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Positioning > Chapter 5 > Flashcards

Chapter 5 Flashcards

1
Q

The shoulder girdle consists of ?, ?, and ?.

A

Proximal humerus, Scapula, and clavicle

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2
Q

The three aspects of the clavicle are the ?, ?, and ?.

A

Sternal extremity, body shaft, and acromial extremity.

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3
Q

The ? (male, or female) clavicle tends to be thicker and more curved in shape.

A

Male

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4
Q

The three angles of the scapula include the ?, ?, and ?.

A

Lateral angle, superior angle, inferior angle

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5
Q

The anterior surface of the scapula is referred to as the ? surface.

A

Costal

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6
Q

What is the anatomic name for the armpit?

A

Axilla

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7
Q

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

A

Infraspinous fossa, supraspinous fossa,

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8
Q

All of the joints of the shoulder girdle are classified as being ?

A

synovial (diarthrodial)

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9
Q

List the movement types of the following joints.

A

Scapulohumeral: Spheroidal
Sternoclavicular: Plane
Scromioclavicular: Plane

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10
Q

Greater turbercle

A

Proximal humerus

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11
Q

Coracoid process

A

Scapula

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12
Q

Crest of Spine

A

Scapula

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13
Q

Coronoid process

A

Not part of the shoulder girdle

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14
Q

Acromial extremity

A

Clavicle

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15
Q

Intertubercular groove

A

Proximal humerus

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16
Q

Condylar process

A

Not part of the shoulder girdle

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17
Q

Surgical neck

A

Proximal humerus

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18
Q

Greater tubercle profiled laterally

A

External rotation

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19
Q

Humeral epicondyles angled 45 degree to image receptor

A

Neutral rotation

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20
Q

Epicondyles perpendicular to IR

A

Internal rotation

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21
Q

Supination of hand

A

External rotation

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22
Q

Palm of hand against thigh

A

Neutral rotation

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23
Q

Epicondyles parallel to IR

A

External rotation

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24
Q

Lesser tubercle profiled medially

A

Internal rotation

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25
Q

Proximal humerus in a lateral position

A

Internal rotation

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26
Q

Proximal humerus in postion for an (AP) projection

A

External rotation

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27
Q

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

A

true

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28
Q

The kV range for adult shoulder projections is between 80 and 90 kV for analog and 100 to 110 kV for digital imaging systems.

A

False

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29
Q

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

A

False

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30
Q

Large focal spot setting should be selected for most adult shoulder studies.

A

False

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31
Q

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

A

True

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32
Q

A 72 inch source image distance (SID) is recommended for most shoulder girdle studies.

A

false

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33
Q

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

A

True

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34
Q

Which one of the following kV ranges (analog) should be used for a shoulder series on an average adult?

A

70 to 80 kV

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35
Q

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

A

parent or guardian

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36
Q

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

A

True

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37
Q

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

A

False

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38
Q

Nuclear medicine bone scans can demonstrate signs of osteomyelitis and cellulitis.

A

True

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39
Q

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

A

False

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40
Q

Sonography (ultrasound) can provide a functional (dynamic) evaluation of joint movement that MRI cannot.

A

True

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41
Q

Compression between the greater tuberosity and soft tissues of the coracoacromial ligamentous and osseous arch

A

Impingement syndrome

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42
Q

Injury of the anteroinferior glenoid labrum

A

Bankart lesion

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43
Q

Inflammatory condition of the tendon

A

Tendonitis

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44
Q

Superior displacement of the distal clavicle

A

Acromioclavicular joint dislocation

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45
Q

Compression fracture of the articular surface of the humeral head

A

Hill-Sachs defect

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46
Q

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

A

Rotator cuff tear

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47
Q

Atrophy of skeletal tissue

A

Osteoporosis

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48
Q

Subacromial spurs

A

Impingement syndrome

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49
Q

Fluid-filled joint space

A

Bursitis

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50
Q

Thin bony cortex

A

Osteoporosis

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51
Q

Abnormal widening of acromioclavicular joint space

A

acromioclavicular joint separation

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52
Q

Calcified tendons

A

tendonitis

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53
Q

Avulsion fracture of the glenoid rim

A

Bankart lesion

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54
Q

Narrowing of joint space

A

Osteoarthritis

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55
Q

Closed joint space

A

Rheumatoid arthritis

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56
Q

Compression fracture of humeral head

A

Hill-Sachs defect

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57
Q

Which one of the following clinical indications requires a decrease in manual exposure factors?

