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RTE 1513 > Exam 4 (Shoulder Girdle) > Flashcards

Exam 4 (Shoulder Girdle) Flashcards

1
Q

process directly below the anatomic neck on the anterior surface is the

A

lesser tubercle

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2
Q

larger lateral process of proximal humerus

A

greater tubercle

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3
Q

the tapered area below the humeral head and tubercles is the

A

surgical neck

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4
Q

where is deltoid tuberosity located on humeral shaft?

A

anterolateral surface

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5
Q

In true AP of prox humerus, the lesser tubercle is located ________ and the greater tubercle is located ___________

A

anteriorly; laterally

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6
Q

upper scapula margin is at the level of

A

the 2nd posterior rib

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7
Q

the lower scapular margin is at the level of

A

the 7th posterior rib (T7)

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8
Q

the female clavicle is generally _______ and _____ curved than the males

A

shorter; less

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9
Q

the lateral angle of the scapula aka

A

head of scapula

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10
Q

___________ is the thickest part of the scapula and ends laterally in a shallow depression called the ___________

A

lateral angle; glenoid cavity/fossa

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11
Q

dorsal/posterior surface of scapula is called the

A

spine

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12
Q

anterior surface of scapula is called

A

the costal surface

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13
Q

3 joint/articulations of shoulder girdle

A

acromioclavicular joint, sternoclavicular joint, and scapulohumeral joint

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14
Q

the 3 aspects of the clavicle

A

sternal extrem, body/shaft, acromial extrem

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15
Q

2 fossae located on post. scapula?

A

infraspinous fossa & supraspinous fossa

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16
Q

all of the shoulder girdle joints are classified as

A

synovial/diarthroidal

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17
Q

what AP shoulder rotation shows the lesser tubercle in med. profile?

A

internal

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18
Q

which shoulder rotation puts greater tubercle in profile laterally

A

AP ext

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19
Q

which AP shoulder puts proximal humerus in true AP

A

AP ext

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20
Q

which AP shoulder puts the proximal humerus in a lat pos?

A

AP int

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21
Q

what focal spot setting should be used for most adult shoulder studies?

A

small

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22
Q

what analog kV range should be used for shoulder series on avg adult

A

70-80

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23
Q

what can provide a F(x)/dynamic study of joint movement that MRI cannot?

A

sonography/US

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24
Q

compression btw the greater tuberosity & soft tissues on the coracoacromial ligamentous and osseous arch

A

impingement syndrome

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25
Q

injury of the anteroinferior glenoid labrum

A

Bankart lesion

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26
Q

inflammation of tendon

A

Tendonitis

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27
Q

sup. displacement of dist. clavicle

A

AC joint dislocation

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28
Q

compression fracture of articular surface of humeral head

A

Hill-Sachs defect

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29
Q

trauma to 1+ supportive mm’s of shoulder girdle

A

rotator cuff tear

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30
Q

atrophy of skeletal tissue

A

osteoperosis

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31
Q

subacromial spurs

A

Impingement Syndrome

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32
Q

fluid-filled joint space

A

bursitis

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33
Q

thin bony cortex

A

osteoperosis

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34
Q

abnormal widening of AC joint space

A

AC joint separation

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35
Q

calcified tendons

A

tendonitis

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36
Q

avulsion fracture of glenoid rim

A

Bankart lesion

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37
Q

narrowing of joint space

A

osteoarthritis

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38
Q

closed joint space

A

rheumatoid arthritis

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39
Q

compression fracture of humeral head

A

Hill-Sachs defect

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40
Q

where is CR centered for AP shoulder?

A

CR perpendicular to 1” inf to coracoid process

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41
Q

which lat XR can be performed to demonstrated entire humerus for pt w a midhumeral fracture?

A

transthoracic lat XR for humerus

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42
Q

to best show Hill-Sachs defect, which additional pos technique can be added to the inferosuperior axial projection?

A

rotate affected arm externally about 45º

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43
Q

what CR angle is needed for inferosuperior axial projection of shoulder?

A

25-30º medially

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44
Q

which XR projections produces a tangential XR of intertubercular groove?

A

Fisk modification

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45
Q

supine version of tangential XR for intertubercular groove needs CR angle of _______ posteriorly from horizontal plane

A

10-15º

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46
Q

which projection is best for a possible dislocation of prox humerus?

A

Scapular Y

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47
Q

the ______________ projection is the special XR of shoulder that best shows the acromiohumeral space for possible subacromial spurs (shoulder impingement symptoms); aka ____________

A

tangential-supraspinatus outlet; Neer method

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48
Q

which NT projection can be done erect to give lat view of prox humerus in relation to glenohumeral joint?

A

PA transaxillary XR (Hobbs modification)

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49
Q

how much CR angle is needed for inferosuperior axial projection (Clements modification) if pt cannot fully abduct arm 90º?

A

5-15º

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50
Q

what CR angle needed for AP axial XR (Alexander method) for AC joints?

