The shoulder girdle consists of what?
humerus scapula clavicle
The three aspects of the clavicle are the?
acromial extremity, body, and sternal angle
The (male or female) clavicle tends to be thicker and more curved in shape?
Male
The three angles of the scapula include the?
Lateral, superior, inferior
The anterior surface of the scapula is referred to as the _____ surface?
Costal
What is the anatomic name for the armpit?
Axilla
What are the names of the two fossae located on the posterior scapula?
infraspinous supra spinous
All of the joints of the shoulder girdle are classified as being?
synovial
What type of movement does the scapulohumeral joint have?
spherodial joint (ball and socket)
What type of movement does the sternoclavicular joint have?
gliding joint (double plane)
What type of movement does the acromioclavicular joint have?
gliding joint (plane)
The use of a grid is not required for shoulder studies that measure
less than 10cm.
TRUE
The kV range for adult shoulder projections is between 80 and 90 kV
for analog and 100 to 110 kV for digital imaging systems.
FALSE
Low mA with short exposure times should be used for adult shoulder studies.
FALSE
Large focal spot setting should be selected for most adult shoulder studies.
FALSE
A high-speed screen-IR system is recommended for analog shoulder
studies when using a grid.
TRUE
A 72in source-image distance (SID) is recommended for most shoulder
girdle studies.
FALSE
The use of contact shields over the breast, lung, and thyroid regions
is recommended for most shoulder projections.
TRUE
Which one of the following kV ranges should be used for a shoulder
series on an average adult?
a. 70-80 kV
b. 55-60 kV
c. 80-90 kV
d. 65-75 kV
A. 70-80 kV
If physical immobilization is required, which individual should be
asked to restrain a child for a shoulder series?
a. parent or guardian
b. radiologic technologist
c. radiography student
d. nurse aide
A. parent or guardian
CT arthrography of the shoulder joint often requires the use of
iodinated contrast media injected into the joint space.
TRUE
Magnetic resonance imaging (MRI) is an excellent modality for
demonstrating bony injuries of the shoulder girdle.
FALSE
Nuclear medicine bone scans can demonstrate signs of osteomyelitis
and cellulitis.
TRUE
Radiography is more sensitive than nuclear medicine for demonstrating
physiologic aspects of the shoulder girdle.
FALSE
Sonography can provide a functional evaluation of joint movement that
MRI cannot.
TRUE
Which one of the following clinical indications requires a decrease
in manual exposure factors?
a. impingement syndrome
b. bursitis
c. bankart lesion
d. osteoporosis
d. osteoporosis
Which two routine shoulder projections are routinely taken for a
shoulder (with no traumatic injury) and proximal humerus?
AP internal and AP external
Specifically, where is the CR placed for an AP projection of the shoulder?
1 inch inferior to coracoid process and CR is perpendicular to IR
Which lateral projection can be performed to demonstrate the entire
humerus for a patient with a midhumeral fracture?
Transthoracic lateral projection for humerus
To best demonstrate a possible Hill-Sachs defect, which additional
positioning technique can be added to the inferosuperior axial projection?
a. angle CR 10-15 degrees caudad
b. rotate affected arm externally approximately 45 degrees
c. angle CR 3-5 degrees caudad
d. place humeral epicondyles parallel to IR
b. rotate affected arm externally approximately 45 degrees
What type of CR angulation is required for the inferosuperior axial
projection for the shoulder?
a. 25-30 degrees medially
b. 35-45 degrees medially
c. 25 degrees anterior and 25 degrees medially
d. CR perpendicular to IR
25-30 degrees medially
The _________ projection of the shoulder produces an image of the
glenoid process in profile.
posterior oblique (grashey method)
Which one of the following projections produces a tangential
projection of the intertubercular groove?
a. fisk modification
b. grashey method
c. hobbs modification
d. lawrence method
a. fisk modification
The supine version of the tangential projection for the
intertubercular groove requires that the CR be angled ____________
posteriorly from the horizontal plane.
