Unit 1 ~ humerus and shoulder
The three aspects of the clavicle are
(1) Acromial Extremity (2) Body (Shaft) (3) Sternal Extremity
The three angles of the scapula include the:
(1) Lateral Angle (head of the scapula) (2) Superior Angle (3) Inferior Angle
Where is the central ray center for an AP projection of the shoulder?
1 inch inferior to the coracoid process
Where is the central ray placed for an AP projection of the shoulder?
1 inch inferior to the coracoid process
What type of Central Ray angulation is required for the introsuperior axial projection of the shoulder?
25 to 30° medially
What type of central ray angulation is required for the inferior superior axial projection of the shoulder?
25 to 30° mediately
What type of CR angle is required for the apical AP axial shoulder projection?
30 degrees caudad
How much is a CR angled for the inferior superior axial projection Clements modification if the patient cannot fully abduct the arm 90°
5° to 15°
Which kV range should be used for shoulder series on an average adult?
70 to 80 kV
Which two basic shoulder projections (positions) are routinely taken for a shoulder and proximal humerus (with no traumatic injury)
AP and lateral
Which special projection of the shoulder requires that the effective side be rotated 45° toward the cassette and uses a 45° call Dad central ray angle?
AP apical oblique axial projection
Which two shoulder projections are taking routinely for a shoulder (with no traumatic injury) and proximal humerus?
AP external rotation, AP internal rotation
The___Projection of the shoulder produces an image of the glenoid process and profile. This is also referred to as the___method
AP oblique shoulder, Grashey method
Superior displacement of the distal clavicle
Acromioclavicular joint dislocation
Abnormal widening of acromioclavicular joint space
Acromioclavicular joint separation
Which structure of the scapula is most posterior
Acromion
On the anterior scapula this is the long curved process that extends laterally
Acromion process
List the movement types for the following joints; Scapula humoral: Sternoclavicular: Acromioclavicular:
Ball and socket plane plane
Avulsion fracture of the glenoid rim
Bankart lesion
Injury of the anterioinferior glenoid labrum
Bankart lesion
Injury of the anterior inferior glenoid labrum
Bankart lesion
Inferiorsuperior Axial Projection
Bernageau method
PA axial transaxillary projection
Bernageau method
What device permits good visualization of soft tissue and Bonnie anatomy for adult shoulder radiography?
Boomerang compensating filter
Specifically, where is the central ray placed for an AP projection of the shoulder
CR perpendicular to IR, directed to 1 inch (2.5 cm) inferior to coracoid process
The distal humerus contains a humoral Condyle that is divided into two parts:
Capitulum: located on the lateral aspect and articulates with the head of the radius Trochlea: located medially and articulates with the ulna.
On the anterior scapula this is the thick beak like process projecting anteriorly
Coracoid process
There are two anterior depressions of the distal humerus
Coronoid fossa: accepts coronoid process of ulna Radial fossa: accepts head of radius
Name the two surfaces of the scapula
Costal (anterior) dorsal (posterior)
Which basic projection of the shoulder requires that the humoral epicondyles be parallel to the IR?
External rotation AP
True or false rheumatoid arthritis is more prevalent in men over women
False
True or false the scapular why lateral position requires the body to be rotated 25° to 30° anteriorly toward the affected side
False
True or false: a 72 inch source image distance is recommended for most shoulder girdle studies
False
True or false: low MA with long exposure time should be used for adult shoulder studies
False
True or false: magnetic resonance imaging is an excellent modality for demonstrating boney injuries of the shoulder girdle
False
True or false: the affected our must be placed into external rotation for the transthoracic lateral projection
False
True or false: the PA axial transaxillary projection (Bernageau) requires no CR angle
False 30° caudad
Tangential for intertubercular (bicipital) groove Also known as what method
Fisk modification
Tangential for intertubercular (bicipital) groove sulcus
Fisk modification
What projection produces a tangential projection of the intertubercular Sulcus (groove)?
Fisk modification
True or false: large focal spot setting should be selected for most adult shoulder studies
Foss
True or false essential ray angle of 10° to 15° call dad maybe used for the transthoracic lateral shoulder projection if the patient is unable to elevate the uninjured arm and shoulder sufficiently
Foss 10° to 15° cephalad
AP apical oblique axial also known as what method
Garth method
AP apical oblique axial projection
Garth method
AP oblique for glenoid cavity also known as what method
Grashey method
Anterior oblique for glenoid cavity
Grashey method
Compression fracture of humeral head
Hill-Sachs defect
Compression fracture of the articular surface of the humeral head
Hill-Sachs defect
Compression between the greater tuberosity and soft tissues on the coracoid acromion ligamentous and osseous arch
Impingement syndrome
What are the names of the two Fosse located on the posterior scapula?
