Shoulder Girdle and Humerus

Question 1

why use grids?

Answer 1

minimize scatter radiation
used when body part Is thicker than 10cm
used with higher kVp

Question 2

Markers

Answer 2

on correct side of body
lateral aspect
int the beam not obstructing anatomy
patient face up - marker face up
patient face down - marker face down

Question 3

what are compensating filters?

Answer 3

even out the density of the anatomy
- improve image quality
- may reduce radiation exposure
know how to position filters, and when
won’t use filters at Fanshawe, but maybe at placement

Question 4

Filter placement

Answer 4

thickest part of filter corresponds with thinnest part of anatomy
collimator mounted and contact

Question 5

What placement of a filter could decrease skin entrance exposure to the patient?

Answer 5

collimator mounted

Question 6

What do you usually see on humeral and shoulder girdle images?

Answer 6

fractures
dislocations
arthritis
bone cysts/neoplasms
- usually located proximal humerus or distal knee)

Question 7

What are the humerus views?

Answer 7

AP
Lateral
Transthoracic lateral

Question 8

Humerus - AP projection

Answer 8

humerus true AP position
CR - perpendicular
CP - middle of humerus, may angle collimator
suspend respiration

Question 9

Humerus - AP evaluation criteria

Answer 9

Both joints on image
no rotation
humeral head and greater tuberosity in profile
lesser tubercle between head and greater tubercle
use a practice breath when positioning to ensure you are not clipping any anatomy when they hold breath

Question 10

Humerus - lateromedial

Answer 10

RPO
back of hand on hip
CR - perpendicular
CP - middle of humerus
- include 5cm/2” above/below humerus
Suspend respiration
epicondyles need to be stacked on top of each other

Question 11

Humerus - Mediolateral

Answer 11

LAO
Arm and hand in same position as lateromedial
patient facing bucky
marker face down

Question 12

Humerus - lateral projection evaluation criteria

Answer 12

both joints on image
superimposed epicondyles
lesser tubercle in profile
greater tubercle superimposed with head

Question 13

Humerus - transthoracic lateral projection

Answer 13

injured humerus against bucky
raise remote arm above head
include all the humerus
use breathing technique - say act like breathing through a straw to ensure no shoulder movement

Question 14

Humerus - transthoracic evaluation criteria

Answer 14

entire humerus on image
scapula, clavicle and humerus seen through lung field
breathing technique will blur ribs
increase time and decrease mA

Question 15

What are the shoulder projections?

Answer 15

AP - internal, external and neutral rotation
Inferosuperior axial
Superoinferior axial
PA/AP oblique - scapular Y
AP oblique

Question 16

Shoulder - AP projections

Answer 16

arm hanging by side - external (true anatomical position), nuetral (oblique, hand to side) and internal (same position as lateromedial humerus)
CP - 2.5cm inferior to coacoid
suspend respiration

Question 17

Shoulder - external, neutral and interior series

Answer 17

entire shoulder girdle for the first image
- full collar bone, apex of scapula and above shoulder
Shows the rotation of humeral head
tighten the collimation after the first image

Question 18

Shoulder - AP evaluation criteria

Answer 18

entire scapula, clavicle, proximal humerus
external - head and greater tubercle in profile
neutral - greater tubercle partially superimposing head
internal - lesser tubercle in profile

Question 19

Shoulder - Glenoid Fossa (AP Oblique) projection

Answer 19

RPO
patient rotated 35-45 degrees to injured side
CP - 5cm/2” medial, 5cm inferior to superolateral border of shoulder
feel for spine of scapula - rotate until it is flat against the IR
glenoid cavity in profile
open scapulohumeral joint

Question 20

Shoulder - transthoracic lateral projection

Answer 20

same as position for humerus
breathing technique

Question 21

Shoulder - transthoracic lateral evaluation criteria

Answer 21

scapula, clavicle and proximal humerus send through the lung field

Question 22

Shoulder - inferosuperior axial projection

Answer 22

marker face up
Use CR cassette crosswise
patient supine with arm abducted - hand supine
CR - horizontal with 15-30 degree angle - more abduction, more angle
CP - exit at acromion
detector and CR same angle
as close as you can get within reason

Question 23

Shoulder - inferosuperior axial evaluation criteria

Answer 23

scapulohumeral joint with some overlap
coracoid process anterior above the clavicle
lesser tubercle in profile anteriorly
AC joint projected through humerus

Question 24

Shoulder - Rafert Modification

Answer 24

looks for a Hills-Sachs defect
external rotation of arm - inferosuperior position with thumb down
CR about 15 degrees medially, exiting acromion

Question 25

Shoulder - superoinferior axial projection

Answer 25

patient leans, shoulder over table - make sure back is straight CR - 5-15 degrees laterally CP - glenohumeral joint Suspend respiration angle from acromion to armpit marker facedown

Question 26

Shoulder - superoinferior axial evaluation criteria

Answer 26

coracoid process above clavicle lesser tubercle in profile AC joint through humeral head

Question 27

Shoulder - PA Oblique - Lateral "Y Scap"

Answer 27

Rotate injured shoulder 45-60 degrees towards IR - feel for scapula CP - midpoint of scapula Marker face down medial border of scapula and acromion need to be lined up

Question 28

Shoulder - PA Oblique Evaluation criteria

Answer 28

No superimposition of scapular body over bony thorax Lateral scapula Humeral head and glenoid between coracoid and acromion demonstrates anterior and posterior dislocations

Question 29

Which shoulder dislocation is most common?

Answer 29

anterior