10-15 degrees
Which one of the following projections is best for demonstrating a
possible dislocation of the proximal humerus?
a. posterior oblique (grashey)
b. fisk modification
c. inferosuperior axial (clements modification)
d. scapular y projection
d. scapular y projection
The ______ projection is the special projection of the shoulder that
best demonstrates the acromiohumeral space for possible subacromial
spurs, which create shoulder impingement symptoms. This projection is
also referred to as the ______ method.
tansgential, Neer
Which of the following nontraume projections can be performed erect
to provide a lateral view of the proximal humerus in relationship to
the glenohumeral joint?
a. tangential projection (fisk modification)
b. AP projection-neutral rotation
c. PA transaxillary projection (hobbs modification)
d. posterior oblique position (grashey method)
c. PA transaxillary projection (hobbs modification)
How much is the CR angled for the inferosuperior axial projeciton
(clements modification) if the patient cannot fully abduct the arm 90 degrees?
a. 5-15 degrees
b. 45 degrees
c. 25-30 degrees
d. 20 degrees
a. 5-15 degrees
What CR angle is required for the AP axial projection (alexander
method) for AC joints?
a. 25 degrees cephalad
b. 5-10 degrees caudad
c. 45 degrees caudad
d. 15 degrees cephalad
d. 15 degrees cephalad
The PA transaxillary projection (hobbs modification) requires no CR angle.
TRUE
The transthoracic lateral projection can be performed for possible
fractures or dislocations of the proximal humerus.
TRUE
The affected arm must be placed into external rotation for the
transthoracic lateral projection.
FALSE
The use of a breathing technique can be performed for the
transthoracic lateral humerus projection.
TRUE
A CR angle of 10-15 degrees caudad may be used for the transthoracic
lateral projections if the patient is unable to elevate the uninjured
arm and shoulder sufficiently.
FALSE
The scapular Y lateral position requires the body to be rotated 30-40
degrees anteriorly toward the affected side.
FALSE
Which two landmarks are placed perpendicular to the IR for the scap Y
lateral projection?
Superior angle of scapula and AC joint
Which special projection of the shoulder requires that the affected
side to be rotated 45 degrees toward the cassette and uses a 45 degree
caudad CR angle.
AP apical oblique axial
A posterior dislocation of the humerus projects the humeral head
______ to the glenoid cavity with the AP apical oblique axial.
(superior or inferior)
superior
A thin-shouldered patient requires (more, less) CR angle for an AP
axial clavicle projection than a large shouldered patient.
more
What must be ruled out before performing the weight bearing study for
the AC joints?
fracture of clavicle
Where is the CR centered for the AP scapula projection?
perpendicular to mid scapula
What type of CR angle is required for the lateral scapula position?
a. 10-15 degrees cephalad
b. 5-15 degrees caudad
c. 10-15 degrees caudad
d. none
d. none
The following factors were used to produce a radiograph of an AP
projection of the shoulder: 85 kV, 20 mAs, high-speed screens,
40" SID, grid, and suspended respiration. The resultant
radiograph demonstrated poor radiographic contrast between bony and
soft tissue structures. Which of these factors can be altered during
the repeat exposure to improve radiographic quality?
Lower the kV to 75 and double mAs to 40, which increases radiographic contrast
A radiograph of an AP axial clavicle projection reveals that the
clavicle is projected below the superior border of the scapula. What
can the technologist do to correct this problem during the repeat exposure?
Increase CR cephalad angle
A radiograph of an AP scapula reveals that the scapula is within the
lung field and difficult to see. Which two things can be the
technologist do to improve the visibility of the scapula during the
repeat expsoure?
Ensure that the affected arm is abducted to 90 degrees and use a
breathing technique
A radiograph of an AP projection (with external rotation) of a
shoulder (with no traumatic injuries) reveals that neither the greater
nor lesser tubercles are profiled. What must be done to correct this
during the repeat exposure?
Supinate the hand and ensure that the epicondyles are parallel to the
IR for a true AP
A radiograph of a lateral scapula position reveals that it is not a
true lateral projection. (Consider separation exists between the
axiallary and vertebral borders) The projection was taken using the
following factors: erect position, 40" SID, 45 degree rotation
toward the cassette from PA, CR centered to midscapula, an no CR
angulation. Based on these factors, how can this position be improved
during the repeat exposure?
Palpate the superior angle of the scapula and AC joint articulation
and ensure that the imaginary plane between these points is
perpendicular to the IR
A radiograph of the AP oblique (grashey) taken as a 35 degree oblique
projection reveals that the borders of the glenoid cavity are not
superimposed. The patient has large, rounded shoulders. What must be
done to get better superimposition of the cavity during the repeat exposure?
