week 10: humerus, shoulder

Question 1

in an AP humerus x-ray, the epicondyles are ________ to the IR

Answer 1

parallel

Question 2

in a lateromedial humerus x-ray, the epicondyles are _______ to the IR

Answer 2

perpendicular

Question 3

what is the general kVp range for humerus x-rays?

Answer 3

70-85 kVp

Question 4

in a lateromedial humerus x-ray, the _______ is placed father away from the IR than the ________ (image analysis)

Answer 4

capitulum, medial trochlea

Question 5

because of medial trochlea/capitulum placement in reference to the IR, in a lateromedial projection, the _________________ (image analysis)

Answer 5

capitulum will be projected to be distal to the medial trochlea

Question 6

what is the general kVp range for shoulder x-rays?

Answer 6

70-85 kVp

Question 7

what is the more descriptive name for the Lawrence method?

Answer 7

inferosuperior axial projection of shoulder

Question 8

what is the more descriptive name for the Grashey method?

Answer 8

AP Oblique Projection – Glenoid Cavity

Question 9

what are the two bones that make up the shoulder girdle?

Answer 9

clavicle, scapula

Question 10

mobility type of SC, AC, and SH joints

Answer 10

diarthrodial

Question 11

movement type of the scaphohumeral joint

Answer 11

ball and socket (spheroidal) joint

Question 12

movement type of SC joint

Answer 12

double plane (gliding) joint

Question 13

movement joint of AC joint

Answer 13

plane (gliding) joint

Question 14

can you have the patient rotate their arm if a fracture/dislocation is suspected?

Answer 14

No

Question 15

a true AP humerus will be demonstrated by

Answer 15

-greater tubercle of humerus in profile seen laterally
-lesser tubercle of humerus superimposed (now located anteriorly)

Question 16

a true lateral humerus will be demonstrated by

Answer 16

-epicondyles directly superimposed
-lesser tubercle shown in profile medially, partially superimposed by lower portion of glenoid cavity

Question 17

in humerus x-rays can scapula and clavicle be clipped from image?

Answer 17

yes

Question 18

sufficient external rotation of AP shoulder (external rotation) evidenced by…

Answer 18

-greater tubercle visualized in full profile on the lateral aspect of the proximal humeral
-lesser tubercle superimposed over humeral head

Question 19

where is the CR centered for an AP shoulder (external rotation)?

Answer 19

1 inch inferior to coracoid process

Question 20

where is the CR centered for an AP shoulder (internal rotation)?

Answer 20

1 inch inferior to coracoid process

Question 21

sufficient internal rotation of AP shoulder (internal rotation) evidenced by…

Answer 21

-lesser tubercle visualized in full profile on the medial aspect of humeral head
-outline of greater tubercle should be visualized superimposed over humeral head

Question 22

how would you position a patient for an AP shoulder (external rotation)?

Answer 22

-position patient to center scapulohumeral joint to center of IR
-abduct extended arm slightly, externally rotate arm (supinate hand) until epicondyles of distal humerus are parallel to the IR

Question 23

how would you position a patient for an AP shoulder (internal rotation)?

Answer 23

-position patient to center scapulohumeral joint to center of IR
-abduct extended arm slightly; internally rotate arm (pronate hand) until epicondyles of distal humerus are perpendicular to IR

Question 24

where is the CR directed for a lawrence method x-ray?

Answer 24

Direct 25-30 degrees medially, centered horizontally to axilla and humeral head

Question 25

how is a patient positioned for a lawrence method x-ray?

Answer 25

Patient supine, shoulder raised approx. 2 inches (place support under shoulder)

Question 26

what is the orientation of the IR for an inferosuperior axial shoulder x-ray?

Answer 26

landscape

Question 27

how do you know you have properly positioned a lawrence method shoulder?

Answer 27

lesser tubercle of humerus are seen in profile corocoid process (not acromion) seen

Question 28

how is the arm positioned for a lawrence method shoulder x-ray?