A

osteoporosis

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58
Q

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

A

AP, exteranl rotation, and AP, Internal Rotation

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59
Q

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

A

CR perpendicular to IR, directed to line inferior to coracoid process

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60
Q

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

A

transthoracic lateral projection for humerus

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61
Q

To best demonstrate a possible Hlil-Sachs defect, which additional positioning technique can be added to the inferosuperior axial projection?

A

Rotate affected arm externally approximately 45 degrees

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62
Q

What type of central ray angulation is required for the inferosuperior axial projection for the shoulder?

A

25 to 30 degrees medially

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63
Q

The ? projection of the shoulder produces an image of the glenoid process in profile.
This projection is also referred to as the ? method.

A

posterior oblique

grashey method

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64
Q

Which one of the following projections produce a tangential projetion of the intertubercular groove?

A

Fisk modification

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65
Q

The supine version of the tangential projection for the intertubercular groove requires that the central ray be angled ? posteriorly from the horizontal plane.

A

10 to 15 degrees

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66
Q

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

A

Scapular Y projection

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67
Q

The ? projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs, which create shoulder impingment symptoms.
This projection is also referred to as the ? method.

A

tangential

supraspinous outlet and neer

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68
Q

Which of the following nontrauma projections can be performed erect to provide a lateral view of the proximal humerus in relationship to the glenohumeral joint?

A

PA transaxillary projection (Hobbs modification)

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69
Q

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

A

5 to 15 degrees

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70
Q

What CR angle is required for the AP axial projection (Alexander method) for AC joints?

A

15 degrees cephalad

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71
Q

The PA transaxillary projection (Hobbs modification) requires no CR angle.

A

True

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72
Q

The transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus.

A

True

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73
Q

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

A

True

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74
Q

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

A

False

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75
Q

A central ray angle of 10 to 15 degrees caudad may be used for the transthoracic lateral projections if the patient is unable to elevate the uninjured arm and shoulder sufficiently.

A

False

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76
Q

The scapular Y lateral (anterior oblique) position requires the body to be rotated 30 to 40 degrees anteriorly toward the affected side.

A

False

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77
Q

Which two landmarks are placed perpendicular to the IR for the scapular Y lateral projection?

A

Superior angle of the scapula and the AC joint articulation

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78
Q

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?

A

AP apical oblique axial projection

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79
Q

A posterior dislocation of the humerus projects the humeral head ? (superior or inferior) to the glenoid cavity with the special projection described in the previous question. (AP apical oblique axial projection)

A

superior

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80
Q

A thin shouldered patient requires ? (more or less) CR angle for an AP axial clavical projection than a large shouldered patient.

A

More

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81
Q

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

A

fracture of clavicle

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82
Q

Inferiorsuperior Axial

A

Lawrence method

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83
Q

Posterior oblique for glenoid cavity

A

Grashey method

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84
Q

Tangential for intertubercular (bicipital) groove

A

fisk modification

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85
Q

Supraspinatus outlet tangential

A

Neer method

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86
Q

Transthoracic lateral

A

Lawrence method

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87
Q

AP apical oblique axial

A

Garth method

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88
Q

Where is the CR centered for the AP scapula projection?

A

CR perpendicular to midcapular, 2 inches inferior to the coracoid process, or to the level of axilla and approximately 2 inches medial from lateral border of patient.

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89
Q

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

A

none

90
Q

The following factors were used to produce a radiograph of an AP projection of the shoulder: 85 kV, 20 mAs, high speed screens, 40 inch SID, grid, and suspended respiration. The resultant radiograph demonstrated poor radiographic contrast between bony and soft tissue structures. Which of these factors can be altered during the repeat exposure to improve radiiographic quality?

A

lower to 75 kV and double Milliamperage seconds (to 40 mAs), which increases radiographic contrast.

91
Q

A radiograph of an AP axial clavicle projection reveals that the clavicle is projected below the superior border of the scapula. What can the technologists do to correct this problem during the repeat exposure?

A

Increase central ray cephalad angle

92
Q

A radiograph of an AP scapula reveals that the scapula is within the lung field and difficult to see. Which two things can the technologist do to improve the visibility of the scapula during the repeat exposure?

A

Ensure that the affected arm is abducted 90 degrees and use a breathing technique

93
Q

A radiograph of an AP projection (with external rotation) of a shoulder (with no traumatic injury) reveals that neither the greater nor lesser tubercles are profiled. What must be done to correct this during the repeat exposure?

