Procedures shoulder review for final exam Flashcards
The shoulder consists of the _______,________ and ________
proximal humorous, scapula, clavicle
The intertubercular groove is also known as the ______ _________.
bicipital groove
The greater and lesser tubercle of the humerus can also be called the _________
tuberosity
what are the three aspects of the clavicle?
The sternal extremity, body, acromial extremity
The mail clavicle is thicker and more______
curved
The three angles of the scapula are?
lateral angle, superior angle and inferior angle
what is the anterior surface of the scapula referred to?
The costal surface
jis the coronoid process part of the shoulder girdle?
no
The glenoid cavity is also called the?
Glenohumeral joint and the scapulohumeral joint
The medial border of the scapula is also called the_____?
vertebral border
The costal surface of the scapula is also called the ________
ventral
internal rotation of the humerus places it in a _________position with the epicondyles of the distal humerus ________to the IR
lateral, perpendicular
The humerus in external rotation places it in a _________position with the epicondyles of the distal humerus ___________to the IR
AP, Parallel
what is the correct term for a Y projection?
scapular Y lateral anterior oblique projection
in what position are the humeral epicondyle’s angled 45° to the IR?
neutral rotation
in which position are the epicondyles perpendicular to the IR?
internal rotation
in which position are the epicondyles parallel to the IR?
external rotation
when is the proximal humerus in a lateral position?
with internal rotation
in which position must the Arm be for the humerus to be seen as an AP projection?
external rotation
True or false Low mA with short exposure times should be used for adult shoulder studies
false
what S ID is recommended for most shoulder girdle studies?
40-44
what is the KV range in analog that should be used for a shoulder series on an average size adult?
70 to 80
what type of study demonstrates signs of osteomyelitis and cellulitis?
nuclear medicine bone scans
what type of study is recommended to provide a functional evaluation of joint movement?
ultrasound
compression between the greater tuberosity and soft tissues on the ligaments and osseous arch…
impingement syndrome
injury of the glenoid labrum
Bankart lesion
compression fracture of the humeral head
Hill Sachs defect
define a rotator cuff tear
injury to one or more of the supportive of muscles of the shoulder girdle
impingement syndrome presents Radiographically as_______
subacromial spurs
an abnormal widening of acromial clavicular joint space.
Acromioclavicular joint separation
if a patient has tendinitis we will see….
calcified tendons
what is Bankart lesion Seen as….
you will see an avulsion fracture of the glenoid rim
what does rheumatoid arthritis look like on the radiograph?
it will appear to have a closed joint space
if the patient has Hill sachs defect they will have a
compression fracture of the humeral head
specifically, where is the central ray placed for an AP projection of the shoulder?
The CR should be perpendicular to the IR 1 inch below the coracoid process
what type of central ray angle is required for the inferosuperior axial projection of the shoulder?
25 to 30° medial
which projection places the glenoid process in profile?
Grashey also known as posterior oblique
which projection is best for demonstrating a possible dislocation of the proximal humerus?
scapular Y projection
which special projection of the shoulder best shows sub acromial spurs in the acromial humeral space
tangential or it can also be called NEER method (supraspinatous outlet)
which nontrauma projection can be done to provide a lateral view of the proximal humerus in relationship to the glenohumeral joint?
PA transaxillary projection (hobbs)
how much is the CR angled for Clements also known as inferosuperior axial projection, if the patient cannot fully abducted the arm 90°?
5 to 15°
when doing an AP axial projection also known as Alexander method, for AC joints what CR angle is required?
15° cephalad
in simple terms describe neer method…
supraspinatus outlet tangential
in simple terms, Lawrence method…
inferosuperior axial
when doing a projection for the AP scapula where do you center the CR?
perpendicular to mid scapula 2 inches below coracoid
name three projections that can be done to demonstrate a Bankart lesion…
AP internal rotation, scapular Y lateral, posterior oblique Grashey
which part of the scapula extends most anteriorly?
coracoid process
which part of the scapula is most posterior?