Increase rotation of affected shoulder toward IR to closer to 45
degree angle
A patient with a possible right shoulder dislocation enters the
emergency room. The technologist attempts to perform an erect
transthoracic lateral projection, but the patient is unable to raise
the left arm and shoulder high enough. The resultant radiograph
reveals that the shoulders are superimposed, and the right shoulder
and humeral head are not well visualized. What can be done to improve
this image during the repeat exposure?
Angle the CR 10-15 degrees cephalad to separate the shoulders
A patient with a possible fracture of the right proximal humerus from
an automobile accident enter the emergency room. The patient has other
injuires and is unable to sit or stand erect. Which positioning
routine should be used to determine the extent of the injury?
The routine includes the AP of right shoulder and humerus without
rotation and a supine horizontal beam, right transthoracic shoulder.
Note: in those cases in which the opposite arm cannot be elevated or
extended, a supine posterior oblique scap Y lateral projection could
also be used as a second option for a lateral shoulder position
A patient with a clinical history of chronic shoulder dislocation
comes to the radiology department. The orthopedic physician suspects
that a Hill-Sachs defect may be present. Which specific position(s)
may be used to best demonstrate this pathologic feature?
Possible positioning options: inferosuperior axial projection with
exaggerated external rotation, inferosuperior axial projection
(clements modification) and AP apical oblique axial projection (Garth method)
A patient with a possible Bankart lesion comes to the radiology
department. List three projections that can be performed that may
demonstrate signs of this injury:
AP internal rotation
Scapular Y lateral
Posterior oblique (grashey)
A patient with a possible rotator cuff tear comes into the radiology
department. Which one of the following imaging modalities would best
demonstrate this injury?
a. arthrography
b. MRI
c. nuclear medicine
d. radiography
b. MRI
A patient with a clinical history of tendon injury in the shoulder
comes to the radiology department. The orthopedic physician needs a
functional study of the shoulder joint performed to determine the
extent of the tendon injury. Which of the following modalities would
best demonstrate this injury?
a. arthrography
b. MRI
c. Ultrasound
d. Nuclear medicine
c. ultrasound
A radiograph of an AP projection with external rotation of the
shoulder does not demonstrate either the greater or lesser tubercle in
profile. What is the most likely cause for this radiographic outcome?
The humeral epicondyles were not placed parallel to the plane of the IR.
A patient enters the ER with a definite fracture to the midhumerus.
Because of other trauma the patient is unable to stand. Which lateral
projection would demonstrate the entire humerus?
Transthoracic lateral projection for humerus
The AP apical oblique axial projection (garth method) is performed on
a patient with a shoulder injury. The resultant radiograph
demonstrates the proximal humeral head projection below the glenoid
cavity. What type of trauma or pathology is indicated with the
radiographic appearance?
Anterior dislocation of the proximal humerus.
A radiograph of a transthoracic lateral projection demonstrates
considerable superimposition of lung markings and ribs over the region
of the proximal shoulder. What can the technologist do to minimize
this problem during the repeat exposure?
Use breathing exposure technique to create blurring of ribs and lung makrings
Select the terms that correctly describe the shoulder joint.
a. humeroscapular
b.scapulohumeral
c. glenohumeral
d. b and c
d. b and c
Which specific joint is found on the lateral end of the clavicle?
a. scapulohumeral
b. sternoclavicular
c. acromioclavicular
d. glenohumeral
c. acromioclavicular
Which of the following is not an angle found on the scapula?
a. inferior angle
b. medial angle
c. lateral angle
d. superior angle
b. medial angle
Which one of the following structures of the scapula extends more anteriorly?
a. glenoid cavity
b. acromion
c. scapular spine
d. coracoid process
d. coracoid process
The male clavicle is shorter and less curved than the female clavicle.
FALSE
Which bony structure separates the supraspinous and infraspinous fossae?
a. scapular spine
b. glenoid cavity
c. acromion
d. superior border of scapula
a. scapular spine
Which one of the following structures is considered to be the most posterior?
a. scapular notch
b. coracoid process
c. acromion
d. glenoid process
c. acromion
What is the type of joint movement for the scapulohumeral joint?
a. plane
b. ellisoidal
c. spheroidal
d. trochoidal
b. spheroidal
Which one of the following analog technical considerations does not
apply for adult shoulder radiography?
a. non-grid
b. high-speed IR
c. 40-44 inch SID
d. 70-80 kV
a. non-grid
Even though the amount of radiation exposure is minimal for most
shoulder projections, gonadal shielding should be used for children
and adults of childbearing age.
