Radiographic Anatomy of the Shoulder

Questions and Answers

What position is the arm in for the AP projection with the humeral epicondyles perpendicular to the image receptor?

Internally rotated against the hip (correct)

Neutral against the hip

Externally rotated against the hip

Supinated against the hip

Which structure is NOT typically visible in the AP projection of the shoulder?

Glenoid cavity

Clavicle

Coracoid process

Humeral head (correct)

In the Transthoracic Lateral (Lawrence) view, what is the required angle of the central ray?

15° cephalad (correct)

Vertical, no angle

30° lateral

10° caudad

What rationale supports the use of a neutral position with the humeral epicondyles at 45° to the image receptor?

Improves visualization of the glenoid cavity Signup and view all the answers

Which anatomy is best demonstrated in a lateral image of the shoulder?

Subscapularis muscle Signup and view all the answers

What is the positioning required for performing a Tangential (Neer) projection of the scapula?

Seated or standing, facing a vertical grid device Signup and view all the answers

What is the angle of the beam used for the AP Axial projection (Alexander) of the AC joint?

15° cephalad Signup and view all the answers

When conducting a PA Axial Oblique (Alexander) view, what is the orientation of the midcoronal plane?

45-60° to the IR Signup and view all the answers

What is the purpose of performing a bilateral AP projection of the AC joint with weight?

To check for AC joint separation Signup and view all the answers

What is commonly assessed when using the Tangential (Neer) projection in imaging?

Shoulder impingement Signup and view all the answers

In the Inferosuperior Axial view with the arm abducted 90°, which muscle tendon insertion is primarily examined?

Teres Minor Signup and view all the answers

Which position describes the arm in the Clements Modification of the Inferosuperior Axial view?

Arm abducted at 90° towards the ceiling Signup and view all the answers

What is the significance of the 25° medial angle in the West Point view of the Inferosuperior Axial rotation?

It angles the shoulder for enhanced glenoid cavity view. Signup and view all the answers

Which anatomical landmark is highlighted in the Hill-Sachs compression fracture during Inferosuperior Axial projection?

Lesser tubercle Signup and view all the answers

In the Inferosuperior Axial view, what position should the head be turned for proper imaging?

Turned 30° medially Signup and view all the answers

What is a specific indicator of chronic shoulder instability visible in the Inferosuperior Axial view?

Bankart lesion Signup and view all the answers

What adjustment is made to the arm in Inferosuperior Axial rotation for proper imaging?

Arm externally rotated at 45° with thumb down Signup and view all the answers

In which position is the shoulder notably elevated during imaging for better glenohumeral joint visibility?

Prone position Signup and view all the answers

What is the correct orientation for a PA Oblique view of the scapula?

Scapula // to IR, arm superimposed over humeral head Signup and view all the answers

Which projection requires the arm to be flexed slightly beyond 90°?

AP Axial (Stryker Supine) Signup and view all the answers

In the AP Oblique (Grashey) projection, what orientation is the arm expected to be in?

Abducted with hand on abdomen Signup and view all the answers

What is the purpose of the 10° cephalad angle in the AP Axial (Stryker Supine) projection?

To open the joint space between humeral head and glenoid Signup and view all the answers

Where is the coracoid process located in relation to the humeral head in the AP Axial projection?

Superior to the humeral head Signup and view all the answers

In the PA Transaxillary Upright projection, what is the required body positioning?

Body rotated 5-10° anterior towards the axilla Signup and view all the answers

What is the key indication for performing an AP Oblique (Apple) projection?

To assess rotator cuff tears Signup and view all the answers

What does the PA Oblique (Scapular RAO or LAO) view primarily demonstrate?

The scapula in lateral profile Signup and view all the answers

What is the required position of the arms when performing the AP projection of the clavicle?

Arms along the sides Signup and view all the answers

In the AP Axial (Lordotic) view, what is the angle of cephalad that should be applied during the projection?

25-35° Signup and view all the answers

When the lordotic or recumbent position is not possible during imaging of the clavicle, which of the following projections is used?

Tangential (Tarrant) projection Signup and view all the answers

What is the direction of the CR for an AP projection of the clavicle?

Perpendicular to the midshaft of the clavicle Signup and view all the answers

Which projection involves the affected arm being abducted with the elbow flexed?

AP projection Signup and view all the answers

During a lateral projection of the scapula, the arm of the affected side should be positioned how?

90° to the long axis of the chest Signup and view all the answers

What anatomical landmark should the CR be directed to for the AP projection of the scapula?

Coracoid process Signup and view all the answers

What is the purpose of elevating the unaffected shoulder 15 degrees during the AP projection?

To avoid superimposition of structures Signup and view all the answers

Study Notes

Evaluation of Shoulder Imaging Techniques

Different projections are utilized for assessing shoulder injuries, each with specific requirements and anatomical focus.
AP (Anteroposterior) views can be external, neutral, or internal, assessing humeral epicondyles in relation to image receptor (IR).
Humerus, glenoid cavity, acromion, and rotator cuff muscles are key structures analyzed in the AP view.

Transthoracic Lateral (Lawrence Method)

Performed with the uninjured arm raised and the forearm resting on the head, projecting the proximal humerus.
Key structures visualized include the glenohumeral joint and acromion.
Positioning involves a 10-15° cephalad angle.

Inferosuperior Axial Views

Arm is abducted 90°, the humerus is externally rotated, with variations such as Lawrence and Rafert Modifications.
Specific angles (15° medially) are maintained to visualize critical areas like the glenohumeral joint and rotator cuff tendons.
Hill-Sachs fracture and Bankart lesions are commonly assessed using these views.

PA Transaxillary (Hobbs Modification)

Required positioning involves being upright with slight anterior rotation, allowing clear visualization of the humeral head and acromial profiles.
Highlights structures like the glenohumeral joint and rotator cuff musculature.

PA Oblique Views

Scapular Y view necessitates the scapula being parallel to the IR, enhancing visibility of the scapulohumeral joint and glenoid cavity.
Various angulations may be utilized for enhanced assessment of impactions or dislocations.

AP Axial and Oblique Views

Stryker Notch view focuses on the humeral head with a 10° cephalad angle providing insight into Glenohumeral joint spaces.
Grashey method captures the joint space between the humeral head and glenoid cavity, particularly for diagnosing rotator cuff tears and joint space narrowing.

Tangential Views

Neer view evaluates for shoulder impingement with specific angling of the IR (10-15° caudad).
Evaluation of the midshaft of the clavicle is crucial in identifying fractures and dislocations.

Special Considerations in Positioning

Variations including lordotic positioning or Tarrant tangential views assist when standard projections are not feasible.
Critical to identify the correct anatomical landmarks and apply appropriate angles for comprehensive evaluation of shoulder complexities.

Clinical Relevance

Specific views are meant to identify unique shoulder pathologies like dislocations, fractures, and chronic instability.
The relationship between the humeral head and glenoid cavity is particularly vital in assessing shoulders using AP and axial projections.

Summary Points

Each imaging technique has particular benefits in diagnosing specific shoulder conditions.
Understanding the anatomy and careful positioning is crucial for accurate imaging results in shoulder pathologies.

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Description

This quiz focuses on the critical aspects of radiographic anatomy related to the shoulder complex, including the scapulohumeral joint and coracoid process. Test your knowledge on positioning, angulation, and anatomical landmarks essential for accurate imaging. Ideal for students in medical imaging or radiography courses.