Shoulder

Question 1

AP Projection: Place IR __1___ to the coracoid process. Slightly rotate pt toward __2__ to overcome natural curve of back and shoulder. May need to support pt when performing the procedure __3__.

Answer 1

1. 1” inferior
2. The affected side
3. Recumbent

Question 2

External rotation: __1__ the hand and __2__ the arm slightly; this places the epicondyles __3__ to the IR; places the shoulder and humerus in true anatomic position.

Answer 2

1. Supinate
2. Abduct
3. Parallel

Question 3

AP Neutral: rest __1__ of the hand against __2__: epicondyles will __3__ @ an approximate angle of 45 degrees.

Answer 3

1. Palm
2. Thigh
3. Lie

Question 4

AP Projection: Internal rotation….flex elbows slightly, rotate __1__ and rest the back of the hand on the hip; epicondyles will be __2__ to the IR.

Answer 4

1. Arm internally

2. Perpendicular

Question 5

AP Projection: Structures Shown…

1. External Rotation: __A__: seen at the site of insertion of the __B__
2. Neutral: __A__ portion of the __B__ insertion
3. Internal rotation: __A__ humerus in a true __B__ position; when adequately abducted the __C__ tendon insertion is seen.

Answer 5

1) A: Greater Tubercle 
    B: supraspinatous tendon
2. A) posterior 
    B) supraspinatous
3. A) proximal
    B) lateral
    C) subscapular

Question 6

When the AP shoulder is in external rotation the __1__ will be seen in profile on the __2__ surface.

Answer 6

1. Greater tubercle

2. Lateral

Question 7

When in the AP Neutral Position the greater tubercle __1__ superimposed on the head: __2__ impartial profile; alight overlap of the humeral head over the __3__.

Answer 7

1. Partially superimposed
2. Humeral head
3. Glenoid Cavity

Question 8

Evaluation Criteria of the AP Projection in neutral position the __1__ partially superimposed on the head; __2__ impartial profile; slight overlap of the humeral head over the glenoid cavity.

Answer 8

1. Greater tubercle

2. Humeral head

Question 9

Evaluation criteria for the AP projection, internal rotation: __1__ in profile and pointing __2__; outline of the greater tubercle __3__ the __4__. Greater amount of humeral overlap of the __5__ cavity.

Answer 9

1. Lesser tubercle
2. Medially
3. Superimposing
4. Humeral head
5. Glenoid

Question 10

Transthorasic Lateral Position AKA ______

Answer 10

Lawrence Method

Question 11

Trans Thoracic Lateral Position (__1__ Method): Regardless if pt is upright or recumbent, __2__ side against the board. Have pt raise __3__ arm, elevate it as much as possible. MCP is __4__ to IR.

Answer 11

1. Lawrence
2. Affected
3. Unaffected
4. Perpendicular

Question 12

Breathing instructions for transthoracic projection:

1. __A__ to improve __B__ and decrease exposure necessary for penetration
2. __A__ with a minimum exposure time of __B__; this gives excellent results when a low __C__ is used

Answer 12

1) A. Full inspiration 
    B. Contrast 
2) A. Slow, deep breathing
    B. 3-4 seconds
    C. Ma

Question 13

Transthoracic Projection: If pt is unable to elevate the unaffected shoulder, angle the CR __1__ degrees __2__

Answer 13

1. 10-15

2. Cephalic

Question 14

The transthoracic projection is used when a trauma exists and the pt can neither abduct nor __1__ the arm due to an injury. This will demonstrate the proximal __2__ in a __3__ degree projection from the AP or frontal projection and show its relationship to the __4__ and __5__.

Answer 14

1. Rotate
2. Humerus
3. 90
4. Scapula
5. Clavicle

Question 15

Infernosuperior Axial Projection AKA ______

Answer 15

Lawrence Method

Question 16

Infernosuperior: pt in a __1__ position, place IR __2__ in a vertical position in a contact with the __3__ portion o the shoulder. When supine, elevate the head, shoulders and __4__ approx __5__”
As much as possible abduct the affected arm at a __6__ to keep the body keeping the humerus in external rotation adjusting forearm and hand comfortably.