A

Supinate the hand and ensure that the epicondyles are parallel to the IR for a true AP.

94
Q

A radiograph of a lateral scapula position reveals that is not a true lateral projection. (considerable separation exists between the axillary and vertebral borders.) The projection was taken using the following factors: erect position, 40 inch SID, 45 degrees rotation toward cassette from PA, central ray centered to midscapula, and no central ray angulation. Based on these factors, how can this position be improved during the repeat exposure?

A

Palpate the superior angle of the scapula and AC joint articulations and ensures that the imaginary plane between this point is perpendicular to the IR

95
Q

A radiograph of the AP oblique (Grashey method) taken as a 35 degree oblique projection reveals that the borders of the glenoid cavity are not superimposed. The patient has large, rounded shoulders. What must be done to get better superimposition of the cavity during the repeat exposure?

A

Increase rotation of affected shoulder toward the IR to closer to 45 degree.

96
Q

A patient with a possible right shoulder dislocation enters the emergency room. The technologist attempts to perform an erect transthoracuc lateral projection, but the patient is unable to raise the left arm and shoulder high enough. The resultant radiograph reveals that the shoulders are superimposed, and the right shoulder and humeral head are not well visualized. What can be done to improve this image during the repeat exposure?

A

Angle the central ray 10 to 15 degree cephalad to separate the shoulder

97
Q

A patient with a possible fracture of the right proximal humerus from an automobile accident enters the emergency room. The patient has other injuries and is unable to stand or sit erect. What positioning routine should be used to determine the extent of the injury?

A

The routine includes an AP of right shoulder and humerus without rotation (neutral rotation) and a supine, horizontal beam, right transthoracic shoulder. Note–In those cases in which the opposite arm cannot be elevated or extended, a supine posterior oblique scapula Y lateral projection could also be used as a second option for a lateral shoulder position.

98
Q

A patient with a clinical history of chronic shoulder dislocation comes to the radiology department. The orthopedic physician suspects that a Hill-Sachs defect may be present. Which specific position may be used to best demonstrate this pathologic feature?

A

Inferosuperior aial projection with exagemerated extermal rotation, inferiosuperior axial projection (clements modification) an AP apical oblique axial projection (garth method)

99
Q

A patient with a possible Bankart lesion comes to the radiology department. List three projections that can be performed that may demonstrate signs of this injury.

A 
AP internal rotation
scapular Y lateral
Posterior oblique (Grashey Method)
100
Q

A patient with a possible rotator cuff tear comes to the radiology department. Which one of the following imaging modalities would best demonstrate this injury?

A

MRI

101
Q

A patient with a clinical history of tendon injury in the shoulder region comes to the radiology department. The orthopedic physician needs a functional study of the shoulder joint performed to determine the extent of the tendon injury. Which of the following modalities would best demonstrate this injury?

A

Ultrasound

102
Q

A radigraph of an AP projection with external rotation of the shoulder does not demonstrate either the greater or lesser tubercle in profile. What is the most likely cause for this radiographic outcome?

A

The humeral epicondyles were not placed parallel to the plane of the IR

103
Q

A radiograph of a transthoracic lateral projection demonstrates considerable superimposition of lung marking and ribs over the region of the proximal shoulder. What can the technologist do to minimize this problem during the repeat exposure?

A

Use breathing exposure technique to create blurring of ribs and lung markings.

104
Q

A patient enters the ER with a definite fracture to the midhumerus. Because of other trauma the patient is unable to stand. Which lateral projection would demonstrate the entire humerus?

A

Transthoracic lateral projection for humerus

105
Q

The AP apical oblique axial projection (Garth method) is performed on a patient with a shoulder injury. The resultant radiography demonstrates the proximal humeral head projected below the glenoid cavity What type of trauma or pathology i indicated with this radiographic appearance.

A

Anterior dislocation of the proximal humerus

106
Q

Select the term(s) that correctly describe(s) the shoulder joint

A

Scapulohumeral

107
Q

Which specific joint is found on the lateral end of the clavicle

A

Acromioclavicular

108
Q

Which of the following is not an angle found on the scapula?

A

medial angle

109
Q

Which one of the following structures of the scapula extends most anteriorly?

A

Coracocid process

110
Q

The male clavicle is shorter and less curved than the female clavicle.

A

False

111
Q

Which bony structure separates the supraspinous and infraspinous fossae?

