Shoulder Anatomy and Imaging Techniques
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Questions and Answers

What is wrong with the positioning of your patient when the scapula is seen inside the lung field on a Scapula Y image?

  • Your patient has been over rotated (correct)
  • Your patient has been under rotated
  • Nothing is wrong, it's normal for the scapula to look flat.

    • Where should the scapula body be seen in an image of a PA Oblique scapula Y?

  • Along the lateral aspect of the thorax but not superimposed (correct)
  • Superimposed with the ribs and lungs
  • Superimposed with the clavicle

    • What projection is the Neer Method associated with?

    Supraspinatus Outlet Tangential

    Where does the CR enter for a Supraspinatus Outlet Tangential (Neer method) projection?

    <p>Superior aspect of the humeral head</p> Signup and view all the answers

    For the Neer method of the shoulder, the CR is angled:

    <p>10 to 15 degrees caudad</p> Signup and view all the answers

    The Neer Method - Tangential supraspinatus 'outlet' projection is used to aid in the diagnosis of:

    <p>Shoulder impingement</p> Signup and view all the answers

    What position would be used in the Neer Method to examine the supraspinatus outlet on a patient's right shoulder?

    <p>45-60 degrees RAO</p> Signup and view all the answers

    What projection is used to visualize the intertubercle grove of the humerus?

    <p>Fisk Method</p> Signup and view all the answers

    How many degrees of angulation is the humerus in for the Fisk method?

    <p>10-15 degrees</p> Signup and view all the answers

    The humerus is in ____ position in a Fisk method projection in relation to the table.

    <p>Vertical</p> Signup and view all the answers

    The CR is ____ to the body in the Fisk Method.

    <p>Tangential</p> Signup and view all the answers

    In a bilateral AP-AC joint (Pearson) projection, the CR is perpendicular to the_____ of the body at the level of AC joint:

    <p>Midline</p> Signup and view all the answers

    If the patient is too large and individual images need to be taken of each shoulder for an AP-AC Joint (Pearson), the CR enters perpendicular to:

    <p>Acromioclavicular joint</p> Signup and view all the answers

    The SID for an AP-AC joint (Pearson) projection is of:

    <p>72 inches</p> Signup and view all the answers

    A 72-inch SID for an AP-AC joint (Pearson) projection helps to:

    <p>Reduce magnification and distortion</p> Signup and view all the answers

    How heavy are the weights for the bilateral Pearson?

    <p>5 to 10 lbs</p> Signup and view all the answers

    AP-AC Joint (Pearson) projections are done to evaluate for dislocation, separation and function of the acromioclavicular joint.

    <p>True</p> Signup and view all the answers

    For an AP Clavicle projection the CR enters at:

    <p>Midshaft of the clavicle</p> Signup and view all the answers

    Besides the clavicle bone being included in an AP clavicle image, which two joints need to be included?

    <p>Acromioclavicular joint</p> Signup and view all the answers

    What is the respiration instructions for an AP Clavicle projection?

    <p>Suspended at the end of exhalation</p> Signup and view all the answers

    What is the respiration instructions for an AP Axial Clavicle projection?

    <p>Suspended at the end of full inspiration</p> Signup and view all the answers

    The shoulder girdle is formed by which two bones?

    <p>Clavicle/Scapula</p> Signup and view all the answers

    What is the function of the shoulder girdle?

    <p>To connect the upper limb to the trunk of the body</p> Signup and view all the answers

    What bone classification is the scapula?

    <p>Flat</p> Signup and view all the answers

    What classification of bone is the clavicle?

    <p>Long</p> Signup and view all the answers

    The medial aspect of the clavicle is also known as?

    <p>Sternal extremity</p> Signup and view all the answers

    What bone articulates with the glenoid cavity?

    <p>Humerus</p> Signup and view all the answers

    What bone articulates with the medial end of the clavicle?

    <p>Sternum</p> Signup and view all the answers

    What structure of the scapula articulates with the lateral end of the clavicle?

    <p>Acromion</p> Signup and view all the answers

    The lateral aspect of the clavicle is also known as?

    <p>Acromial extremity</p> Signup and view all the answers

    Which end of the clavicle articulates with the scapula?

    <p>Lateral aspect</p> Signup and view all the answers

    Which end of the clavicle articulates with the manubrium?

    <p>Sternal extremity</p> Signup and view all the answers

    Which classification of joints are sternoclavicular (SC) joints and acromioclavicular (AC) joints?

    <p>Synovial</p> Signup and view all the answers

    What type of joint are SC joints and AC joints?

    <p>Gliding</p> Signup and view all the answers

    The clavicle has a double curve body, this curve is more pronounced in ____ than in ____.

    <p>males/females</p> Signup and view all the answers

    Which surface of the scapula is the costal surface?