TRUE
The greatest technical concern during a pediatric shoulder study is
voluntary motion.
TRUE
Which one of the following imaging modalities or procedures provides
a functional, or dynamic, study of the shoulder joint?
a. ultrasound
b. CT arthrography
c. MRI
d. nuclear medicine
d. nuclear medicine
Which one of the following projections and/or positions best
demonstrates signs of impingement syndrome?
a. AP and lateral shoulder external rotation
b. inferosuperior axial
c. inferosuperior axial with exaggerated rotation
d. tangential projection (neer method)
d. tangential projection (neer method)
Which one of the following pathological conditions often produces
narrowing of the joint space?
a. osteoarthritis
b. bursitis
c. osteoporosis
d. idopathic chronic adhesive capsulitis
a. osteoarthritis
Which one of the following pathological conditions may require a
reduction in manual exposure factors?
a. bursitis
b. rheumatoid arthritis
c. rotator cuff tear
d. bankart lesion
b. rheumatoid arthritis
Which routine projection of the shoulder requires that the humeral
epicondyles be parallel to the IR?
a. external rotation
b. neutral rotation
c. internal rotation
d. posterior oblique-grashey method
a. external rotation
Where is the CR centered for an AP projection - external rotation of
the shoulder?
a. acromion
b. 1" superior to coracoid process
c. 1" inferior to coracoid process
d. 2" inferior to acromioclavicular joint
c. 1" inferior to coracoid process
Which position of the shoulder and proximal humerus projects the
lesser tubercle in profile medially?
a. external rotation
b. neutral rotation
c. internal rotation
d. exaggerated rotation
c. internal rotation
What CR angle should be used for the inferosuperior axial projection
for the scapulohumeral joint space?
a. 15 degrees medially
b. 25-30 degrees medially
c. 25 degrees anteriorly and medially
d. 35-45 degrees medially
b. 25-30 degrees medially
To best demonstrate the Hill-Sachs defect on the inferosuperior axial
projection, which additional positioning maneuver must be used?
a. angle CR 35 degrees medially
b. use exaggerated external rotation
c. use exaggerate internal rotation
d. abduct arm 120 degree rotation from midsagittal plane
b. use exaggerated external rotation
How are the humeral epicondyles aligned for a rotational lateromedial
projection of the humerus?
a. 45 degrees to IR
b. perpendicular to IR
c. parallel to IR
d. 20 degree angle to IR
b. perpendicular to IR
Which special projection of the shoulder places the glenoid cavity in
profile for an "open" scapulohumeral joint?
a. garth method
b. fisk modification
c. transthoracic lateral - lawrence method
d. grashey method
d. grashey method
For the erect version of the tangential projection for the
intertubercular groove, the patient leans forward _______ from vertical.
a. 5-7 degrees
b. 20-25 degrees
c. 10-15 degrees
d. 35-45 degrees
c. 10-15 degrees
What is the major advantage of the supine, tangential version of the
intertubercular groove projection over the erect version?
a. less radiation exposure
b. reduced OID
c. less risk for motion
d. ability to use automatic exposure control
b. reduced OID
Which one of the following projections best demonstrates the
supraspinatus outlet region?
a. tangential projection (neer method)
b. fisk method
c. inferosuperior axial
d. PA transaxillary projection (hobbs modification)
a. tangential projection (neer method)
Which one of the following projections can a breathing technique be employed?
a. grashey method
b. transthoracic lateral for humerus
c. scapular Y lateral
d. garth method
b. transthoracic lateral for humerus
What CR angulation is required for the tangential
projection-supraspinatus outlet(neer method)?
a. 10-15 degrees caudad
b. 45 degrees caudad
c. 25 degrees anteriorly and medially
d. none, CR is perpendicular
a. 10-15 degrees caudad
Which clinical indication is best demonstrated with the Garth method?
a. bursitis
b. rheumatoid arthritis
c. scapulohumeral dislocations
d. signs of shoulder impingement
c. scapulohumeral dislocations
Which anatomy of the shoulder is best demonstrated with a PA
transaxillary projection (Hobbs modification)?
a. scaulohumeral joint space.
b. coracoacromial arch
c. coracoid process
d. scapula in profile
a. scapulohumeral joint space
If the patient cannot fully abduct the affected arm 90 degrees for
the inferosuperior axial projection (clements modification), the
technologist can angle the CR ________ degrees toward the axilla.
