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MEDIMAGE 301 > Shoulder > Flashcards

Shoulder Flashcards

1
Q

How should the patient be positioned for an AP shoulder girdle X-ray?

A
  • Erect, facing the X-ray tube

Rotate 10% toward the affected side (to make scapula parallel to IR)
Internally rotate affected arm (elbow flexed, forearm across chest)

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2
Q

Where should the central ray (HCR) be positioned for an AP shoulder girdle X-ray?

A

Approximately 2.5cm inferior to the coracoid process

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3
Q

What structures should be included in collimation for an AP shoulder girdle X-ray?

A
  • Entire shoulder girdle

Entire clavicle
Entire scapula
Upper 1/3 of humerus

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4
Q

What are the technical exposure factors for an AP shoulder girdle X-ray?

A
  • Centre Chamber – AEC

60-70 kVp

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5
Q

What should be included in the Region of Interest (ROI) for an AP shoulder girdle X-ray?

A
  • Proximal humerus

Full scapula and clavicle

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6
Q

What key image criteria indicate a properly positioned AP shoulder girdle X-ray?

A
  • Humeral head slightly superimposes the glenoid fossa

Lesser tuberosity seen in profile
Superolateral border of the scapula visible (without thorax superimposition)

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7
Q

What is the purpose of the AP Glenoid View (Glenohumeral Joint)?

A

To visualize the glenohumeral joint space and the glenoid labrum in profile.

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8
Q

How should the patient be positioned for an AP Glenoid View X-ray?

A

Erect, facing the X-ray tube
Rotate approximately 45° toward the affected side
Hand in neutral or external rotation (for some patients)

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9
Q

Where should the central ray (HCR) be positioned for an AP Glenoid View X-ray?

A

Approximately 1 cm inferior to the coracoid process.

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10
Q

What structures should be included in collimation for an AP Glenoid View X-ray?

A

The glenohumeral joint.

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11
Q

What should be demonstrated in an optimal AP Glenoid View X-ray?

A

✔️ Glenoid cavity in profile
✔️ Greater tuberosity in profile
✔️ Glenohumeral joint space should be open
✔️ Coracoid process partially superimposes the humeral head
✔️ Glenoid cavity free from thorax superimposition.

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12
Q

How can you tell if the patient is under-rotated in an AP Glenoid View X-ray?

A

The clavicle appears elongated, meaning it looks ‘stretched out’ compared to its normal appearance.

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13
Q

How can you tell if the patient is over-rotated in an AP Glenoid View X-ray?

A

The clavicle appears foreshortened, meaning it looks more distorted than usual.

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14
Q

What is included in the AP Shoulder view for trauma?

A

✔️ Humeral head
✔️ Clavicle
✔️ Scapula
✔️ No obliquity.

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15
Q

Why is the lateral humeral head view important in trauma?

A

It helps assess fractures, dislocations, and the alignment of the humeral head with the glenoid.

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16
Q

What is the purpose of the Gleno-Humeral Joint view in trauma?

A

It assesses joint alignment, glenoid fractures, and dislocations.

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17
Q

What is the purpose of the Axial (Infero-Superior) view?

A

✔️ Provides a clear view of the glenoid cavity
✔️ Helps evaluate humeral head position
✔️ Detects posterior dislocations.

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18
Q

Why is the lateral scapula view included in trauma protocols?

A

It allows visualization of scapular fractures and dislocations in relation to the thorax.

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19
Q

How should the patient be positioned for a Supero-Inferior Axial Shoulder view?

A

✔️ Seated with affected side next to IR
✔️ Lean well across the IR
✔️ Raise IR to mid-thoracic height
✔️ Abduct arm, elbow resting on detector/table
✔️ Tilt head away from the affected side

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20
Q

Where should the central ray be directed for a Supero-Inferior Axial Shoulder view?

A

✔️ Vertically angled (VCR) 5-10° towards elbow
✔️ Center on glenohumeral joint

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21
Q

What should be visible in a correctly positioned Supero-Inferior Axial Shoulder X-ray?

A

✔️ Humeral head & glenoid fossa relationship
✔️ Inferior & superior glenoid margins superimposed
✔️ Proximal humerus without distortion
✔️ Lesser tuberosity in profile
✔️ Coracoid process in profile, pointing superiorly
✔️ AC joint superimposing humeral head
✔️ Humeral head centered in collimated field

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22
Q

What precaution should be taken to protect the patient’s head?

