Deck 5: Image Analysis of the Shoulder

Question 1

An inferosuperior axial shoulder projection obtained with the humerus in exaggerated external rotation (epicondyles at a greater than 45-degree angle with the floor) demonstrates the
1)Hill-Sachs defect.
2)humeral neck in profile.
3)humeral head in profile anteriorly.
4)greater tubercle in profile posteriorly.

A) 1 only
B) 1 and 2 only
C) 3 and 4 only
D) 1, 2, and 3 only

Answer 1

3 and 4 only

Question 2

An AP shoulder projection with accurate positioning demonstrates the
1)glenoid fossa in profile.
2)glenohumeral joint centered within the collimated field.
3)superolateral scapular border without thorax superimposition.
4)superior scapular angle superior to the midclavicle.

A) 1, 2, and 3 only
B) 2, 3, and 4 only
C) 2 and 3 only
D) 3 and 4 only

Answer 2

2 and 3 only

Question 3

For an AP shoulder projection, the
1)shoulders are positioned at equal distances from the IR.
2)central ray is centered 1 inch (2.5 cm) inferior to the coracoid.
3)imaginary line connecting the humeral epicondyles is positioned at a 45-degree angle to the IR.
4)central ray is angled cephalically when a kyphotic patient is imaged.

A) 1 and 2 only
B) 3 and 4 only
C) 1, 2, and 3 only
D) 1, 2, 3, and 4

Answer 3

1, 2, 3, and 4

Question 4

An AP oblique shoulder projection (Grashey method) with accurate positioning demonstrates
1)the glenoid fossa in profile and facing superiorly.
2)an open glenohumeral joint space.
3)a longitudinally foreshortened clavicle.
4)the glenohumeral joint in the center of the collimated field.

A) 1 and 3 only
B) 1, 2, and 4 only
C) 2, 3, and 4 only
D) 1, 2, 3, and 4

Question 5

An AP right shoulder projection obtained with the patient's body rotated away from the affected shoulder demonstrates
1)the scapula with decreased thoracic superimposition.
2)the medial end of the right clavicle superimposed over the vertebral column.
3)a transversely foreshortened scapular body.
4)the glenoid fossa in profile.

A) 1 and 4 only
B) 1, 2, and 3 only
C) 3 and 4 only
D) 1, 2, 3, and 4

Question 6

Under which of the following conditions is it necessary to use a grid for an axial shoulder projection?
1)The AP measurement is over 4 inches (10 cm).
2)The kilovoltage used is above 60.
3)The inferosuperior measurement is more than 4 inches (10 cm).
4)The kilovoltage used is below 60.

A) 1 and 2 only
B) 2 and 3 only
C) 1 and 4 only
D) 3 and 4 only

Question 7

For a PA oblique scapular Y shoulder projection, the patient's
1)humerus is elevated until the hand is placed on the hip.
2)body is rotated toward the unaffected shoulder.
3)body is rotated until an imaginary line connecting the acromion angle and coracoid processes is aligned parallel with the IR.
4)midcoronal plane is vertical.

A) 2 and 3 only
B) 3 and 4 only
C) 2, 3, and 4 only
D) 1, 2, 3, and 4

Question 8

An AP shoulder projection demonstrates longitudinal foreshortening of the scapular body when the
1)patient's upper midcoronal plane is tilted away from the IR.
2)patient is rotated onto the affected shoulder.
3)patient is kyphotic.
4)affected shoulder is protracted.

A) 1 and 3 only
B) 2 and 4 only
C) 1, 3, and 4 only
D) 1, 2, 3, and 4

Question 9

For an inferosuperior axial shoulder projection,
1)the patient's shoulder is elevated on a sponge or washcloth.
2)the patient's head is tilted and rotated toward the affected shoulder.
3)the patient's affected arm is externally rotated.
4)a 30- to 35-degree central ray to lateral body surface angle is used if the arm is abducted at a 90-degree angle to the torso.

