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Clinical Imaging > Shoulder > Flashcards

Shoulder Flashcards

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1
Q

What are routine x-ray projections for the shoulder?

A

AP
Lateral (Y View)

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2
Q

What are routine x-ray projections for the clavicle?

A

AP
Axial

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3
Q

What are the clinical indications of the x-ray?

A

Shoulder trauma
Bony tenderness at the glenohumeral joint/region
Restriction of rotation
Instability
Suspected dislocation
AC jointinjury
Scapulatrauma
Suspected arthritis
Non-traumatic shoulder pain

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4
Q

AC joint injuries are graded up until what number?

A

6

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5
Q

In an AP clavicle x-ray, what would you call the lateral portion of the clavicle?

A

Distal clavicle

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6
Q

If you want to x-ray the right shoulder in a Y view lateral x-ray, how is the patient positioned?

A

The patient is in Right Anterior Oblique position
RAO
The side that is being x-rayed is the side you want against the image receptor

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7
Q

In an axial clavicle x-ray, what direction/angle is the x-ray beam facing?

A

X-ray is angled 15-20 degrees cephalad - i.e xray beam is positioned towards the head

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8
Q

What does cephalad mean?

A

Towards the head end

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9
Q

What does cordad mean?

A

Towards the tail end

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10
Q

How would a displacement fracture present of the clavicle?

A

Displacement fracture means one side has moved - normally up

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11
Q

What are additional projections of the shoulder?

A

AP Internal/External Rotation
AP Glenoid (Grashey)
Axial

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12
Q

What are additional projections of the shoulder?

A

Sternoclavicular Joint
Acromioclavicular joint

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13
Q

What are Hills-Sachs lesions?

A

type of fracture at the humeral head

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14
Q

What is the best x-ray to detect Hills-Sachs lesions?

A

AP internal rotation

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15
Q

What does en face mean?

A

facing the front

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16
Q

What does in profile mean?

A

facing the side

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17
Q

In AP internal rotation and the analogy of the ice cream. Is the ice cream sitting nicely on top or is it falling off the cone?

A

Sitting nicely on top

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18
Q

In an AP internal rotation x-ray of the shoulder, the lesser tuberosity is facing en face or in profile?

A

in profile

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19
Q

In an AP internal rotation x-ray of the shoulder, the greater tuberosity is en face or in profile?

A

en face

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20
Q

In an AP external rotation x-ray of the shoulder, with the analogy of the ice cream, is this sitting nicely on top or falling off?

A

Ice cream is falling off of the cone

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21
Q

What is the x-ray view that assess the Glenohumeral joint space?

A

AP Glenoid (Grashey) View

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22
Q

What shape is the clavicle in Grashey view?

Study These Flashcards
A

S shaped (Chicken wing)

23
Q

How is the patient positioned for a Right Grashey x-ray?

Study These Flashcards
A

In a right posterior oblique position - RPO

24
Q

Why would you perform an axial shoulder x-ray?

Study These Flashcards
A

additional information when assessing dislocations and glenohumeral instability
relationship between the glenoid and humeral head and the acromion and coracoid processes

