Chapter 3:Abdomen Flashcards
largest and longest bone of the upper limb?
humerus
what does the humerus articulate with at the shoulder joint?
shoulder blade aka scapula
what action places the humerus in a true ap?
external rotation
what does a natural position of the arm leave the humerus position in?
in an oblique position midway btw an ap (external rotation) and a lateral (internal rotation)
how are the tubercles located in a true ap projection?
the lesser tubercle is anterior and the greater tubercle is lateral
The three aspects of the clavicle are the:
(1) Acromial Extremity (2) Body (Shaft) (3) Sternal Extremity
The male/female clavicle tends to be thicker and more curved in shape.
Male
what is the function of the clavicle and scapula?
to connect each upper limb to the trunk/axial skeleton
how does the shoulder girdle connect to the trunk anteriorly vs posteriorly?
anterior: upper sternum
posterior: incomplete since the scapula is connected by muscles only
we know where the lower margin of the scapula is located (what rib number aka T7) but where is the upper margin?
at T2
jugular notch
the combo of the sternoclavicular joints on either side of the manubrium helps to form the imp positioning landmark called…
the three borders of the scapula
medial/vertebral
superior border
lateral/axillary
The three angles of the scapula include the:
(1) Lateral Angle (head of the scapula) (2) Superior Angle (3) Inferior Angle
this angle is the thickest part and ends laterally as the glenoid cavity
lateral angle
why is the body of the scaupula arched?
for greater strength
acromion
long curved process that extends laterally over the head of the humerus
thick, beaklike process that projects anteriorly beneath the clavicle coracoid process
thick, beaklike process that projects anteriorly beneath the clavicle
scapular notch
notch on the superior border that is partially formed by the base of the coracoid process
the dorsal side of the scapula has an elevated spine starting at the vertebral border and coninues laterally to end at what?
acromion
The anterior surface of the scapula is referred to as the ___________________ surface.
Costal
the spine separated the posterior surface of the scapula into two parts…
uppper: supraspinous fossa
lower: infraspinous fossa
what is special about the way the fossa of the scapula are labeled?
the fossae serve as surfaces of attachment for shoulder muscles; the names of the muscles are associated with their respective fossa
the lateral projection of the scapula makes the bone look like what letter?
Y
what are the upper parts of the y?
acromion: expanded distal end of spine extending superiorly/posteriorly to glenoid fossa
coracoid: located aneriorly in relation to the glenoid cavity/shoulder joint
bottom leg of the y is the body of the scapula
coracoid: located aneriorly in relation to the glenoid cavity/show to get scapular y?
pt in an antrior oblique with the upper body rotated until the scapula is separated from the rib cage in a true end-on or lateral projectionhoulder joint
what results from a true lateral view of the scapula?
the y shape
What is the atomic name for the armpit?
Axilla
What are the names of the two fossae located on the posterior scapula?
(1) Infraspinous Fossa (2) Supraspinous Fossa
All the joints of the shoulder girdle are classified as being:
Synovial (Diarthrodial)
Movement type for the Scapulohumeral Joint:
Spheroidal (ball and socket)
what are the different movements the scapulohumeral joint can do?
flexion/extension, abduction/adduction, circumduction, medial/lateral rotation
this is very shallow which allows the greatest freedom in mobility of any joint in the human body but at some expense to its strength and stability
glenoid cavity
there are strong ligaments and tendons and muscles surrounding the scapulohumeral joint…however…
stretching of muscles/tendons cause separation/dislocation of humeral head from glenoid cavity
dislocations at what joint occur more freq than at any other joint in the body requiring…
shoulder joint requiring the need for freq radiographic exams of the shoulder to evaluate for structural damage
which of the two joints by the clavicle has more gliding free reign?
the acromioclavicular joint over the sternoclavicular joint
sterno:
limited amount of gliding in every direction
acromio:
end of clavicle plus acromion movement and then rotary mm as the scapula moves forward and backward with the clavicle
Movement type for the Sternoclavicular Joint:
Plane (gliding)
Movement type for the Acromioclavicular Joint:
Plane (gliding)
rotational views of the proximal humerus are commonly taken on what kind of patients when what have been ruled out?
nontrauma when fractures/dislocations of the humerus have been ruled out
when are grids generally used?
when the humerus is performed erect with the use of a bucky. Adult shoulders generally measure 10-15cm and require grid use.
AEC for shoulder
center cell for AEC if used for the shoulder
radiography of the shoulder region may provide potentially significant doses to what radiosensitve organs ?
orgns that have a relative risk of becoming cancerous compared with whole body effective doses thyroid, lung, breasts
what to do to help protect these areas?
close collimation to area of interest
why is close collimation important?
ensuring that the final image after processing is of optimal detail quality
is accurate centering important?