A) 1 and 2 only
B) 2 and 3 only
C) 1, 3, and 4 only
D) 1, 2, 3, and 4

Question 10

A PA oblique scapular Y shoulder projection that shows accurate positioning of a patient with an anterior dislocation demonstrates
1)a Y formation.
2)the humeral head positioned anterior to the glenoid fossa beneath the coracoid.
3)superimposition of the medial and lateral scapular borders.
4)the humerus superimposed over the scapular body.

A) 1 and 3 only
B) 1 and 2 only
C) 1, 2, and 3 only
D) 3 and 4 only

Question 11

An AP shoulder projection obtained with the humeral epicondyles positioned parallel with the IR demonstrates the
1)greater tubercle in profile laterally.
2)lesser tubercle in profile medially.
3)humeral head in profile medially.
4)greater tubercle superimposed over the humeral head.

A) 1 and 3 only
B) 1 and 2 only
C) 3 and 4 only
D) 2 and 4 only

Question 12

An inferosuperior axial shoulder projection that does not include the posterior aspects of the acromion and humerus was obtained

A) without the patient's head rotated or tilted toward the affected shoulder.
B) using a central ray to lateral body surface angle that was too large.
C) without the patient's shoulder elevated on a sponge or washcloth.
D) without the IR positioned proximally enough.

Question 13

An AP oblique shoulder projection (Grashey method) obtained with the patient rotated less than required to obtain accurate positioning demonstrates
1)more than 0.25 inch (0.6 cm) of the coracoid superimposed over the humeral head.
2)a closed glenohumeral joint.
3)increased longitudinal clavicular foreshortening.
4)an increase in the amount of thorax and scapular body superimposition.

A) 2 only
B) 1, 2, and 3 only
C) 3 and 4 only
D) 1, 2, 3, and 4

Question 14

For an AP oblique shoulder projection (Grashey method), the patient is rotated more than 45 degrees when the patient is
1)recumbent.
2)kyphotic.
3)seated.
4)upright and leaning against the upright IR holder.

A) 1 and 2 only
B) 3 and 4 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 15

How can the positioning setup be adjusted for an AP shoulder projection to demonstrate uniform density throughout the shoulder and clavicular areas?
1)Position the top of the shoulder at the cathode end of the tube.
2)Place a compensating filter over or under the laterally located acromion and clavicular end.
3)Use a kilovoltage above 75.
4)Use a grid.

A) 1 and 2 only
B) 2 only
C) 1 and 3 only
D) 1, 3, and 4 only

Question 16

An inferosuperior axial shoulder projection that shows accurate positioning and was obtained with the humeral epicondyles positioned at a 45-degree angle with the floor demonstrates
1)the posterolateral aspect of the humeral head.
2)almost superimposed inferior and superior glenoid fossa margins.
3)the lesser tubercle in partial profile anteriorly.
4)the lateral edge of the coracoid base medial to the inferior glenoid cavity.

A) 1 and 2 only
B) 3 and 4 only
C) 1, 2, and 3 only
D) 1, 2, 3, and 4

Question 17

A PA oblique scapular Y shoulder projection with accurate positioning demonstrates
1)the superior angle of the scapular at the same transverse level as the clavicle.
2)superimposed scapular borders.
3)a laterally situated glenoid fossa.
4)the coracoid, acromion, and humerus creating the arms and leg of the Y formation.

A) 1 and 2 only
B) 2 and 4 only
C) 1 and 3 only
D) 1, 2, and 4 only

Question 18

An AP shoulder projection obtained in a patient whose upper midcoronal plane was tilted anteriorly demonstrates the
1)lesser tubercle in profile laterally.
2)scapular body longitudinally foreshortened.
3)superior scapular angle superior to the clavicle.
4)scapular body with increased thoracic cavity superimposition.

A) 1 and 4 only
B) 2 and 3 only
C) 2, 3, and 4 only
D) 1, 2, 3, and 4

Question 19

The arms of the Y on a PA oblique scapular Y shoulder projection are formed by the
1)coracoid.
2)scapular body.
3)acromion.
4)glenoid fossa.

