Chapter 5 Flashcards
1
Q
The shoulder girdle consists of ?, ?, and ?.
A
Proximal humerus, Scapula, and clavicle
2
Q
The three aspects of the clavicle are the ?, ?, and ?.
A
Sternal extremity, body shaft, and acromial extremity.
3
Q
The ? (male, or female) clavicle tends to be thicker and more curved in shape.
A
Male
4
Q
The three angles of the scapula include the ?, ?, and ?.
A
Lateral angle, superior angle, inferior angle
5
Q
The anterior surface of the scapula is referred to as the ? surface.
A
Costal
6
Q
What is the anatomic name for the armpit?
A
Axilla
7
Q
What are the names of the two fossae located on the posterior scapula?
A
Infraspinous fossa, supraspinous fossa,
8
Q
All of the joints of the shoulder girdle are classified as being ?
A
synovial (diarthrodial)
9
Q
List the movement types of the following joints.
A
Scapulohumeral: Spheroidal
Sternoclavicular: Plane
Scromioclavicular: Plane
10
Q
Greater turbercle
A
Proximal humerus
11
Q
Coracoid process
A
Scapula
12
Q
Crest of Spine
A
Scapula
13
Q
Coronoid process
A
Not part of the shoulder girdle
14
Q
Acromial extremity
A
Clavicle
15
Q
Intertubercular groove
A
Proximal humerus
16
Q
Condylar process
A
Not part of the shoulder girdle
17
Q
Surgical neck
A
Proximal humerus
18
Q
Greater tubercle profiled laterally
A
External rotation
19
Q
Humeral epicondyles angled 45 degree to image receptor
A
Neutral rotation
20
Q
Epicondyles perpendicular to IR
A
Internal rotation
21
Q
Supination of hand
A
External rotation
22
Q
Palm of hand against thigh
A
Neutral rotation
23
Q
Epicondyles parallel to IR
A
External rotation
24
Q
Lesser tubercle profiled medially
A
Internal rotation
25
Proximal humerus in a lateral position
Internal rotation
26
Proximal humerus in postion for an (AP) projection
External rotation
27
The use of a grid is not required for shoulder studies that measure less than 10cm.
true
28
The kV range for adult shoulder projections is between 80 and 90 kV for analog and 100 to 110 kV for digital imaging systems.
False
29
Low mA with short exposure times should be used for adult shoulder studies.
False
30
Large focal spot setting should be selected for most adult shoulder studies.
False
31
A high speed screen IR system is recommended for analog shoulder studies when using a grid.
True
32
A 72 inch source image distance (SID) is recommended for most shoulder girdle studies.
false
33
The use of contact shields over the breast, lung, and thyroid regions is recommended for most shoulder projections.
True
34
Which one of the following kV ranges (analog) should be used for a shoulder series on an average adult?
70 to 80 kV
35
If physical immobilization is required, which individual should be asked to restrain a child for a shoulder series?
parent or guardian
36
CT arthrography of the shoulder joint often requires the use of iodinated contrast media injected into the joint space.
True
37
MRI is an excellent modality for demonstrating bony injuries of the shoulder girdle.
False
38
Nuclear medicine bone scans can demonstrate signs of osteomyelitis and cellulitis.
True
39
Radiography is more sensitive than nuclear medicine for demonstrating physiologic aspects of the shoulder girdle.
False
40
Sonography (ultrasound) can provide a functional (dynamic) evaluation of joint movement that MRI cannot.
True
41
Compression between the greater tuberosity and soft tissues of the coracoacromial ligamentous and osseous arch
Impingement syndrome
42
Injury of the anteroinferior glenoid labrum
Bankart lesion
43
Inflammatory condition of the tendon
Tendonitis
44
Superior displacement of the distal clavicle
Acromioclavicular joint dislocation
45
Compression fracture of the articular surface of the humeral head
Hill-Sachs defect
46
Traumatic injury to one or more of the supportive muscles of the shoulder girdle
Rotator cuff tear
47
Atrophy of skeletal tissue
Osteoporosis
48
Subacromial spurs
Impingement syndrome
49
Fluid-filled joint space
Bursitis
50
Thin bony cortex
Osteoporosis
51
Abnormal widening of acromioclavicular joint space
acromioclavicular joint separation
52
Calcified tendons
tendonitis
53
Avulsion fracture of the glenoid rim
Bankart lesion
54
Narrowing of joint space
Osteoarthritis
55
Closed joint space
Rheumatoid arthritis
56
Compression fracture of humeral head
Hill-Sachs defect
57
Which one of the following clinical indications requires a decrease in manual exposure factors?
osteoporosis
58
Which two routine shoulder projections are routinely taken for a shoulder (with no traumatic injury) and proximal humerus?
