radiographic positioning chapter 5

proximal humerus, scapula, clavicle

what does the shoulder girdle consist of?

sternal extremity, body (shaft), acromial extremity

The three aspects of the clavicle are the

lateral angle, superior angle, inferior angle

The three angles of the scapula include include

male

Which clavicle tends to be thicker and more cured in shape, male or female?

costal surface

the anterior surface of the scapula is is referred to as the

axilla

what is the anatomic name for armpit

infraspinous fossa, supraspinous fossa

What are the names of the two fossae located on the posterior scapula

synovial

all of the joints in the shoulder are classified as

ball and socket

what kind of movement is the scapulohumeral joint

plane

what kind of movement is the sternoclavicular joint

plane

what kind of movement Is the acromioclaviclar joint

scapula

coracoid process location

scapula

crest of spine location

clavicle

acromial extremity location

proximal humerus

greater tubercle location

proximal humerus

intertubercular groove location

proximal humerus

surgical neck location

not part of the shoulder girdle

coronoid process

not part of the shoulder girdle

condylar process

external rotation

greater tubercle profiled laterally

neutral rotation

humeral epicondyles angled 45 degrees to IR

internal rotation

epicondyles perpendicular to IR

external rotation

supination of hand

neutral rotation

palm of hand against thigh

external rotation

epicondyles parallel to IR

internal rotation

lesser tubercle profiled medially

internal rotation

proximal humerus in lateral position

external rotation

proximal humerus in position for an AP projection

true

the use of a grid is not required for shoulder studies that measure less than 10 cm

false

The Kv range for adult shoulder projections is between 60 and 70 kV for analog and 100-110 kV for digital imaging systems

false

low mA with short exposure times should be used for adult shoulder studies

false

large focal spot setting should be selected for most adult should studies

true

a high speed screen IR system is recommended for analog shoulder studies when using a grid

false

a 72 inch SID is recommended for most shoulder girdle studies

true

the use of contact shields over the breast, lung, and thyroid regions is recommended for most should projections

80-90 kV

which of the following kV ranges (digital) should be used for a shoulder series on an average adult using a grid

boomerang compensating filter

Which of the following devices permits good visualization of soft-tissue and bony anatomy for adult shoulder radiograph?

parent or guardian

if physical immobilization is required, which individual should be asked to restrain a child for a shoulder series

true

it is recommended to perform shoulder positions on obese patients in the erect position when possible

true

CT arthography of the shoulder joint often requires the use of iodinated contrast media injected into the joint space

false

MRI is an excellent modality for demonstrating bony inquiries of the shoulder girdle

true

nuclear medicine bone scans can demonstrate signs of osteomylelitis and cellulitis

false

radiography is more sensitive than nuclear medicine for demonstrating physiologic aspects of the shoulder girdle

true

sonography can provide a functional dynamic evaluation of joint movement that MRI cannot

impingement syndrome

compression between the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch

bankart lesion

injury of the anteroinferior glenoid labrum

tendonitis

inflammatory condition of the tendon

acromioclavicular joint dislocation

superior displacement of the distal clavicle

hill-sachs defect

compression fracture of the articular surface of the humeral head

rotor cuff tear

traumatic injury to one or more of the supportive muscles of the shoulder girdle

osteoporosis

atrophy of skeletal tissue

impingement syndrome

radiographic appearance - subacromial spurs

bursitis

radiographic appearance - fluid-filled joint space

osteoporosis

radiographic appearance - thin bony cortex

acromioclavicular joint seperation

radiographic appearance - abnormal/asymmetric widening of acromioclavicular joint space

tendonitis

radiographic appearance - calcified tendons

bankart lesion

radiographic appearance - avulsion fracture of the anteroinferior glenoid rim

osteoarthritis

radiographic appearance - narrowing of joint space

rheumatoid arthritis

radiographic appearance - closed/loss of joint space

hill- Sachs defect

radiographic appearance - compression fracture of anterior humeral head

osteoporosis

which of the following clinical indications requires a decrease in manual exposure factors

true

the shoulder is the most common joint to develop bursitis due to repetitive motion

false

rheumatoid arthritis is more prevalent in men over woman

supraspinatus

the most common injury to the rotator cuff

AP external rotation, AP internal rotation

Which two routine shoulder projections are routinely taken for a shoulder and proximal humerus? with no traumatic injury