A

Scapular spine

112
Q

Which one of the following structures is considered to be the most posterior?

A

Acromion

113
Q

What is the type of joint movement for the scapulohumeral joint?

A

Spheroidal

114
Q

Even though the amount of radiation exposure is minimal for most shoulder projections, gonadal shielding should be used for children and adults of childbearing age.

A

True

115
Q

The greatest technical concern during a pediatric shoulder study is voluntary motion.

A

True

116
Q

Which one of the following imaging modalities or procedures provide a functional, or dynamic, study of the shoulder joint?

A

Ultrasound

117
Q

Which one of the following pathologic conditions often produces narrowing of the joint spine?

A

Osteoarthritis

118
Q

Which one of the following pathologic conditions may require a reduction in manual exposure factors?

A

Rheumatoid arthritis

119
Q

Which routine projection of the shoulder requires that the humeral epicondyles be paralel to the IR.

A

External rotation

120
Q

Where is the CR centered for an AP projection-external rotation of the shoulder?

A

1 inch superior to coracoid process

121
Q

Which position of the shoulder and proximal humerus projects the lesser tubercle in profile medially?

A

internal rotation

122
Q

To best demonstrate the Hill-Sachs defect on the inferosuperior axial projection, which additional positioning maneuver must be used?

A

Use exaggerated external rotation

123
Q

How are the humeral epicondyles aligned for a rotational lateromedial projection of the humerus?

A

Perpendicular to IRr

124
Q

Which special projection of the shoulder places the glenoid cavity in profile for an “open” scapulohumeral joint?

A

Grashey method

125
Q

For the erect version of the tangential projection for the intertubercular groove, the patient leans forward ? from vertical.

A

10 to 15 degrees

126
Q

What is the major advantage of the supine, tangential version of the intertubercular groove projection over the erect version?

A

Reduced OID

127
Q

Which one of the following projections best demonstrates the supraspinatus outlet region?

A

Tangential projection (neer method)

128
Q

With which one of the following projections can a breathing technique be employed?

A

transthoracic lateral for humerus

129
Q

What central ray angulation is required for the tangential projection-supraspinatus outlet (Neer method)?

A

10 to 15 degrees caudad

130
Q

Which clinical indication is best demonstrated with the Garth method?

A

Scapulohumeral dislocations

131
Q

Which anatomy of the shoulder is best demonstrated with a PA transaxillary projection (Hobbs modification)?

A

Scapulohumeral joint

132
Q

If the patient cannot fully abduct the affected arm 90 degrees for the inferosuperior axial projection (Clements modification), the technologist can angle the CR ? toward the axilla.

A

5 to 15 degrees

133
Q

Which one of the following projections requires the CR to be centered 2 inches inferior and medial from the superolateral border of the shoulder?

A

Posterior oblique (Grashey method)

134
Q

Which anatomy is best demonstrated with the Alexander method?

A

AC joints

135
Q

Which type of injury must be ruled before the weight bearing phase of an AC joint study?

A

Fractured clavicile

136
Q

What is the minimum amount of weight a large adult should have strapped to each wrist for the weight bearing phase of an AC joint study?

A

8 to 10 pounds

137
Q

A posteroanterior (PA) axial projection of the clavicle requires a 35 to 45 degree caudal central ray angle.

A

False

138
Q

A 72” SID is recommended for acromioclavicular joint studies.

A

TRue

139
Q

Which two positioning landmarks are aligned perpendicularly to the IR for the lateral scapula projection?

A

Superior angle and AC joint

140
Q

A radiograph of a posterior oblique (Grashey method) reveals that the anterior and posterior glenoid rims are not superimposed. The following positioning factors were used: erect position, body rotated 25 to 30 degrees toward the affected side, central ray perpendicular to scapulohumeral joint space, and affected arm slightly abducted in neutral rotation. Which one of the following modifications will superimpose the glenoid rims during the repeat exposure?

A

Rotate body less toward affected side

141
Q

A radiograph of an AP axial clavicle taken on an asthenic type patient reveals that the clavicle is projected in the lung field below the top of the shoulder. The following positioning factors were used; erect position, central ray angled 15 degrees cephalad, 40 inch SID, and respiration suspended at end of expiration. Which one of the following modifications should be made during the repeat exposure?

A

Increase central ray angulation

142
Q

A patient with a possible right shoulder separation enters the emergency room. Which one of the following routines should be used?