AP, exteranl rotation, and AP, Internal Rotation
59
Specifically, where is the central ray placed for an AP projection of the shoulder?
CR perpendicular to IR, directed to line inferior to coracoid process
60
Which lateral projection can be performed to demonstrate the entire humerus for a patient with a midhumeral fracture?
transthoracic lateral projection for humerus
61
To best demonstrate a possible Hlil-Sachs defect, which additional positioning technique can be added to the inferosuperior axial projection?
Rotate affected arm externally approximately 45 degrees
62
What type of central ray angulation is required for the inferosuperior axial projection for the shoulder?
25 to 30 degrees medially
63
The ? projection of the shoulder produces an image of the glenoid process in profile.
This projection is also referred to as the ? method.
posterior oblique
| grashey method
64
Which one of the following projections produce a tangential projetion of the intertubercular groove?
Fisk modification
65
The supine version of the tangential projection for the intertubercular groove requires that the central ray be angled ? posteriorly from the horizontal plane.
10 to 15 degrees
66
Which one of the following projections is best for demonstrating a possible dislocation of the proximal humerus?
Scapular Y projection
67
The ? projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs, which create shoulder impingment symptoms.
This projection is also referred to as the ? method.
tangential
| supraspinous outlet and neer
68
Which of the following nontrauma projections can be performed erect to provide a lateral view of the proximal humerus in relationship to the glenohumeral joint?
PA transaxillary projection (Hobbs modification)
69
How much is the CR angled for the inferosuperior axial projection (clements modification) if the patient cannot fully abduct the arm 90 degrees?
5 to 15 degrees
70
What CR angle is required for the AP axial projection (Alexander method) for AC joints?
15 degrees cephalad
71
The PA transaxillary projection (Hobbs modification) requires no CR angle.
True
72
The transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus.
True
73
The use of a breathing technique can be performed for the transthoracic lateral humerus projection.
True
74
The affected arm must be placed into external rotation for the transthoracic lateral projection.
False
75
A central ray angle of 10 to 15 degrees caudad may be used for the transthoracic lateral projections if the patient is unable to elevate the uninjured arm and shoulder sufficiently.
False
76
The scapular Y lateral (anterior oblique) position requires the body to be rotated 30 to 40 degrees anteriorly toward the affected side.
False
77
Which two landmarks are placed perpendicular to the IR for the scapular Y lateral projection?
Superior angle of the scapula and the AC joint articulation
78
Which special projection of the shoulder requires that the affected side be rotated 45 degrees toward the cassette and uses a 45 degree caudad central ray angle?
AP apical oblique axial projection
79
A posterior dislocation of the humerus projects the humeral head ? (superior or inferior) to the glenoid cavity with the special projection described in the previous question. (AP apical oblique axial projection)
superior
80
A thin shouldered patient requires ? (more or less) CR angle for an AP axial clavical projection than a large shouldered patient.
More
81
What must be ruled out before performing the weight bearing study for acromioclavicular joints?
fracture of clavicle
82
Inferiorsuperior Axial
Lawrence method
83
Posterior oblique for glenoid cavity
Grashey method
84
Tangential for intertubercular (bicipital) groove
fisk modification
85
Supraspinatus outlet tangential
Neer method
86
Transthoracic lateral
Lawrence method
87
AP apical oblique axial
Garth method
88
Where is the CR centered for the AP scapula projection?
CR perpendicular to midcapular, 2 inches inferior to the coracoid process, or to the level of axilla and approximately 2 inches medial from lateral border of patient.
89
What type of CR angle is required for the lateral scapula position?
none
90
The following factors were used to produce a radiograph of an AP projection of the shoulder: 85 kV, 20 mAs, high speed screens, 40 inch SID, grid, and suspended respiration. The resultant radiograph demonstrated poor radiographic contrast between bony and soft tissue structures. Which of these factors can be altered during the repeat exposure to improve radiiographic quality?
lower to 75 kV and double Milliamperage seconds (to 40 mAs), which increases radiographic contrast.
