Exam 4 (Shoulder Girdle) Flashcards
process directly below the anatomic neck on the anterior surface is the
lesser tubercle
larger lateral process of proximal humerus
greater tubercle
the tapered area below the humeral head and tubercles is the
surgical neck
where is deltoid tuberosity located on humeral shaft?
anterolateral surface
In true AP of prox humerus, the lesser tubercle is located ________ and the greater tubercle is located ___________
anteriorly; laterally
upper scapula margin is at the level of
the 2nd posterior rib
the lower scapular margin is at the level of
the 7th posterior rib (T7)
the female clavicle is generally _______ and _____ curved than the males
shorter; less
the lateral angle of the scapula aka
head of scapula
___________ is the thickest part of the scapula and ends laterally in a shallow depression called the ___________
lateral angle; glenoid cavity/fossa
dorsal/posterior surface of scapula is called the
spine
anterior surface of scapula is called
the costal surface
3 joint/articulations of shoulder girdle
acromioclavicular joint, sternoclavicular joint, and scapulohumeral joint
the 3 aspects of the clavicle
sternal extrem, body/shaft, acromial extrem
2 fossae located on post. scapula?
infraspinous fossa & supraspinous fossa
all of the shoulder girdle joints are classified as
synovial/diarthroidal
what AP shoulder rotation shows the lesser tubercle in med. profile?
internal
which shoulder rotation puts greater tubercle in profile laterally
AP ext
which AP shoulder puts proximal humerus in true AP
AP ext
which AP shoulder puts the proximal humerus in a lat pos?
AP int
what focal spot setting should be used for most adult shoulder studies?
small
what analog kV range should be used for shoulder series on avg adult
70-80
what can provide a F(x)/dynamic study of joint movement that MRI cannot?
sonography/US
compression btw the greater tuberosity & soft tissues on the coracoacromial ligamentous and osseous arch
impingement syndrome
injury of the anteroinferior glenoid labrum
Bankart lesion
inflammation of tendon
Tendonitis
sup. displacement of dist. clavicle
AC joint dislocation
compression fracture of articular surface of humeral head
Hill-Sachs defect
trauma to 1+ supportive mm’s of shoulder girdle
rotator cuff tear
atrophy of skeletal tissue
osteoperosis
subacromial spurs
Impingement Syndrome
fluid-filled joint space
bursitis
thin bony cortex
osteoperosis
abnormal widening of AC joint space
AC joint separation
calcified tendons
tendonitis
avulsion fracture of glenoid rim
Bankart lesion
narrowing of joint space
osteoarthritis
closed joint space
rheumatoid arthritis
compression fracture of humeral head
Hill-Sachs defect
where is CR centered for AP shoulder?
CR perpendicular to 1” inf to coracoid process
which lat XR can be performed to demonstrated entire humerus for pt w a midhumeral fracture?
transthoracic lat XR for humerus
to best show Hill-Sachs defect, which additional pos technique can be added to the inferosuperior axial projection?
rotate affected arm externally about 45º
what CR angle is needed for inferosuperior axial projection of shoulder?
25-30º medially
which XR projections produces a tangential XR of intertubercular groove?
Fisk modification
supine version of tangential XR for intertubercular groove needs CR angle of _______ posteriorly from horizontal plane
10-15º
which projection is best for a possible dislocation of prox humerus?
Scapular Y
the ______________ projection is the special XR of shoulder that best shows the acromiohumeral space for possible subacromial spurs (shoulder impingement symptoms); aka ____________
tangential-supraspinatus outlet; Neer method
which NT projection can be done erect to give lat view of prox humerus in relation to glenohumeral joint?
PA transaxillary XR (Hobbs modification)
how much CR angle is needed for inferosuperior axial projection (Clements modification) if pt cannot fully abduct arm 90º?
5-15º
what CR angle needed for AP axial XR (Alexander method) for AC joints?
15º cephalad
PA transaxillary XR (Hobbs modification) needs _____ CR angle
no
transthoracic lat XR can be done for possible…
fracture or dislocation of prox humerus
which 2 landmarks are placed perpendicular to IR for scapula Y view?
sup angle of scapula & AC joint articulation
which special XR of shoulder needs the affected side to be rotated 45º toward the cassette and uses a 45º caudad angle?
AP apical obl axial XR
a post dislocation of humerus projects the humeral head __________ to the glenoid cavity w the AP apical obl axial XR?
superior
thin-shouldered pt needs ____ CR angle for an AP axial clavicle XR compared to large-shouldered pt?
more
what must be ruled out before performing the weight-bearing study for AC joints?
clavicular fracture and AC dislocations
inferosuperior axial aka
Lawrence method (CR 25-30º med, or 15-20º if pt can’t abduct arm 90º)/Clements (CR perpendicular, or 5-15º toward axilla if pt can’t abduct arm 90º)
post obl for glenoid cavity aka
Grashey method
tangential for intertubercular (bicipital) groove aka
Fisk modification
supraspinatus outlet tangential aka
Neer method
transthoracic lat aka
Lawrence method
AP apical obl axial aka
Garth method
where is CR centered for AP scapula XR?
