Deck 5: Humerus and Shoulder Girdle

Question 1

Part 3 refers to the:

A) scapulohumeral joint.
B) glenohumeral joint.
C) glenoid cavity or fossa.
D) all of the above.

Answer 1

all of the above.

Question 2

Which of the following shoulder positions is considered a trauma projection (can be performed safely for a possible fracture or dislocation)?

A) AP apical oblique axial (Garth method) projection
B) Inferosuperior axial (Clements modification) projection
C) AP projection-internal rotation
D) None of the above

Answer 2

AP apical oblique axial (Garth method) projection

Question 3

All of the joints of the shoulder girdle are diarthrodial.

Answer 3

True

Question 4

Which AP projection of the shoulder and proximal humerus is created by placing the affected palm of the hand facing inward toward the thigh?

A) Internal rotation
B) Neutral rotation
C) External rotation
D) AP axial

Question 5

What additional maneuver must be added to the inferosuperior axial shoulder (Lawrence method)projection to best demonstrate a possible Hill-Sachs defect?

A) Increase medial CR angulation.
B) Angle the CR 10° to 15° downward or posteriorly in addition to the medial angle.
C) Perform exaggerated external rotation of the affected upper limb.
D) Increase abduction of the affected upper limb.

Question 6

The use of a grid during shoulder radiography will result in higher patient dose over nongrid procedures.

Question 7

Which term describes the medial end of the clavicle?

A) Acromial extremity
B) Acromion
C) Sternal extremity
D) Acromial tuberosity

Question 8

Which of the following joints is considered to have a spheroidal type of movement?

A) Acromioclavicular joints
B) Sternoclavicular joints
C) Bicipital joint
D) Scapulohumeral joint

Question 9

Part 5 refers to the:

A) coracoid process.
B) superior border of scapula.
C) lateral angle of scapula.
D) none of the above.

Question 10

Which view and projection of the proximal humerus is represented in the figure?

A) External rotation, anteroposterior (AP) projection
B) Neutral rotation, AP projection
C) Internal rotation, AP projection
D) External rotation, lateral projection

Question 11

Which of the following structures is not part of the proximal humerus?

A) Lesser tubercle
B) Glenoid process
C) Intertubercular groove
D) Anatomic neck

Question 12

Which rotation of the humerus will result in a lateral position of the proximal humerus?

A) Internal rotation (epicondyles perpendicular to image receptor)
B) Neutral rotation (epicondyles 45° to the image receptor)
C) External rotation (epicondyles parallel to the image receptor)
D) None of the above

Question 13

Part 3 refers to the greater tubercle.

Question 14

What medial central ray (CR)angle is required for the inferosuperior axial shoulder (Lawrence method)?

A) 5° to 10°
B) 40° to 45°
C) 25° to 30°
D) 10° to 15°

Question 15

The female clavicle is usually shorter and less curved than that of the male.

Question 16

What is the name of the insertion point for the deltoid muscle located on the anterolateral surface of the humerus?

A) Surgical neck
B) Deltoid protuberance
C) Deltoid tuberosity
D) Intertubercular groove

Question 17

Which of the following shoulder projections best demonstrates the glenoid cavity in profile?

A) Grashey method
B) Clements modification
C) Garth method
D) AP shoulder, neutral rotation

Question 18

Part 10 refers to the vertebral border of the scapula.

Question 19

What is the name of the large fossa found within the anterior surface of the scapula?

A) Supraspinous fossa
B) Infraspinous fossa
C) Subscapular fossa
D) Glenoid fossa

Question 20

The anterior surface of the scapula is referred to as the:

A) scapular surface.
B) dorsal surface.
C) supraspinous and infraspinous fossa.
D) costal surface.

Question 21

A radiograph of a transthoracic lateral projection reveals that it is difficult to visualize the proximal humerus due to the ribs and lung markings.The following analog exposure factors were used: 75 kV,30 mAs,40-inch (102 cm)SID,grid,and suspended respiration.Which of the following changes will improve the visibility of the proximal humerus?

A) Make the exposure on second inspiration.
B) Use a compression band to prevent patient movement.
C) Use a 72-inch (183 cm) SID.
D) Use an orthostatic (breathing) technique.

Question 22

An AP apical oblique projection for an anteriorly dislocated scapulohumeral joint will project the humerus _____ to the glenoid cavity.

A) superior
B) inferior
C) lateral
D) medial

Question 23

Where is the CR centered for a transthoracic lateral projection for proximal humerus?