91
A radiograph of an AP axial clavicle projection reveals that the clavicle is projected below the superior border of the scapula. What can the technologists do to correct this problem during the repeat exposure?
Increase central ray cephalad angle
92
A radiograph of an AP scapula reveals that the scapula is within the lung field and difficult to see. Which two things can the technologist do to improve the visibility of the scapula during the repeat exposure?
Ensure that the affected arm is abducted 90 degrees and use a breathing technique
93
A radiograph of an AP projection (with external rotation) of a shoulder (with no traumatic injury) reveals that neither the greater nor lesser tubercles are profiled. What must be done to correct this during the repeat exposure?
Supinate the hand and ensure that the epicondyles are parallel to the IR for a true AP.
94
A radiograph of a lateral scapula position reveals that is not a true lateral projection. (considerable separation exists between the axillary and vertebral borders.) The projection was taken using the following factors: erect position, 40 inch SID, 45 degrees rotation toward cassette from PA, central ray centered to midscapula, and no central ray angulation. Based on these factors, how can this position be improved during the repeat exposure?
Palpate the superior angle of the scapula and AC joint articulations and ensures that the imaginary plane between this point is perpendicular to the IR
95
A radiograph of the AP oblique (Grashey method) taken as a 35 degree oblique projection reveals that the borders of the glenoid cavity are not superimposed. The patient has large, rounded shoulders. What must be done to get better superimposition of the cavity during the repeat exposure?
Increase rotation of affected shoulder toward the IR to closer to 45 degree.
96
A patient with a possible right shoulder dislocation enters the emergency room. The technologist attempts to perform an erect transthoracuc lateral projection, but the patient is unable to raise the left arm and shoulder high enough. The resultant radiograph reveals that the shoulders are superimposed, and the right shoulder and humeral head are not well visualized. What can be done to improve this image during the repeat exposure?
Angle the central ray 10 to 15 degree cephalad to separate the shoulder
97
A patient with a possible fracture of the right proximal humerus from an automobile accident enters the emergency room. The patient has other injuries and is unable to stand or sit erect. What positioning routine should be used to determine the extent of the injury?
The routine includes an AP of right shoulder and humerus without rotation (neutral rotation) and a supine, horizontal beam, right transthoracic shoulder. Note--In those cases in which the opposite arm cannot be elevated or extended, a supine posterior oblique scapula Y lateral projection could also be used as a second option for a lateral shoulder position.
98
A patient with a clinical history of chronic shoulder dislocation comes to the radiology department. The orthopedic physician suspects that a Hill-Sachs defect may be present. Which specific position may be used to best demonstrate this pathologic feature?
Inferosuperior aial projection with exagemerated extermal rotation, inferiosuperior axial projection (clements modification) an AP apical oblique axial projection (garth method)
99
A patient with a possible Bankart lesion comes to the radiology department. List three projections that can be performed that may demonstrate signs of this injury.
```
AP internal rotation
scapular Y lateral
Posterior oblique (Grashey Method)
```
100
A patient with a possible rotator cuff tear comes to the radiology department. Which one of the following imaging modalities would best demonstrate this injury?
MRI
101
A patient with a clinical history of tendon injury in the shoulder region comes to the radiology department. The orthopedic physician needs a functional study of the shoulder joint performed to determine the extent of the tendon injury. Which of the following modalities would best demonstrate this injury?
Ultrasound
102
A radigraph of an AP projection with external rotation of the shoulder does not demonstrate either the greater or lesser tubercle in profile. What is the most likely cause for this radiographic outcome?
The humeral epicondyles were not placed parallel to the plane of the IR
103
A radiograph of a transthoracic lateral projection demonstrates considerable superimposition of lung marking and ribs over the region of the proximal shoulder. What can the technologist do to minimize this problem during the repeat exposure?
Use breathing exposure technique to create blurring of ribs and lung markings.
104
A patient enters the ER with a definite fracture to the midhumerus. Because of other trauma the patient is unable to stand. Which lateral projection would demonstrate the entire humerus?
Transthoracic lateral projection for humerus
105
The AP apical oblique axial projection (Garth method) is performed on a patient with a shoulder injury. The resultant radiography demonstrates the proximal humeral head projected below the glenoid cavity What type of trauma or pathology i indicated with this radiographic appearance.
