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Image Analysis > Chapter 5: Shoulder > Flashcards

Chapter 5: Shoulder Flashcards

1
Q

How is the patient positioned for an AP shoulder

A

supine or upright at equal distance to the IR

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2
Q

How should the clavicle be demonstrated in an AP shoulder projection

A

Clavicle demonstrated horizontally

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3
Q

KVP and distance for an AP shoulder

A

Optimal kVp 65-75, SID 40-48 inches

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4
Q

how is the scapular body in an AP shoulder

A

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

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5
Q

What should be included in an AP shoulder projection

A

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

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6
Q

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

A

Evaluate the scapular body, glenoid cavity and clavicle

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7
Q

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

A

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

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8
Q

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

A

The glenoid cavity and scapular neck are more in profile

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9
Q

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

A

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

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10
Q

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

A

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

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11
Q

how is the thorax in a rotation away from effected shoulder

A

Thorax is demonstrated over a smaller amount of the scapula

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12
Q

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

A

Scapular body demonstrates increased transverse foreshortening

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13
Q

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

A

The glenoid cavity is better demonstrated (more on end)

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14
Q

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

A

Medial clavicular end is superimposed over the vertebral column

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15
Q

Some indications there is rotation away from effected shoulder

A
  • clavicle end is now on spine
    -thorax is off of scapular body
  • glenoid cavity is way far over on humeral head
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16
Q

which type of dislocation is more common ?

A

anterior dislocations

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17
Q

how is an anterior location?

A

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

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18
Q

how is a posterior dislocation

A

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

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19
Q

Key indications it is an anterior dislocation

A

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

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20
Q

Key indication that it is a posterior dislocation

A
  • humeral head is below acromion
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21
Q

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

A

will be demonstrated superior to the midclavicle

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22
Q

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

A

superior scapular angle will shown inferior to midclavicle

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23
Q

What tilt is more common

A

anterior

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24
Q

what should you do when you have a kyphotic patient

A

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

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25
Q

how should the superior scapular angle be in an AP shoulder

A

superior angle should lie directly on clavicle mid-shaft

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26
Q

is the scapula above or below clavicle in an anterior tilt

A

scapula above clavicle

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27
Q

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

A

below clavicle

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28
Q

what do you look at for indication of a tilt

A

superior scapular body

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29
Q

what is the lateral epicondyle alligned with

A

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

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30
Q

what is the medial epicondyle alligned with

A

the humeral head

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31
Q

how is the lesser tuberical in relation to the greater tubercle

A

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

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32
Q

how are the epicondyles in a neutral position

A

neither are in profile
epicondyles 45 degrees with IR

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33
Q

what is in profile in neutral position

A

partial profile of greater tubercle laterally
and head profile medially

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34
Q

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

A

neutral

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35
Q

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

A

external

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36
Q

how are the epicondyles in external

A

parallel with IR

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37
Q

what is in profile in a external shoulder

A

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

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38
Q

how are the epicondyles in an internal rotation

A

epicondyles are perpendicular with the IR

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39
Q

what is in profile in an internal rotation

A

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

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40
Q

what is in profile in a grashey

A

Glenoid cavity is in profile with the glenohumeral joint space open

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41
Q

how is the clavicle in a grashey

A

Clavicle is longitudinally foreshortened

42
Q

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

A

rolled too much ( should not have an thorax superimposition)

43
Q

how is the patient rotated for a grashey

A

Patient is rotated 35 to 45° toward affected shoulder

44
Q

what are you more concerned about for a grashey

A

joint space

45
Q

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

A

over rotated

46
Q

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

A

under rotated

47
Q

how should the shoulder be in a grashey

A

Shoulder in neutral position and not protracted (moved forward)

48
Q

how should the CR be for a grashey

A

CR 1 inch inferior and medial to the coracoid process

49
Q

Main reason for grashey

A

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

50
Q

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

A

6o degrees

51
Q

criteria for grashey

A

-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

52
Q

positioning for grashey

A

-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

53
Q

how are the coracoid and acromion in a grashey position

A

superimposed and perpendicular to the IR

54
Q

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

A

excessive rotation of grashey

55
Q

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

A

insufficient rotation of grashey

56
Q

what parts form the scapular y

A

The body, acromion and coracoid processes form a Y

57
Q

what part is in a lateral position of a scapular y

A

Scapular body is in a lateral position

58
Q

what is on end of the scapular y

A

glenoid cavity

59
Q

how should the humerus be in a scapular y

A

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

60
Q

what border of the scapular is thicker

A

lateral border

61
Q

how is the lateral border of the scapula

A

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

62
Q

what border of the scapula is thinner

A

medial border

63
Q

how is the medial border of the scapula

A

Medial border is thinner and shows only one single thin line

64
Q

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

A

excessive

65
Q

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

A

If medial border is next to the ribs (insufficient)

66
Q

lateral y view is good for what two things

A

-fractures and dislocations

67
Q

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

A

fracture of humeral head

68
Q

criteria for AP projection of clavicle

A

-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

69
Q

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

A

affected side rotated away

70
Q

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

A

affected side rotated away

70
Q

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

A

rotated toward the affected

70
Q

what type of rotation for ap clavicle

A

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

71
Q

what is the angle of ap axial clavicle

A

15 to 30 angle cephalic

71
Q

why do we do an axial clavicle

A

to get medial aspect off of rib cage

72
Q

where do 80 percent of the fractures of the clavicle happen

A

middle third

73
Q

where do 15 percent of fractures of the clavicle happen

A

at the lateral third

74
Q

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

A

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

75
Q

how should AC joints be done

A

Upright and Weight-bearing/Non Weight-bearing

76
Q

how to detect rotation of ac joints

A

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

77
Q

what does rotation of ac joints result in

A

Rotation results in a narrowed or closed AC joint

78
Q

SID for AC joints

A

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

79
Q

where should the weights be for ac joints

A

on the wrists

80
Q

breathing for AP scapula

A

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

81
Q

how should pt be positioned for ap scapula

A

abduct humerus and supinate hand and flex elbow 90 degrees

82
Q

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

A

Kyphotic patient- angle cephalic /perpendicular to the scapular body

83
Q

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

A

do the patient supine

84
Q

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

A

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

85
Q

positioning for lateral scapula

A

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)

86
Q

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

A

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)

87
Q

Also known as the lawrence method

A

Inferosuperior (Axial) Projection

88
Q

For inferior and superior margins of the glenoid cavity

A

Inferosuperior (Axial) Projection

89
Q

how much to angle for the Inferosuperior (Axial) Projection

A

30 to 35 degrees and abduct the arm 9- degrees

90
Q

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

A

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

91
Q

what should the CR be for Inferosuperior (Axial) Projection

A

CR should be parallel to the glenohumeral joint space

92
Q

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

A

Inferosuperior (Axial) Projection

93
Q

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

A

hill sachs defect

94
Q

correct positioning for inferosuperior projections

A

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)

95
Q

need to change angle for inferosuperior axial

A

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

96
Q

which two views open up glenoid

A

grashey and axial

97
Q

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

A

scapula

98
Q

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

A

shoulder

99
Q

for the axial views, what two things should line up

A

glenoid and coracoid

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