A) 1 and 2 only
B) 2 and 3 only
C) 3 and 4 only
D) 1 and 3 only

Question 20

For an AP oblique shoulder projection (Grashey method), the
1)patient's midcoronal plane is rotated to a 45-degree angle with the IR.
2)central ray is centered to the coracoid process.
3)patient is rotated toward the affected shoulder.
4)image is obtained with the patient in an upright position.

A) 1 and 3 only
B) 2 and 4 only
C) 2, 3, and 4 only
D) 1, 2, 3, and 4

Question 21

An AP clavicle projection with accurate positioning demonstrates
1)the medial clavicular end next to the lateral edge of the vertebral column.
2)the superior scapular angle superior to the clavicle.
3)inferosuperior foreshortening on the kyphotic patient unless the central ray is angled cephalically.
4)an overexposed medial clavicle unless a compensating filter is used.

A) 2 only
B) 1 and 3 only
C) 1, 3, and 4 only
D) 1, 2, and 3 only

Question 22

A PA oblique scapular Y shoulder projection that was obtained with the patient overrotated demonstrates the
1)glenoid fossa medially.
2)medial scapular border closer to the ribs than the lateral scapular border.
3)superior scapular angle superior to the clavicle.
4)lateral scapular border closer to the ribs than the medial scapular border.

A) 1 and 2 only
B) 1 and 4 only
C) 2 and 3 only
D) 3 and 4 only

Question 23

An imaginary line connecting the humeral epicondyles is positioned perpendicular to the IR for a(n)
1)internally rotated AP shoulder projection.
2)AP oblique shoulder projection (Grashey method).
3)lateral humeral projection.
4)PA oblique scapular Y shoulder projection.

A) 1 and 3 only
B) 2 and 4 only
C) 3 only
D) 1, 3, and 4 only

Question 24

An AP scapular projection with accurate positioning demonstrates
1)almost superimposed anterior and posterior glenoid fossa margins.
2)the vertebral scapular border without thoracic cavity superimposition.
3)the humeral shaft at a 90-degree angle with the body.
4)the supraspinatus fossa and superior scapular angle without clavicular superimposition.

A) 1 and 3 only
B) 1, 3, and 4 only
C) 1 and 2 only
D) 3 and 4 only

Question 25

An AP axial shoulder projection (Stryker method) with accurate positioning demonstrates the
1)coracoid process situated directly lateral to the conoid tubercle of the clavicle.
2)posterolateral aspect of the humeral head in profile laterally.
3)greater and lesser tubercles in partial profile.
4)coracoid process superimposed over the lateral clavicle.

A) 1 and 2 only
B) 2 and 3 only
C) 3 and 4 only
D) 1, 2, 3, and 4

Question 26

An AP clavicle projection obtained with the patient rotated away from the affected shoulder demonstrates the
1)medial clavicular end superimposed over the vertebral column.
2)medial clavicular end shifted away from the vertebral column.
3)scapular body with increased thoracic superimposition.
4)scapular body with decreased thoracic superimposition.

A) 1 and 3 only
B) 1 and 4 only
C) 2 and 3 only
D) 2 and 4 only

Question 27

A lateral scapular projection obtained with the patient underrotated and the arm placed at a 90-degree angle with the patient demonstrates
1)superimposed lateral and vertebra scapular borders.
2)the lateral scapular border medial to the vertebral border.
3)the superior scapular angle inferior to the coracoid.
4)the vertebral scapular border medial to the lateral border.

A) 1 and 3 only
B) 2 only
C) 2 and 3 only
D) 4 only

Question 28

A PA oblique scapular Y shoulder projection obtained with the patient's upper midcoronal plane tilted toward the IR demonstrates
1)the glenoid cavity on end.
2)the superior scapular angle superior to the clavicle.
3)a longitudinally foreshortened scapular body.
4)the superior scapular angle inferior to the clavicle.