Anterior dislocation of the proximal humerus
106
Select the term(s) that correctly describe(s) the shoulder joint
Scapulohumeral
107
Which specific joint is found on the lateral end of the clavicle
Acromioclavicular
108
Which of the following is not an angle found on the scapula?
medial angle
109
Which one of the following structures of the scapula extends most anteriorly?
Coracocid process
110
The male clavicle is shorter and less curved than the female clavicle.
False
111
Which bony structure separates the supraspinous and infraspinous fossae?
Scapular spine
112
Which one of the following structures is considered to be the most posterior?
Acromion
113
What is the type of joint movement for the scapulohumeral joint?
Spheroidal
114
Even though the amount of radiation exposure is minimal for most shoulder projections, gonadal shielding should be used for children and adults of childbearing age.
True
115
The greatest technical concern during a pediatric shoulder study is voluntary motion.
True
116
Which one of the following imaging modalities or procedures provide a functional, or dynamic, study of the shoulder joint?
Ultrasound
117
Which one of the following pathologic conditions often produces narrowing of the joint spine?
Osteoarthritis
118
Which one of the following pathologic conditions may require a reduction in manual exposure factors?
Rheumatoid arthritis
119
Which routine projection of the shoulder requires that the humeral epicondyles be paralel to the IR.
External rotation
120
Where is the CR centered for an AP projection-external rotation of the shoulder?
1 inch superior to coracoid process
121
Which position of the shoulder and proximal humerus projects the lesser tubercle in profile medially?
internal rotation
122
To best demonstrate the Hill-Sachs defect on the inferosuperior axial projection, which additional positioning maneuver must be used?
Use exaggerated external rotation
123
How are the humeral epicondyles aligned for a rotational lateromedial projection of the humerus?
Perpendicular to IRr
124
Which special projection of the shoulder places the glenoid cavity in profile for an "open" scapulohumeral joint?
Grashey method
125
For the erect version of the tangential projection for the intertubercular groove, the patient leans forward ? from vertical.
10 to 15 degrees
126
What is the major advantage of the supine, tangential version of the intertubercular groove projection over the erect version?
Reduced OID
127
Which one of the following projections best demonstrates the supraspinatus outlet region?
Tangential projection (neer method)
128
With which one of the following projections can a breathing technique be employed?
transthoracic lateral for humerus
129
What central ray angulation is required for the tangential projection-supraspinatus outlet (Neer method)?
10 to 15 degrees caudad
130
Which clinical indication is best demonstrated with the Garth method?
Scapulohumeral dislocations
131
Which anatomy of the shoulder is best demonstrated with a PA transaxillary projection (Hobbs modification)?
Scapulohumeral joint
132
If the patient cannot fully abduct the affected arm 90 degrees for the inferosuperior axial projection (Clements modification), the technologist can angle the CR ? toward the axilla.
5 to 15 degrees
133
Which one of the following projections requires the CR to be centered 2 inches inferior and medial from the superolateral border of the shoulder?
Posterior oblique (Grashey method)
134
Which anatomy is best demonstrated with the Alexander method?
AC joints
135
Which type of injury must be ruled before the weight bearing phase of an AC joint study?
Fractured clavicile
136
What is the minimum amount of weight a large adult should have strapped to each wrist for the weight bearing phase of an AC joint study?
8 to 10 pounds
137
A posteroanterior (PA) axial projection of the clavicle requires a 35 to 45 degree caudal central ray angle.
False
138
A 72" SID is recommended for acromioclavicular joint studies.
TRue
139
Which two positioning landmarks are aligned perpendicularly to the IR for the lateral scapula projection?
Superior angle and AC joint
140
A radiograph of a posterior oblique (Grashey method) reveals that the anterior and posterior glenoid rims are not superimposed. The following positioning factors were used: erect position, body rotated 25 to 30 degrees toward the affected side, central ray perpendicular to scapulohumeral joint space, and affected arm slightly abducted in neutral rotation. Which one of the following modifications will superimpose the glenoid rims during the repeat exposure?
Rotate body less toward affected side
141
A radiograph of an AP axial clavicle taken on an asthenic type patient reveals that the clavicle is projected in the lung field below the top of the shoulder. The following positioning factors were used; erect position, central ray angled 15 degrees cephalad, 40 inch SID, and respiration suspended at end of expiration. Which one of the following modifications should be made during the repeat exposure?