    <p>Anterior</p> Signup and view all the answers

    What is the lateral, thickened end of the scapular spine called?

    <p>Acromion</p> Signup and view all the answers

    The scapular notch is located on the?

    <p>Superior border</p> Signup and view all the answers

    Shoulder procedures can be performed in?

    <p>Upright/recumbent</p> Signup and view all the answers

    Standard SID for shoulder images is:

    <p>40 inches</p> Signup and view all the answers

    What are the two basic shoulder projections routinely taken?

    <p>AP Shoulder internal/external</p> Signup and view all the answers

    For AP projections (internal/external/neutral) of the shoulder the patient's respiration should be?

    <p>Suspended</p> Signup and view all the answers

    Supinating hand and adjusting epicondyles parallel to the IR positions the humerus in the _____ rotation in an AP Shoulder projection.

    <p>External</p> Signup and view all the answers

    The CR enters patient ____ inch ____ to coracoid process and perpendicular to the IR for AP shoulder projections internal, external, and neutral rotation.

    <p>1 inch inferior</p> Signup and view all the answers

    What structures should be in profile in an AP Shoulder projection in external rotation?

    <p>Humeral Head/Greater Tubercle</p> Signup and view all the answers

    Posterior aspect of the hand placed against the hip and epicondyles adjusted perpendicular to the IR positions the humerus in _____ rotation in an AP Shoulder.

    <p>Internal</p> Signup and view all the answers

    What structure should be in profile in an AP Shoulder projection internal rotation?

    <p>Lesser Tubercle</p> Signup and view all the answers

    In which AP shoulder projection is the scapulohumeral joint visualized?

    <p>AP shoulder external rotation</p> Signup and view all the answers

    For an AP shoulder projection what positioning maneuver should be avoided if the patient possibly has a fractured humerus or dislocation of the scapulohumeral joint?

    <p>Rotating the arm in external or internal rotation</p> Signup and view all the answers

    Palm of the hand placed against hip and epicondyles adjusted at approximately a 45 degrees angle with the IR positions the humerus in ____ rotation in an AP Shoulder.

    <p>Neutral</p> Signup and view all the answers

    What structure should be partially superimposing the humeral head in an AP Shoulder projection neutral rotation?

    <p>Greater Tubercle</p> Signup and view all the answers

    For trauma cases which AP shoulder projection would be best to?

    <p>Neutral rotation</p> Signup and view all the answers

    What AP shoulder projection is obtained when the humeral epicondyles are parallel to the IR?

    <p>External Rotation</p> Signup and view all the answers

    What AP shoulder projection is obtained when the humeral epicondyles are perpendicular to the IR?

    <p>Internal Rotation</p> Signup and view all the answers

    Which AP shoulder projection is obtained by positioning the humeral epicondyles at an angle of approximately 45 degrees with the IR?

    <p>Neutral Rotation</p> Signup and view all the answers

    Which AP shoulder projection shows the greater tubercle in profile on the lateral aspect of the humerus?

    <p>External Rotation</p> Signup and view all the answers

    Which AP shoulder projection shows the lesser tubercle in profile and pointing medially?

    <p>Internal Rotation</p> Signup and view all the answers

    The CR enters the patient ____ inches _____ and inferior to the superolateral border of the shoulder, perpendicular to the glenoid cavity in an AP Oblique shoulder-Grashey Method.

    <p>2 inches medial</p> Signup and view all the answers

    How many degrees should the patient be rotated for an AP Oblique shoulder (Grashey) projection?

    <p>35-45</p> Signup and view all the answers

    What patient position would be required if the patient's right shoulder is to be examined in an AP Oblique projection?

    <p>35 to 45 Degrees - RPO</p> Signup and view all the answers

    The CR enters ____ to the glenoid cavity in an AP Oblique projection (Grashey Method).

    <p>Perpendicular</p> Signup and view all the answers

    The scapula bone should be ____ to IR in the AP Oblique shoulder (Grashey) projection when rotating the patient 35 to 45 degrees towards IR.

    <p>Parallel</p> Signup and view all the answers

    What is the proper arm position for the Grashey method?

    <p>Abducted in slight internal rotation</p> Signup and view all the answers

    What shoulder projection produces an image of the glenoid cavity in profile?

    <p>Grashey Method</p> Signup and view all the answers

    The Transthoracic Lateral projection (Lawrence Method) may be performed with the patient positioned upright or:

    <p>Supine</p> Signup and view all the answers

    In a transthoracic lateral shoulder projection, having the patient raise the non-injured arm, and resting the forearm on the head, while NOT suspending respiration will help your image in which way?

    <p>The scapula, clavicle, and humerus will be seen through the lung field.</p> Signup and view all the answers

    This method is used when trauma exists and the affected arm cannot be rotated or abducted because of an injury.