A) 2 and 4 only
B) 3 only
C) 2 and 3 only
D) 1, 2, and 3 only

Question 29

A tangential supraspinatus outlet projection (Neer method) with accurate positioning is obtained when
1)the arm is abducted and the midcoronal plane is at a 60-degree angle with the IR.
2)a 10- to 15-degree caudal central ray angulation is used.
3)the central ray is centered to the superior aspect of the humeral head.
4)the midcoronal plane is vertical.

A) 1 and 2 only
B) 1 and 3 only
C) 2, 3, and 4 only
D) 1, 2, 3, and 4

Question 30

An AP axial shoulder projection (Stryker method) with poor positioning that demonstrates the lesser tubercle in profile
1)also demonstrates an obscured greater tubercle.
2)was obtained because the humerus was elevated beyond vertical.
3)demonstrates the Hill-Sachs defect.
4)was obtained because the distal humerus was tilted laterally.

A) 1 and 2 only
B) 1 and 4 only
C) 2 and 3 only
D) 3 and 4 only

Question 31

For an AP scapular projection, the
1)patient's arm is abducted 90 degrees to the body.
2)image is exposed on expiration.
3)patient's upper midcoronal plane leans slightly away from the IR.
4)central ray is centered 2 inches (5 cm) inferior to the coracoid.

A) 1 and 4 only
B) 2 and 3 only
C) 1, 3, and 4 only
D) 1, 2, and 4 only

Question 32

For an AP axial clavicle projection,
1)the patient's shoulders are positioned at equal distances from the IR.
2)the central ray is angled 15 to 30 degrees cephalad.
3)a compensating filter is positioned over or under the lateral clavicle.
4)the central ray is centered halfway between the medial and lateral clavicular ends.

A) 2 and 4 only
B) 1 and 3 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 33

An AP axial clavicle projection with accurate positioning demonstrates the
1)medial clavicular end superimposed over the first and second ribs.
2)middle and lateral thirds of the clavicle superior to the acromion.
3)clavicle bowing upward.
4)medial clavicular end superimposed over the vertebral column.

A) 1 and 2 only
B) 2 and 3 only
C) 1, 2, and 3 only
D) 1, 2, 3, and 4

Question 34

A tangential supraspinatus outlet projection (Neer method) that was obtained with the patient underrotated demonstrates the
1)glenoid fossa medially.
2)medial scapular border closer to the ribs than the lateral scapular border.
3)superior scapular angle 0.5 inch inferior to the clavicle.
4)lateral scapular border closer to the ribs than the medial scapular border.

A) 1 and 3 only
B) 1 and 4 only
C) 2 and 3 only
D) 3 and 4 only

Question 35

The AP axial shoulder projection (Stryker method)
1)is performed to demonstrate the Hill-Sachs defect.
2)is obtained with the affected humerus vertical and the palm of the hand placed on top of the head.
3)uses a 10-degree caudal central ray angle.
4)is obtained with the patient in a supine position.

A) 3 and 4 only
B) 2, 3, and 4 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 36

A tangential supraspinatus outlet projection (Neer method) with accurate positioning demonstrates
1)the superior scapular spine inferior to the clavicle.
2)superimposed scapular borders.
3)the glenoid cavity on end.
4)the coracoid, acromion, and scapular body creating the arms and leg of the Y formation.

A) 1 and 2 only
B) 3 and 4 only
C) 2, 3, and 4 only
D) 1, 2, 3, and 4

Question 37

A lateral scapular projection with accurate positioning obtained with the humerus abducted to a 90-degree angle with the body demonstrates
1)superimposition of the lateral and vertebral scapular borders.
2)the scapula in a Y formation.
3)the superior scapular angle inferior to the coracoid.
4)the midscapular body in the center of the collimated field.

