RADT 1030 - Humerus and Shoulder Girdle

An injury of the anteroinferior aspect of the glenoid labrum often caused by anterior dislocation of the proximal humerus. Repeated dislocation may result in small avulsion fracture of the glenoid rim.

Bankart lesion

projection at the lateral end of the scapular spine

acromion

thickened posterior border of the scapular spine

crest of the spine

projection that results in a lateral view of the head and neck of the humerus and demonstrates the relationship of the humerus and glenoid cavity

inferosuperior (axiolateral) projection

projection of the humerus - epicondyles perpendicular to the IR

internal rotation

projection of the humerus - epicondyles parallel to IR

external rotation

projection of the humerus - epicondyles oblique to IR

neutral rotation

kVp w/o grid and with grid for analog and digital

analog:

without grid: 65-70 kVp

with grid: 70-80 kVp

digital:

+ 5-10 kVp

Impingement of the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch, generally during abduction of the arm

impingement syndrome

most common Bankart lesion exams

AP internal rotation, Scapular Y and Grashey

subacromial spurs appear in what pathology

impingement syndrome

compression fracture of the articular surface of the posterolateral aspect of the humeral head associated with anterior of humeral head dislocation

Hill- Sachs defect

another name for the anterior surface of the scapiula

costal surface

the angels of the scapula

superior

inferior

lateral (head)

borders of the scapula

superior border

medial (vertebral) border

lateral (axillary) border

most common exams for shoulder disloaction

scapular Y

transthoracic lateral

Garth Method

Upper scapular margin location

T2 (2nd posterior rib)

which tubercle is on lateral aspect of the humerus?

greater tubercle

which tubercle is on medial aspect of the humerus?

lesser tubercle

CR location on AP shoulder?

1" inferior to coracoid process

what does the NEER method demonstrate?

coracoacromial arch for supraspinatus outlet region for possible shoulder impingement

common exams for impingement syndrome?

Scapular Y

Neer method

most common exams for Hill - Sachs defect?

AP internal rotation

exaggerated external rotation

axillary lateral

Description for lateral scapula - ERECT

-patient faces IR

-to demonstrate the body of the scapula, have the patient grab opposite shoulder.

-to demonstrate acromion and coracoid process, drop affected arm and flex elbow and place arm behind back.

-CR to mid vertebral border of scapula

Description for lateral scapula - RECUMBENT

-supine position with arm across chest, bend knee to maintain oblique

-CR to midscapular lateral border

AP radiograph with what rotation places the humerus in true AP or frontal position?

AP with external rotation

Shoulder girdle consists of what bones?

scapula

clavicle

most fractured neck of the humerus?

surgical neck

where does the deltoid attach?

deltoid tuberosity

AP position that has the greater tubercle in profile?

AP with external rotation

humeral condyles 45 degree angle from IR

natural humerus

What position is AP humerus with lesser tubercle in profile, greater tubercle mid and humeral epicondyles perpendicular to IR?

AP humerus w/ internal rotation

what is the only articulation between the upper limb and axial skeleton?

SC joints

Parts of the clavicle

articulation of the clavicle and sternum

sternoclavicular joint (SC joint)

Clavicles are usually shorter and less curved in which gender?

female

prominent structure on the dorsal (posterior) surface of the scapula

spine of the scapula

the 3 shoulder girdle joints are classified as what type of joint?

synovial

the mobility types of the 3 shoulder girdle joints

diarthrodial

movement type of the scapulohumeral (glenohumeral) joint

spheroidal (ball and socket)

Movement type of the sternoclavicular joint

plane/gliding

Movement type of the acromioclavicular joint

plane/gliding

injury in which the distal clavicle is displaced superiorly, usually caused by a fall?

AC dislocation

rotator cuff muscles

supraspinatus

infraspinatus

subscapularis

teres minor

For Humerus/Shoulder:

Grid or no grid?

What AEC cell is used?

What is shielded if possible?

higher or lower mA and exposure time?

- grid (wall or table bucky)

- center cell AEC

- shield breast, thyroid, lungs gonads

- higher mA, lower exposure time

Trauma projections of the humerus

transthoracic lateral

horizontal beam lateral

breathing instructions given for AP humerus?

deep breath in an hold

SID for humerus

40 inch SID

most common exams for bursitis, idiopathic chronic adhesive capsulitis, osteoarthritis, RA and osteoporosis?

