CH 5 - Humerus & Shoulder Girdle - Lampignano

1. Which of the following structures is not part of the proximal humerus?

Glenoid process

3 multiple choice options

2. Which term describes the medial end of the clavicle?

Sternal extremity

T/F 3. The female clavicle is usually shorter and less curved than that of the male.

True

4. The anterior surface of the scapula is referred to as the:

Costal surface

5. What is the name of the large fossa found within the anterior surface of the scapula?

Subscapular fossa

6. What is the name of the insertion point for the deltoid muscle located on the anterolateral surface of the humerus?

Deltoid tuberosity

T/F 7. All of the joints of the shoulder girdle are diarthrodial.

True

8. Which of the following joints is considered to have a spheroidal type of movement?

Scapulohumeral joint

9. Which view and projection of the proximal humerus is represented in the figure?

External rotation, AP projection

10. Part 5 refers

None of the above

T/F 12. Part 10 refers to the vertebral border of the scapula.

False

T/F 13. Part 3 refers to the greater tubercle.

True

14. Which rotation of the humerus will result in a lateral position of the proximal humerus?

Internal rotation

15. Which AP projection of the shoulder and proximal humerus is created by placing the affected palm of the hand facing inward toward the thigh?

Neutral rotation

T/F 16. The use of a grid during shoulder radiography will result in higher patient dose over nongrid procedures.

True

17. Which of the following shoulder positions is considered a trauma projection (can be performed safely for a possible fracture or dislocation)?

AP apical oblique axial (Garth method)

18. What medial central ray (CR) angle is required for the inferosuperior axial shoulder (Lawrence method)

25 to 30

19. What additional maneuver must be added to the inferosuperior axial shoulder (Lawrence method) projection to best demonstrate a possible Hill-Sachs defect?

Perform exaggerated external rotation of the affected upper limb

20.Which of the following shoulder projections best demonstrates the glenoid cavity in profile?

Grashey method

T/F 21. A radiograph of the inferosuperior axial projection (Lawrence method) demonstrates the acromion process of the shoulder to be located most superiorly (anteriorly).

False

T/F 22. For a Grashey method projection of the shoulder, the CR is centered to the acromion.

False

23. How much posterior CR angulation is required for the supine version of the tangential projection for the intertubercular (bicipital) groove?

10 to 15

24. Which ionization chamber(s) for the AEC should be used for a tangential projection for an intertubercular groove?

Cannot use AEC with this projection

25. Which of the following projections can be performed using a breathing technique?

AP scapula

26. How much CR angulation should be used for a scapular Y projection?

No CR angle should be used.

No CR angle should be used

T/F 28. The PA transaxillary projection (Hobbs modification) is performed to rule out possible shoulder dislocation.

True

27. Where is the CR centered for a transthoracic lateral projection for proximal humerus?

Level of the surgical neck

29. An AP apical oblique projection for an anteriorly dislocated scapulohumeral joint will project the humerus _____ to the glenoid cavity.

s

Inferior

30. Which projection of the shoulder requires that the patient be rotated 45° to 60° toward the IR from a PA position?

Lateral scapula projection

31. Which of the following modalities best demonstrates shoulder joint pathology such as rotator cuff tears using dynamic evaluation techniques during joint movements?

Arthrography

T/F 32. PA transaxillary (Hobbs modification) requires a 5° to 15° CR cephalic angle.

False

33. Which of the following best demonstrates the coracoacromial arch?

Neer method

34. The inferosuperior axial projection (Clements modification) requires a CR angle of ____ toward axilla if a patient cannot fully abduct extremity

5-15

35. How much CR angulation is required for an asthenic patient for an AP axial projection of the clavicle?

30

36. Where is the CR centered for the bilateral acromioclavicular (AC) joint projection on a single 14- × 17-inch (35 × 43 cm) image receptor?

1 inch above the jugular notch

37. 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?

Increase rotation of the body

38. 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?

Use an orthostatic breathing technique

39. 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?

Positioning is acceptable, do not repeat it

40. A radiograph of an AP clavicle reveals that the sternal extremity is partially collimated off. What should the technologist do?

Repeat the AP projection and correct collimation.

Repeat the AP projection and correct collimation.

42. 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?

Posterior oblique (Grashey)

41. 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?

Increase rotation of thorax.

43. 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 midshaft of the clavicle is discovered. What should the technologist do in this situation?

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

44. A patient enters the ED with a midshaft 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?

Horizontal beam transthoracic lateral projection for humerus

45. 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?

PA scapular Y lateral with 10 to 15 degrees caudal angle

46. 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?

AP shoulder and recumbent AP oblique scapular Y projection

47. 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?

Non-weight-bearing and weight-bearing type of projections performed with the patient recumbent by pulling down on the shoulders.

48. A patient enters the ED with a possible bony defect of the midwing 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?

.

Have the patient reach across the chest and grasp the opposite shoulder for a lateral scapula projection.

T/F 49. The recommended SID for AC joints is 72 inches (183 cm).

True

T/F 50. The Hill-Sachs defect is a fracture of the articular surface of the glenoid cavity.

False

T/F 51. The arm should be abducted about 45° for an AP scapula.

False-90 degrees

T/F 52. An orthostatic (breathing) technique can be performed for the AP projection of the scapula.

True

53. Which one of the following projections/positions should NOT be performed for a possible shoulder dislocation?

Inferosuperior axial (Clements modification)

T/F 54. A posterior dislocation of the shoulder occurs more frequently than an anterior dislocation.

False

T/F 55. The Alexander method for AC joints requires a 15° cephalic CR angle.

True

T/F 56. 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.

True

57. Which of the following AP shoulder projections demonstrates the greater tubercle in profile medially?

None of the above

58. Which of the following AP shoulder projections demonstrates the lesser tubercle in profile medially?

Internal rotation

59. 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?

AP and horizontal beam transthoracic lateral shoulder projection

60. The AP humerus requires that the humeral epicondyles are _____ to the IR.

set at a 45° angle

Parallel

61. 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?

Angle the CR 10-15 cephalad

62. A patient is scheduled for an 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?

Fisk modification

63. 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?

Angle CR 5 to 15 degrees to the axilla

64. A radiograph of an AP axial projection of the clavicle demonstrates that the clavicle is within the midaspect of the lung apices. What should the technologist do to correct this error?

Increase the cephalic CR angle during repeat exposure

65. What is a possible radiographic sign for impingement syndrome of the shoulder?

Subacromial spurring

66. What type of CR angle is required for the superoinferior axial projection (Hobbs modification)?

CR is perpendicular to IR

T/F 67. Sonography is an effective diagnostic tool in studying the shoulder joint.

True

68. Where is the CR centered for the posterior oblique position for the glenoid cavity?

Acromion

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

Coracoid process

1 inch ( 2.5 cm) superior to the coracoid process

2 inches medial and inferior to the superolateral border of shoulder

69. What is the common term for idiopathic chronic adhesive capsulitis?

Bankart lesion

Tendinitis

Bursitis

Frozen shoulder

Frozen shoulder

Clements modification

Inferosuperior axial projection

Neer method

Tangential, supraspinatus outlet projection

Fisk modification

Tangential, intertubercular groove projection

Hobbs modification

PA transaxillary projection

Garth method

AP apical oblique axial projection

Grashey method

Posterior oblique, Glenoid cavity projection.

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