Increase central ray angulation
142
A patient with a possible right shoulder separation enters the emergency room. Which one of the following routines should be used?
Acromioclavicular joint series: Non-weight bearing and weight bearing projections
143
A patient enters the ER with a proximal and midhumeral fracture. The patient is in extreme pain.. Which one of the following positioning routines would demonstrate the entire humerus without excessive movement of the limb?
AP and transthoracic lateral of humerus
144
Which two routine shoulder projections are routinely taken for a shoulder (with no traumatic injury) and proximal humerus?
AP internal rotation, AP external rotation
145
Specifically, where is the central ray placed for an AP projection of the shoulder?
1 inch inferior to coracoid process
146
Which lateral projection can be performed to demonstrate the entire humerus for a patient with a midhumeral fracture?
transthoracic lateral projection of humerus
147
The ? projection of the shoulder produces an image of the glenoid process in profile
posterior oblique (Grashey method)
148
The posterior oblique projection of the shoulder is also referred to as the ? method
Grashey
149
Which projection is best for demonstrating a possible dislocation of the proximal humerus?
Scapular Y
150
What CR angle is required for the AP axial projection (Alexander method) for AC joints?
15 degrees cephalad
151
The transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus.
true
152
The use of a breathing technique can be performed for the transthoraic lateral humerus projection.
true
153
The affected arm must be placed into external rotation for the transthoracic lateral projection.
false
154
A central ray angle of 10-15 degrees caudad may be used for the transthoracic lateral projections if the patient is unable to elevate the uninjured arm and shoulder sufficiently.
false
155
The scapular Y lateral (anterior oblique) position requires the body to be rotated 30-40 degrees anteriorly toward the affected side
false
156
Which two landmarks are placed perpendicular to the IR for the scapular Y lateral projection?
superior angle of the scapula, AC joint articulation
157
A thin shouldered patient requires ? (more/less) CR angle for an AP axial clavicle projection than a large-shouldered patient.
more
158
What must be ruled out before performing the weight bearing study for acrmioclavicular joints?
fracture of clavicle
159
What is the method name for the transthoracic lateral projection?
Lawrence method
160
Where is the CR centered for the AP scapula projection?
level of the axilla
161
What type of CR angle is required for the lateral scapula position?
none
162
The following factors were used to produce a radiograph of an AP projection of the shoulder: 85 kV, 20 mAs, high speed screens, 40" SID, grid, and suspended respiration. The resultant radiograph demonstrated poor radiographic contrast between bony and soft tissue structures. Which of these factors can be altered during the repeat exposure to improve radiograhic quality?
lower kV and double mAs to increase contrast
163
A radiograph of an AP axial clavicle projection reveals that the clavicle is projected below the superior border the of the scapula. What can the technologists do to correct this problem during the repeat exposure.
increase CR cephalad angle
164
A radiograph of an AP scapula reveals that the scapula is within the lung field and difficult to see. Which two things can the technologists do to improve the visibility of the scapula during the repeat exposure?
ensure arm is abducted 90 degrees and use a breathing technique
165
A radiograph of an AP projection (with external rotation) of a shoulder (with no traumatic injury) reveals that neither the greater nor lesser tubercles are profiled. What must be done to correct this during the repeat exposure?
epicondyles are parallel to the IR
166
A radiograph of the AP oblique (Grashey method) taken at 35 degree oblique projection reveals that the borders of the glenoid cavity are not superimposed. The patient has large, round shouders. What must be done to get better superimposition of the cavity during the repeat exposure?
increase rotation of affected shoulder to closer to 45 degrees
167
A patient with a possible right shoulder dislocation enters the ER. The technologist attempts to perform an erect transthoracic lateral projection, but the patient is unable to raise the left arm and shoulder high enough. The resultant radiograph reveals that the shoulders are superimposed, and the right shoulder and humeral head are not well visualized. What can be done to improve this image during the repeat exposure?
Angle CR 10-15 degrees cephalad
168
A patient with a possible fracture of the right proximal humerus from an automobile accident enters the ER. The patient has other injuries and is unable to stand or sit erect. Which positioning routine should be used to determine the extent of the injury?
AP with neutral rotation and supine horizontal beam transthoracic shoulder
169
A patient with a possible Bankart lesion comes to the radiology department. List three projections that can be performed that may demonstrate signs of this injury.