AP and Lateral shoulder

Most common AC joint exams for dislocation?

Bilateral AP erect AC w/o weights

Most common AC joint exams for separation?

Bilateral AP with and without weights

____________% of shoulder dislocations are_______________.

95%

anterior

Chronic systemic disease characterized by inflammatory changes that occur throughout the connective tissues of the body

Rheumatoid arthritis (RA)

Osteoarthritis generally occurs in what groups of people?

people ages 50+

chronically obese

atheletes

noninflammatory joint disease characterized by gradual deterioration of articular cartilage w/ hypertonic bone formation

osteoarthritis (degenerative joint disease (DJD))

another name for osteoarthritis?

Degenerative Joint Disease (DJD)

another name for inferosuperior axial projection : shoulder

Clements modification

another name for inferosuperior axial projection: shoulder and what is it used for?

(non trauma)

Lawerence method

- used for degenerative conditions and Hill-Sachs defect

How do you position the patient and tube for non trauma Lawrence method?

Patient is supine with should raised about 2 inches from table top using a sponge. Place cart at edge of table to support forearm. IR at top of shoulder, patient head turned .

CR - 25-30 degree into axilla

another name for transaxillary projection of the shoulder?

Hobbs modification

patient position and CR direction for Hobbs method?

-Patient is erect or leaning over the end of the table with arm of interest raised as high as possible. The patient is positioned in a slight 5 to 10 degree anterior oblique.

-CR is directed perpendicular to the axilla and the humeral head to pass through the glenohumeral joint.

another name for the posterior oblique position - Glenoid Cavity : Shoulder

Grashey method

Patient and CR position on Grashey method?

patient is rotated 35-45 degrees from the IR toward affected side.

CR - centered to scapulohumeral joint

Method name of the tangential projection - intertubercular Groove: shoulder?

Fisk Method

Patient and CR location for Fisk method?

ERECT - patient is bent over end of table with elbow flexed holding IR in supinated hand, leaning forward 10-15 degrees from vertical

SUPINE- Arm at side with hand supinated. Cassette against top of shoulder, head turned away from cassette. CR 10-15 degrees cephalad @ mid humeral head.

AP Neutral rotation shoulder, TRAUMA CR location

CR is directed at mid scapulohumeral joint

What is the CR difference in the Transthoracic lateral humerus and the Lawerence method Trauma?

The transthoracic lateral humerus & CR is a mid- diaphysis. The lawrence trauma visualizes the proximal humerus with CR at surgical neck of humerus.

Guidelines to be followed when using digital imaging systems?

collimation

accurate centering

exposure factors

post processing evaluation of exposure factors

Tangential projection - Supraspinatus Outlet: Shoulder (TRAUMA) -

whats the name for this method?

NEER method

Patient and CR location of an AP scapular Y lateral oblique position

rotate patient into anterior oblique position, to 45-60 degrees, the line between the superior angle of the scapula and the AC joint should be perpendicular to IR>. CR is directed at the scapulohumeral joinh.

What is the trauma Lawrence method and the non trauma Lawrence method

Trauma - transthoracic proximal humerus

Nontrauma - inferosuperior axial projection of the shoulder

Patient position and CR location of NEER method

patient is at 45-60 degree anterior oblique position

CR 10-15 degree caudal angle centered at superior margin of humeral head

another name for the AP apical oblique axial projection : Shoulder (trauma)

Garth method

patient position and CR position for AP projection of clavicle

patient standing with back to IR

CR perpendicular to IR and centered at mid clavicle

patient position and CR position for AP Axial projection of clavicle

patient standing with back to IR

CR at 15-30 degree cephalad angle and centered mid clavicle

patient and cr position for Garth method

patient erect or supine at 45 degrees toward affected side

CR at 45 degree caudad angle and centered at scapulohumeral joint

What is the Alexander method?

AP axial projection of AC joints

CR is 15 degrees cephalic angle centered at the level of the AC joints

How are AC joints projections positioned?

bilateral

with and without weights

72 in SID

CR is 1 " inch above jugular notch

How to position patient and CR fo AP scapula?

Patient with back to IR, abduct arm 90 degrees and supinate hand (fainting look)

CR at level of axilla and 2 inches medial from lateral side of patient

How to position the patient and CR for AP scapula?

Patient with back of IR, abduct arm 90 degrees and supinate hand (fainting look).

CR @ level of Axilla and 2 inches medial from lateral side of patient