Acromion
what type of joint movement is the scapulohumeral joint?
spheroidal
which imaging modality best demonstrates osteomyelitis?
nuclear medicine
which projection is done for impingement syndrome?
NEER ( tangential)
which projection best demonstrates the supraspinatus outlet region ?
NEER (tangential)
what is the central ray angle for neer method
10 to 15° caudad
this projection requires the CR to be centered 2 inches below and medial from the superolateral border of the shoulder…
scapula Y lateral projection
what anatomy is seen with the Alexander method
AC joints
Acromioclavicular (AC) dislocation
-Injury in which the distal clavicle usually is displaced superiorly. -Most common cause is a fall
AC joint separation
Trauma to the upper shoulder region resulting in a partial or complete tear of the AC or coracoclavicular (CC) ligament or both ligaments.
Bankart lesion
-Injury of the anteroinferior aspect of the glenoid labrum. -often caused by anterior dislocation of the proximal humerus. -repeated dislocation may result in a small avulsion fracture in the anteroinferior region of glenoid rim.
Bursitis
-Inflammation of the bursae (fluid filled sacs) enclosing the joints. -generally involves the formation of calcification in associated tendons, causing pain and limitation of joint movement.
Hill-Sachs defect
-Compression fracture of the articulate surface of the posterolateral aspect of the humoral head - often associated with an anterior dislocation of the humoral head
Idiopathic chronic adhesive capsulitis (frozen shoulder)
-Disability of the shoulder joint that is caused by chronic inflammation in and around the joint. -characterized by pain and limitation of motion.
Impingement syndrome
-Impingement of the greater tubercle and soft tissues on the coracoacromial ligamentous and osseous arch -generally during abduction of the arm
Osteoarthritis (degenerative joint disease)
-noninflammatory joint disease characterized by gradual deterioration of the articular cartilage with hypertrophic bone formation. -most common type of arthritis, normal part of aging process, ages older than 50, chronically obese persons and athletes.
Osteoporosis
-Resultant fractures are due to a reduction in the quantity of bone or atrophy of skeletal tissue. -occurs in premenopausal women and elderly men. -results in bone trabeculae that are scanty and thin.
Rheumatoid arthritis
Chronic systemic disease characterized by inflammatory changes that occur throughout the connective tissues of the body.
Rotator cuff
-Acute or chronic and traumatic injury to one or more of the muscles that make up the rotator cuff (teres minor, supraspinatus, infraspinatus, and subscapularis. -limit range of motion of the shoulder
Most common rotator cuff injury
Impingement of the supraspinatus muscle as it passes beneath the acromion caused by a sunacromial bone spur.
Shoulder dislocation
-Occurs as a traumatic removal of humeral head from the glenoid cavity -95% are anterior, in which the humeral head is projected anterior to the glenoid cavity.
Tendonitis
Inflammatory condition of the tendon that usually results from a strain.
Humerus (Nontrauma and Trauma Routine)
Routine -AP -AP rotational lateral -Horizontal beam lateral Special -Transthoracic lateral
Shoulder (Nontrauma Routine)
-AP external rotation -AP internal rotation
Shoulder (Nontrauma Routine) Special
-Inferosuperior axial (Lawrence Method) -PA transaxillary (Hobbs modification) -Inferosuperior axial (Clements modification) -Posterior oblique-Glenoid cavity (Grashey Method) -Tangenital projection-intertubercular groove (Fisk modification)
Shoulder (Trauma Routine)
- AP neutral rotation -Transthoracic lateral (Lawrence method) -Scapular Y lateral
Shoulder (Trauma Routine) Special
-Tangenital projection-supraspinatus outlet -AP apical oblique axial (Garth Method)
Clavicle
-AP -AP axial
what projections are done for AC joints?