A) 1 inch (2.5 cm) inferior to the acromion
B) Level of the greater tubercle
C) Level of surgical neck
D) Midaxilla

Question 24

Which projection of the shoulder requires that the patient be rotated 45° to 60° toward the IR from a PA position?

A) Inferosuperior axiolateral projection
B) AP oblique projection
C) Lateral scapula projection
D) None of the above

Question 25

Where is the CR centered for the bilateral acromioclavicular (AC)joint projection on a single 14- *17-inch (35 *43 cm)image receptor?

A) At the affected AC joint
B) 1 inch (2.5 cm) above jugular notch
C) At the level of the thyroid cartilage
D) At the sternal angle

Question 26

How much CR angulation should be used for a scapular Y projection?

A) No CR angle should be used.
B) 10° to 15°
C) 20° to 30°
D) 35° to 45°

Question 27

A radiograph of the inferosuperior axial projection (Lawrence method)demonstrates the acromion process of the shoulder to be located most superiorly (anteriorly).

Question 28

Which of the following projections can be performed using a breathing technique?

A) Scapular Y lateral projection
B) Inferosuperior axiolateral projection
C) AP clavicle
D) AP scapula

Question 29

A radiograph of an AP clavicle reveals that the sternal extremity is partially collimated off.What should the technologist do?

A) Repeat the AP projection and correct collimation.
B) Make sure the sternal extremity is included on the AP axial projection.
C) Only repeat it if the patient's pain/symptoms involve the sternal extremity.
D) Ask the radiologist whether he or she wants the projection repeated.

Question 30

The PA transaxillary projection (Hobbs modification)is performed to rule out possible shoulder dislocation.

Question 31

How much CR angulation is required for an asthenic patient for an AP axial projection of the clavicle?

A) 15°
B) 30°
C) 45°
D) No CR angulation should be used for this projection.

Question 32

For a Grashey method projection of the shoulder,the CR is centered to the acromion.

Question 33

A radiograph of an AP oblique projection for the glenoid cavity reveals that the anterior and posterior rims of the glenoid process are not superimposed.Which of the following modifications should produce a more acceptable image?

A) Angle CR 5° to 10° caudad.
B) Angle CR 5° to 10° cephalad.
C) Increase rotation of the body.
D) Abduct the arm slightly.

Question 34

Which of the following best demonstrates the coracoacromial arch?

A) Neer method
B) West Point method
C) Fisk method
D) Garth method

Question 35

A radiograph for an AP projection with external rotation of the proximal humerus reveals that the greater tubercle is profiled laterally.What should be changed to improve this image for a repeat exposure?

A) Rotate epicondyles so they are perpendicular to the image receptor.
B) Move the patient obliquely 10° to 15° toward the affected side.
C) Rotate the arm to place palm of the patient's hand against the thigh.
D) Positioning is acceptable; do not repeat it.

Question 36

The inferosuperior axial projection (Clements modification)requires a CR angle of ____ toward axilla if a patient cannot fully abduct extremity 90°.

A) 35°
B) none
C) 40° to 45°
D) 5° to 15°

Question 37

How much posterior CR angulation is required for the supine version of the tangential projection for the intertubercular (bicipital)groove?

A) 20° to 30°
B) 30° to 40°
C) 10° to 15°
D) No angle is used for this projection.

Question 38

PA transaxillary (Hobbs modification)requires a 5° to 15° CR cephalic angle.

Question 39

Which of the following modalities best demonstrates shoulder joint pathology such as rotator cuff tears using dynamic evaluation techniques during joint movements?

A) Ultrasound
B) Magnetic resonance imaging (MRI)
C) Computed tomography (CT)
D) Arthrography

Question 40

Which ionization chamber(s)for the AEC should be used for a tangential projection for an intertubercular groove?

A) Center chamber
B) Both outside chambers
C) Left chamber
D) Cannot use AEC with this projection

Question 41

A patient enters the ED with multiple injuries.The physician is concerned about a dislocation of the left proximal humerus.The patient is unable to stand.Which of the following routines is advisable to best demonstrate this condition?

A) AP shoulder and inferosuperior axiolateral projection
B) AP shoulder and 35° to 45° LPO position (Grashey method)
C) AP shoulder and Neer projection
D) AP shoulder and recumbent AP oblique scapular Y projection

Question 42

A radiograph of a scapular Y lateral position reveals that the scapula is slightly rotated (the vertebral and axillary borders are not superimposed).The axillary border of the scapula is determined to be more lateral compared with the vertebral border.Which of the following modifications should be made for the repeat exposure?