AP internal rotation, scapular Y lateral, posterior oblique (Grashey method)
170
A patient with a possible rotator cuff tear comes to the radiology department. Which one of the following imaging modalities would best demonstrate this injury?
MRI
171
A patient with a clinical history of tendon injury in the shoulder region comes to the radiology department. The orthopedic physician needs a functional study of the shoulder joint performed to determine the extend of the tendon injury. Which modality would best demonstrate this injury.
ultrasound
172
A radiograph of an AP projection with external rotation of the shoulder does not demonstrate either the greater or lesser tubercle in profile. What is the most likely cause for this radiographic outcome?
humeral epicondyles were not paralllel to IR
173
A radiograph of a transthoracic lateral projection demonstrates considerable superimposition of lung markings and ribs over the region of the proximal shoulder. What can the technologist do to minimize this problem during the repeat exposure?
use a breathing technique
174
A patient enters the ER with a definite fracture to the midhumerus. Because of other trauma the patient is unable to stand. Which lateral projection would demonstrate the entire humerus?
transthoracic lateral for humerus
175
Which routine projection of the shoulder requires that the humeral epicondyles be parallel to the IR?
external rotation
176
Where is the CR centered for an AP projection external rotation of the shoulder?
1 inch inferior to coracoid process
177
Which position of the shoulder and proximal humerus projects the lesser tubercle in profile medially?
internal rotation
178
How are the humeral epicondyles aligned for a rotational lateromedial projection of the humerus?
perpendicular to IR
179
Which special projection of the shoulder places the glenoid cavity in profile for an "open" scapulohumeral joint.
Grashey method
180
With which one of the following projections cannch a breathing technique be employed?
transthoracic lateral for humerus
181
which one of the following projections requires the CR to be centered 2 inches inferior and medial from the superolateral border of the shoulder
posterior oblique (grashey method)
182
Which anatomy is best demonstrated with the Alexander method?
AC joints
183
Which type of injury must be ruled out before the weight bearing phase of the AC joint study?
fractured clavicle
184
What is the minimum amount of weight a large adult should have strapped to each wrist for the weight bearing phase of an AC joint study?
8 to 10 pounds
185
A PA axial projection of the clavicle requires a 35-45 degree caudal CR angle
false
186
A 72 inch SID is recommended for acrmioclavicular joint studies
true
187
Which two positioning landmarks are aligned perpendicular to the IR for the lateral scapula projection?
Superior angle and AC joint
188
A radiograph of a posterior oblique (grashey method) reveeals that the anterior and posterior glenoid rims are not superimposed. the following factors were used: boy rotated 25-30 degrees toward affected side, CR perpendicular to scapulohumeral joint space, affected arm slightly abducted in neutral rotation. Which modification will superimpose the glenoid rims during repeat exposure?
rotate body less toward affected side
189
A radiograph of an AP axial clavicle taken on an asthenic type patient reveals that the clavicle is projected in the lung field below the top of the shoulder. The following factors were used: erect position, CR angled 15 degree cephalad, 40 inch SID, respiration suspended. What modification should be made during the repeat exposure?
Increase CR angulation
190
A patient with a possible right shoulder separation enters the ER. Which one of the following routines should be used?
acromioclavicular joint series: non weight bearing and weight bearing
191
A patient enters the ER with a proximal and midhumeral fracture. The patient is in extreme pain. Which one of the following positioning routines would demonstrate the entire humerus without excessive movement of the limb?
AP and tansthoracic lateral of humerus
192
humerus
is the longest and largest bone of the upper limb. its length on an adult equals approximately one-fifth of body height. the humerus articulates with the scapula (shoulder blade) at the shoulder joint.
193
proximal humerus
the most proximal part of the humerus is the rounded head. the slightly constricted area directly below and lateral to the head is the anatomic neck, which appears as a line of demarcation between the rounded head and the adjoining greater and lesser tubercles.
the process directly below the anatomic neck on the anterior surface is the lesser tubercle. the larger lateral process is the greater tubercle, to which the pectoralis major and supraspinatus muscles attach. The deep groove between these two tubercles is the intertubercular groove. The tapered area below the head and tubercles is the surgical neck, and distal to the surgical neck is the long body (shaft) of the humerus.
The surgical neck is so named because it is the site of frequent fractures requiring surgery. Fractures of the thick anatomic neck are rarer.
