Shoulder

Question 1

What are the routine views of the shoulder?

Answer 1

• AP in IR
• AP in ER
• WB vs NWB of AC joint
• Scapula AP
• Scapula Lateral

Question 2

What can should be noted when comparing WB vs NWB views of the AC joint?

Answer 2

• AC gap
• Coracoclavicular gap

for ligament sprains

Question 3

What 4 things is the axillary view of the shoulder useful in evaluating?

Answer 3

• Coracoid
• Rim of glenoid
• Humeral head and shape
• Subluxation/ dislocation

Question 4

What is the scapular Y lateral view of the shoulder useful in evaluating?

Answer 4

• GH dislocations

- Subacromial space

Question 5

How is the patient oriented in relation to the image receptor for the scapula AP view?

Answer 5

• Image posterior to patient
• Shoulder abducted 90 degrees and externally rotated.
• Should position causes scap to be abducted, upwardly rotated, and clear of the rib cage laterally
• Otherwise in AP

Question 6

How is the patient oriented in relation to the image receptor for the scapula lateral view?

Answer 6

• Patient sidelying with the scapula being evaluated positioned upwards towards the x-ray beam
• Shoulder flexed to 90 degrees, horizontally adducted to free view of scap
• Elbow flexed for comfort
• Arm positioned across front of the Pt’s chest to free the body of the scap from superimposition of the humeral shaft.
• The arm may be positioned behind the Pt’s back to free the acromion and coracoid processes from superimposition of the humeral head

Question 7

How is the patient oriented in relation to the image receptor for the axillary view?

Answer 7

• Shoulder abducted 90 degrees
• Patient supine or prone
• Image receptor placed on superior aspect of shoulder
• X-ray beam passes inferiolateral to superiormedial through the joint

Question 8

What is the more technical name of the axillary view?

Answer 8

• inferiosuperor axial projection of GH joint

Question 9

How is the patient orient in relation to the image receptor for the scapular Y lateral view?

Answer 9

• patient is standing facing the image receptor with their affected shoulder in direct contact, but their body canted at an angle of 60 degrees.
• X-ray enters joint perpendicular to image receptor

Question 10

What is the more technical name of the scapular Y lateral view?

Answer 10

• anterior oblique view of the shoulder

Question 11

What two fractures/ bony deformities may occur due to GH dislocations?

Answer 11

• Bankart fracture of glenoid

- Hill-sachs deformity of humeral head

Question 12

What is a bankart fracture?

Answer 12

• Pocket at front of glenoid forms that the humeral head dislocates into anteriorly

Question 13

What is a hill-sachs lesion?

Answer 13

Compressed posterolateral head of humerus due to forceful impaction of the humerus into the anterioinferior glenoid.

Question 14

What is a primary impingement? What are some examples of them in the shoulder joint?

Answer 14

• Skeletal or structural problem

- Spurs (hooked acromion)

Question 15

What is secondary impingement, and what is an example in the shoulder?

Answer 15

• Changes in muscle lead to compression of tissue against bony structures
• Deltoid/ rotator cuff imbalance leads to humeral head being pulled superiorly

Question 16

How can impingements be viewed in radiographic studies?

Answer 16

• Dislocation of bones into impingement
• Calcific deposits indicating injury
• Bone spurs
• White masses in tendons in T-2 MRI indicating tears

Question 17

What are some radiologic signs of adhesive capsulitis?

Answer 17

• A lack of redundant capsule hanging inferiorly to the shoulder when contrast in injected into the GH joint.
• MRI can demonstrate a thickened capsule