Answer 16

1. Supine
2. CW
3. Superior
4. Elbow
5. 3
6. Right angle

Question 17

Inferosuperior Axial Projection the CR should be directed __1__ through the axilla to the __2__ joint region. The degree of medial rotation is dependent on the degree of arm __3__; the CR medial angulation is often between __4__ degrees.

Answer 17

1. Horizontally
2. AC
3. Abduction
4. 15-30

Question 18

The evaluation criteria for the infernosuperior:

• scapula humeral joint with slight overlap
• __1__ pointing anteriorly
• __2__ in profile pointing anteriorly
• __3_, acromion, and the __4__ end of the clavicle projected through the humeral head
• soft tissue of the __5__ and adequate bony __6__

Answer 18

1. Coracoid process
2. Lesser tubercle
3. AC joint
4. Acromial

Question 19

Superiorinferior Axial Projection: __1__ IR LW. CR angled __2__ degrees through the shoulder joint and toward the __3__ side elbow. The less the pt is able to extend over the IR, the __4__ the CR angle is needed.

Answer 19

1. 8X10
2. 5-15
3. Affected
4. Greater

Question 20

Evaluation criteria for the superioinferior axial projection:

• open __1__ joint
• coracoid process protected above the __2__
• __3__ in profile
• AC joint through the __4__

Answer 20

1. Scapulohumeral
2. Clavicle
3. Lesser tubercle
4. Humeral head

Question 21

Scapular Y: may be preformed on a standing or recumbent pt, but standing is preferred. Place __1__ surface against the upright grid and rotate so that the MCP forms and angle of of __2__ degrees with the IR.
CR will be directed perpendicular to IR and __3__ joint.

Answer 21

1. Anterior
2. 45-60
3. Scapulohumeral

Question 22

Scapular Y:

• Normal Shoulder: humeral head __1__ directly __2__ the junction of the Y
• Anterior dislocation: humeral head beneath the __3__
• Posterior dislocation: humeral head beneath the __4__

Answer 22

1. Superimposed
2. Over
3. Coracoid process
4. Acromion process

Question 23

Scapular Y:
-PA projection places the __1__ side down or closer to the IR
-AP projection will place the affected side __2__ or __3__ from IR (higher __4__); with the pt supine or facing the tube, rotate the affected side __5__ IR 45-60 degrees. The CR remains perpendicular to IR passing through __6__.
AP Axial Projection may also be helpful in diagnosing __7__ dislocations.

Answer 23

1. Affected
2. Up
3. Away
4. OID
5. Affected
6. Scapulohumeral
7. Posterior

Question 24

Glenoid Cavity
AP Oblique Projection (__1__ Method). __2__ or __3__ position.
Pt maybe supine or __4__. Center IR to the scapulohumeral joint (approx __5__” medial and inferior to the __6__ border). Rotate body __7__ degrees __8__ affected side. The scapula will be __9__ to the IR.

Answer 24

1. Grashey
2. RPO
3. LPO
4. Upright
5. 2
6. Superolateral
7. 35-45
8. Towards
9. Parallel

Question 25

If the pt is supine during the Grashey Method you may need to rotate the body __1__ degrees in order to place scapula and IR __2__. You may also need to support the pt’s __3__ side with __4__ and/or __5__

Answer 25

1. 45
2. Parallel
3. Elevated
4. Sponge
5. Sandbags

Question 26

Interubercular groove
Tangential Projection AKA __1__ Modification:
In all modifications of this position, the CR should be __2__ to the Interubercular groove (lies on the __3__ surface of the humerus). Dependent upon the capabilities of your tube, the performance of this exam may be limited. The pt may be either __4__, seated, or __5__: extend the chin or rotate away from the __6__ side.

Answer 26

1. Fisk
2. Tangential
3. Anterior
4. Supine
5. Standing
6. Affected

Question 27

Fisk Modification:
With the pt supine palate the anterior surface to locate __1__ .
Have hand in __2__ position, place IR against the superior shoulder surface and immobilize with sandbags/sponges.
CR angled __3__ degrees posterior to the long axis of the humerus for the supine position. Perpendicular to IR when pt is leaning forward and the __4__ humerus is positioned __5__ degrees.

Answer 27

1. Groove
2. Supinated
3. 10-15
4. Vertical
5. 10-15