a. 5-10
b. 20-25
c. 25-30
d. 45
a. 5-10
Which one of the following projections requires the CR to be centered
2" inferior and medial from the superolateral border of the shoulder?
a. tangential projection (fisk modification)
b. inferosuperior axial (clements projection)
c. posterior oblique (grashey method)
d. scapular y lateral projection
c. posterior oblique (grashey method)
Which anatomy is best demonstrated with the alexander method?
a. scapulohumeral joint
b. coracoid process
c. proximal humerus
d. AC joints
d. AC joints
Which type of injury must be ruled out before the weight-bearing
phase of the AC joint study?
a. shoulder separation
b. fractured clavicle
c. bursitis of the scapulohumeral joint
d. bankart lesion
b. fractured clavicle
What is the minimum amount of weight a large adult should have
strapped to each wrist for the weight-bearing phase of an AC joint study?
a. 5-7 pounds
b. 8-10 pounds
c. 12-15 pounds
d. 20-30 pounds
b. 8-10 pounds
A PA axial projection of the clavicle requires a 35-45 degree caudal
CR angle.
FALSE
A 72" SID is recommended for AC joint studies.
True.
Which two positioning lankmarks are aligned perpendicular to the IR
for the lateral scapula projection?
a. scapular spine and greater tubercle
b. superior angle and AC joints
c. AC joint and greater tubercle
d. acromion and coracoid process
b. superior angle and AC joints
A radiograph of a posterior oblique (grashey method) reveals that the
anterior and posterior glenoid rims are not superimposed. The
following positioning factors were used: erect position, body rotated
25-30 degrees toward the affected side, CR perpendicular to
scapulohumeral joint space, and affected arm slightly abducted in
neutral rotation. Which one of the following modifications will
superimpose the glenoid rims during the repeat exposure?
a. angle CR 10-15 degrees caudad
b. rotate body less toward affected side
c. place affected arm in external rotation position
d. rotate body more toward affected side
d. rotate body more toward affected side
A patient with a possible shoulder dislocation enters the emergency
room. A neutral AP projection of the shoulder has been taken,
confirming a dislocation. Which additional projection should be taken?
a. inferosuperior axial (clements method)
b. alexander method
c. garth method
d. AP, external rotation
c. garth method
A radiograph of an AP axial clavicle taken on an asthenic type
patient reveals that the clavicle is projected in the lung field below
the top of the shoulder. The following positioning factors were used:
erect position, CR angled 15 degrees cephalad, 40" SID, and
respiration suspended at the end of expiration. Which one of the
following modifications should be made during the repeat exposure?
a. increase CR angulation
b. suspend respiration at end of inspiration
c. reverse CR angulation
d. use 72" SID
a. increase CR angulation
A patient with a possible right shoulder separation enters the
emergency room. Which one of the following routines should be used?
a. AC joint series: non-weight-bearing and weight-bearing projections
b. AP neutral projection and garth method
c. AP neutral projection and transthoracic lateral projections
d. AP internal and external projections
a. AC joint series: non-weight bearing and weight-bearing projections
A patient comes to the radiology department with a history of
tendonitis of the bicep tendon. Which of the following projections
will best demonstrate calcification of the tendon within the
intertubercular groove?
a. garth method
b. grashey method
c. PA transaxillary projection (hobbs modification)
d. tangential projection - fisk modification
d. tangential projection - fisk modification
An AP apical oblique axial (garth method) radiographic image
demonstrates poor visibility of the shoulder joint. The technologist
used the following factors: patient erect, facing the x-ray tube, 45
degree rotation of affected shoulder toward the IR, 45 degree cephalad
angle, and CR centered to the scapulohumeral joint. What of the
following factors would have contributed to this poor garth position?
a. wrong direction of CR angle
b. incorrect CR centering
c. position must be performed recumbent
d. shoulder rotated in wrong direction
a. wrong direction of CR angle
A patient is referred to radiology department for a nontrauma
shoulder series. The routine calls for a PA transaxillary projection
(hobbs modification) be included. But the patient is unable to stand
and is confined to a wheelchair. What should the technologist do at
this point?
a. ask another technologist to hold the patient erect for the projection
b. perform the projection with the patients upper chest prone on the table
c. perform a recumbent posterior oblique (grashey method) instead
d. eliminate projection from positioning routine
b. perform the projection with the patient's upper chest prone on the table