerated external rotation of the affected upper limb.

Where does CR enter for AP external shoulder? a. Perpendicular to IR approximately 3 inches inferior to coracoid process. b. Perpendicular to IR approximately 1 inch inferior to coracoid process. c. Perpendicular to IR at level of coracoid process. d. Mid-shoulder area.

Perpendicular to IR approximately 1 inch inferior to coracoid process.

Grashey Method

Posterior oblique, glenoid cavity projection

The female clavicle is usually shorter and less curved than that of the male. a. True b. False

True

The garth method for shoulder is good for demonstrating scapulohumeral dislocations. a. True b. False

True

The recommended SID for AC joints is 72 inches (183 cm). a. True b. False

True

The use of a grid during shoulder radiography will result in higher patient dose over non-grid procedures. a. True b. False

True