Ch. 6 Humerus & Shoulder Girdle

Front 1

The shoulder girdle consists of:

Back 1

*proximal humerus
*scapula
*clavicle

Front 2

The 3 aspects of the clavicle are:

Back 2

*sternal extremity
*body (shaft)
*acromial extremity

Front 3

The male or female clavicle tends to be thicker and more curved in shape?

Back 3

male

Front 4

The 3 angles of the scapula include:

Back 4

*lateral angle
*superior angle
*inferior angle

Front 5

The anterior surface of the scapula is referred to as the ______ surface.

Back 5

costal

Front 6

What is the anatomic name for the armpit?

Back 6

axilla

Front 7

What are the names of the 2 fossae located on the posterior scapula?

Back 7

*infraspinous fossa
*supraspinous fossa

Front 8

All of the joints of the shoulder girdle are classified as being _____.

Back 8

synovial (diarthrodial)

Front 9

Name the movement types for the following joints:
A. Scapulohumeral:
B. Sternoclavicular:
C. Acromioclavicular:

Back 9

A. Spheroidal
B. Plane
C. Plane

Front 10

Proximal Humerus Rotations:
(*External, *Internal, *Neutral)

Greater tubercle profiled laternally...

Back 10

External

Front 11

Proximal Humerus Rotations:
(*External, *Internal, *Neutral)

Humeral epicondyles angled 45 degrees to IR...

Back 11

Neutral

Front 12

Proximal Humerus Rotations:
(*External, *Internal, *Neutral)

Epicondyles perpendicular to IR...

Back 12

Internal

Front 13

Proximal Humerus Rotations:
(*External, *Internal, *Neutral)

Supination of hand...

Back 13

External

Front 14

Proximal Humerus Rotations:
(*External, *Internal, *Neutral)

Palm of hand against thigh...

Back 14

Neutral

Front 15

Proximal Humerus Rotations:
(*External, *Internal, *Neutral)

Epicondyles parallel to IR...

Back 15

External

Front 16

Proximal Humerus Rotations:
(*External, *Internal, *Neutral)

Lesser tubercle profiled medially...

Back 16

Internal

Front 17

Proximal Humerus Rotations:
(*External, *Internal, *Neutral)

Proximal humerus in a lateral position...

Back 17

Internal

Front 18

Proximal Humerus Rotations:
(*External, *Internal, *Neutral)

Proximal humerus in position for an AP projection...

Back 18

External

Front 19

True/False

The use of a grid is not required for shoulders that measure less than 10 cm.

Back 19

True

Front 20

True/False:

The kV range for adult shoulder projections is b/t 80-90 kV.

Back 20

false
70-80 kV

Front 21

True/False:

Low mA w/short exposure times should be used for adult shoulder studies.

Back 21

false

High mA w/short exposure times

Front 22

True/False:

Large focal spot setting should be selected for most adult shoulder studies.

Back 22

false

Small focal spots

Front 23

True/False:

A high-speed screen IR system is recommended for shoulder studies when using a grid.

Back 23

true

Front 24

True/False:

A 72" (180cm) SID is recommended for most shoulder girdle studies.

Back 24

false

40-44" SID (except for AC joints which requires 72" for less beam divergence)

Front 25

True/False:

The gonadal dose for most shoulder projections is 0.1 mrad or less.

Back 25

true

Front 26

True/False:

The use of contact shields over the breast, lung, and thyroid regions is recommended for most shoulder projections.

Back 26

true

Front 27

What kV range should be used for a shoulder series on an average adult?

Back 27

70 - 80 kV

Front 28

If physical immobilization is required, what individual should be asked to restrain a child for a shoulder series?

Back 28

Parent or guardian

Front 29

True/False:

CT arthrography of the shoulder joint requires the use of iodinated contrast media injected into the joint space.

Back 29

true

Front 30

True/False:

MRI is an excellent modality for demonstrating nondisplaced fractures of the shoulder girdle.

Back 30

false

MRI's are useful in the diagnosis of rotator cuff injuries.

Front 31

True/False:

Nuclear medicine bone scans can demonstrate signs of osteomyelities and cellulities.