A) Decrease rotation of thorax.
B) Decrease CR angle.
C) Increase rotation of thorax.
D) Abduct the arm more and flex it at the elbow.

Question 43

The Hill-Sachs defect is a fracture of the articular surface of the glenoid cavity.

Question 44

The Alexander method for AC joints requires a 15° cephalic CR angle.

Question 45

The AP humerus requires that the humeral epicondyles are _____ to the IR.

A) set at a 45° angle
B) parallel
C) perpendicular
D) slightly oblique

Question 46

A referring physician suspects that a subacromial spur may be the cause for a patient's arm numbness.She asks the technologist for a projection that would best demonstrate any possible spurs.Which of the following projections would accomplish this objective?

A) PA scapular Y lateral with 10° to 15° caudal angle
B) PA scapular Y lateral with 10° to 15° cephalad angle
C) AP oblique shoulder with 45° caudal angle
D) AP shoulder with 10° to 15° caudal angle

Question 47

An orthostatic (breathing)technique can be performed for the AP projection of the scapula.

Question 48

A patient enters the ED with a midshaft humeral fracture.The AP projection taken on the cart demonstrates another fracture near the surgical neck of the humerus.The patient is unable to stand or rotate the humerus because of the extent of the trauma.What other projection should be taken for this patient?

A) Scapular Y lateral-AP oblique projection
B) Apical oblique projection
C) Horizontal beam transthoracic lateral projection for humerus
D) Rotational lateral projection for humerus

Question 49

A patient enters the ED with a possible bony defect of the midwing area of the scapula.The patient is able to stand and move the upper limb freely.In addition to the routine AP scapula projection with the arm abducted,which of the following would best demonstrate the involved area?

A) Take an apical oblique projection of the shoulder.
B) Take a transthoracic lateral projection of the shoulder region.
C) Have the patient reach across the chest and grasp the opposite shoulder for a lateral scapula projection.
D) Have the patient drop the affected arm behind him or her and take a lateral scapula projection.

Question 50

Which of the following AP shoulder projections demonstrates the greater tubercle in profile medially?

A) External rotation
B) Internal rotation
C) Neutral rotation
D) None of the above

Question 51

A posterior dislocation of the shoulder occurs more frequently than an anterior dislocation.

Question 52

A patient enters the ED with multiple injuries including a possible fracture of the left proximal humerus.Which positioning rotation should be performed to determine the extent of the humerus injury?

A) AP neutral shoulder rotation and carefully rotated internally proximal humerus
B) AP shoulder as is; show radiograph to the ED physician before attempting a rotational lateral projection
C) AP and horizontal beam transthoracic lateral shoulder projection
D) AP and apical oblique shoulder without any arm rotation

Question 53

For AC joint weight-bearing studies,patients should not be asked to hold on to the weights with their hands; rather,the weights should be attached to the wrists.

Question 54

Which of the following AP shoulder projections demonstrates the lesser tubercle in profile medially?

A) External rotation
B) Internal rotation
C) Neutral rotation
D) None of the above

Question 55

Which one of the following projections/positions should NOT be performed for a possible shoulder dislocation?

A) AP axial oblique (Garth method)
B) Transthoracic lateral (Lawrence method)
C) Inferosuperior axial (Clements modification)
D) Scapular Y

Question 56

The arm should be abducted about 45° for an AP scapula.

Question 57

A patient comes to radiology for treatment of an arthritic condition of the right shoulder.The radiologist orders AP internal/external rotation projections and an inferosuperior axiolateral projection of the scapulohumeral joint.However,the patient cannot abduct the arm for this projection.Which other projection will best demonstrate the scapulohumeral joint space?

A) Posterior oblique (Grashey method)
B) Scapular Y lateral
C) Transthoracic lateral
D) AP projection-neutral rotation

Question 58

The recommended SID for AC joints is 72 inches (183 cm).

Question 59

A patient comes to the emergency department (ED)with a possible right AC joint separation.Right clavicle and AC joint exams are ordered.The clavicle is taken first,and a small linear fracture of the midshaft of the clavicle is discovered.What should the technologist do in this situation?

A) Perform the weight-bearing phase as ordered.
B) Reduce the amount of weight that would normally be given to the patient and perform the weight-bearing study.
C) Consult with the ED physician before continuing with the AC joint study.
D) Slowly give the patient more weight to hold until he begins to complain and then complete the AC joint study.