    <p>Transthoracic Lateral</p> Signup and view all the answers

    Where does the CR enter a patient for the Transthoracic lateral projection (Lawrence Method)?

    <p>Surgical neck-humerus</p> Signup and view all the answers

    How many degrees and in which direction should the CR be directed if it cannot be directed perpendicular to the IR because the patient is unable to elevate the unaffected shoulder for a transthoracic lateral projection?

    <p>10 to 15 degrees cephalad</p> Signup and view all the answers

    In a Transthoracic lateral projection (Lawrence Method), slow, deep breathing and a minimum exposure time of 3 seconds allows for?

    <p>Blurring lung and rib markings in the image.</p> Signup and view all the answers

    Which two of the following demonstrate appropriate patient positioning for a Transthoracic lateral projection (Lawrence Method) of the humerus?

    <p>Lying supine on the X-ray table</p> Signup and view all the answers

    How much tube angulation is needed when performing a Transthoracic lateral projection (Lawrence Method) of the humerus?

    <p>0 degrees</p> Signup and view all the answers

    In a transthoracic lateral projection (Lawrence Method), of the humerus, which anatomical structures should be seen through the lung field?

    <p>Proximal humerus and greater tubercle in profile</p> Signup and view all the answers

    What is the angle degree for the CR in an Inferosuperior axial projection?

    <p>15-30</p> Signup and view all the answers

    What positioning factor determines how many degrees the CR should be directed medially in an Inferosuperior Axial Projection?

    <p>The degree of abduction of the affected arm</p> Signup and view all the answers

    In the Inferosuperior axial projection, the hand should be in:

    <p>External Rotation</p> Signup and view all the answers

    In an Inferosuperior axial projection (Lawrence method), when the patient is recumbent, the head and upper torso should be elevated 3 inches from the x-ray table on a radiolucent sponge.

    <p>True</p> Signup and view all the answers

    In an Inferosuperior axial projection (Lawrence method), when using a horizontally directed CR, the patient is placed in the supine body position.

    <p>True</p> Signup and view all the answers

    What joint does the CR enter a patient in an Inferosuperior axial projection (Lawrence Method)?

    <p>AC joint</p> Signup and view all the answers

    In an _____ image you will see the scapulohumeral joint with slight overlap, coracoid process and lesser tubercle in profile.

    <p>Inferosuperior Axial</p> Signup and view all the answers

    The CR enters perpendicular to the ____ for PA Oblique Scapular Y projections?

    <p>Scapulohumeral joint</p> Signup and view all the answers

    The PA oblique -scapula Y projection is particularly useful to diagnose?

    <p>Shoulder dislocations</p> Signup and view all the answers

    What side of the shoulder should be placed closest to the IR when imaging a PA oblique -scapula Y projection?

    <p>The affected side</p> Signup and view all the answers

    PA Oblique -Scapula Y is named this way because when properly positioned the ____ and ____ form a Y shape.

    <p>Coracoid Process/Acromion</p> Signup and view all the answers

    The patient should be rotated for a PA oblique -scapula Y projection how many degrees towards the IR?

    <p>45-60</p> Signup and view all the answers

    In an image of a normal shoulder, the humeral head should be directly superimposed over the junction of the scapula Y (acromion and coracoid process).

    <p>True</p> Signup and view all the answers

    What position and degrees of rotation would you place a patient with an injured left shoulder when using the PA oblique -scapula Y projection?

    <p>LAO 45-60 degrees</p> Signup and view all the answers

    What are the breathing instructions for a PA Oblique Scapular Y projection?

    <p>Suspended</p> Signup and view all the answers

    The CR enters ____ to the scapulohumeral joint for PA Oblique Scapular Y projections?

    <p>Perpendicular</p> Signup and view all the answers

    90% of shoulder dislocations are anterior dislocations.

    <p>True</p> Signup and view all the answers

    When the head of the humerus appears to be below the coracoid process in an image of a Scapula Y, what does this mean?

    <p>The shoulder presents an anterior dislocation</p> Signup and view all the answers

    When the head of the humerus appears to be behind or at the tip of the acromion process in an image of a Scapula Y, what does this mean?

    <p>The shoulder presents a posterior dislocation</p> Signup and view all the answers

    You take a Scapula Y image and see that the scapula looks flat. What is wrong with the positioning of your patient?

    <p>Your patient has been over rotated</p> Signup and view all the answers

    Study Notes

    Shoulder Girdle Overview

    • Formed by the clavicle and scapula, connecting the upper limb to the trunk.
    • Clavicle is classified as a long bone, while the scapula is classified as a flat bone.

