Chpt. 5 Practice Test Questions-IE

What does an externally rotated shoulder demonstrate?

G. tubercle in profile laterally and humeral head in profile medially

What does an internally rotated shoulder demonstrate?

L. tubercle in profile medially and humeral head superimposed by G. tubercle.

How should the humeral epicondyles be aligned for an externally rotated shoulder?

Parallel with the IR

How should the humeral epicondyles be aligned for an internally rotated shoulder?

Perpendicular to the IR

For an AP shoulder what is the relationship of the MCP? What does this do to the shoulders position?

MCP is parrallel to the IR; positions them equal distance from the IR

What occurs when the shoulder is rotated toward the affected side?

-Increased thoracic superimposition of the scapular body

-Increased clavicular foreshortening

-Medial end of clavicle rotates away from the vertebral column

-Increased clavicular foreshortening

-Medial end of clavicle rotates away from the vertebral column

What occurs when the shoulder is rotated away from the affected side?

-Decreased thoracic superimposition of scapular body

-Decreased clavicular foreshortening

-Medial end of clavicle superimposing vertebral column

-Decreased clavicular foreshortening

-Medial end of clavicle superimposing vertebral column

What is demonstrated on a shoulder x-ray

-Glenohumeral joint

-clavicle

-proximal 1/3 humerus

-superior scapula

Evaluation of AP shoulder x-ray

-scapular body minimal transverse foreshortening

-1/2 superior scapula body without thorax superimposition

-clavicle minimal foreshortening & medial end close to vertebral column

• glenoid cavity partially seen w/h humeral head superimposing non dislocated shoulder

-scapular body not foreshortened

-midclavicle superimposes superior scapular angle

-humerus seen w/o abduction

How can anterior dislocation of the shoulder be determined?

The humeral head will be demonstrated anteriorly beneath the coracoid process

-more common 95%

How can posterior dislocation of the shoulder be determined?

The humeral head will be demonstrated posteriorly beneath the acromion process (or scapular spine)

-uncommon 2%-4%

What is the proper positioning for an inferiorsuperior axial shoulder?

Abduct affected arm 90* from the body and elevate shoulder 2-3" from the table

-supine w/h affected shoulder by lateral edge of table

-horizontal CR 30-35 parallel with glenohumeral joint

-CR to midaxillary region

What are the anatomy relationships for an inferiorsuperior axial shoulder?

-Inferior and superior margins of the glenoid cavity are superimposed (glenohumeral joint open)

-Lesser tubercle in profile (parallel epicondyles w/ floor) or partially in profile (epicondyles 45* w/ floor)

-Glenoid cavity, coracoid process, scapular spine, acromion process, and 1/3 of proximal humerus included

-coracoid in profile w/h medial aspect included

-base of coracoid fully seen anterior to scapular neck

What is the proper positioning for an AP oblique (Grashey method) shoulder?

Rotate body toward effected shoulder until MCP is at a 35-45* oblique with the IR or until coracoid process and acromion angle are superimposed

-Glenoid cavity seen w/o thorax superimposition

-superior margin of coracoid process and glenoid cavity aligned

-CR to coracoid process

What is patient rotation when recumbant

45-60

How can under rotation on an AP oblique (Grashey method) shoulder be determined?

-The glenohumeral joint will be closed

What does an externally rotated shoulder demonstrate?

G. tubercle in profile laterally and humeral head in profile medially

What does an internally rotated shoulder demonstrate?

L. tubercle in profile medially and humeral head superimposed by G. tubercle.

How should the humeral epicondyles be aligned for an externally rotated shoulder?

Parallel with the IR

How should the humeral epicondyles be aligned for an internally rotated shoulder?

Perpendicular to the IR

For an AP shoulder what is the relationship of the MCP? What does this do to the shoulders position?

MCP is parrallel to the IR; positions them equal distance from the IR

What occurs when the shoulder is rotated toward the affected side?