A

Acromioclavicular joint series: Non-weight bearing and weight bearing projections

143
Q

A patient enters the ER with a proximal and midhumeral fracture. The patient is in extreme pain.. Which one of the following positioning routines would demonstrate the entire humerus without excessive movement of the limb?

A

AP and transthoracic lateral of humerus

144
Q

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

A

AP internal rotation, AP external rotation

145
Q

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

A

1 inch inferior to coracoid process

146
Q

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

A

transthoracic lateral projection of humerus

147
Q

The ? projection of the shoulder produces an image of the glenoid process in profile

A

posterior oblique (Grashey method)

148
Q

The posterior oblique projection of the shoulder is also referred to as the ? method

A

Grashey

149
Q

Which projection is best for demonstrating a possible dislocation of the proximal humerus?

A

Scapular Y

150
Q

What CR angle is required for the AP axial projection (Alexander method) for AC joints?

A

15 degrees cephalad

151
Q

The transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus.

A

true

152
Q

The use of a breathing technique can be performed for the transthoraic lateral humerus projection.

A

true

153
Q

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

A

false

154
Q

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.

A

false

155
Q

The scapular Y lateral (anterior oblique) position requires the body to be rotated 30-40 degrees anteriorly toward the affected side

A

false

156
Q

Which two landmarks are placed perpendicular to the IR for the scapular Y lateral projection?

A

superior angle of the scapula, AC joint articulation

157
Q

A thin shouldered patient requires ? (more/less) CR angle for an AP axial clavicle projection than a large-shouldered patient.

A

more

158
Q

What must be ruled out before performing the weight bearing study for acrmioclavicular joints?

A

fracture of clavicle

159
Q

What is the method name for the transthoracic lateral projection?

A

Lawrence method

160
Q

Where is the CR centered for the AP scapula projection?

A

level of the axilla

161
Q

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

A

none

162
Q

The following factors were used to produce a radiograph of an AP projection of the shoulder: 85 kV, 20 mAs, high speed screens, 40” SID, grid, and suspended respiration. The resultant radiograph demonstrated poor radiographic contrast between bony and soft tissue structures. Which of these factors can be altered during the repeat exposure to improve radiograhic quality?

A

lower kV and double mAs to increase contrast

163
Q

A radiograph of an AP axial clavicle projection reveals that the clavicle is projected below the superior border the of the scapula. What can the technologists do to correct this problem during the repeat exposure.

A

increase CR cephalad angle

164
Q

A radiograph of an AP scapula reveals that the scapula is within the lung field and difficult to see. Which two things can the technologists do to improve the visibility of the scapula during the repeat exposure?

A

ensure arm is abducted 90 degrees and use a breathing technique

165
Q

A radiograph of an AP projection (with external rotation) of a shoulder (with no traumatic injury) reveals that neither the greater nor lesser tubercles are profiled. What must be done to correct this during the repeat exposure?

A

epicondyles are parallel to the IR

166
Q

A radiograph of the AP oblique (Grashey method) taken at 35 degree oblique projection reveals that the borders of the glenoid cavity are not superimposed. The patient has large, round shouders. What must be done to get better superimposition of the cavity during the repeat exposure?

A

increase rotation of affected shoulder to closer to 45 degrees

167
Q

A patient with a possible right shoulder dislocation enters the ER. The technologist attempts to perform an erect transthoracic lateral projection, but the patient is unable to raise the left arm and shoulder high enough. The resultant radiograph reveals that the shoulders are superimposed, and the right shoulder and humeral head are not well visualized. What can be done to improve this image during the repeat exposure?

A

Angle CR 10-15 degrees cephalad

168
Q

A patient with a possible fracture of the right proximal humerus from an automobile accident enters the ER. The patient has other injuries and is unable to stand or sit erect. Which positioning routine should be used to determine the extent of the injury?

A

AP with neutral rotation and supine horizontal beam transthoracic shoulder

169
Q

A patient with a possible Bankart lesion comes to the radiology department. List three projections that can be performed that may demonstrate signs of this injury.

A

AP internal rotation, scapular Y lateral, posterior oblique (Grashey method)

170
Q

A patient with a possible rotator cuff tear comes to the radiology department. Which one of the following imaging modalities would best demonstrate this injury?

A

MRI

171
Q

A patient with a clinical history of tendon injury in the shoulder region comes to the radiology department. The orthopedic physician needs a functional study of the shoulder joint performed to determine the extend of the tendon injury. Which modality would best demonstrate this injury.