A

✔️ Check collimation light to ensure head is not irradiated

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23
Q

How should the patient be positioned for an Axial (Infero-Superior) Shoulder X-ray?

A

✔️ Supine with shoulder slightly elevated
✔️ Arm abducted 90°
✔️ IR placed along superior shoulder, snug against the neck
✔️ Arm externally rotated as far as possible

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24
Q

Where should the central ray be directed for an Axial (Infero-Superior) Shoulder X-ray?

A

✔️ Horizontally to the axilla
✔️ 15° medial angulation

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25
What should be visible in a correctly positioned Axial (Infero-Superior) Shoulder X-ray?
✔️ Humeral head & glenoid fossa relationship ✔️ Inferior & superior glenoid margins superimposed ✔️ Proximal humerus without distortion ✔️ Lesser tuberosity in profile ✔️ Coracoid process in profile, pointing superiorly ✔️ AC joint superimposing humeral head ✔️ Humeral head centered in collimated field
26
Why is a Lateral Scapula X-ray performed?
✔️ To assess true lateral orientation of the shoulder girdle ✔️ Used in suspected dislocations or fractures ✔️ Demonstrates scapular blade, spine, & humeral head position
27
How should the patient be positioned for a Lateral Scapula X-ray?
✔️ Patient faces the bucky ✔️ Rotate unaffected side forward ✔️ Align medial scapular border & AC joint perpendicular to IR
28
Where should the central ray be directed for a Lateral Scapula X-ray?
✔️ Midpoint of IR at glenohumeral joint level CR directed to scapulohumeral joint.
29
What should be visible in a correctly positioned Lateral Scapula X-ray?
✔️ Scapula body, acromion, & coracoid processes form a “Y” ✔️ Scapula in true lateral position, free from thorax superimposition ✔️ Glenoid cavity appears end-on at the Y junction ✔️ Humeral head should overlie the Y junction
30
What happens if the patient is under-rotated during a Lateral Scapula X-ray?
✔️ Lateral border of the scapula is obscured by ribs ✔️ Glenoid cavity is demonstrated medially ✔️ The patient was not obliqued enough to superimpose the scapula margins
31
What happens if the patient is over-rotated during a Lateral Scapula X-ray?
* Lateral border obscured by ribs * Glenoid cavity is demonstrated medially * The patient was obliqued more than necessary to superimpose the scapula margins
32
What are the key adjustments when the patient cannot stand for a Lateral Scapula X-ray?
✔️ Borders of scapula should be superimposed ✔️ Free of superimposition by ribs ✔️ Arm elevated to demonstrate the scapular body
33
What is the patient position for an Impingement View to assess the subacromial space?
✔️ Patient is erect, facing the bucky ✔️ Unaffected side raised to approximately 60° ✔️ Affected shoulder should be touching the bucky
34
What is the centering for an Impingement View of the shoulder?
✔️ CR (Central Ray) – 15°-20° caudal angulation ✔️ CP (Central Point) – 2cm superior to the medial end of the scapular spine
35
What is Impingement Syndrome, and how can bone spurs contribute to it?
✔️ Impingement Syndrome occurs when the acromion rubs against the rotator cuff, causing pain and irritation. ✔️ A possible cause of impingement syndrome is bone spurs, which narrow the space around the rotator cuff and lead to irritation.
36
What are examples of typical shoulder series for pathology (1)?
AP Glenoid (with AP HOH), 10° caudal angulation AP (soft tissue) with 20° caudal angulation (to show subacromial space) Axial (supero-inferior or occasionally infero-superior) Impingement view with 15-20° caudal angulation
37
What are examples of typical shoulder series for pathology (2)?
AP Shoulder Girdle (with lateral HOH, lesser tuberosity in profile) AP Glenoid (AP HOH) with 15-20° caudal angulation (to show subacromial space) Axial (supero-inferior or infero-superior) Impingement view with 20° caudal angulation
38
What are examples of typical shoulder series for pathology (3)?
Grashey view of glenoid. Patient rotated 30-45° towards affected side. Humerus in an AP position (to profile greater tuberosity). AP Shoulder – scapula parallel to IR. Humerus in lateral position (elbow flexed with forearm across chest). Angle the tube 15-20° caudally. Centre 1cm below the acromion. Outlet view (impingement)
39
What are examples of typical shoulder series for trauma (1)?
AP Shoulder Girdle (arm is internally rotated, HOH is lateral, lesser tuberosity in profile) AP Glenoid (with AP HOH, greater tuberosity in profile. You may include the entire scapula – site dependent) Axial (supero-inferior or infero-superior) Lateral Scapula (if scapula is involved or axial is not possible)