CR perpendicular to midscapula (2” inf to coracoid process; or level of axilla & 2” medial from lat border of pt)
what type of CR angle needed for lat scapula pos?
none
85 kV, 20 mAs, high-speed screens, 40” SID, grid, and suspend resp used on AP shoulder XR. Poor rad contrast btw bony and soft tissue structures. What should be done on repeat?
lower to 75 kV & 2x mAs to increase contrast
AP axial clavicle XR shows clavicle below sup border of scapula. what needs to be corrected?
+ CR cephalad angle
AP scapula XR shows that the scapula is w/in the lung field and hard to see. what 2 things can improve repeat?
abduct arm 90º & use breathing technique
XR of AP ext shoulder (NT) shows neither the greater nor lesser tubercles in profile. How to correct?
supinate hand and ensure epicondyles II to IR
lat scapula XR pos shows it is not true lat. (considerable separation btw axillary and vertebral borders). It was done erect, 40” SID, 45º rotation, CR centered mid scapula. what to improve?
palpate sup scapula angle and AC joint and ensure imaginary plane btw them are perpendicular to IR
XR of AP obl (Grashey method) taken at 35º obl pos shows that the borders of the glenoid cavity are not superimposed. pt has lg, rounded shoulders, what must be done on repeat?
increase rotation of affected shoulder toward IR to closer to 45º
pt w possible R shoulder dislocation eneter ER. tech attempts to perform erect transthoracic lat XR, but pt unable to raise L arm and shoulder high enough. (shoulders superimposed and R shoulder and humeral head not well visualized). what can be done for repeat?
angle CR 10-15º cephalad to separate shoulders
pt w possible fracture of R prox humerus from MVA enters ER and has other injuries and can’t stand or sit erect. which pos routine should be done?
AP R shoulder & humerus neutral & supine horizontal beam R transthoracic shoulder (or when opp arm can’t be elevated/extended, a supine post obl scapular Y lat XR can be done)
pt w clinical history of chronic shoulder dislocation comes in. doc suspects that a Hill-Sachs defect may be present. what XR(s) would best demonstrate this path?
inferosuperior axial projection w exaggerated ext rotation (Lawrence), inferosuperior axial XR (Clements) & AP apical obl axial XR (Garth method)
pt w possible Bankart lesion comes in. list 3 XRs that can be performed to show this injury
AP int, scapular Y, post obl (Grashey)
pt possible rotator cuff tear comes in. which ing modality best shows this?
MRI
pt w clinical history of tendon injury in shoulder comes in. doc needs f(x)al study of shoulder joint performed to show extent of injury. which ing modality best shows this?
U/S
pt enters ER w definite fracture to midhumerus. bc of other T, pt can’t stand. which lat XR would show entire humerus?
transthoracic lat XR
AP apical obl axial XR (Garth method) is done on a pt w a shoulder injury. it shows prox humeral head projected below the glenoid cavity. what type of T/path is indicated?
ant dislocation of prox humerus
angles of scapula?
inf, lat, sup
which structure of scapula extends most anteriorly?
coracoid process
the ___ clavicle is shorter and less curved.
female
which bony structure separates the supraspinous and infraspinous fossae?
scapular spine
which scapular structure is the most post.?
acromion
what type of joint movement for the scapulohumeral joint?
spheroidal (ball & socket)
greatest technical concern during pediatric shoulder study is?
voluntary motion
what modality best shows osteomyelitis?
Nuclear med
which modality provides f(x)al/dynamic study of shoulder joint
MRI
which XR best shows signs of impingement syndrome?
Tangential XR (Neer method)
which path often produces narrowing of joint spaces
osteoarthritis
which path conditions may require a reduction in manual exposure factors?
osteoarthritis, rheumatoid arthritis
which routine shoulder XR requires humeral epicondyles to be II to IR?
AP ext
which shoulder XR projects lesser tubercle in profile medially?
int rotation
what CR angle should be used for inferosuperior axial XR for scapulpohumeral joint space?
25-30º medially
to best show Hill-Sachs defect on the inferosuperior axial XR, which additional pos maneuver must be used?
exaggerated ext rotation
which special shoulder XR places glenoid cavity in profile for an “open” scapulohumeral joint?
Grashey method
for erect version of tangential XR for intertubercular groove, the pt leans forward ______ from vertical
10-15º
which XR best shows the supraspinatus outlet region?
tangential XR (Neer method)
which XR should use a breathing technique? (Grashey, Scapular Y lat, transthoracic lat of rhumerus, garth method?)
transthoracic lat for humerus
what CR angle is needed for the tangential XR of supraspinatus outlet (Neer method)
10-15º caudad
which clinical indication is best shown w Garth method?
scapulohumeral dislocations, Hill-Sachs lesions
which shoulder anatomy is best shown w PA transaxillary XR (Hobbs modification)?