A

ultrasound

172
Q

A radiograph of an AP projection with external rotation of the shoulder does not demonstrate either the greater or lesser tubercle in profile. What is the most likely cause for this radiographic outcome?

A

humeral epicondyles were not paralllel to IR

173
Q

A radiograph of a transthoracic lateral projection demonstrates considerable superimposition of lung markings and ribs over the region of the proximal shoulder. What can the technologist do to minimize this problem during the repeat exposure?

A

use a breathing technique

174
Q

A patient enters the ER with a definite fracture to the midhumerus. Because of other trauma the patient is unable to stand. Which lateral projection would demonstrate the entire humerus?

A

transthoracic lateral for humerus

175
Q

Which routine projection of the shoulder requires that the humeral epicondyles be parallel to the IR?

A

external rotation

176
Q

Where is the CR centered for an AP projection external rotation of the shoulder?

A

1 inch inferior to coracoid process

177
Q

Which position of the shoulder and proximal humerus projects the lesser tubercle in profile medially?

A

internal rotation

178
Q

How are the humeral epicondyles aligned for a rotational lateromedial projection of the humerus?

A

perpendicular to IR

179
Q

Which special projection of the shoulder places the glenoid cavity in profile for an “open” scapulohumeral joint.

A

Grashey method

180
Q

With which one of the following projections cannch a breathing technique be employed?

A

transthoracic lateral for humerus

181
Q

which one of the following projections requires the CR to be centered 2 inches inferior and medial from the superolateral border of the shoulder

A

posterior oblique (grashey method)

182
Q

Which anatomy is best demonstrated with the Alexander method?

A

AC joints

183
Q

Which type of injury must be ruled out before the weight bearing phase of the AC joint study?

A

fractured clavicle

184
Q

What is the minimum amount of weight a large adult should have strapped to each wrist for the weight bearing phase of an AC joint study?

A

8 to 10 pounds

185
Q

A PA axial projection of the clavicle requires a 35-45 degree caudal CR angle

A

false

186
Q

A 72 inch SID is recommended for acrmioclavicular joint studies

A

true

187
Q

Which two positioning landmarks are aligned perpendicular to the IR for the lateral scapula projection?

A

Superior angle and AC joint

188
Q

A radiograph of a posterior oblique (grashey method) reveeals that the anterior and posterior glenoid rims are not superimposed. the following factors were used: boy rotated 25-30 degrees toward affected side, CR perpendicular to scapulohumeral joint space, affected arm slightly abducted in neutral rotation. Which modification will superimpose the glenoid rims during repeat exposure?

A

rotate body less toward affected side

189
Q

A radiograph of an AP axial clavicle taken on an asthenic type patient reveals that the clavicle is projected in the lung field below the top of the shoulder. The following factors were used: erect position, CR angled 15 degree cephalad, 40 inch SID, respiration suspended. What modification should be made during the repeat exposure?

A

Increase CR angulation

190
Q

A patient with a possible right shoulder separation enters the ER. Which one of the following routines should be used?

A

acromioclavicular joint series: non weight bearing and weight bearing

191
Q

A patient enters the ER with a proximal and midhumeral fracture. The patient is in extreme pain. Which one of the following positioning routines would demonstrate the entire humerus without excessive movement of the limb?

A

AP and tansthoracic lateral of humerus

192
Q

humerus

A

is the longest and largest bone of the upper limb. its length on an adult equals approximately one-fifth of body height. the humerus articulates with the scapula (shoulder blade) at the shoulder joint.

193
Q

proximal humerus

A

the most proximal part of the humerus is the rounded head. the slightly constricted area directly below and lateral to the head is the anatomic neck, which appears as a line of demarcation between the rounded head and the adjoining greater and lesser tubercles.
the process directly below the anatomic neck on the anterior surface is the lesser tubercle. the larger lateral process is the greater tubercle, to which the pectoralis major and supraspinatus muscles attach. The deep groove between these two tubercles is the intertubercular groove. The tapered area below the head and tubercles is the surgical neck, and distal to the surgical neck is the long body (shaft) of the humerus.
The surgical neck is so named because it is the site of frequent fractures requiring surgery. Fractures of the thick anatomic neck are rarer.
The deltoid tuberosity is the roughened raised triangular elevation along the anterolateral surface of the body (shaft) to which the deltoid muscle is attached.