Infraspinous fossa and supraspinous fossa
What are the three angles of the scapula?
Lateral- thickest portion sometimes called the head; ends at the glenoid cavity and excepts the head of the humerus to form the scapulohumeral joint Inferior - lower end of medial (vertebral) boarder Superior - upper end of medial (vertebral) boarder
Inferiosuperior axial also known as what method
Lawrence method
Transthoracic lateral also known as what method
Lawrence method
The___ (male or female) clavicle tends to be thicker and more curved in shape.
Male
An aesthetic patient requires___more or less CR angle for an AP axial clavicle projection and a hypersonic patient
More CR angle
Supraspinatus outlet tangential
Neer method
Supraspinatus outlet tangential Also known as what method
Neer method
What is the posterior depression of the distal humerus?
Olecranon fossa: accepts the olecranon process of the ulna
Which of the following clinical indication requires a decrease in manual exposure factors A: impingement syndrome B: bursitis C: Bankart lesion D: osteoporosis
Osteoporosis
What non-trauma projection can be performed erect to provide a lateral perspective of the proximal humerus in relationship to the scapulohumeral joint
PA axial transaxillary projection (Bernageau method)
Physical immobilization is required, which individual should be asked to restrain a child for a shoulder series?
Parent or guardian
How are the humoral epicondyles aligned for a rotation lateralomedial projection of the humerus?
Perpendicular to the IR
What projection of the shoulder produces an image of the glenoid process and profile
Posterior oblique (Grashey method)
Which projection is best for demonstrating a possible dislocation of the proximal humerus
Posterior oblique (Scapular Y) projection
To best demonstrate a possible hill Sachs defect, which additional positioning technique can be added to the the inferiosuperior axial (Lawrence method) projection?
Rotate affected arm externally approximately 45°
Traumatic injury to one or more of the support of muscles of the shoulder girdle
Rotator cuff tear
Which projection would be best for demonstrating a possible dislocation of the proximal humerus?
Scapular Y
On the anterior scapula, this is the notch on the superior border partially formed by the base of the coracoid
Scapular notch
Which non-trauma projection can be performed erect to provide a lateral view of the proximal humerus in relationship to the glenohumeral joint?
Superioinferior axial projection (Hobbs modification)
Which two landmarks are placed perpendicular to the IR for the scapular why lateral projection?
Superior angle of the scapula and the AC joint articulation
What are the three borders of the scapula?
Superior, medial (vertebral) lateral (axillary)
The most common injury to the rotator cuff is to the___tendon
Supraspinatus tendon
Special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs. Which create shoulder impingement symptoms
Tangential projection Supraspinatus outlet Near method or apical AP axial projection
Calcified tendons
Tendonisitis
With which projection is a breathing technique recommended?
Trans thoracic lateral for humerus
Which lateral projection can be performed to demonstrate the entire humorous for a patient with mid humeral fracture?
Transthoracic lateral projection for humorous
True or false call Lynn the use of a grid is not required for shoulder studies that measure less than 10 cm
True
True or false the shoulder is the most common joint to develop bursitis do too repetitive motion
True
True or false: CT arthrography of the shoulder joint often requires the use of iodinated contrast media injected into the joint space
True
True or false: nuclear medicine bone scans can demonstrate signs of osteomyelitis and cellulitis
True
True or false: shoulder projections are best performed erect when possible
True
True or false: sonography can provide a functional evaluation of joint movement that MRI cannot
True
True or false: the transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus
True
True or false: the use of a breathing technique can be performed for the transthoracic lateral humorous projection
True
True or false: the use of contact shields over the breast, long, and thyroid regions is recommended for most shoulder projections
True
True or false: it is recommended to perform shoulder positions on obese patients in the erect position when possible
True (to reduce OID and part distortion)
What is the anatomical name for the armpit?
axillary
Fluid filled joint space
bursitis
Which structure of the scapula extends most anteriorly
coracoid process
The anterior surface of the scapula is referred to as the
costal surface
True or false radiography is more sensitive than nuclear medicine for demonstrating physiologic aspects of the shoulder girdle
false
True or false: the KVP range for adult shoulder projections is between 100 to 110 KVP
false
What must be ruled out before performing the weight bearing study for AC joints?
fracture of the clavicle
Compression between the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch
impingement syndrome
Subacromial spurs
impingement syndrome
Narrowing of joint space
osteoarthritis
Atrophy of skeletal tissue
osteoporosis
Thin bony cortex
osteoporosis
The shoulder girdle consists of
proximal humerus, scapula, clavicle
Closed joint space
rheumatoid arthritis
Traumatic injury to one or more of the supportive muscles of the shoulder girdle
rotator cuff tear
All of the joints of the shoulder girdle are classified as being
synovial, diarthrodial
Inflammatory condition of the tendon
tendonitis