Answer 28

arm abducted 90 degrees from body

Question 29

where is the CR centered for a Grashey method x-ray?

Answer 29

Scapulohumeral joint (approx. 2 inches inferior and 2 inches medial from the superolateral border of shoulder)

Question 30

where is the scapulohumeral joint?

Answer 30

approx. 2 inches inferior and 2 inches medial from the superolateral border of shoulder

Question 31

what anatomy is to be demonstrated in a Grashey method x-ray?

Answer 31

glenoid cavity seen in profile without humeral head superimposition

Question 32

how many degrees should the patient be rotated for a Grashey method x-ray?

Answer 32

35-45 degrees toward affected side

Question 33

what is the CR angle for AP Axial Clavicle

Answer 33

-asthenic patients require 25-30 degrees -hypersthenic patients require 15-20 degrees

Question 34

is the CR angled cephalad or caudal for a AP Axial Clavicle x-ray?

Answer 34

cephalad

Question 35

what is the orientation of the IR for clavicle x-rays?

Answer 35

landscape

Question 36

what are the respiration instructions for clavicle x-rays? why?

Answer 36

suspend at end of inhalation; helps to elevate clavicles

Question 37

what is the anatomy to be demonstrated on a clavicle x-ray (both AP and AP axial)

Answer 37

entire clavicle, AC joint, SC joint, acromion process

Question 38

which is the best projection for clavicles in terms of a radiation protection standpoint?

Answer 38

PA projection

Question 39

is the PA projection for clavicles angled caudal or cephalad?

Answer 39

caudal (opposite of AP projection)

Question 40

how would you position patient for an AP Scapula?

Answer 40

abduct arm 90 degrees and supinate hand ("salute")

Question 41

where is the CR centered for AP Scapula?

Answer 41

"mid-scapula"; 2 inches inferior to coracoid process (or to level of axilla) and approximately 2 inches medial from lateral border of patient

Question 42

what gives the "Y" view of lateral scapula x-ray?

Answer 42

direct superimposition of lateral and vertebral (medial borders) of scapula

Question 43

where is the CR centered for a lateral Scapula?

Answer 43

midvertebral border of scapula

Question 44

which of the scapula borders is thicker? thinner?

Answer 44

thicker = lateral thinner = medial/vertebral

Question 45

how is the patient positioned in a lateral scapula x-ray? (Per textbook)

Answer 45

patient rotated 45-60 degrees; patient facing IR

Question 46

AP Scapula breathing instructions

Answer 46

orthostatic breathing; exposure for minimum of 3 seconds

Question 47

how do you know if a lateral scapula x-ray is overrotated?

Answer 47

thicker nearest thorax = too much rotation

Question 48

how do you know if a lateral scapula x-ray is underrotated?

Answer 48

thinner nearest thorax = insufficient rotation

Question 49

in a lateral scapula x-ray, where is the acromion process?

Answer 49

on the "outer"/lateral portion of the x-ray; coracoid is more medial

Question 50

if a patient is rotated toward the affected shoulder in an AP clavicle x-ray, what will occur?

Answer 50

medial end of clavicle is drawn away from vertebral column

Question 51

if a patient is rotated toward the unaffected shoulder in an AP clavicle x-ray, what will occur?

Answer 51

medial end of clavicle is drawn towards the vertebral column

Question 52

where will the superior scapular angle be if a patient is tilted anteriorly for a clavicle x-ray?

Answer 52

superior angle will be above clavicle

Question 53

where will the superior scapular angle be if a patient is tilted posteriorly for a clavicle x-ray?

Answer 53

superior angle will be below clavicle

Question 54

an AC joints x-ray (can/cannot) be taken at either 40 inch or 72 inch SID

Answer 54

can

Question 55

where is the CR directed in a unilateral AC joint study?

Answer 55

1 inch below affected AC joint

Question 56

where is the CR directed in a bilateral AC joint study?

Answer 56

midpoint between AC joints, 1 inch above jugular notch