A) 1 and 4 only
B) 2 and 4 only
C) 1, 2, and 3 only
D) 1, 2, and 4 only

Question 38

The lesser tubercle is demonstrated in profile on a(n)
1)neutral AP shoulder projection.
2)lateral humeral projection.
3)transthoracic lateral proximal humeral projection.
4)inferosuperior axial shoulder projection.

A) 1 and 3 only
B) 2 and 4 only
C) 1, 3, and 4 only
D) 2, 3, and 4 only

Question 39

For an AP AC joint projection without weights,
1)the central ray is centered to the AC joint.
2)the midcoronal plane is positioned parallel with the IR.
3)a grid is used if the patient's AP measurement is 6 inches (15 cm).
4)the patient's shoulders are positioned at equal distances from the IR.

A) 1 and 4 only
B) 3 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 40

A nondislocated AP oblique scapular Y shoulder projection demonstrates
1)the humeral head superimposed over the glenoid fossa.
2)the glenoid fossa on end.
3)the medial scapular border closer to the ribs than the lateral scapular border.
4)magnification of the scapula and humerus.

A) 1 and 3 only
B) 2 and 4 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 41

An optimal AP clavicle projection demonstrates all of the following except the

A) midclavicle in the center of the IR.
B) midclavicle superimposing the superior scapular angle.
C) middle and lateral thirds of the clavicle seen superior to the acromion process.
D) medial clavicular end adjacent to the vertebral column.

Question 42

A poorly positioned AP shoulder projection demonstrating most of the articulating surface of the glenoid cavity

A) will also demonstrate the medial clavicular end superimposing the vertebrae.
B) will also demonstrate longitudinal foreshortening of the scapular body.
C) was obtained because the upper midcoronal plane was tilted posteriorly.
D) was obtained because the patient was rotated toward the affected shoulder.

Question 43

An anteriorly dislocated shoulder is demonstrated on an AP shoulder projection when the humeral head is demonstrated inferior to the

A) acromion process.
B) coracoid process.
C) scapular spine.
D) scapular notch.

Question 44

Which of the following statements is true about an AP axial (Stryker method) projection of the proximal humerus?

A) An optimal image demonstrates the coracoid situated directly medial to the conoid tubercle.
B) An optimal image demonstrates the greater tubercle in profile.
C) It is performed to diagnose the Hill-Sachs defect.
D) It is obtained with the patient's affected arm elevated until the humerus is at a 45-degree angle with the IR.

Question 45

The glenohumeral joint space is demonstrated as an open space on a(n)
1)inferosuperior axial shoulder projection.
2)transthoracic lateral shoulder projection.
3)AP oblique shoulder projection (Grashey method).
4)PA oblique scapular Y shoulder projection.

A) 1 only
B) 1 and 3 only
C) 2 and 3 only
D) 1, 2, 3, and 4

Question 46

Accurate alignment of the central ray and glenoid cavity on an inferosuperior axial shoulder projection

A) is unaffected by the degree of humeral abduction.
B) is affected by the alignment of the humeral epicondyle with the floor.
C) is obtained when the humerus is abducted to 60 degrees and the central ray to lateral body surface angle is set at 30 degrees.
D) will demonstrate the lateral edge of the coracoid process base aligned with the inferior glenoid cavity.

Question 47

A poorly positioned inferosuperior axial shoulder projection demonstrates the inferior glenoid cavity medial to the lateral edge of the coracoid process. To obtain an optimal projection,

A) increase the central ray to lateral body surface angle.
B) decrease the central ray to lateral body surface angle.
C) decrease the degree of humeral abduction.
D) elevate the patient on a sponge or washcloth.

Question 48

An AP oblique shoulder projection (Grashey method) taken with insufficient patient obliquity

A) demonstrates an excessively longitudinally foreshortened clavicle.
B) demonstrates more than 0.25 inch (0.6 cm) of the coracoid process superimposing the humeral head.
C) demonstrates an open glenohumeral joint space.
D) occurs when the patient is in a recumbent position and rotated 45 degrees.

Question 49

A poorly positioned AP axial projection (Stryker method) of the proximal humerus demonstrates the lesser tubercle in profile medially. How was the setup mispositioned to obtain such an image?