CR perpendicular to IR, directed to 1 inch inferior to corocoid process

Specifically, where is the CR placed for an AP projection of the shoulder?

transthoracic lateral projection for humerus

Which lateral projection can be formed to demonstrate the entire humerus for a patient with a midhumeral fracture?

rotate affected arm externally approximately 45 degrees

to best demonstrate a possible Hill-Sachs defect, which additional positioning technique can be added to the inferosuperior axial projection (lawrence method)?

25-30 degrees medially

what type of CR angulation is required for the inferosuperior axial projection (lawrence method) for the shoulder?

anterior oblique (grashey method)

what projection of the shoulder produces an image of the glenoid process in profile.

Grashey Method

what is an alternate name for the anterior oblique projection

10-15 degrees

the supine version of the tangential projection for the intertubercular sulcus (fisk modification) requires that the CR be angled to ___ posteriorly from the horizontal plane

posterior oblique (scapula Y) projection

which of the following projections is best for demonstrating a possible dislocation of the proximal humerus?

tangential projection supraspinatus outlet (neer method)

what projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs, which create shoulder impingement symptoms.

30 degrees caudad

What type of CR angle is required for the apical AP axial shoulder projection

15-20 degrees

How much is the CR angled for inferosuperior axial projection (lawrence method) if the patient cannot fully abduct the arm 90 degrees

15 degrees cephalad

What CR angle is required for the AP axial projection for AC joints

false - 30 degrees caudad

The PA transaxillary projection (modified bernageau) requires no CR angle

true

The transthoracic lateral projection (lawrence method) can be performed for possible fractures or dislocations of the proximal humerus

true (orthostatic)

the use of a breathing technique can be performed for the transthoracic lateral humerus projection

false - neutral rotation

the affected arm must be placed into external rotation for the transthoracic lateral projection

false - 10-15 cephalad

a central ray angle of 10-15 degrees caudal may be used for transthoracic lateral shoulder projection (lawrence method) if the patient is unable to elevate the uninjured arm and shoulder sufficiently

false - 45 degrees

the scapula y lateral position requires the body to be rotated 25-30 degrees anteriorly toward the affected side

superior angle of the scapula, AC joint articulation

which two landmarks are placed perpendicular to the IR for the scapula Y lateral projection

AP apical oblique (garth method)

which special projection of the shoulder requires that the affected side be rotated 45 degrees toward the cassette and uses a 45 degree caudad CR angle

superior

a posterior dislocation of the humerus projects the humeral head _______ to the glenoid cavity in the AP apical oblique projection

more

an asthenic patient requires_________ CR angle for an AP axial clavicle projection that a hypersthenic patient

fracture of clavicle

what must be ruled out before performing the weight-bearing study for acromioclavicular joints?

Lawrence method

inferosuperior axial

Grashey method

anterior oblique for glenoid cavity

Lawrence method

transthoracic lateral

Garth method

AP apical oblique axial

suspected AC joint subluxation

What is the most common clinical indication to perform the Alexander method for the AC joints

15 degree cephalad

what type of CR angle is required for the Alexander method for AC joints

perpendicular to mid scapula, 2 inch inferior to coracoid process, level of axilla, 2 inches medial from lateral border of patient

Where is the CR centered for the AP scapula projection

none

What type of CR angle is required for the lateral scapula position

true

orthostatic technique is recommended for the AP projection of the scapula

false

the lateral scapula and posterior oblique projections are the same projection

humerus

what is the largest and longest bone of the upper limb

head

what is the most proximal part of the humerus