Back 31

true

Front 32

True/False:

Radiography is more sensitive than nuclear medicine for demonstrating physiologic aspects of the shoulder girdle.

Back 32

false

Nuc. Med is more sensitive than radiography b/c it assesses the physiologic aspect instead of the anatomic aspect.

Front 33

True/False:

Ultrasound can provide a functional (dynamic) evaluation of joint movement that MRI cannot.

Back 33

true

Front 34

Pathology:

Compression b/t the greater tuberosity and soft tissues on the corocoascromial ligamentous and osseous arch

Back 34

Impingement syndrome
(subacromial spurs)

Front 35

Pathology:

Injury of the anteroinferior glenoid labrum.

Back 35

Bankart lesion
(avulsion fx of the glenoid rim)

Front 36

Pathology:

Inflammatory condition of the tendon.

Back 36

Tendonitis
(calcified tendons)

Front 37

Pathology:

Superior displacement of the distal clavicle.

Back 37

Acromioclavicular (AC) joint dislocation
(Abnormal widening of AC joint space)

Front 38

Pathology:

Compression fracture of the articular surface of the humeral head.

Back 38

Hill-Sachs defect (Compression fx of humeral head)

Front 39

Pathology:

Traumatic injury to one or more of the supportive muscles of the shoulder girdle.

Back 39

Rotator cuff tear

Front 40

Pathology:

Atrophy of skeletal tissue.

Back 40

Osteoporosis
(narrowing of joint space)

Front 41

Pathology appearance:

Rheumatiod arthritis

Back 41

closed joint space

Front 42

Pathology appearance:

Bursitis

Back 42

fluid-filled joint space

Front 43

Pathology appearance:

Osteoporosis

Back 43

thin bony cortex

Front 44

What pathologic indication requires a decrease in manual exposure factors?

Back 44

osteoporosis

Front 45

What 2 basic shoulder projections are routinely taken for a shoulder (no trauma) & proximal humerus?

Back 45

1. AP, external rotation
2. AP, internal rotation

Front 46

Specifically, where is the CR placed for an AP projection of the shoulder?

Back 46

to midscapulohumeral joint, 3/4" inferior & lateral to coracoid process.

Front 47

Which lateral projection can be performed to demonstrate the entire humerus for a pt. w/a midhumeral fx?

Back 47

transthoracid lateral projection for humerus
*affected arm in neutral rotation*

Front 48

To best demonstrate a possible Hill-Sachs defect, which additional positioning technique can be added to the inferosuperior axial projection?

Back 48

Rotate affected arm externally ~45 degree

Front 49

What type of central ray angulation is required for the inferosuperior axial projection for the shoulder?

Back 49

25-30 degrees medially

Front 50

The _____ projection of the shoulder produces an image of the glenoid process in profile. The projection is also referred to as the _______ method.

Back 50

AP oblique; Grashey method

Front 51

Which projection produces a tangential projection of the intertubercular groove?

Back 51

Tangential projection (Fisk modification)

Front 52

The supine version of the tangential projection for the intertubercular groove requires that the CR be angled _____ posteriorly from the horizontal plane.

Back 52

10-15 degrees

Front 53

Which one of the following projections would be best for demonstrating a possible dislocation of the proximal humerus?

Back 53

scapular Y

Front 54

The _______ projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs, which create shoulder impingement symptoms.

Back 54

supraspinatus outle tangential projection: Neer method

Front 55

What nontrauma projection can be performed erect to provide a lateral view of the proximal humerus in relationship to the glenohumeral joint?

Back 55

Superoinferior axial projection (Hobbs modification)

Front 57

What CR angle is required for the AP axial projection (clavicle above the scapula and ribs) for AC joints?

Back 57

15 (heavier pt)-30 (thinner pt) degrees cephalad

Front 58

True/False:

The superoinferior axial projection (Hobbs mod.) requires no CR angle.

Back 58

true

Front 59

True/False:

The transthoracic lateral projection can be performed for possible fx or dislocations of the proximal humerus.

Back 59

true

Front 60

True/False:

The use of a breathing technique is recommended for the transthoracic lateral humerus projection.