YES: the body part and the CR need to be centered to the IR bc of the way the digital image plate reader scans the exposed imaging plate
True/False: The use of contact shields over the breast, lung, and thyroid regions is recommended for most shoulder projections True
True
If physical immobilization is required, which individual should be asked to restrain a child for a shoulder series?
Parent or guardian
True/False: CT arthrography of the shoulder joint often requires the use of iodinated contrast media injected into the joint space.
True
True/False: Magnetic resonance imaging (MRI) is an excellent modality for demonstrating bony injuries of the shoulder girdle.
False (it is often used on the shoulder to evaluate soft tissue and skeletal involvement of lesions an soft tissue injuries)
Impingement Syndrome
Compression between the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch. Characterized by Abnormal widening of acromioclavicular joint space.
Bankart Lesion
Injury to the anteroinferior glenoid labrum. Characterized by Avulsion fracture of the gleniod rim.
Tendonitis
Inflammatory condition of the tendon. Characterized by Calcified tendons.
Superior displacement of the distal clavicle.
Characterized by Widening of AC joint space. Acromioclavicular joint dislocation
Hill-Sachs defect
Compression fracture of the articular surface of the humeral head. Characterized by Compression fracture of the humeral head.
Rotator cuff tear
Traumatic injury to one or more of the supportive muscles of the shoulder girdle: Teres minor, supraspinatus, infraspinatus, and subscapularis. Characterized by Partial or complete tear in musculature.
Osteoporosis
Atrophy of skeletal muscle and reduction in the quantity of bone. Characterized by Thin bony cortex.
Osteoarthritis
Known as degenerative joint disease (DJD) is a noninflammatory joint disease characterized by gradual deterioration of the articular cartilage with hypertrophic bone formation. Evidenced by the narrowing of joint space.
Rheumatoid Arthritis (RA)
Chronic systemic disease characterized by inflammatory changes that occur throughout the connective tissues of the body. Characterized by Closed joint space.
Bursitis
An inflammation of the bursae, or fluid-filled sacs enclosing the joints. Characterized by Fluid-filled joint space with possible calcification.
Which clinical indications requires a decrease in manual exposure factors?
Osteoporosis
Which two routine shoulder projections are routinely taken for a shoulder (with no traumatic injury) and proximal humerus?
(1) AP, external rotation (2) AP, internal rotation
Specifically, where is the the central ray placed for an AP projection of the shoulder?
CR perpendicular to IR, directed to 1 inch (2.5 cm) inferior to coracoid process
Which lateral projection can be preformed to demonstrate the entire humerus for a patient with midhumeral fracture?
Transthoracic Lateral Projection for Humerus (Lawerence Method)
To best demonstrate a possible Hill-Sachs defect, which additional positioning technique can added to the inferosuperior axial projection?
Rotate affected arm externally approximately 45 degrees
What type of central ray angulation is required for the inferosuperior axial projection of the shoulder?
25-30 degrees medially
What projection of the shoulder produces an image of the glenoid process in profile? Posterior oblique; Grashey Method
Posterior oblique; Grashey Method
The supine version of the tangential projection for the intertubercular groove requires that the central ray be angled __________________ posteriorly from the horizontal plane.
15-20 degrees
Which projection is best for demonstrating possible dislocation of the proximal humerus?
Scapular Y Projection
Which nontrauma projection can be performed erect to provide lateral view of the proximal humerus in relationship to the glenohumeral joint?
PA transaxillary projection (Hobbs Modification)
How much is the CR angled for the inferosuperior axial projection (Clements modification) if the patient cannot fully abduct the arm 90 degrees?
5-15 degrees
What CR angle is required for the AP axial projection (Alexander method) for AC joints?
15 degrees cephalad
True/False: The PA tranaxillary projection (Hobbs modification) requires no CR angle.
True
True/False: The transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus.
True
True/False: The use of a breathing technique can be preformed for the transthoracic lateral humerus projection.
True
True/False: The affected arm must be paced into external rotation for the transthoracic lateral position.
False (Neutral)
True/False: A central ray angle of 10-15 degrees caudad may be used for the transthoracic lateral projections if the patient is unable to elevate the uninjured arm and shoulder sufficiently.
False (CR angle of 10-15 degrees cephalad)
True/False: The scapular Y lateral (anterior oblique) position requires the body to be rotated 30-40 degrees anteriorly toward the affected side.
False (45-60 degrees)
Which two landmarks are placed perpendicular to the IR for the scapular Y lateral projection?
(1) Superior angle of the Scapula (2) AC Joint articulation
Which special projection of the shoulder requires that the affected side be rotated 45 degrees toward the cassette and uses a 45 degree caudad central ray angle?
AP Apical Oblique Axial Projection (Garth Method)
A posterior dislocation of the humerus projects the humeral head ___________________ to the glenoid cavity with the AP Apical Oblique Axial Projection.
Superior