40
What are examples of typical shoulder series for trauma (2)?
AP Shoulder Girdle (arm is internally rotated, HOH is lateral, lesser tuberosity in profile) Grashey view of glenoid – patient rotated 30-45° towards affected side with humerus in an AP position to profile greater tuberosity Lateral Scapula Axial View
41
What is the incidence of shoulder dislocations?
96% Anterior dislocation 2-3% Posterior dislocation 1% Inferior dislocation
42
What are the key features of an anterior shoulder dislocation?
Most common type of shoulder dislocation Occurs from contact sports in younger patients or falls in older patients Associated with Hill’s Sach’s Deformity (humeral head depression fracture on the postero-lateral aspect of the humerus) Frequently accompanied by a Bankart Lesion (injury to the labrum)
43
What is Hill’s Sach’s Deformity?
A humeral head depression fracture on the postero-lateral aspect of the humerus, often caused by impact with the anterior glenoid rim.
44
What is a Bankart Lesion?
An injury to the labrum, commonly associated with a fracture of the anterior inferior glenoid labrum.
45
What is the mechanism of injury for posterior shoulder dislocation?
Most commonly caused by indirect force Electric shock Seizures Direct blow to the anterior aspect of the shoulder (less common)
46
What are common mechanisms of injury for AC (Acromio-Clavicular) joints?
Direct trauma Blow to the shoulder Contact sports FOOSH (Fall On Outstretched Hand) Car accidents Repetitive overhead movements (occupational, weightlifting, baseball/cricket)
47
What happens in ligamentous damage to the acromio-clavicular joint?
Results in subluxation Complete dislocation typically indicates rupture of the coracoclavicular ligament
48
How can persistent laxity of the AC joint be demonstrated radiographically?
By examining the patient in an erect position, holding weights in both hands.
49
What is the patient positioning for AC joints?
Patient stands facing the tube in an AP position. Arm held by side in neutral position (no weight-bearing) or with a weight (e.g., water bottle). Both joints are imaged for comparison.
50
Where is the CR and CP for AC joint positioning?
CR: Horizontal. CP: To the AC Joint.
51
What is the common injury to the clavicle
A fracture to the mid-shaft, usually caused by a direct fall on the shoulder or a direct blow to the lateral aspect of the shoulder.
52
What is the patient positioning for clavicle imaging?
Patient stands erect, facing the tube. Centre to the midpoint of the shaft of the clavicle. Open collimation to include the entire length of the clavicle.
53
Where is the CR and CP for clavicle positioning?
CR: Horizontal (or vertical if supine), angle tube 15° cranially for axial view. CP: To the midpoint of the clavicle. SID: 110-115 cm (site-dependent).
54
What are the clinical indications for Sterno-clavicular joints imaging?
Joint separation/subluxation, Trauma, Infection, Deformity in the absence of trauma, Congenital abnormalities, Dislocation.
55
What are the two projections for Sterno-clavicular joints?
Anterior oblique, Serendipity view.
56
What is the positioning for the Anterior oblique projection of the SC joints?
Prone. Raise each side 10-15°. Centre to the raised side – just lateral to the spine at the level of T2 or T3.
57
What is the positioning for the Serendipity view of the SC joints?
Patient supine. IR under shoulders and upper chest. Collimate laterally to include the medial third of both clavicles. Collimate inferiorly to include the sternoclavicular joints and part of the manubrium.
58
What is the CR and CP for the Serendipity view of the SC joints?
CR: 40° cranially. CP: Midline at the level of the sternoclavicular joint. SID: 110-115 cm (site-dependent).
59
What are the technical factors for the Serendipity view of the SC joints?
60-70kVp, 10-20mAs. If using AEC: 70kVp, center chamber, Fine Focus. Suspended expiration.
60
Position of tubercles in external rotation
Greater tubercle is lateral and most prominent; lesser tubercle is anterior but less visible.
61
Position of tubercles in internal rotation
Lesser tubercle is medial and prominent anteriorly; greater tubercle moves posteriorly.
62
Position of tubercles in neutral rotation
Greater tubercle is lateral; lesser tubercle is slightly anterior but not prominent.

MEDIMAGE 301 (11 decks)

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