Question 60

A patient enters the ED with a possible AC joint separation.The patient is paraplegic; therefore,the study cannot be done erect.Which of the following routines would be performed to diagnose this condition?

A) Non-weight-bearing and weight-bearing type of projections performed with the patient recumbent by pulling down on the shoulders
B) Recumbent AP and AP axial projection of the clavicles to include AC joints
C) AP projections of shoulders with external and internal rotation performed recumbent
D) AP and AP apical oblique projection of the shoulder performed recumbent

Question 61

What type of CR angle is required for the superoinferior axial projection (Hobbs modification)?

A) CR is perpendicular to IR
B) 5° to 15° toward axilla
C) 25° away from axilla
D) 10° toward shoulder

Question 62

Where is the CR centered for the posterior oblique position for the glenoid cavity?

A) Acromion
B) 2 inches (5 cm) medial and inferior to the superolateral border of shoulder
C) Coracoid process
D) 1 inch ( 2.5 cm) superior to the coracoid process

Question 63

What is a possible radiographic sign for impingement syndrome of the shoulder?

A) Calcified tendons
B) Fluid-filled joint space
C) Fracture of the glenoid rim
D) Subacromial spurring

Question 64

MATCHING
Select the correct method name to match each shoulder projection.(Use each choice only once.)
AP apical oblique axial projection

A)Clements modification
B)Neer method
C)Fisk modification
D)Hobbs modification
E)Garth method
F)Grashey method

Question 65

MATCHING
Select the correct method name to match each shoulder projection.(Use each choice only once.)
Inferosuperior axial projection

A)Clements modification
B)Neer method
C)Fisk modification
D)Hobbs modification
E)Garth method
F)Grashey method

Question 66

MATCHING
Select the correct method name to match each shoulder projection.(Use each choice only once.)
Tangential,intertubercular groove projection

A)Clements modification
B)Neer method
C)Fisk modification
D)Hobbs modification
E)Garth method
F)Grashey method

Question 67

MATCHING
Select the correct method name to match each shoulder projection.(Use each choice only once.)
Posterior oblique,glenoid cavity projection

A)Clements modification
B)Neer method
C)Fisk modification
D)Hobbs modification
E)Garth method
F)Grashey method

Question 68

An inferosuperior axial projection (Clements modification)is performed on a patient with a nontraumatic shoulder injury.The patient cannot fully abduct the upper limb 90°.Which of the following modifications of the position should be performed for this patient?

A) Angle CR 30° toward the axilla.
B) Angle CR 5 to 15° toward the axilla.
C) Angle CR 45° toward the elbow AC joint separation.
D) Rotate shoulder slightly anterior to open joint space.

Question 69

A radiograph of an AP axial projection of the clavicle demonstrates that the clavicle is within the midaspect of the lung apices.What should the technologist do to correct this error?

A) Do nothing; this is an acceptable AP axial clavicle projection.
B) Increase the caudal CR angle during repeat exposure.
C) Increase the cephalic CR angle during repeat exposure.
D) Make the exposure upon complete inspiration.

Question 70

A patient is scheduled for an arthrogram.During the course of the study,the radiologist requests a projection to demonstrate the intertubercular groove.Which one of the following projections would best demonstrate this structure?

A) Fisk modification
B) Garth method
C) Grashey method
D) Pearson method

Question 71

MATCHING
Select the correct method name to match each shoulder projection.(Use each choice only once.)
PA transaxillary projection

A)Clements modification
B)Neer method
C)Fisk modification
D)Hobbs modification
E)Garth method
F)Grashey method

Question 72

A patient enters the ED with a dislocated shoulder.The technologist attempts to position the patient into the transthoracic lateral projection,but the patient is unable to raise the unaffected arm over his head completely.What can the technologist do to compensate for the patient's inability to raise his arm completely?

A) Perform the Grashey method instead.
B) Use a breathing technique.
C) Increase kV to penetrate through both shoulders.
D) Angle the CR 10° to 15° cephalad.

Question 73

Sonography is an effective diagnostic tool in studying the shoulder joint.

Question 74

MATCHING
Select the correct method name to match each shoulder projection.(Use each choice only once.)
Tangential,supraspinatus outlet projection

A)Clements modification
B)Neer method
C)Fisk modification
D)Hobbs modification
E)Garth method
F)Grashey method

Question 75

What is the common term for idiopathic chronic adhesive capsulitis?

A) Bankart lesion
B) Tendinitis
C) Bursitis
D) Frozen shoulder