194
Q

Anatomy of proximal humerus on Radiograph

A

The lesser tubercle is located anteriorly and the greater tubercle is located laterally in a true AP.

195
Q

Shoulder Girdle

A

The shoulder girdle consists of two bones: the clavicle and scapula. The function of the clavicle and scapula is to connect each upper limb to the trunk or axial skeleton. Anteriorly, the shoulder girdle connects to the trunk at the upper sternum; however, poteriorly, the connection to the trunk is incomplete because the scapula is connected to the trunk by muscles only.
Each shoulder girdle and each upper limb connect at the shoulder joint between the scapula and the humerus. Each clavicle is located over the upper anterior rib cage Each scapula is situated over the upper posterior rib cage.
The upper margin of the scapula is at the level of the second posterior rib, and the lower margin is at the level of the seventh posterior rib (T7). The lower margin of the scapula corresponds to T7.

196
Q

Clavicle

A 
The clavicle (collarbone) is a long bone with a double curvature that has three main parts: two ends and a long central portion.  The lateral or acromial extremity (end) of the clavicle articulates with the acromion of the scapula.  This joint or articulation is called the acromioclavicular joint and generally can be readily palpated.
The medial or sternal extremity (end) articulates with the manubrium, which is the upper part of the sternum.  This articulation is called the sternoclavicular joint.  The combination of the sternoclavicular joints on either side of the manubrium helps to form an important positioning landmark called the jugular notch.
The body (shaft) of the clavicle is the elongated portion between the two extremities.  The acromial end of the clavicle is flattened and has a downward curvature at its attachment with the acromion.  The sternal end is more triangular in shape and is directed downward to articulate with the sternum.
In general, the size and shape of the clavicle differ  between males and females.  The female clavicle is usually shorter and less curved than the male clavicle.  The male clavicle tends to be thicker and more curved, usually being most curved in heavily muscled men.
197
Q

Scapula

A

Shoulder blade, which forms the posterior part of the shoulder girdle, is a flat triangular bone with three borders, three angles, and two surfaces. The three borders are the medial (vertebral) border, which is the long edge or border near the vertebrae; the superior border, or the uppermost margin of the scapula; and the lateral (axllary) border, or the border nearest the axilla. The axilla is the medial term for the armpit.

198
Q

Anterior view (Scapula)

A

The corners of the triaapula to form the angular scapula are called angles. The lateral angle, sometimes called the head of the scapula, is the thickest part and ends laterally in a shallow depression called the glenoid cavity (fossa)
The humeral head articulates with the glenoid cavity of the scapula to form the scapulohumeral joint, also known as the glenohumeral joint, or shoulder joint.
The constricted area between the head and the body of the scapula is the neck. The superior and inferior angles refer to the upper and lower ends of the medial or vertebral border. The body (blade) of the scapula is arched for greater strength. The thin, flat, lower part of the body sometimes is referred to as the wing or ala of the scapula.
The anterior surface of the scapula is termed the costal surface because of its proximity to the ribs (costa, literally means “rib”). The middle area of the costal surface presents a large concavity or depression, known as the subscapular fossa.
The acromion is a long, curved process that extends laterally over the head of the humerus. The coracoid process is a thick, beaklike process that projects anteriorly beneath the clavicle. The scapular notch is a notchon the superior border that is partially formed by the base of the coracoid process.

199
Q

Posterior View (Scapula)

A

The elevated spine of the scapula starts at the vertebral border as a smooth triangular area and continues laterally to end at the acromion. The acromion overhangs the shoulder joint posteriorly.
The posterior border or ridge of the spine is thickened and is termed the crest of the spine. The spine separates the posterior surface into an infraspinous fossa and a supraspinous fossa. Both of these fossae serve as surfaes of attachment for shoulder muscles.

200
Q

Lateral view (Scapula)

A

The thin scapula looks like the letter Y in a lateral view. The upper parts of the Y are the acromion and the coracoid process. The acromion is the expanded distal end of the spine that extends superiorly and posteriorly to the glenoid cavity (fossa). The coracoid process is located more anteriorly in relationship to the glenoid cavity or shoulder joint.
The bottome leg of the Y is the body of the scapula. The posterior surface or back portion of the thin body portion of the scapula is the dorsal surface. The spine extends from the dorsal surface at its upper margin. The anterior surface of the body is the ventral (costa) surface. The lateral (axillary) border is a thicker edge or border that extends from the glenoid cavity to the inferior angle.