A) The humerus was elevated to less than a vertical position.
B) The central ray was angled less than the required 10-degree cephalic angle.
C) The humerus was elevated beyond a vertical position.
D) The distal humerus was tilted laterally.

Question 50

An optimal AP scapula projection demonstrates all of the following except the

A) lateral scapular border without thoracic superimposition.
B) superior scapular angle about 0.25 inch (0.6 cm) inferior to the clavicle.
C) humeral shaft at 90 degrees of abduction.
D) glenoid cavity in profile.

Question 51

To prevent longitudinal scapular foreshortening when obtaining an AP shoulder projection on a patient with excessive thoracic kyphosis, the

A) central ray should be angled 5 degrees caudally.
B) patient's upper midcoronal plane should be tilted anteriorly.
C) central ray should be angled cephalically until it is aligned perpendicular to the scapular body.
D) positioning procedure should not be adjusted from the routine.

Question 52

A Hill-Sachs defect is a(n) _____ fracture that results from _____ dislocations of the humeral head against the _____ rim of the glenoid cavity.

A) avulsion; posterior; posteroinferior
B) compression; anterior; anteroinferior
C) avulsion; anterior; anteroinferior
D) compression; posterior; posteroinferior

Question 53

An accurate PA oblique scapular Y shoulder projection is obtained

A) when an imaginary line connecting the coracoid process and acromion angle is aligned perpendicular to the IR.
B) when the resulting image demonstrates the superior scapular angle positioned superior to the clavicle.
C) when an imaginary line connecting the coracoid process and acromion angle is aligned parallel with the IR.
D) only when the glenoid cavity superimposes the humeral head.

Question 54

The vertebral and lateral borders of the scapular body are demonstrated without superimposition on a tangential supraspinatus outlet projection. The medial scapular border is demonstrated next to the ribs, and the lateral border is visualized laterally. How should the patient or central ray be repositioned to obtain an optimal image?

A) Increase the degree of patient rotation.
B) Decrease the degree of patient rotation.
C) Tilt the upper midcoronal plane toward the IR.
D) Increase the central ray angulation.

Question 55

A poorly positioned AP axial clavicle projection that demonstrates the medial clavicular end drawn away from the vertebral column

A) will also demonstrate the clavicle bowing upward.
B) will also demonstrate a transversely foreshortened clavicle.
C) was obtained with the patient rotated toward the unaffected shoulder.
D) will require a 10-degree cephalic angle to obtain optimal positioning.

Question 56

In an AP shoulder projection with external rotation of the humerus, the greater tubercle will be seen

A) in lateral profile.
B) in medial profile.
C) superimposed with the humeral head.
D) in partial lateral profile.

Question 57

When positioning for an AP shoulder projection, a kyphotic patient's _____ in spinal _____ will prevent the upper midcoronal plane from being straightened.

A) increase; concavity
B) increase; convexity
C) decrease; concavity
D) decrease; convexity

Question 58

An accurately positioned lateral scapula demonstrates
1)superimposed lateral and vertebral scapular borders.
2)the scapular angle superior to the clavicle.
3)the midscapular body at the center of the exposure field.
4)the scapular body and thoracic cavity without superimposition.

A) 1 and 3 only
B) 1 and 2 only
C) 3 and 4 only
D) 1, 3, and 4 only

Question 59

An AP AC joint projection with a kyphotic patient will require a _____ angulation of the CR, aligned perpendicular to the _____.

A) caudal, scapular body
B) cephalic, scapular body
C) cephalic, upper one-third of the humerus
D) caudal, upper one-third of the humerus

Question 60

Longitudinal foreshortening of the scapula is demonstrated on an AP shoulder projection when the

A) superior scapular angle is visualized superior to the clavicle.
B) clavicle superimposes the superior scapular angle.
C) glenoid cavity is demonstrated in profile.
D) glenoid cavity is demonstrated on end.