-AP bilateral with weights -AP bilateral without weights
Scapula
-AP -Lateral -Erect -Recumbent
Trauma
-As Is -Y
AP Projection: Humerus
-Pt position: erect or supine/ body rotated toward affected side/ hand and forearm extended as far as Pt can tolerate/arm abducted slightly/hand supinated slightly to bring epicondyles parallel to IR. -CR: perpendicular to IR; midpoint of humerus -In profile: greater tubercle in profile medially, minimal superimposition of glenoid cavity. Lateral and medial epicondyles both seen in profile **suspend breathing
Rotational Lateral (Lateromedial) Humerus
-Pt position: erect or supine/ back to IR/ body rotated toward affected side/internally rotate arm/epicondyles perpendicular to IR -CR: Perpendicular to IR; midpoint of humerus -In profile: epicondyles directly superimposed/lesser tubercle in profile medially, partially superimposed by lower portion of glenoid cavity. **suspend breathing
Rotational lateral (Mediolateral) Humerus
-Pt position: Facing IR/oblique as needed (20-30degrees from PA)/ elbow flexed 90 degrees -CR: perpendicular to IR; midpoint of humerus -In profile: epicondyles directly superimposed/lesser tubercle shown in profile medially, partially superimposed by lower portion of glenoid cavity ** suspend breathing
Trauma Horizontal Beam Lateral-Lateromedial : Humerus
-Pt position: recumbent/support under arm/arm flexed if possible 90 degrees/cassette between humerus and thorax. -CR: horizontal, perpendicular to midpoint of distal 2/3 of humerus. -In profile: include elbow joint and distal 2/3 of humerus **suspend breathing
Transthoracic lateral Projection: Humerus (Trauma)
-Pt position: lateral position w/ affected side closest to IR in a neutral rotation (drop shoulder if possible)/place other arm above head (shoulder raised as much as possible), slight anterior rotation of unaffected shoulder -CR: perpendicular to IR; through thorax to mid-diaphysis -In profile: outline of shaft of humerus anterior to thoracic vertebrae/relationship if the humeral head and glenoid cavity **orthostatic (breathing) technique preferred
AP Projection-External Rotation: Shoulder (NonTrauma) AP Proximal Humerus
-Pt position: erect or supine/affected side rotated toward IR or tabletop/ scapulohumeral joint centered to IR/ abduct slightly and externally rotate arm until epicondyles parallel to IR. -CR: perpendicular to IR; 1 inch below coracoid process (3/4 in below lateral clavicle) -In profile: Greater tubercle laterally/Lesser tubercle superimposed over humeral head **suspend respiration
AP Projection-Internal Rotation: Shoulder (NonTrauma) Lateral Proximal Humerus
-Pt position: center scapulohumeral joint to center of IR/abduct extended arm slightly/internally rotate arm (pronate hand)/ epicondyles perpendicular to IR -CR: perpendicular to IR/ 1 inch below coracoid process (3/4in below lateral clavicle) -In profile: Lesser tubercle visualized in full profile on medial aspect of humeral head/outline of greater tubercle superimposed over the humeral head **suspend breathing
Inferosuperior Axial Projection: Shoulder (NonTrauma) Lawrence Method
-Pt Position: Supine/shoulder raised 2in from tabletop with support/ arm abducted 90 if possible/ externally rotated,Palm up/head rotated opposite side/ cassette close to neck as possible -CR:medially 25-30 degrees(15-20 if arm is less than 90) /centered to Axilla and humeral head -In profile: superior and inferior borders of glenoid cavity should be directly superimposed from CR angle. ** suspend breathing
Inferosuperior Axial projection: Shoulder (NonTrauma) Lawrence Method Alternative
-Exaggerated external rotation/thumb pointed down and posteriorly about 45 degrees -best for Hills-Sachs defect
Posterior Oblique Position-Glenoid Cavity: shoulder (NonTrauma) Grashey Method
-Pt position: rotate body 35-45 degrees toward affected side/center midscapulohumeral joint to IR/cassette 2 in above shoulder and 2in from lateral border of humerus/abduct arm slightly with arm in neutral rotation -CR: perpendicular; center at midscapulohumeral joint -In profile: scapulohumeral joint space should be open/anterior and posterior rims of glenoid cavity superimposed. ** suspend breathing
Tangenital Projection- Intertubercular (Bicipital) Groove: Shoulder (NonTrauma) Fisk Modification