201
Q

Lateral projection (scapula)

A

The scapular Y lateral projection of the scapula is taken with the patient in an anterior oblique position and with the upper body rotated until the scapula is separated from the rib cage in a true end on or lateral projection.

202
Q

Proximal Rotation of humerus

External Rotation

A

The external rotation position represents a true AP projection of the humerus

203
Q

Proximal Rotation of humerus

Internal Rotation

A

The hand and arm are rotated internally until the epicondyles of the distal humerus are perpendicular to the IR, placing the humerus in a true lateral position. The hand must be pronated and the elbow adjusted to place the epicondyles perpendicular to the IR.
The AP projection of the shoulder taken in the internal rotation position is a lateral position of the proximal humerus in which the greater tubercle now is rotated around to the anterior and medial aspect of the proximal humerus. The lesser tubercle is seen in profile medially.

204
Q

Proximal Rotation of humerus

Neutral Rotation

A

is appropriate for a trauma patient when rotation of the part is unacceptable. the epicondyles of the distal humerus appear at an approximate 45 degree angle to the IR. A 45 degree oblique position of the humerus results when the palm of the hand is facing inward toward the thigh. The neutral position is about midway between the external and internal positions and places the greater tubercle anteriorly but still lateral to the lesser tubercle.

205
Q

Average Adult Humerus and Shoulder

A

Medium kV, 70 to 80 with grid–5 to 10 higher kV for digital systems is common for most procedures.
Higher mA with short exposure times
Small focal spot

206
Q

Arthrography

A

used to image soft tissue pathologies such as rotator cuff tears associated with the shoulder girdle. This modality uses contrast medium injected into the joint capsule under fluoroscopy and sterile conditions.

207
Q

CT and MRI

A

Evaluate soft tissue and skeletal involvement of lesions and soft tissue injuries.

208
Q

Nuclear Medicine

A

useful in demonstrating osteomyelitis, metastic bone lesions, and cellulitis

209
Q

Sonography

A

useful for musculoskeletal imaging of joints such as the shoulder to evaluate soft tissues within the joint for possible rotator cuff tears; bursa injuries; or disruption and damage to nerves, tendons, or ligaments.

210
Q

Acromioclavicular dislocation

A

refers to an injury in which the distal clavicle usually is displaced superiorly. This injury is usually caused by a fall.

211
Q

AC joint seperation

A

refers to trauma to the upper shoulder region resulting in a partial or complete tear of the AC or coracoclavicular ligament or both ligaments.

212
Q

Bankart lesion

A

is an injury of the anteroinferior aspect of the glenoid labrum. This type of injury often is caused by anterioatior dislocation of the proximal humerus. Repeated dislocation may result in a small avulsion fracture in the anterioinferior region of the glenoid rim.

213
Q

Bursitis

A

is an inflammation of the bursae, or fluid filled sacs enclosing the joints. It usually involves the formation of calcification in associated c tendons, causing pain and limitation of joint movement.

214
Q

hill-Sachs defect

A

a compression fracture of the articular surface of the posteorolateral aspect of the humeral head that often is associated with an anterior dislocation of the humeral head.

215
Q

Idiopathic chronic adhesive capsulitis

A

(frozen shoulder) is a disability of the shoulder joint that is caused by chronic inflammation in and around the joint. It is characterized by pain and limitation of motion.

216
Q

impingement syndrome

A

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

217
Q

Osteoporosis

A

also known as degenerative joint disease, is a noninflammatory joint disease characterized by gradual deteriroration of the articular cartilage with hypertrophic bone formation. DJD is the most common type of arthritis and is considered to be part of the normal aging process. It generally considered to be part of the normal aging process. it generally occurs in people older than 50, chronically obese patients, and athletes.

218
Q

Osteoporosis

A

resultant fractures are due to a reduction in the quantity of bone or atrophy of skeletal tissue. occurs in postmenopausal women and elderly men, resulting in bony trabeculae that are scanity and thin.

219
Q

Rheumatoid Arthritis

A

is a chronic systemic disease characterized by inflammatory changes that occur throughout the connective tissues of the body

220
Q

Rotator Cuff

A

Partial or complete tear in musculature

221
Q

Shoulder dislocation

A

occurs as traumatic removal of humeral head from the glenoid cavity. of shoulder dislocations, 95% are anterior, in which the humeral head is projected anterior to the glenoid cavity.

222
Q

Tendonitis

A

an inflammatory condition of the tendon that usually results from a strain

Positioning (5 decks)

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