A

15º cephalad

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51
Q

PA transaxillary XR (Hobbs modification) needs _____ CR angle

A

no

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52
Q

transthoracic lat XR can be done for possible…

A

fracture or dislocation of prox humerus

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53
Q

which 2 landmarks are placed perpendicular to IR for scapula Y view?

A

sup angle of scapula & AC joint articulation

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54
Q

which special XR of shoulder needs the affected side to be rotated 45º toward the cassette and uses a 45º caudad angle?

A

AP apical obl axial XR

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55
Q

a post dislocation of humerus projects the humeral head __________ to the glenoid cavity w the AP apical obl axial XR?

A

superior

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56
Q

thin-shouldered pt needs ____ CR angle for an AP axial clavicle XR compared to large-shouldered pt?

A

more

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57
Q

what must be ruled out before performing the weight-bearing study for AC joints?

A

clavicular fracture and AC dislocations

58
Q

inferosuperior axial aka

A

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)

59
Q

post obl for glenoid cavity aka

A

Grashey method

60
Q

tangential for intertubercular (bicipital) groove aka

A

Fisk modification

61
Q

supraspinatus outlet tangential aka

A

Neer method

62
Q

transthoracic lat aka

A

Lawrence method

63
Q

AP apical obl axial aka

A

Garth method

64
Q

where is CR centered for AP scapula XR?

A

CR perpendicular to midscapula (2” inf to coracoid process; or level of axilla & 2” medial from lat border of pt)

65
Q

what type of CR angle needed for lat scapula pos?

A

none

66
Q

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?

A

lower to 75 kV & 2x mAs to increase contrast

67
Q

AP axial clavicle XR shows clavicle below sup border of scapula. what needs to be corrected?

A

+ CR cephalad angle

68
Q

AP scapula XR shows that the scapula is w/in the lung field and hard to see. what 2 things can improve repeat?

A

abduct arm 90º & use breathing technique

69
Q

XR of AP ext shoulder (NT) shows neither the greater nor lesser tubercles in profile. How to correct?

A

supinate hand and ensure epicondyles II to IR

70
Q

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?

A

palpate sup scapula angle and AC joint and ensure imaginary plane btw them are perpendicular to IR

71
Q

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?

A

increase rotation of affected shoulder toward IR to closer to 45º

72
Q

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?

A

angle CR 10-15º cephalad to separate shoulders

73
Q

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?

A

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)

74
Q

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?

A

inferosuperior axial projection w exaggerated ext rotation (Lawrence), inferosuperior axial XR (Clements) & AP apical obl axial XR (Garth method)

75
Q

pt w possible Bankart lesion comes in. list 3 XRs that can be performed to show this injury

A

AP int, scapular Y, post obl (Grashey)

76
Q

pt possible rotator cuff tear comes in. which ing modality best shows this?

A

MRI

77
Q

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?

A

U/S

78
Q

pt enters ER w definite fracture to midhumerus. bc of other T, pt can’t stand. which lat XR would show entire humerus?

A

transthoracic lat XR

79
Q

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?

A

ant dislocation of prox humerus

80
Q

angles of scapula?

A

inf, lat, sup

81
Q

which structure of scapula extends most anteriorly?

A

coracoid process

82
Q

the ___ clavicle is shorter and less curved.

A

female

83
Q

which bony structure separates the supraspinous and infraspinous fossae?

A

scapular spine

84
Q

which scapular structure is the most post.?

A

acromion

85
Q

what type of joint movement for the scapulohumeral joint?

A

spheroidal (ball & socket)

86
Q

greatest technical concern during pediatric shoulder study is?

A

voluntary motion

87
Q

what modality best shows osteomyelitis?

A

Nuclear med

88
Q

which modality provides f(x)al/dynamic study of shoulder joint

A

MRI

89
Q

which XR best shows signs of impingement syndrome?

A

Tangential XR (Neer method)

90
Q

which path often produces narrowing of joint spaces

A

osteoarthritis

91
Q

which path conditions may require a reduction in manual exposure factors?

A

osteoarthritis, rheumatoid arthritis

92
Q

which routine shoulder XR requires humeral epicondyles to be II to IR?

A

AP ext

93
Q

which shoulder XR projects lesser tubercle in profile medially?

A

int rotation

94
Q

what CR angle should be used for inferosuperior axial XR for scapulpohumeral joint space?

A

25-30º medially

95
Q

to best show Hill-Sachs defect on the inferosuperior axial XR, which additional pos maneuver must be used?

A

exaggerated ext rotation

96
Q

which special shoulder XR places glenoid cavity in profile for an “open” scapulohumeral joint?

A

Grashey method

97
Q

for erect version of tangential XR for intertubercular groove, the pt leans forward ______ from vertical

A

10-15º

98
Q

which XR best shows the supraspinatus outlet region?

A

tangential XR (Neer method)

99
Q

which XR should use a breathing technique? (Grashey, Scapular Y lat, transthoracic lat of rhumerus, garth method?)