The deltoid tuberosity is the roughened raised triangular elevation along the anterolateral surface of the body (shaft) to which the deltoid muscle is attached.
194
Anatomy of proximal humerus on Radiograph
The lesser tubercle is located anteriorly and the greater tubercle is located laterally in a true AP.
195
Shoulder Girdle
The shoulder girdle consists of two bones: the clavicle and scapula. The function of the clavicle and scapula is to connect each upper limb to the trunk or axial skeleton. Anteriorly, the shoulder girdle connects to the trunk at the upper sternum; however, poteriorly, the connection to the trunk is incomplete because the scapula is connected to the trunk by muscles only.
Each shoulder girdle and each upper limb connect at the shoulder joint between the scapula and the humerus. Each clavicle is located over the upper anterior rib cage Each scapula is situated over the upper posterior rib cage.
The upper margin of the scapula is at the level of the second posterior rib, and the lower margin is at the level of the seventh posterior rib (T7). The lower margin of the scapula corresponds to T7.
196
Clavicle
```
The clavicle (collarbone) is a long bone with a double curvature that has three main parts: two ends and a long central portion. The lateral or acromial extremity (end) of the clavicle articulates with the acromion of the scapula. This joint or articulation is called the acromioclavicular joint and generally can be readily palpated.
The medial or sternal extremity (end) articulates with the manubrium, which is the upper part of the sternum. This articulation is called the sternoclavicular joint. The combination of the sternoclavicular joints on either side of the manubrium helps to form an important positioning landmark called the jugular notch.
The body (shaft) of the clavicle is the elongated portion between the two extremities. The acromial end of the clavicle is flattened and has a downward curvature at its attachment with the acromion. The sternal end is more triangular in shape and is directed downward to articulate with the sternum.
In general, the size and shape of the clavicle differ between males and females. The female clavicle is usually shorter and less curved than the male clavicle. The male clavicle tends to be thicker and more curved, usually being most curved in heavily muscled men.
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Scapula
Shoulder blade, which forms the posterior part of the shoulder girdle, is a flat triangular bone with three borders, three angles, and two surfaces. The three borders are the medial (vertebral) border, which is the long edge or border near the vertebrae; the superior border, or the uppermost margin of the scapula; and the lateral (axllary) border, or the border nearest the axilla. The axilla is the medial term for the armpit.
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Anterior view (Scapula)
The corners of the triaapula to form the angular scapula are called angles. The lateral angle, sometimes called the head of the scapula, is the thickest part and ends laterally in a shallow depression called the glenoid cavity (fossa)
The humeral head articulates with the glenoid cavity of the scapula to form the scapulohumeral joint, also known as the glenohumeral joint, or shoulder joint.
The constricted area between the head and the body of the scapula is the neck. The superior and inferior angles refer to the upper and lower ends of the medial or vertebral border. The body (blade) of the scapula is arched for greater strength. The thin, flat, lower part of the body sometimes is referred to as the wing or ala of the scapula.
The anterior surface of the scapula is termed the costal surface because of its proximity to the ribs (costa, literally means "rib"). The middle area of the costal surface presents a large concavity or depression, known as the subscapular fossa.
The acromion is a long, curved process that extends laterally over the head of the humerus. The coracoid process is a thick, beaklike process that projects anteriorly beneath the clavicle. The scapular notch is a notchon the superior border that is partially formed by the base of the coracoid process.
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Posterior View (Scapula)
The elevated spine of the scapula starts at the vertebral border as a smooth triangular area and continues laterally to end at the acromion. The acromion overhangs the shoulder joint posteriorly.
The posterior border or ridge of the spine is thickened and is termed the crest of the spine. The spine separates the posterior surface into an infraspinous fossa and a supraspinous fossa. Both of these fossae serve as surfaes of attachment for shoulder muscles.
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Lateral view (Scapula)
The thin scapula looks like the letter Y in a lateral view. The upper parts of the Y are the acromion and the coracoid process. The acromion is the expanded distal end of the spine that extends superiorly and posteriorly to the glenoid cavity (fossa). The coracoid process is located more anteriorly in relationship to the glenoid cavity or shoulder joint.
The bottome leg of the Y is the body of the scapula. The posterior surface or back portion of the thin body portion of the scapula is the dorsal surface. The spine extends from the dorsal surface at its upper margin. The anterior surface of the body is the ventral (costa) surface. The lateral (axillary) border is a thicker edge or border that extends from the glenoid cavity to the inferior angle.
