Shoulder Girdle Positioning

How much should a patient be rotated for an AP oblique (Grashey Method)

35-40 degrees LPO or RPO

For AP projections, what should the patient’s respiration be?

Suspended

What is the CR for AP projections (internal, external, neutral)?

Perpendicular to 1 inch inferior to the coracoid

How do the epicondyles appear in external rotation?

Parallel

How do the epicondyles appear in internal rotation?

Perpendicular

How do the epicondyles appear in neutral rotation?

45 degrees

What is the CR for the Grashey method?

2 inches medial + 2 inches inferior to the superolateral border of the shoulder

Where do you center the IR for the Grashey method?

To the scapulohumeral joint

What is in profile for the inferosuperior axial projection (Lawrence method)?

Lesser tubercle

What is the CR for the inferosuperior axial projection (Lawrence method)?

15-30 degrees medially, horizontally through the axilla

What is the patient positioning for the inferosuperior axial projection (Lawrence method)

abduct the arm and supinate the hand

Which arm do you elevate for the transthoracic lateral (Lawrence method)?

Unaffected arm

Where is the IR centered for the transthoracic lateral (Lawrence method)?

To the surgical neck

Where is the CR centered for the transthoracic lateral (Lawrence method)?

Perpendicular to the IR, entering the mid-coronal plane at the surgical neck

What does the Scapular Y rule out?

Dislocation

How much should a patient be rotated for a scapular Y?

45-60 degrees LAO or RAO

What is perpendicular to the IR for the scapular Y?

Flat surface of the scapula

What is the CR for the scapular Y?

Perpendicular to the scapulohumeral joint

What AP positioning should be avoided if the patient has a fracture or a dislocation?

Internal rotation

What AP image shows the greater tubercle in profile on the lateral aspect of the humerus?

External rotation

What AP image shows the lesser tubercle in profile and pointing medially?

Internal rotation

What AP image shows the outline of the lesser tubercle between the humeral head and the greater tubercle?

Neutral rotation

What should be parallel with the plane of the IR for the Grashey method?

The scapula

What is the proper arm positioning for the Grashey method?

Abducted with slight internal rotation

What does the Grashey method demonstrate?

The glenoid cavity

Other than upright, how else can a patient be positioned for a transthoracic lateral?

Supine

If the patient cannot elevate their unaffected arm, how many degrees and in what direction should the CR be directed?

10-15 degrees cephalad

Which change to radiographic exposure factors should be used to aid effectively the blurring of lung detail by the action of the heart when the patient is able to hold their breath for a sustained period?

Use a low mA/ long exposure time combination with the usual mAs factor

In the inferosuperior axial projection, when should the head and upper torso be elevated 3 inches?

When the patient is supine

In the inferosuperior axial projection, when a patient is supine what direction is the CR?

Horizontal

In the inferosuperior axial projection, how should the affected arm be positioned?

It should be abducted a minimum of 20 degrees

In the inferosuperior axial projection, how is the humerus rotated?

Externally

In the inferosuperior axial projection, which area of the body does the CR enter?

Axilla of the affected arm

In the inferosuperior axial projection, which positioning factor determines how many degrees the CR should be directed medially?

How abducted the arm is

True or False. In an image of a normal shoulder, the humeral head should be directly superimposed over the junction of the scapular Y.

True

What is the breathing instructions for the scapular Y?

Suspend

With reference from the thorax, where should the scapular body be demonstrated in the image of the PA Oblique projection (scapular Y)?

along the lateral aspect but not superimposed

For the Neer method, how is the CR angled?

10-15 degrees caudad

Where does the CR enter for the tangential projection (Neer method)?

superior aspect of the humeral head

What does the Neer method diagnose?

Impingement

What is the name of this position?

AP external rotation

What is the name of this position?

AP neutral rotation

What is the name of this position?

AP internal rotation

What are two alternatives for the inferosuperior projection?

superoinferior and PA transaxillary (Hobbs modification)