A

transthoracic lat for humerus

100
Q

what CR angle is needed for the tangential XR of supraspinatus outlet (Neer method)

A

10-15º caudad

101
Q

which clinical indication is best shown w Garth method?

A

scapulohumeral dislocations, Hill-Sachs lesions

102
Q

which shoulder anatomy is best shown w PA transaxillary XR (Hobbs modification)?

A

Coracoid process

103
Q

if pt cannot fully abduct affected arm 90º for inferosuperior axial XR (Clements modification), tech can angle CR ____ towards axilla

A

5-15º

104
Q

which XR needs CR centered 2” inf and med from the superolateral border of shoulder? (i.e. to scapulohumeral joint)

A

post obl Grashey

105
Q

which anatomy is best shown in the Alexander method?

A

AC joints

106
Q

what is min amount of weight a large adult should have for weight-bearing AC joints?

A

8-10 lbs (5-7lbs for small pt)

107
Q

PA axial projection of clavicle needs what CR angle?

A

15-30º caudal

108
Q

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?

A

rotate body more towards affected side (35-45º)

109
Q

pt w possible shoulder dislocation comes in ER. A neutral AP of shoulder was taken confirming dislocation. what additional view should be taken?

A

Garth method (T)

110
Q

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?

A

increase CR angle (thin pt needs 10-15º more angle)

111
Q

pt w possible R shoulder separation enters ER. Which routine should be used?

A

AP neutral and Garth

112
Q

pt comes in w history of tendonitis of bicep tendon. which XR will best show calcification of tendon w/in the intertubercular groove

A

Tangential XR - Fisk modification

113
Q

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?

A

wrong CR angle direction. (45º caudad)

114
Q

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?

A

perform XR w pt’s upper chest prone on table

115
Q

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?

A

AP and transthoracic lat of humerus

116
Q

AC joints, and shoulders measuring less than 10cm, generally require ______(__-__) kV ____ grid

A

less; 65-70º; w/o

117
Q

avg adult humerus and shoulder joint use ____ focal spot

A

small

118
Q

if coracoid process cannot be palpated, where is it’s approx location?

A

about 3/4” inf to lat portion of clavicle

119
Q

what XR needs a medial 25-30º CR angle?

A

Inferosuperior axial shoulder (Lawrence method)

120
Q

if arm cannot be abducted 90º for inferosuperior axial shoulder (Lawrence), what should be done?

A

CR medial angle should be decreased to 15-20º

121
Q

what is best shown in the alt pos of inferosuperior axial shoulder (Lawrence) w exaggerated ext rotation?

A

ant dislocation of humeral head can lead to compression fracture of articular surface aka Hills-Sachs defect

122
Q

what shows fractures of glenoid labrum/brim and Bankart lesions?

A

Post Obl for Glenoid Cavity (Grashey)

123
Q

do you rotate a rounder/curved shoulder/back more or less for post obl Grashey?

A

more

124
Q

In neutral pos, epicondyles are generally how many degrees to plane of IR?

A

45º

125
Q

in AP neutral shoulder, midscapulohumeral joint is approx where?

A

about 3/4” inf & slightly lat to coracoid process

126
Q

Which 2 XR’s for shoulder girdle are the use of an orthostatic breathing technique, w a min of 3s exposure T, recommended?

A

Transthoracic lat Prox Humerus (T - Lawrence method) & AP Scapula

127
Q

Which 5 XRs of shoulder girdle are AEC NOT recommended?

A

Tangential Supraspinatus Outlet Shoulder (T - Neer), AP Clavicle, AP AC Joints, AP Scapula, Lat Scapula

128
Q

which displacement is most common for shoulder?

A

anterior

129
Q

what is superimposed for the stick part of the Y?

A

med & lat scapular borders

130
Q

by abducting arm 90º, can you fully bring the scapula fully out?

A

no

131
Q

Grashey method is to see what?

A

glenoid cavity, scapulohumeral joint

132
Q

for Scapula Y, do you rotate a thin pt more or less?

A

less

133
Q

rotate body how many degrees until scapula in true lat?

A

30º

134
Q

which projection for post obl shoulder increases magnification by increasing the OID of the shoulder?

A

AP

135
Q

if you cannot get both AC joints on 1 bilat XR at 72”, what do you do?

A

do ea at 40”

136
Q

if pt can’t hold weights for AC joints, what do you do?

A

pt supine w sheet to push w feet and flexed knees

137
Q

AC joints are preferred at what SID?

A

72”

138
Q

glenoid/humeral cavity can only be seen when?

A

pt obl

139
Q

what is best T XR for possible scapulohumeral dislocations?

A

AP Apical Obl Axial Shoulder (Garth method)

140
Q

How is IR positioned for shoulder XR (LW/CW)?

A

CW

141
Q

which shoulder view shows glenoid fossa in profile?

A

post obl - Grashey

142
Q

which views of shoulder show dislocation?

A

Y-view, Garth, or transthoracic

RTE 1513 (15 decks)

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