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Lateral projection (scapula)
The scapular Y lateral projection of the scapula is taken with the patient in an anterior oblique position and with the upper body rotated until the scapula is separated from the rib cage in a true end on or lateral projection.
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Proximal Rotation of humerus
| External Rotation
The external rotation position represents a true AP projection of the humerus
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Proximal Rotation of humerus
| Internal Rotation
The hand and arm are rotated internally until the epicondyles of the distal humerus are perpendicular to the IR, placing the humerus in a true lateral position. The hand must be pronated and the elbow adjusted to place the epicondyles perpendicular to the IR.
The AP projection of the shoulder taken in the internal rotation position is a lateral position of the proximal humerus in which the greater tubercle now is rotated around to the anterior and medial aspect of the proximal humerus. The lesser tubercle is seen in profile medially.
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Proximal Rotation of humerus
| Neutral Rotation
is appropriate for a trauma patient when rotation of the part is unacceptable. the epicondyles of the distal humerus appear at an approximate 45 degree angle to the IR. A 45 degree oblique position of the humerus results when the palm of the hand is facing inward toward the thigh. The neutral position is about midway between the external and internal positions and places the greater tubercle anteriorly but still lateral to the lesser tubercle.
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Average Adult Humerus and Shoulder
Medium kV, 70 to 80 with grid--5 to 10 higher kV for digital systems is common for most procedures.
Higher mA with short exposure times
Small focal spot
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Arthrography
used to image soft tissue pathologies such as rotator cuff tears associated with the shoulder girdle. This modality uses contrast medium injected into the joint capsule under fluoroscopy and sterile conditions.
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CT and MRI
Evaluate soft tissue and skeletal involvement of lesions and soft tissue injuries.
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Nuclear Medicine
useful in demonstrating osteomyelitis, metastic bone lesions, and cellulitis
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Sonography
useful for musculoskeletal imaging of joints such as the shoulder to evaluate soft tissues within the joint for possible rotator cuff tears; bursa injuries; or disruption and damage to nerves, tendons, or ligaments.
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Acromioclavicular dislocation
refers to an injury in which the distal clavicle usually is displaced superiorly. This injury is usually caused by a fall.
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AC joint seperation
refers to trauma to the upper shoulder region resulting in a partial or complete tear of the AC or coracoclavicular ligament or both ligaments.
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Bankart lesion
is an injury of the anteroinferior aspect of the glenoid labrum. This type of injury often is caused by anterioatior dislocation of the proximal humerus. Repeated dislocation may result in a small avulsion fracture in the anterioinferior region of the glenoid rim.
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Bursitis
is an inflammation of the bursae, or fluid filled sacs enclosing the joints. It usually involves the formation of calcification in associated c tendons, causing pain and limitation of joint movement.
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hill-Sachs defect
a compression fracture of the articular surface of the posteorolateral aspect of the humeral head that often is associated with an anterior dislocation of the humeral head.
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Idiopathic chronic adhesive capsulitis
(frozen shoulder) is a disability of the shoulder joint that is caused by chronic inflammation in and around the joint. It is characterized by pain and limitation of motion.
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impingement syndrome
Is impingement of the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch, generally during abduction of the arm.
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Osteoporosis
also known as degenerative joint disease, is a noninflammatory joint disease characterized by gradual deteriroration of the articular cartilage with hypertrophic bone formation. DJD is the most common type of arthritis and is considered to be part of the normal aging process. It generally considered to be part of the normal aging process. it generally occurs in people older than 50, chronically obese patients, and athletes.
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Osteoporosis
resultant fractures are due to a reduction in the quantity of bone or atrophy of skeletal tissue. occurs in postmenopausal women and elderly men, resulting in bony trabeculae that are scanity and thin.
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Rheumatoid Arthritis
is a chronic systemic disease characterized by inflammatory changes that occur throughout the connective tissues of the body
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Rotator Cuff
Partial or complete tear in musculature
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Shoulder dislocation
occurs as traumatic removal of humeral head from the glenoid cavity. of shoulder dislocations, 95% are anterior, in which the humeral head is projected anterior to the glenoid cavity.
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Tendonitis
an inflammatory condition of the tendon that usually results from a strain
