What does the shoulder girdle consist of
What does the shoulder girdle articulate with
Head of humerus (shoulder joint)
Manubrium of sternum (Sternoclavicular joint) or SC joint
Acromioclavicular joint or AC joint
What are the functions of the shoulder girdle
To connect the upper limb to the trunk of the body
What is not considered to be part of the shoulder girdle
What is the shoulder joint classified as by function
What is the shoulder joint classified as by anatomy (structure)
What type of joint is the shoulder joint
Ball and socket, capable of all motions
What type of bone is the clavicle classified as
What rib does the clavicle lie just above
What does the acromial extremity (lateral end) of the clavicle articulate with
Articulates with the acromion of the scapula (AC joint)
What does the sternal extremity (medial end) of the clavicle articulate with
Articulates with manubrium of the sternum (SC joint)
Who has more of a curve in the clavicles males or females
What kind of bone is the scapula classified as
Does the scapula form the anterior or posterior portion of the shoulder girdle
What shape does the scapula resemble
What are the two surfaces for the scapula
Costal (anterior)
Dorsal (posterior)
What are the three borders of the scapula
Lateral, medial, superior
What are the three angles of the scapula
Superior, inferior, lateral
What are two radiation protection measures
Close collimation
Optimum technique factors
What projection of the shoulder may use a breathing technique
Transthoracic lateral projection (low mA with long exposure time)
What are the essential projections for a shoulder
AP projection
- Internal rotation
- external rotation
- neutral position
AP oblique (Grashey method)
Transthoracic lateral (Lawrence method)
Inferosuperior axial (Lawrence method)
PA oblique (scapular Y)
Where is the CR for an AP projection internal rotation of the shoulder
enters patient 1 inch inferior to the coracoid process
AP shoulder - internal rotation
For an AP projection internal rotation of the shoulder what tubercle should be seen in profile and pointing medially
For an AP projection internal rotation of the shoulder what tubercle is superimposing the humeral head
Where is the CR for an AP projection external rotation of the shoulder
1 inch inferior to the coracoid process
AP shoulder - external rotation
What projection of the shoulder shows the humeral head in profile
AP projection - external rotation
For an AP projection external rotation of the shoulder what tubercle is in profile on the lateral aspect of the humerus
What joint should be visualized with slight overlap of the humeral head on the glenoid cavity on a projection of an AP shoulder external rotation
For an AP projection neutral position of the shoulder how should the patient rest the palm of their hand
Against the thigh to place the epicondyles at a 45° angle to the IR
Where is the CR for an AP projection neutral position of a shoulder
1 inch inferior to the coracoid process
For an AP oblique (Grashey) what is the degrees for the position
Where is the CR for an AP oblique shoulder (Grashey)
Perpendicular to the glenoid cavity
For an AP oblique shoulder (Grashey) what open joint space should we see
Open joint space between the humeral head and glenoid cavity
What projection of the shoulder is used for trauma patients who cannot rotate or abduct the arm
Transthoracic lateral (Lawrence method)
What is the CR for a transthoracic lateral shoulder
Enters midcoronal plane at surgical neck (if shoulders are in the same plane, the CR is angled 10 to 15° cephalad)
If possible, how should the arm be placed for an inferosuperior axial projection of the shoulder (Lawrence method)
Place arm in external rotation
How should the image receptor be placed for a supine inferosuperior axial projection of the shoulder
Where is the CR for an inferosuperior axial projection of a shoulder
Enters axilla; passes through AC joint
-horizontal
- Medial
angulation of 15 to 30° (angle
depends on abduction of humerus)
Inferosuperior axial projection
Which projection of the shoulder shows the coracoid process, and lesser tubercle pointing/directed anteriorly
Inferosuperior axial projection
Why is the PA oblique projection also known as scapular Y
Because when properly positioned, the acromion and coracoid process form a Y shape
What position of the shoulder is particularly useful to diagnose shoulder dislocations
What is the degree of angle for a PA oblique (scapular Y) shoulder
Where is the CR for a PA oblique (scapular Y) shoulder
Perpendicular to the scapulohumeral joint
What things should be superimposed on a PA oblique (scapular Y) shoulder projection
Humeral head and glenoid cavity
Humeral shaft and scapular body
What is the essential projection for an AC joint
AP projection (Pearson method)
What is an AP projection of the AC joint also known as
For an AP AC joint projection why does the patient need to be upright
Because the supine position will reduce dislocation, if present
What two exposures need to be made for an AP AC joint projection
One without patients arms weighted
One with weights affixed to patient’s arm
Where is the CR for an AP AC joint projection
Perpendicular to the midline of the body at the level of AC joint
What are the essential projections for a clavicle
Why are PA projections of the clavicle preferred
Because of reduced OID and improved image quality.
How are AP projections of the clavicle done
With a patient in a recumbent position
Where is the CR for an AP clavicle
Perpendicular to midshaft clavicle
For an AP/PA clavicle where should the lateral half of the clavicle be
For an AP/PA clavicle where should the medial half of the clavicle be
How is the patient positioned for an AP axial clavicle
Upright, lordotic position, if possible (if lordotic position is not possible supine with the shoulders in the same plane)
Where is the CR for an AP axial clavicle lordotic position
Enters midshaft clavicle 0 to 15° cephalic
Where is the central ray for an AP axial clavicle in the supine position
Enters mid shaft of clavicle 15 to 30° cephalic
For an AP axial clavicle the amount of angle varies with what
Patient thickness (thinner patients equals more angle)
For an AP/PA axial clavicle most of the clavicle needs to be projected above the what
Ribs & scapula with the medial end overlapping the first or second rib
What are the essential projections for the scapula
For an AP scapula how is the arm positioned
Abduct arm to right angle and flex elbow
Where is the CR for an AP scapula
Perpendicular to 2 inches inferior to the coracoid process
For an AP scapula which portion of the scapula is free of superimposition from the ribs
What is the degree of angle for a lateral scapula
45 to 60° anterior oblique position
Can a posterior oblique position be used for a lateral scapula?