Back 60

true

Front 61

True/False:

The affected arm must be placed into external rotation for the transthoracic lateral projection.

Back 61

false

Front 62

True/False:

A CR angle of 10-15 degrees caudad may be used for the transthoracic lateral projections if the pt. is unable to elevate the uninjured arm and shoulder sufficiently.

Back 62

false

Front 63

True/False:

The scapular Y lateral (anterior oblique) position requires the body to be rotated 45-60 degrees anteriorly toward the affected side.

Back 63

true

Front 64

What shoulder projection delivers the greatest skin dose to the pt.?

Back 64

Transthoracic lateral

Front 65

What projections requires the smallest thyroid dose?

Back 65

scapular Y lateral

Front 66

What projection would result in the highest thyroid dose?

Back 66

transthoracic lateral

Front 67

What special proj. of the shoulder requires that the affected side be rotated 45 degrees toward the cassette & uses a 45 degrees caudad CR angle?

Back 67

AP apical oblique axial proj.

Front 68

A posterior dislocation of the humerus projects the humeral head _______ (superior or inferior) glenoid cavity

Back 68

superior

Front 69

A thin-shouldered pt. requires ____ (more or less) CR angle for an AP axial clavicle projection than a large-shouldered pt.

Back 69

More

Front 70

What must be ruled out before performing the weight-bearing study for acromioclavicular joints?

Back 70

fx of clavicle

Front 71

Method name:

Inferosuperior axial (CR at the armpit)

Back 71

Lawrence method

Front 72

Method name:

AP oblique for glenoid cavity

Back 72

Grashy method

Front 73

Method name:

Trangential for intertubercular (bicipital) groove

Back 73

Fisk modification

Front 74

Method name:

Supraspinatus outlet tangential

Back 74

Neer method

Front 75

Method name:

Transthoracic lateral

Back 75

Lawrence method

Front 76

Method name:

AP apical oblique axial

Back 76

Garth method

Front 77

Most common fx is in the ____ due to sports & falls. More than 80% occur in the middle 3rd, which lacks ligamentour support.

Back 77

clavicle

Front 78

The upper margin of the scapula corresponds with which rib?

Back 78

2nd posterior rib (T2)

Front 79

The lower margin of the scapula corresponds with which rib?

Back 79

7th posterior rib (T7)

Front 80

The lateral extremity (end) of the clavicle is also called?

Back 80

acromial extremity

Front 81

The medial or _____extremity (end) articulates with the_____, which is the upper part of the sternum.

Back 81

*sternal
*manubruim

Front 82

The shoulder girdle consists of which 2 bones?

Back 82

*clavicle
*scapula

Front 83

The scapula is what type of bone?

Back 83

flat bone

Front 84

The scapula has 3 borders, 3 angles & 2 surfaces. Name the 3 borders.

Back 84

3 borders:
*medial (vertebral) - long edge or border near the vertebrae
*superior or the uppermost margin of the scapula
*lateral (axillary) border, the border nearest the axilla (armpit)

Front 85

The scapula has 3 borders, 3 angles & 2 surfaces. Name the 3 angles.

Back 85

3 triangular angles:
*lateral angle, or "head of the scapula", the thickest part and ends laterally in a shallow depression called the "glenoid cavity (fossa).
*superior or upper end of the medial or vertebral border
*inferior or lower end of the medial or vertebral border

Front 86

The body of the scapula is arched for greater strength. The thin, flat (blade) lower part of the body is sometimes referred to as:

Back 86

Body:
blade, wing, or ala

Front 87

3 borders, 3 angles & 2 surfaces. Name the 2 surfaces.

Back 87

2 surfaces:
*anterior surface or costal surface b/c of its proximity to the ribs (costa means ribs)
*posterior surface or dorsal called the "spine"

Front 88

The posterior border or ridge of the spine is somewhat thickened and termed the _____ of the spine.

Back 88

crest

Front 89

The spine separates the posterior surface into an ______ fossa and a ______ fossa. Both of these fossae serve as surfaces of the attachment for shoulder muscles.

Back 89

*infraspinous fossa
*supraspinous fossa

Front 90

The lateral view of the scapula looks like the letter "Y". The upper parts of the "Y" are the ______ & ______ process.