-Increased thoracic superimposition of the scapular body

-Increased clavicular foreshortening

-Medial end of clavicle rotates away from the vertebral column

What occurs when the shoulder is rotated away from the affected side?

-Decreased thoracic superimposition of scapular body

-Decreased clavicular foreshortening

-Medial end of clavicle superimposing vertebral column

What is demonstrated on a shoulder x-ray

-Glenohumeral joint

-clavicle

-proximal 1/3 humerus

-superior scapula

Evaluation of AP shoulder x-ray

-scapular body minimal transverse foreshortening

-1/2 superior scapula body without thorax superimposition

-clavicle minimal foreshortening & medial end close to vertebral column

• glenoid cavity partially seen w/h humeral head superimposing non dislocated shoulder

-scapular body not foreshortened

-midclavicle superimposes superior scapular angle

-humerus seen w/o abduction

How can anterior dislocation of the shoulder be determined?

The humeral head will be demonstrated anteriorly beneath the coracoid process

-more common 95%

How can posterior dislocation of the shoulder be determined?

The humeral head will be demonstrated posteriorly beneath the acromion process (or scapular spine)

-uncommon 2%-4%

What is the proper positioning for an inferiorsuperior axial shoulder?

Abduct affected arm 90* from the body and elevate shoulder 2-3" from the table

-supine w/h affected shoulder by lateral edge of table

-horizontal CR 30-35 parallel with glenohumeral joint

-CR to midaxillary region

What are the anatomy relationships for an inferiorsuperior axial shoulder?

-Inferior and superior margins of the glenoid cavity are superimposed (glenohumeral joint open)

-Lesser tubercle in profile (parallel epicondyles w/ floor) or partially in profile (epicondyles 45* w/ floor)

-Glenoid cavity, coracoid process, scapular spine, acromion process, and 1/3 of proximal humerus included

-coracoid in profile w/h medial aspect included

-base of coracoid fully seen anterior to scapular neck

What is the proper positioning for an AP oblique (Grashey method) shoulder?

Rotate body toward effected shoulder until MCP is at a 35-45* oblique with the IR or until coracoid process and acromion angle are superimposed

-Glenoid cavity seen w/o thorax superimposition

-superior margin of coracoid process and glenoid cavity aligned

-CR to coracoid process

What is patient rotation when recumbant

45-60

How can under rotation on an AP oblique (Grashey method) shoulder be determined?

-The glenohumeral joint will be closed

-Lateral tip of the coracoid process demonstrates less than 0.25" of humeral head superimposition

-Thorax is not superimposed over the scapular neck

-Clavicle demonstrates little longitudinal foreshortening

How can over rotation on an AP oblique (Grashey method) shoulder be determined?

-The glenohumeral joint is closed

-More then 0.25" of the lateral tip of the coracoid process is superimposed over the humeral head

-Thorax is superimposed over glenoid cavity and scapular neck

-Clavicle demonstrates excessive longitudinal foreshortening

Proper positioning for a PA oblique (scapular Y)

-Center shoulder to upright IR

-Rotate pt toward affected shoulder 45* with IR (imaginary line between coracoid process and acromion parallel with IR positioning vertebral border of scapula between them)

How does a scapular Y w/ no injury appear?

Glenoid cavity and humeral head, and scapular body and humeral shaft are superimposed

How does a scapular Y w/ dislocation appear?

Glenoid cavity does not superimpose the humeral head

How does a scapular Y proximal humerus fx appear?

Scapular body does not superimpose the humeral shaft.

What parts of the shoulder make up the scapular Y?

Acromion (arm), coracoid process (arm), superimposed medial and lateral border, and inferior angle, scapular body (leg)

Correct rotation on scapular y

superimposed lateral and vertebral scapular border

Excessive torso and shoulder obliquity of scapular y

-lateral border superimposed by thorax

-positioned closer to thorax than vertebral border

Insufficient torso and shoulder obliquity of scapular y

-vertebral border superimposes the thorax

-demonstrated closer to thorax than lateral border