Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
79 Cards in this Set
- Front
- Back
|
Shoulder girdle consists of... |
Clavicles, Scapulae (and Proximal Humerus) |
|
|
Another name for tubercle on humerus |
Tuberosities |
|
|
Neutral rotation of proximal humerus/shoulder |
Can't see greater or lesser tubercle in profile, both more anterior, arm relaxed/epicondyles obliqued 45 degrees Palm usually touching side of leg |
|
|
External rotation of proximal humerus/shoulder |
Greater tubercle in profile laterally, epicondyles parallel to IR AP position for humerus |
|
|
Internal rotation of shoulder |
Lesser tubercle in profile medially, epicondyles perpendicular to IR Lateral position for humerus Hand pronated and rotated internally/medially |
|
|
Which gender has a thicker, longer, more curved clavicle? |
Male |
|
|
Anterior surface of scapula called? |
Costal/ventral surface (with subscapular fossa) |
|
|
Names of fossae on posterior scapula? |
Supraspinous fossa and infraspinous fossa
|
|
|
Scapular upper margin landmark at... |
2nd rib |
|
|
Scapular lower margin landmark at... |
T7 (chest xray landmark!) |
|
|
Surgical neck of humerus |
Site of frequent fractures requiring surgery to fix |
|
|
Where do shoulder girdle attach on trunk? |
Anterior, attach at the manubrium of sternum Posterior, scapula is attached to trunk only by muscles |
|
|
Joint classification for: -Glenohumeral/scapulohumeral joint -Acromioclavicular (AC) joints -Sternoclavicular (SC) joints |
-Spheroidal/ball and socket -Planar/gliding -Planar/gliding |
|
|
How much should arm be abducted for Lawrence method/inferosuperior axial? |
90 degrees, arm elevated on sponges to keep arm level |
|
|
All shoulder girdle joints are what type? |
Synovial/diarthrodial |
|
|
Most frequently dislocated joint in body |
Scapulohumeral joint - tradeoff for most freedom of movement is less stability |
|
|
What view most important to determine shoulder dislocation? |
Lateral "Y" Scapula for shoulder trauma - will show if dislocation anterior (more common) or posterior |
|
|
What do you need for true lateral shoulder/scapula? |
Medial/vertebral and lateral/axillary borders to be superimposed to make "Y" shape |
|
|
AC or SC joints have more movement? |
AC joints - planar as well as some rotary movement when scapula is moved back and forth |
|
|
Should not do what if fracture of shoulder girdle/humerus or dislocation suspected? |
Should not rotate arm/shoulder or abduct arm - should be in neutral rotation |
|
|
If shoulder is less than 10cm, need grid? |
No grid if less than 10cm - children and asthenic adults |
|
|
AC joints need grid? |
Not technically since less than 10 cm - but often use grid b/c reduce scatter and holds IR |
|
|
General Adult Humerus/Shoulder Technical Considerations |
-Medium kV, 70 to 80kV with grid (65-70 without grid) -Increase by 5-10kV for digital systems -High mA, short exposure time -Small focal spot -Center cell if using AEC for shoulder (usually set manual) -40 to 44 inch SID, except for AC joints which need 72 inch SID (less beam divergence) -Adequate mAs to see soft tissues and bony markings -Gonadal shielding -Close collimation and possibly contact shields over breasts/thyroids to protect tissue |
|
|
Pediatric Considerations |
Reduce exposure b/c smaller patient Reduce patient motion with immobilization - tape, sponges, parents help hold If parents hold, must shield Calm manner with child |
|
|
Geriatric Considerations |
Clear, complete instructions May require modified positioning to suit pt condition May need to decrease exposure due to arthritis/osteoporosis |
|
|
Digital Imaging Considerations |
Close collimation Accurate centering of body part with CR and IR Exposure factors - higher kV, lower mAs for ALARA Check exposure indicator (S number) for good exposure factors |
|
|
Arthrography |
Inject iodinated contrast medium in joint capsule to image soft tissue like rotator cuff tears |
|
|
CT/MRI |
Useful for evaluating soft tissue injuries, skeletal lesions, and sectional exam of fractures |
|
|
Nuclear medicine |
Assesses physiologic aspect - osteomyelitis, metastatic bone lesions and cellulitis |
|
|
Sonography |
Alternative to MRI, allows for evaluation of joint movement Look for soft tissue injuries such as rotator cuff tear, bursa, damage to tendons/ligaments/nerves |
|
|
What screen for analog shoulder studies with grid? |
High speed screens |
|
|
Hill Sachs Defect |
Compression fx of posterolateral articular surface of humeral head from anterior dislocation of shoulder - best demonstrated with exaggerated external rotation (45 degrees) Can also do AP internal rotation or axillary |
|
|
If pt can't depress shoulder, what angle needed on transthoracic lateral humerus? |
10-15 degrees cephalad |
|
|
What two structures must be perpendicular for lateral scapula? |
AC joint and superior angle of scapula |
|
|
which end of clavicle is flatter? |
Acromial end |
|
|
Which position best demo's acromion and coracoid process of scapula? |
Lateral scapula with arm down at side behind pt if erect 60 degree anterior oblique if recumbent - increases OID |
