Chapter 5: Shoulder

Question 1

How is the patient positioned for an AP shoulder

Answer 1

supine or upright at equal distance to the IR

Question 2

How should the clavicle be demonstrated in an AP shoulder projection

Answer 2

Clavicle demonstrated horizontally

Question 3

KVP and distance for an AP shoulder

Answer 3

Optimal kVp 65-75, SID 40-48 inches

Question 4

how is the scapular body in an AP shoulder

Answer 4

Scapular body is curved around rib cage so there is a 35 to 45 degree of obliquity

Question 5

What should be included in an AP shoulder projection

Answer 5

Include
-glenohumeral joint space
-lateral 2/3 of the clavicle
-proximal third of the humerus
-and superior scapula

Question 6

What three main parts should be evaluated to detect rotation of the shoulder

Answer 6

Evaluate the scapular body, glenoid cavity and clavicle

Question 7

how is the scapular body when the patient is rotated toward the affected shoulder

Answer 7

the scapular body is more parallel with the IR and appears wider on the image

Question 8

how are the glenoid cavity and scapular neck when the patient is rotated toward the affected shoulder

Answer 8

The glenoid cavity and scapular neck are more in profile

Question 9

how is the clavicle when the patient is rotated toward the affected shoulder

Answer 9

Clavicle is longitudinally foreshortened, medial end is shifted away from the vertebral column

Question 10

What are some things that would detect there is rotation toward affected shoulder

Answer 10

-thoracic vertebrae on top of scapula
-ribs elongated
-will rotate more on coracoid
-flattening scapula out
-opening joint space of humeral head and glenoid

Question 11

how is the thorax in a rotation away from effected shoulder

Answer 11

Thorax is demonstrated over a smaller amount of the scapula

Question 12

how is the scapular body demonstrated in a rotation away from effected shoulder

Answer 12

Scapular body demonstrates increased transverse foreshortening

Question 13

how is the glenoid demonstrated in a rotation away from effected side

Answer 13

The glenoid cavity is better demonstrated (more on end)

Question 14

what is the medial clavicular end superimposed over in a rotation away from effected shoulder

Answer 14

Medial clavicular end is superimposed over the vertebral column

Question 15

Some indications there is rotation away from effected shoulder

Answer 15

• clavicle end is now on spine
  -thorax is off of scapular body
• glenoid cavity is way far over on humeral head

Question 16

which type of dislocation is more common ?

Answer 16

anterior dislocations

Question 17

how is an anterior location?

Answer 17

They are anterior and beneath the coracoid process
(coracoid more anterior)

Question 18

how is a posterior dislocation

Answer 18

Posterior dislocation result in the humeral head being demonstrated posterior and beneath the acromion process or spine of the scapula
(acromion more posterior)

Question 19

Key indications it is an anterior dislocation

Answer 19

-head of humerus not within glenoid cavity
-head of humerus is sitting below coracoid process

Question 20

Key indication that it is a posterior dislocation

Answer 20

• humeral head is below acromion

Question 21

how is the superior scapular angle when there is an anterior (forward) tilt

Answer 21

will be demonstrated superior to the midclavicle

Question 22

how is the superior scapular angle when there is a posterior (backward) tilt

Answer 22

superior scapular angle will shown inferior to midclavicle

Question 23

What tilt is more common

Answer 23

anterior

Question 24

what should you do when you have a kyphotic patient

Answer 24

With a kyphotic patient angle the central ray cephalic to be perpendicular to the scapular body

Question 25

how should the superior scapular angle be in an AP shoulder

Answer 25

superior angle should lie directly on clavicle mid-shaft

Question 26

is the scapula above or below clavicle in an anterior tilt

Answer 26

scapula above clavicle

Question 27

is the scapular above or below the clavicle in a posterior tilt

Answer 27

below clavicle

Question 28

what do you look at for indication of a tilt

Answer 28

superior scapular body

Question 29

what is the lateral epicondyle alligned with

Answer 29

The lateral epicondyle is aligned with the greater tubercle (and the thumb)

Question 30

what is the medial epicondyle alligned with

Answer 30

the humeral head

Question 31

how is the lesser tuberical in relation to the greater tubercle

Answer 31

The lesser tubercle is anterior at a right angle to the greater tubercle

Question 32

how are the epicondyles in a neutral position

Answer 32

neither are in profile epicondyles 45 degrees with IR

Question 33

what is in profile in neutral position

Answer 33

partial profile of greater tubercle laterally and head profile medially

Question 34

palm against the side, epicondyles at 45° with the IR (partial profile of greater tubercle laterally, and head profile medially