Yes but the scapula will be magnified
How is the patient positioned for a lateral scapula to demonstrate the acromion and coracoid process
Flex elbow, and place back of the hand on posterior thorax (adjust to ensure humerus does not overlap scapula,
OR
bring arm across the anterior thorax and grasp opposite shoulder
How is the patient positioned for a lateral scapula to demonstrate the body of the scapula
Extend arm upward, and rest forearm on head
OR
Bring across anterior chest, grasp opposite shoulder
Where is the CR for a lateral scapula
Perpendicular to the medial border of the scapula
Lateral scapula with arm across upper anterior thorax
On a lateral scapula what borders are superimposed
Lateral and medial borders
The scapular notch is located on what border
What is the lateral, thickened end of the scapular spine called
What is the required patient position to demonstrate the left shoulder in a PA oblique scapular Y
How is the affected arm positioned for the inferosuperior axial projection (Lawrence method)
Abducted to a right angle and in external rotation
What is the CR angle and direction for the AP axial projection of the clavicle when the patient is positioned supine
How is the affected upper limb positioned to demonstrate the acromion and coracoid on the lateral projection of the scapula
Elbow flexed with the back of the hand resting on the posterior thorax
What classification of bone is the scapula?
What classification of bone is the clavicle?
What is the name of the fossa in the anterior surface of the scapula?
Which border of the scapula extends from the glenoid cavity to the inferior angle?
Which border of the scapula extends from the superior angle to the inferior angle
Of which part of the scapula is the acromion an extension?
Where is the coracoid process located in reference to the body of the scapula?
Which borders of the scapula unite to form the superior angle?
Which borders of the scapula unite to form the inferior angle
Where is the scapular notch located?
Which joint is a ball and socket joint?
Which portion of the scapula articulates with the humeral head?
Which portion of the scapula articulates with the clavicle?
When performing AP projections of the shoulder where should the central ray be directed?
1 inch inferior to the coracoid process
With reference to the plane of the IR, how should the humeral epicondyles be positioned for the AP projection of the shoulder with the shoulder in external rotation?
With reference to the plane of the IR, how should the humeral epicondyles be positioned for the AP projection of the shoulder with the shoulder in internal rotation?
With reference to the plane of the IR, how should the humeral epicondyles be positioned for the AP projection of the shoulder with the shoulder in neutral position?
45 degrees medial oblique
Which projection of the shoulder best demonstrates the greater tubercle of the humerus in profile?
AP projection with external rotation
Which projection of the shoulder best demonstrates the humeral head in profile?
AP projection with external rotation
Which projection of the shoulder best demonstrates the lesser tubercle of the humerus in profile and pointing toward the glenoid cavity?
AP projection with internal rotation
Which projection of the shoulder is being performed when the patient is supine with the right shoulder centered on the IR, a vertical central ray is being directed perpendicular to the center of the IR and the humeral epicondyles are parallel with the plane of the IR?
AP projection with external rotation
What should be adjusted from the regular procedure for the transthoracic lateral projection (Lawrence method) of the humerus if the patient is unable to elevate the unaffected arm?
Which projection of the upper limb should be performed to demonstrate a fracture of the proximal humerus when that arm can not be abducted?
Transthoracic lateral projection (Lawrence method) of the humerus
When performing the transthoracic lateral projection (Lawrence method) of the humerus, which breathing technique should be used?
Suspended full inspiration
Which projection of the shoulder requires that a horizontal central ray be directed 15-30 degrees medially and enter the axilla of the affected arm?
Inferosuperior axial projection (Lawrence method)
What is the proper position of the humerus for the inferosuperior axial projection?
Abducted to a right angle and externally rotated
How should the central ray be directed for the PA oblique projection (scapular Y) of the shoulder?
In which body position should the patient be placed to demonstrate the left shoulder with the PA oblique projection (scapular Y)
Which projection of the shoulder joint requires the patient to be rotated until the midcoronal plane forms an angle of 45-60 degrees with the plane of the IR?
PA oblique projection (scapular Y)
Where is the humerus generally demonstrated on a PA oblique shoulder (scapular Y) image if the shoulder is normal?
Superimposed on the junction of the acromion and coracoid process
Where is the humeral head usually seen on a PA oblique (scapular Y) image if the shoulder is anteriorly dislocated?
Beneath the coracoid process
Which projection of the shoulder girdle is performed with the patient supine, an IR placed vertically against the superior surface of the shoulder, and the central ray angled 10-15 degrees posteriorly
Tangential for the intertubercular (bicipital) groove
Which projection demonstrates the scapulohumeral joint space open and the glenoid cavity in profile?
AP oblique projection (grashey method)
What would be the required patient position to demonstrate the left shoulder using the AP oblique projection (Grashey Method)
If the patients condition permits, which joint should be demonstrated with the patient in an upright position?
How many degrees and in which direction should the central ray be directed for the PA axial projection of the clavicle?
How many degrees and in which direction should the central ray be for the AP axial projection of the clavicle with the patient supine?
When performing the AP projection of the scapula, the central way should be directed toward a point, 2 inches WHAT to the coracoid process
When performing a lateral projection of the scapula with the patient positioned RAO or LAO, approximately how much body rotation is necessary for the average patient?