    Clavicle Anatomy

    • Medial end known as the sternal extremity; lateral end known as the acromial extremity.
    • The double curve of the clavicle is more pronounced in males.

    Scapula Anatomy

    • The costal surface (anterior surface) faces the thoracic cavity.
    • Acromion is a lateral extension of the scapula, articulating with the clavicle.

    Joints and Classifications

    • Sternoclavicular (SC) and acromioclavicular (AC) joints are synovial and classified as gliding joints.

    Imaging Techniques

    • Standard SID for shoulder images is 40 inches.
    • Common shoulder projections include AP Shoulder (internal/external rotation) and AP Oblique (Grashey method).

    Patient Positioning and Technique

    • AP shoulder projections require suspended respiration.
    • Use neutral arm position for patients with suspected fractures or dislocations.

    Specific Projections

    • AP Shoulder External Rotation: Supinate hand, epicondyles parallel to the IR.
    • AP Shoulder Internal Rotation: Hand against hip, epicondyles perpendicular to the IR.
    • AP Shoulder Neutral Rotation: Epicondyles at a 45-degree angle to the IR.
    • Grashey Method: 35-45 degrees rotation towards the IR, abduct arm in slight internal rotation.
    • Transthoracic Lateral Projection (Lawrence Method): Performed upright or supine; CR enters at the surgical neck.

    CR Directions and Angles

    • AP projections: CR enters 1 inch inferior to coracoid process.
    • Inferosuperior Axial Projection: CR angles 15-30 degrees medially based on arm abduction.
    • Neer Method: CR angled 10-15 degrees caudad, aimed at the superior aspect of the humeral head.

    Diagnostic Uses

    • PA Oblique scapular Y projection is useful for diagnosing shoulder dislocations.
    • Neer Method aids in identifying shoulder impingement.
    • Normal shoulder imaging should show the humeral head superimposed over the scapula's junction.

    Observations in Imaging

    • Anterior dislocation presents with the humeral head located below the coracoid process.
    • Proper positioning prevents the scapula from appearing overly flat or superimposed on lung markings.

    Breathing Instructions

    • Breathing for most shoulder projections should be suspended.
    • For the Lawrence method, slow deep breathing helps minimize lung motion in imaging.

    Common Issues

    • Under-rotation or over-rotation can distort scapula appearance in scapular Y projections.
    • The scapula should not be superimposed on ribs; it should lie flat along the thorax's lateral aspect.

    Clinical Implications

    • 90% of shoulder dislocations are anterior.
    • Recognizing the position of the humeral head relative to surrounding structures is crucial in trauma assessments.### Projection Techniques
    • RPO (Right Posterior Oblique) position requires angulation of 35-45 degrees for imaging.
    • RAO (Right Anterior Oblique) position requires 45-60 degrees of angulation.
    • LAO (Left Anterior Oblique) position also requires 45-60 degrees of angulation.

    Frisk Method

    • The Fisk method is utilized to visualize the intertubercle groove of the humerus.
    • Alternative methods for imaging include the Neer Method and Garth Method.

    Humerus Position in Fisk Method

    • For the Fisk method, the humerus is angulated at 10-15 degrees.
    • In this projection, the humerus maintains a vertical position relative to the table.
    • The Central Ray (CR) in the Fisk method is positioned tangential to the body.

    Bilateral AP-AC Joint (Pearson) Projection

    • The CR must be perpendicular to the midline of the body, centered at the level of the AC joint.
    • If images are taken individually for each shoulder, the CR is perpendicular to the acromioclavicular joint.

    SID Requirements

    • The Standard Source-to-Image Distance (SID) for an AP-AC joint (Pearson) projection is 72 inches.
    • A longer SID (72 inches) aids in reducing magnification and distortion in images.

    Weights for Bilateral Pearson Projection

    • The weights used in the bilateral Pearson projection should range from 5 to 10 pounds.

    Evaluation through AP-AC Joint Projections

    • AP-AC joint (Pearson) projections are performed to assess dislocation, separation, and function of the acromioclavicular joint. This statement is true.

    CR Location for Clavicle Projections

    • For an AP clavicle projection, the CR enters at the midshaft of the clavicle.
    • Essential joints included in an AP clavicle image are the acromioclavicular joint and the sternoclavicular joint.

    Respiratory Instructions for Projections

    • For the AP clavicle projection, breathing should be suspended at the end of exhalation.
    • In the AP axial clavicle projection, respiration instructions specify to be suspended at the end of full inspiration.

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    Description

    This quiz covers the anatomy of the shoulder girdle, including the clavicle and scapula, as well as the associated joints like the sternoclavicular and acromioclavicular joints. Additionally, it addresses imaging techniques and patient positioning for shoulder assessments. Test your knowledge on these critical concepts in shoulder anatomy.

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