|
|
What position best demo's glenoid cavity? |
Grashey method - Posterior oblique shoulder |
|
|
What angle used for AP axial clavicle? |
15 to 30 degrees (higher degree for thinner pts) |
|
|
Where center for transthoracic PROXIMAL humerus? |
Surgical neck |
|
|
Clavicles exposed on... |
End of inhalation to raise clavicles |
|
|
Optional breathing technique for what position? |
AP scapula - gentle breathing without moving arm |
|
|
8x10 cassette used for... |
Grashey method Inferosuperior axial (lawrence) |
|
|
How much angle for Lawrence method? |
25-30 degrees medially, if pt can't abduct arm go as much as can and lessen angle of tube to 15-20 degrees (or just do transthoracic lateral/scapular Y lateral) |
|
|
Decrease exposure for which pathologies? |
Osteoarthritis, osteoporosis, and rheumatoid arthritis |
|
|
AC dislocation |
Do bilateral erect AC joints - looks like widening of AC joint space (distal clavicle usually displaced superiorly due to fall) |
|
|
AC joint separation |
Bilateral erect AC joints with and w/o weights Asymmetric widening of AC joint compared to opposite side |
|
|
Bankart lesion |
Injury of anteroinferior aspect of glenoid fossa due to repeated anterior shoulder dislocation - small avulsion fx Do Grashey, scapular Y or AP internal rotation |
|
|
Bursitis |
Calcifications in fluid filled joint space AP and lateral shoulder |
|
|
Idiopathic chronic adhesive capsulitis (Frozen shoulder) |
AP and lateral shoulder chronic inflammation and limited motion May see joint space calcification |
|
|
Impingement syndrome |
Scapular Y lateral impingement of greater tubercle on coracoacromial arch during abduction - see bone spurs under the acromion |
|
|
Osteoarthritis |
AP and lateral shoulder Narrowing of joint space due to deteriorated cartilage and hypertrophic bone formation |
|
|
Osteoporosis |
AP and lateral shoulder thin bony cortex, secondary cause of fx due to bone atrophy |
|
|
Rheumatoid arthritis |
AP and lateral shoulder Closed joint space due to inflammation |
|
|
Rotator cuff tear |
Arthrogram/MRI Tear in soft tissue |
|
|
Shoulder dislocation |
AP Neutral rotation, Transthoracic lateral and scapular Y lateral If below coracoid is anterior dislocation if below acromion is posterior (less common) |
|
|
Tendonitis |
MRI Calcification of tendons |
|
|
What is routine shoulder/proximal humerus projections with no injury? |
AP (external rotation) Lateral (internal rotation) |
|
|
Where is CR placed for AP projection of shoulder? |
CR perpendicular to IR, 1 inch below coracoid process |
|
|
What lateral projection can demo entire humerus for pt with mid-humeral fx? |
Transthoracic lateral, CR to mid-diaphysis through thorax |
|
|
CR angle for inferosuperior axillary of shoulder? |
25-30 degrees medially, 15-20 if pt can't abduct arm fully 90 degrees |
|
|
What produces image of glenoid cavity in profile? |
Posterior oblique projection of shoulder aka Grashey method |
|
|
Which projection best demo's possible dislocation of proximal humerus? |
Scapular Y lateral |
|
|
CR angle for Alexander method of AC joints |
AP axial projection for AC joints, 15 degrees cephalad |
|
|
Arm in what rotation for transthoracic lateral? |
Neutral rotation |
|
|
What angle for transthoracic if pt can't lift unaffected arm enough? |
10 to 15 degrees cephalad to separate shoulders |
|
|
What must be ruled out before performing weight bearing study for AC joints? |
Fracture of clavicles |
|
|
Where is CR centered for AP scapula? |
2 inches below coracoid, 2 inches medial to lateral border of pt body |
|
|
Angle for lateral scapula? |
No angle |
|
|
Grashey method amount of rotation |
35 to 45 degrees - larger pt shoulders will need more rotation |
|
|
Trauma routine for humerus |
AP neutral rotation - don't rotate arm! Horizontal beam lateral (lateromedial) for distal humerus OR Transthoracic lateral/Lawrence for humerus to get whole humerus (CR at mid diaphysis) |
|
|
Trauma routine for shoulder |
AP neutral rotation - CR to mid scapulohumeral joint Transthoracic lateral/Lawrence - CR to surgical neck Scapular Y Lateral for shoulder - CR to scapulohumeral joint (2 inches below top of shoulder) |
|
|
Mid scapulohumeral joint |
3/4 inch below coracoid process and slightly lateral |
|
|
75 to 85 kV digital |
AP humerus Lateral humerus AP shoulder/external rotation Lateral shoulder/internal rotation Grashey method/Posterior oblique shoulder AP neutral rotation shoulder Transthoracic lateral for proximal humerus Scapular Y Lateral Shoulder AP and AP axial clavicles AP and Lateral Scapula (erect/recumbent) |
|
|
70 to 85 kV digital |
Trauma horizontal beam lateral humerus |
|
|
80 to 90 kV digital |
Transthoracic lateral/Lawrence **for humerus** |
|
|
75 to 80 kV digital |
Inferosuperior axial projection shoulder/Lawrence |
|
|
70 to 80 kV digital |
AC joints w/ and w/o weights |
|
|
AEC not recommended for... |
clavicles, AC joints, and scapula |
|
|
Most commonly fractured bone in body... |
Clavicle - happens to babies during childbirth often |