Coracoid process
if pt cannot fully abduct affected arm 90º for inferosuperior axial XR (Clements modification), tech can angle CR ____ towards axilla
5-15º
which XR needs CR centered 2” inf and med from the superolateral border of shoulder? (i.e. to scapulohumeral joint)
post obl Grashey
which anatomy is best shown in the Alexander method?
AC joints
what is min amount of weight a large adult should have for weight-bearing AC joints?
8-10 lbs (5-7lbs for small pt)
PA axial projection of clavicle needs what CR angle?
15-30º caudal
a post obl Grashey XR shows that the ant and post glenoid rims are not superimposed. erect pos, body rotated 25-30º toward the affected side, CR perpendicular to scapulohumeral joint and affected arm slightly abducted in neutral rotation. what needs correction?
rotate body more towards affected side (35-45º)
pt w possible shoulder dislocation comes in ER. A neutral AP of shoulder was taken confirming dislocation. what additional view should be taken?
Garth method (T)
XR of AP axial clavicle taken on asthenic pt shows that clavicle is projected in lung field below the top of shoulder. erect pos, CR 15º cephalic, 40” SID, and resp suspended at exp. what needs to be corrected?
increase CR angle (thin pt needs 10-15º more angle)
pt w possible R shoulder separation enters ER. Which routine should be used?
AP neutral and Garth
pt comes in w history of tendonitis of bicep tendon. which XR will best show calcification of tendon w/in the intertubercular groove
Tangential XR - Fisk modification
AP obl axial (Garth) XR shows poor visibility of shoulder joint. tech used pt erect, facing XR tube, 45º rotation of affected shoulder toward the IR, 45º cephalad angle and CR centered to scapulohumeral joint. what caused repeat?
wrong CR angle direction. (45º caudad)
pt comes in for NT shoulder series. routine calls for PA transaxillary XR (Hobbs modification) to be included. but pt unable to stand and confined to wheelchair. what should tech do?
perform XR w pt’s upper chest prone on table
pt enters ER w prox and midhumeral fracture. pt in extreme pn. which routine would best show the entire humerus w/o excessive movement of limb?
AP and transthoracic lat of humerus
AC joints, and shoulders measuring less than 10cm, generally require ______(__-__) kV ____ grid
less; 65-70º; w/o
avg adult humerus and shoulder joint use ____ focal spot
small
if coracoid process cannot be palpated, where is it’s approx location?
about 3/4” inf to lat portion of clavicle
what XR needs a medial 25-30º CR angle?
Inferosuperior axial shoulder (Lawrence method)
if arm cannot be abducted 90º for inferosuperior axial shoulder (Lawrence), what should be done?
CR medial angle should be decreased to 15-20º
what is best shown in the alt pos of inferosuperior axial shoulder (Lawrence) w exaggerated ext rotation?
ant dislocation of humeral head can lead to compression fracture of articular surface aka Hills-Sachs defect
what shows fractures of glenoid labrum/brim and Bankart lesions?
Post Obl for Glenoid Cavity (Grashey)
do you rotate a rounder/curved shoulder/back more or less for post obl Grashey?
more
In neutral pos, epicondyles are generally how many degrees to plane of IR?
45º
in AP neutral shoulder, midscapulohumeral joint is approx where?
about 3/4” inf & slightly lat to coracoid process
Which 2 XR’s for shoulder girdle are the use of an orthostatic breathing technique, w a min of 3s exposure T, recommended?
Transthoracic lat Prox Humerus (T - Lawrence method) & AP Scapula
Which 5 XRs of shoulder girdle are AEC NOT recommended?
Tangential Supraspinatus Outlet Shoulder (T - Neer), AP Clavicle, AP AC Joints, AP Scapula, Lat Scapula
which displacement is most common for shoulder?
anterior
what is superimposed for the stick part of the Y?
med & lat scapular borders
by abducting arm 90º, can you fully bring the scapula fully out?
no
Grashey method is to see what?
glenoid cavity, scapulohumeral joint
for Scapula Y, do you rotate a thin pt more or less?
less
rotate body how many degrees until scapula in true lat?
30º
which projection for post obl shoulder increases magnification by increasing the OID of the shoulder?
AP
if you cannot get both AC joints on 1 bilat XR at 72”, what do you do?
do ea at 40”
if pt can’t hold weights for AC joints, what do you do?
pt supine w sheet to push w feet and flexed knees
AC joints are preferred at what SID?
72”
glenoid/humeral cavity can only be seen when?
pt obl
what is best T XR for possible scapulohumeral dislocations?
AP Apical Obl Axial Shoulder (Garth method)
How is IR positioned for shoulder XR (LW/CW)?
CW
which shoulder view shows glenoid fossa in profile?
post obl - Grashey
which views of shoulder show dislocation?
Y-view, Garth, or transthoracic