Answer 34

neutral

Question 35

epicondyles are parallel with IR( greater tubercle in profile laterally, humeral head profile medially, lesser tubercle halfway in between)

Answer 35

external

Question 36

how are the epicondyles in external

Answer 36

parallel with IR

Question 37

what is in profile in a external shoulder

Answer 37

-greater tubercle in profile laterally -humeral head profile medially -lesser tubercle halfway in between)

Question 38

how are the epicondyles in an internal rotation

Answer 38

epicondyles are perpendicular with the IR

Question 39

what is in profile in an internal rotation

Answer 39

Lesser tubercle is demonstrated in profile medially and humeral head is superimposed by the greater tubercle

Question 40

what is in profile in a grashey

Answer 40

Glenoid cavity is in profile with the glenohumeral joint space open

Question 41

how is the clavicle in a grashey

Answer 41

Clavicle is longitudinally foreshortened

Question 42

if there is thorax on image in a grashey, what does that mean

Answer 42

rolled too much ( should not have an thorax superimposition)

Question 43

how is the patient rotated for a grashey

Answer 43

Patient is rotated 35 to 45° toward affected shoulder

Question 44

what are you more concerned about for a grashey

Answer 44

joint space

Question 45

in a grashey, if yjere is more coracoid on humeral head is it over or under rotated

Answer 45

over rotated

Question 46

in a grashey, if you dont see the coracoid is it over or under rotated

Answer 46

under rotated

Question 47

how should the shoulder be in a grashey

Answer 47

Shoulder in neutral position and not protracted (moved forward)

Question 48

how should the CR be for a grashey

Answer 48

CR 1 inch inferior and medial to the coracoid process

Question 49

Main reason for grashey

Answer 49

-glenoid cavity in profile -open up glenoid and humeral joint space

Question 50

how many degrees should you rotate the pateint if you are doing a grashey shoulder on the table

Answer 50

6o degrees

Question 51

criteria for grashey

Answer 51

-roll shoulder forward so head of humerus is lying flat against ir -joint space is opened of head of humerus and glenoid cavity -rib cage over neck of scapular -clavicle foreshortened -coracoid is superimposed over head of humerus

Question 52

positioning for grashey

Answer 52

-rotate pt. 35 to 45 degree oblique -Palpate the coracoid and acromion -Rotate Pt. so both coracoid and acromion are superimposed and perpendicular to the IR

Question 53

how are the coracoid and acromion in a grashey position

Answer 53

superimposed and perpendicular to the IR

Question 54

space is closed, more than ¼ of the tip of the coracoid process is superimposed over the humeral head, excessive longitudinal foreshortening of clavicle

Answer 54

excessive rotation of grashey

Question 55

space is closed, less than ¼ of tip of coracoid process is superimposed over humeral head, clavicle shows little foreshortening

Answer 55

insufficient rotation of grashey

Question 56

what parts form the scapular y

Answer 56

The body, acromion and coracoid processes form a Y

Question 57

what part is in a lateral position of a scapular y

Answer 57

Scapular body is in a lateral position

Question 58

what is on end of the scapular y

Answer 58

glenoid cavity

Question 59

how should the humerus be in a scapular y

Answer 59

the humerus should be over the body humeral head will be sitting on the glenoid cavity

Question 60

what border of the scapular is thicker

Answer 60

lateral border

Question 61

how is the lateral border of the scapula

Answer 61

The lateral border of the scapula is thicker and shows two cortical outlines

Question 62

what border of the scapula is thinner

Answer 62

medial border

Question 63

how is the medial border of the scapula

Answer 63

Medial border is thinner and shows only one single thin line

Question 64

in a scapular y, if the lateral border is next to the ribs is it an excessive or insufficient roatation

Answer 64

excessive

Question 65

in a scapular y, if the medial boder is next to the ribs is it excessive or insufficient rotation

Answer 65

If medial border is next to the ribs (insufficient)

Question 66

lateral y view is good for what two things

Answer 66

-fractures and dislocations

Question 67

humeral shaft is not on the body (humerus has gone anteriorly)

Answer 67

fracture of humeral head

Question 68

criteria for AP projection of clavicle

Answer 68

-medial end should be over toward spine -SC and AC joints -clavicle in entirety (no foreshortening) -superior angle of scapula should be right on clavicle

Question 69

what type of rotation for an AP clavicle: -medial clavicle on the spine -more scapular and less ribs on scapula

Answer 69

affected side rotated away

Question 70

in a clavicle, if the medial clavicle is on the spine what time of rotation is it