Back 90

*acromion process
*coracoid process

Front 91

Which process from the "Y" view is the expanded distal end of the spine that extends superiorly and posteriorly to the glenoid cavity (fossa)?

Back 91

acromion
(glenoid cavity/fossa is where the head of the humerus sits)

Front 92

Which process from the "Y" view is the more anteriorly in relationship to the glenoid cavity/fossa or shoulder joint?

Back 92

*coracoid process

Front 93

The bottom 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 _____ surface.

Back 93

dorsal surface

Front 94

The bottom leg of the "Y" is the body of the scapula. The anterior surface of the body is the _____ surface.

Back 94

ventral (costal) surface

Front 95

The bottom leg of the "Y" is the body of the scapula. Which "border" has a thicker edge or border that extends from the glenoid cavity to the inferior angle?

Back 95

lateral (axillary) border

Front 96

80%-95% of shoulder disclocations are disclocated:

Back 96

anteriorly

Front 97

Most common compression fx?

Back 97

Hill-Sachs defect -
a compression fx of the articular surface of the posterolateral aspect of the humeral head

Front 98

***Rotational views of the proximal humerus or shoulder girdle are commonly taken on nontrauma pt. when gross fx or dislocations of the humerus have been ruled out.
These AP rotational projections delineate well the scapulohumeral joint (shoulder joint), revealing possible calcuim deposits or other pathology.***

Back 98

***

Front 99

Which rotation position represents a true AP projection of the humerus in the anatomic position, as determined by the epicondyles of the distal humerus?

Back 99

external rotation (palm out)
*epicondyles are parallel to the IR

Front 100

On the external rotation, which tubercle (greater or lesser) is seen laterally in profile? And which tubercle now is located anteriorly, just medial to the greater tubercle?

Back 100

*greater tubercle
*lesser tubercle

Front 101

Which rotation position, the hand and arm are rotated internally until the epicondyles of the distal humerus are perpendicular to the IR, thus placing the humerus in a "true lateral position"?

Back 101

internal rotation (palm facing IR)

Front 102

On the internal rotation, which tubercle (greater or lesser) is now rotated around to the anterior and medial aspect of the proximal humerus. And which tubercle is seen in profile medially?

Back 102

*greater tubercle
*lesser tubercle

Front 103

Which rotation position is appropriate for a trauma pt. when rotation of the part is unacceptable? The epicondyles of the distal humerus will appear at an ~45 degree angle to the IR.

Back 103

neutral rotation (palm toward body)
**This results in a 45 degree oblique position of the humerus when the palm is facing inward against the thigh.

Front 104

AP Projection: Humerus
**External rotation (palm out)

Back 104

*Fx & dislocation
*14x or 11x lengthwise
*70/6
*pt's arm & hand slightly supinated, epicondyles of elbow are equidistant (equal distant) from IR.
*CR midpoint of humerus
*greater tubercle in profile laterally, the lesser tubercle is located anteriorly, & humeral head is partially seen in profile medially w/min. superimposition of the glenoid cavity.
*40" min. SID
*suspend respiration

Front 105

Lateromedial or Mediolateral Projection: Humerus
**Lateral rotation (lateromedial & mediolateral)

Back 105

*Fx & dislocation
*14x or 11x lengthwise
*70/6
*Lateromedial: pt's arm internally rotate arm, epicondyles are perpendicular to IR
*Mediolateral: face pt toward IR and oblique 20-30 degrees from PA, flex elbow 90 degrees.
*epicondyles are directly superimposed; lesser tubercle is shown in profile medially, partially superimposed by lower portion of glenoid cavity
*CR midpoint of humerus
*40" min. SID
*suspend respiration

Front 106

Shoulder girdle:

Most distal angle:

Back 106

inferior

Front 107

Shoulder girdle:

Scapular spinal process:

Back 107

acromion

Front 108

Shoulder girdle:

Posterior shoulder girdle bone:

Back 108

scapula

Front 109

Shoulder girdle:

Articulates with scapula:

Back 109

humerus

Front 110

Shoulder girdle:

Ball and socket joint:

Back 110

scapulohumeral