25
What is a sternoclavicular x-ray for?
To assess Sternoclavicular. These are to look at the SC joint Pt is positioned closer to the image receptor to enable less distortion of the image. This can be in PA, RAO, LAO
26
Why would you do an Acromioclavicular joint x-ray for?
shoulder trauma direct blows to the shoulder region following a fall onto an adducted arm suspected dislocation suspected arthritis
27
What is the normal joint space of the Glenohumeral joint?
3-6mm
28
What is the normal joint space of the Acromiohumeral Distance?
7-11mm
29
What is the normal joint space of the Acromioclavicular Joint?
2-4mm
30
What is the normal joint space of the Coracoclavicular Distance?
11-13mm
31
What could be indicative of decreased joint space in the Glenohumeral joint?
Degenerative Joint Disease (DJD), Arthropathies, Anterior or Posterior Dislocation
32
What could be indicative of decreased joint space in the Acromioclavicular Joint?
Degenerative Joint Disease (DJD)
33
What could be indicative of decreased joint space in the Acromiohumeral Distance?
Rotator Cuff Tear
34
What could be indicative of increased joint space in the Acromiohumeral Distance?
Subluxation, Dislocation
35
What could be indicative of increased joint space in the Coracoclavicular Distance?
ACJ Separation
36
What could be indicative of increased joint space in the Glenohumeral Joint?
Posterior Dislocation
37
What could be indicative of increased joint space in the Acromioclavicular Joint?
ACJ Separation, Clavicular Erosion/Absorption
38
What is Maloney's arch?
the curve from the lateral border of the scapula to the medial humerus This line can be disrupted with a posterior shoulder dislocation
39
What is a Rhomboid Fossa?
Roughened area along the inferior border of the medial clavicle, appears as a pronounced depression or crescent defect Notch that looks like an erosion in the medial inferior clavicle
40
What does a Rhomboid Fossa look like on an x-ray and what is the clinical significance?
Delineated from clavicle by a band of increased density; notch on inferomedial clavicle Clinical Significance - None – developmental variation
41
What is Sprengel’s Deformity?
Congenital elevation of the scapula Complex deformity of the shoulder
42
How could Sprengel’s Deformity display on an x-ray?
elevation of one or both scapular
43
What is the clinical significance of Sprengel’s Deformity?
Klippel-Feil Syndrome Spina Bifida Kyphoscoliosis Torticollis Under development of the clavicle or humerus
44
What is a conoid tubercle enlargement?
Insertion site of the Conoid Ligament Prominent and hypertrophied X-ray: large outgrowth of the bone at the conoid tubercle of the clavicle with continuous cortex and normal bony matrix.
45
What is a Supraclavicular Foramen?
Osseus tunnel in the superior aspect of the distal 1/3 of clavicle What causes it? - Anatomical variant Passage of supraclavicular nerve X-ray: small, round, radiolucent foramen in the superior clavicle Clinical Significance - Incidental finding Reports of cause of supraclavicular nerve entrapment syndrome
46
What is the name of the accessory ossicle of the shoulder?
Os Acromiale
47
Where is the Os Acromiale located?
best seen on axial shoulder view Small, round, bony structure with smooth cortical margins at the distal acromion
48
What is the clinical significance of Os Acromiale?
may cause shoulder impingement, rotator cuff tear or degenerative acromioclavicular joint disease DDx: normal AC Joint: acromion fusion may not occur till around 18-25 years of age. degenerative ossicles fracture of the acromion calcific tendinosis of the supraspinatus
49
What are normal structures that can simulate pathology?
Nutrient Channels/foramina Vacuum Phenomenon Companion Shadow
50
What is a companion shadow?
soft tissue that overlies the bone Common shadows include: Rib Companion Shadow: Shadows of 1st and 2nd rib are present in approx 35% of population Clavicle Companion Shadow: Thin line running along upper border of clavicle Scapula Companion Shadow: Runs parallel to medial border of scapula
51
What is a vacuum phenomenon?
presence of intra-articular gas in the shoulder joint and they are very common. X-ray: very common in ER - Circular or linear lucent appearance
52
What are Nutrient Channels/foramina?
a small tunnel through the cortex of a long bone containing a nutrient artery which supplies the bone. They are caused by nutrient artery enters a long bone via an obliquely orientated canal. Anatomical variant X-ray : radiolucent line passing through the cortex into the medullary portion of the diaphysis of the bone. Well-corticated edge Directed AWAY from bone growth Clinical significance: mimic oblique fractures (#) on plain radiographs
53
Can Os Acromiale be bi-lateral?
Yes, they can be. 8% of people have Os Acromiale and 30% of them have it bilaterally

Clinical Imaging (22 decks)

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