-Pt Position: erect/standing or leaning over end of table with elbow flexed/posterior surface of arm resting on table/ hand supinated holding cassette/ humerus flexed 10-15 degrees -CR: perpendicular to IR; groove area at mid anterior margin of humeral head -In profile: Intertubercular groove and tubercles without superimposition of the acromion process ** suspend respiration
AP projection-Neutral Rotation: Shoulder (Trauma)
-Pt position: center scapulohumeral joint to IR/pts arm at side “as is” neutral rotation/ epicondyles approx. 40 degrees to plane of IR. -CR: perpendicular to IR; midscapulohumeral joint (3/4in below and slightly lateral to coracoid process) -In profile: both greater and less tubercles
The 3 aspects of the clavicle
Acromial extremity Body (shaft) Eternal extremity
3 angles of the scapula
Inferior Superior Lateral
What is the anterior surface of the scapula called
Costal surface
What are the names of the two fossae located on the posterior scapula
Infraspinous and supraspinous
All the joints of the shoulder are classified as
Synovial joints
What rotation shows the greater tubercle in profile laterally
External
What rotation puts the humerus epicondyles at 45 degree angle to IR
Neutral position
What rotation puts epicondyles perpendicular to IR
Internal rotation
Which rotation involves supination of hand
External rotation
Which rotation puts humoral epicondyles parallel to IR
External rotation
Which rotation puts the lesser tubercle in profile medially
Internal rotation
Which position puts humerus in lateral position
Internal rotation
Which position puts humerus in AP projection
External rotation
Which clinical indication requires a decrease in exposure factors
Osteoporosis
Which lateral projection demonstrates the entire humerus with a midhumeral fracture
Tranathoracic lateral projection
what 2 bones make up the shoulder girdle?
clavicle and scapula
where does the shoulder girdle connect to the trunk?
anteriorly at the upper sternum
The upper margin of the scapula is at the level of the _________and the lower margin is at the level of the ________
Second posterior rib level of the seventh posterior rib
what are the two joints associated with the clavicle?
Acromioclavicular and sternoclavicular
what are the three borders of the scapula?
medial, superior, lateral
what are the three angles of the scapula?
lateral, superior, inferior
in which position is the humerus in a true AP? and how is this evident?
external rotation The greater tubercle of the humeral head is in profile laterally
in which position is the humerus in a lateral position? how is this evident ?
internal rotation lesser tubercle of the humeral head is in profile medially
what type of technique should be used for the humerus and AC joint?
manual
what S I D is used for an AC joint?
72 inch
which S ID is used for shoulder and humerus?
40-44 Sid
summarize all of the projections for humerus:
AP Ext rotation AP internal rotation, horizontal beam lateral, special : transthoracic lateral
which bones make up the shoulder girdle :
humeral head scapula clavicle
what is the best position for the trauma shoulder
upright
in order to demonstrate the greater tubercle of the humerus and AP projection of the shoulder the epicondyles must be
parallel with the plane of the IR
for an AP projection of the shoulder the central ray should enter:
1 inch below the coracoid process
what position is the humerus in if the patient places the palm of the hand against the thigh
neutral rotation
The PA oblique projection of the shoulder joint (Y) is done in what position??
RAO LAO
what projection is done to evaluate dislocation?
pa oblique scapular Y
for delineation of the acromion on and coracoid processes of the scapula in the lateral projection, the arm is positioned:
with the elbow flexed and the hand on the posterior thorax
what projection best demonstrates the Coracoacromial arch?
NEER method
what is the most common dislocation of the shoulder
anterior dislocation
and AP humerus requires that the humeral epicondyles are __________ to the IR
parallel
what type of CR angle is required for the superoinferior axial projection or (Hobbs modification?)
no angle the CR should be perpendicular to the IR