Answer 70

affected side rotated away

Question 70

what type of rotation is it when the medial clavicle is off the spine

Answer 70

rotated toward the affected

Question 70

what type of rotation for ap clavicle

Answer 70

medial clavicle off the spine clavicle foreshortened rib cage more over on scapula

Question 71

what is the angle of ap axial clavicle

Answer 71

15 to 30 angle cephalic

Question 71

why do we do an axial clavicle

Answer 71

to get medial aspect off of rib cage

Question 72

where do 80 percent of the fractures of the clavicle happen

Answer 72

middle third

Question 73

where do 15 percent of fractures of the clavicle happen

Answer 73

at the lateral third

Question 74

how should ther lateral and middle third of the clavicle be projected

Answer 74

project the lateral and middle thirds of the clavicle superior to the thorax and scapula

Question 75

how should AC joints be done

Answer 75

Upright and Weight-bearing/Non Weight-bearing

Question 76

how to detect rotation of ac joints

Answer 76

Detect rotation by evaluation of clavicles and acromion apex( out of profile if rotated towards that side)

Question 77

what does rotation of ac joints result in

Answer 77

Rotation results in a narrowed or closed AC joint

Question 78

SID for AC joints

Answer 78

72 inches- bilateral (bc of divergence of the beam) 40 inches- unilateral

Question 79

where should the weights be for ac joints

Answer 79

on the wrists

Question 80

breathing for AP scapula

Answer 80

expose on expiration (less air in the lungs) or shallow (to blur out lungs and ribs)

Question 81

how should pt be positioned for ap scapula

Answer 81

abduct humerus and supinate hand and flex elbow 90 degrees

Question 82

for a kyphotic patient what do you do for the ap scapula

Answer 82

Kyphotic patient- angle cephalic /perpendicular to the scapular body

Question 83

to Take advantage of gravity and max. shoulder retraction, how do you do the patient for a ap scapula

Answer 83

do the patient supine

Question 84

how should the lateral aspect and superior scapular be for the ap scapula

Answer 84

Lateral aspect should not have thoracic superimposition and superior scapular angle is approx. ¼ inch inferior to the clavicle

Question 85

positioning for lateral scapula

Answer 85

Oblique patient enough to superimpose scapular borders Humerus is elevated/ moving scapula around the thoracic cavity( the more you do this the less of obliquity you need)

Question 86

how do you positiong patient for lateral scapula to see coracoid and acromion and body

Answer 86

arm behind the back - demonstrated coracoid and acromion look at the lateral body- bring arm above head or arm across the chest and rest hand on opposite shoulder (last two will cover up coracoid and acromion but all three will give a good view of the body)

Question 87

Also known as the lawrence method

Answer 87

Inferosuperior (Axial) Projection

Question 88

For inferior and superior margins of the glenoid cavity

Answer 88

Inferosuperior (Axial) Projection

Question 89

how much to angle for the Inferosuperior (Axial) Projection

Answer 89

30 to 35 degrees and abduct the arm 9- degrees

Question 90

how much do you angle the tube when the arm can not be abducted atleast 60 degrees in an Inferosuperior (Axial) Projection

Answer 90

when the arm can not be abducted atleast 60 degrees angle the tube 20 to 25

Question 91

what should the CR be for Inferosuperior (Axial) Projection

Answer 91

CR should be parallel to the glenohumeral joint space

Question 92

arm positioned out at 90 degrees and put hand supinated (epicondyles parallel) -see lesser in profiler anteriorly

Answer 92

Inferosuperior (Axial) Projection

Question 93

bring arm out to 90 degrees and turn thumb to the floor epicondyles at 45 degrees (lesser will be partially in profile) posterior lateral part of the humeral head is the area of interest

Answer 93

hill sachs defect

Question 94

correct positioning for inferosuperior projections

Answer 94

epicondyles parallel hand supinated lesser tubericle in profile with epicondyles in parallel hills sachs lesser only partial in profile when epicondyles are 45 degrees looking at coracoid (lines up with glenoid cavity)

Question 95

need to change angle for inferosuperior axial

Answer 95

coracoid should line up with glenoid cavity -too far forward - too much angle -too far back - too less of an angle

Question 96

which two views open up glenoid

Answer 96

grashey and axial

Question 97

if the arm is not in the way, what is the image for (shoulder or scapula)

Answer 97

scapula

Question 98

if you see the head of the humerus what view is it for (shoulder or scapula)

Answer 98

shoulder

Question 99

for the axial views, what two things should line up

Answer 99

glenoid and coracoid