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What two bones make up the shoulder girdle proper?
- scapula
- clavicle
- (humerus is a part of the shoulder girdle, but not the shoulder girdle proper)
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What type of girdle is the shoulder girdle?
incomplete (open in the back)
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Give the common name for the clavicle and list its three parts:
- collar bone
- acromial extremity (flattened, lateral end)
- sternal extremity (medial end)
- body/shaft
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Describe the differences in the female and male clavicle:
- male: stronger, thicker, more prominent double curve
- female: shorter, not as thick, double curve less pronounced
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The thickest part of the scapula:
The most anterior part:
- head
- coracoid process (positioning landmark)
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How is the costal surface of the scapula shaped:
concave anteriorly
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What part of the scapula lies against the rib cage and gives the scapula it's strength and concave shape?
subscapular fossa
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Name 3 borders and 3 angles of the scapula:
- medial/vertebral border
- lateral/axillary border
- superior border
- superior angle
- lateral angle
- inferior angle
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What starts at the posterior surface of the scapula and projects anteriorly to articulate with the clavicle?
acromion process (forming the AC joint)
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- A. medial/vertebral border
- B. inferior angle
- C. lateral/axillary border
- D. glenoid cavity
- E. superior border
- F. superior angle
- G. acromion process
- H. coracoid process
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The spine of the scapula separates the posterior surface into the _____________ and ____________.
- supraspinous fossa
- infraspinous fossa
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What is the function of the the infraspinous and supraspinous fossas?
they both serve as muscle attachments for the infraspinous and supraspinous muscles
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What does the head of the humerus articulate with to form the shoulder joint?
glenoid cavity or fossa
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What is the most common reason for a Y view?
humeral head displacement
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Anatomical names for the shoulder joint:
- scapulohumeral joint
- glenohumeral joint
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What is the name of the deep cleft or depression that runs between the greater and lesser tubercles of the humerus?
intertubercular groove/ bicipital groove
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Which tubercle of the humerus is located directly below the anatomic neck on the anterior surface?
lesser tubercle
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Which tubercle of the humerus is located laterally?
greater tubercle
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What is the tapered area inferior to the head and tubercles of the humerus and what is the reason for its name?
- surgical neck
- because it is a site of frequent fractures requiring surgery
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- A. greater tubercle
- B. intertubercular (bicipital) groove
- C. head
- D. anatomic neck
- E. lesser tubercle
- F. body (shaft)
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The largest bursa where the most bursitis occurs, and where it is positioned:
- subacromial bursa
- under the acromion
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Small, synovial-fluid filled sacs between the bones and skin:
bursa
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What is the condition when the small, synovial-fluid filled sacs between the bones and skin become inflammed from calcium deposits rubbing and grinding?
bursitis (doesn't show up on xray unless very severe)
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Name movements of a spheroidal (ball & socket) joint:
- flexion
- extension
- abduction
- adduction
- circumduction
- medial (internal) rotation
- lateral (external) rotation
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Name three classification descriptions of the shoulder joint:
- synovial (enclosed in an articular capsule with synovial fluid)
- diarthrodial (freely movable)
- spheroidal (ball and socket)
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Name two joints of the shoulder girdle besides the shoulder joint:
- AC (acromioclavicular) Joints
- SC (sternoclavicular) Joints
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What types of joints are the AC and SC joints?
diarthrodial, plane or gliding joints
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What does the SC joint have that allows it to make movements similar to a ball and socket joint?
a fibrocartilaginous disk between the clavicle and the sternum
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Name technique considerations for the shoulder joint:
- (if over 10cm) medium kVp, 70-80 with grid
- (if less than 10cm) 65-70 kVp, without grid
- center cell (for AEC)
- 400RS
- 40"SID except for AC joints (72"SID for less divergence)
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Name alternate modalities that are used for the shoulder girdle (4)
- arthrography
- CT & MRI
- Nuclear Medicine
- Sonography
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For positioning, how do you locate the coracoid process?
it is about 1" inferior to the lateral portion of the clavicle
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- AP Shoulder, External Rotation
- (slight overlap of glenoid cavity)
- (greater tubercle visualized on lateral aspect, in profile)
- (lesser tubercle is superimposed over humeral head)
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What are the breathing instructions for an AP shoulder projection?
suspended respiration
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- AP Shoulder, Neutral Rotation
- (both tubercles are mostly superimposed by humeral head)
- (humeral head in partial profile with slight overlap of glenoid cavity)
- (slightly more overlap of joint compared with external rotation)
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- AP Shoulder, Internal Rotation
- (lesser tubercle visualized in full profile medially)
- (outline of greater tubercle superimposed over humeral head)
- (greater amount of overlap than in other two AP projections)
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What are the breathing instruction for a transthorasic lateral projection of the shoulder?
- short, panting breaths
- long exposure time
- this blurs out the ribs and lung markings
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- Transthorasic Lateral Shoulder
- (lateral view of proximal half of humerus and glenohumeral joint visualized)
- (relationship of humeral head and glenoid cavity demonstrated)
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How should the CR be angled for the Inferosuperior Axial projection:
25-30 degrees medially
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Name the projection and label:
- Inferosuperior Axial Projection
- A. lesser tubercle
- B. head
- C. coracoid process
- D. clavicle
- E. scapulo-humeral joint
- F. acromioclavicular joint
- G. Acromion
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Name the two Shoulder projections that are named the Lawrence Method:
- Transthorasic Lateral Projection
- Inferosuperior Axial Projection
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What specific pathologies are reasons to perform a West Point Method view of the the shoulder?
- Hill-Sachs defects
- Bankart fractures
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What is a condition of the posterior lateral aspect of the humeral head that results in chronic instability of the shoulder?
Hill-Sachs defect
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What is a chip or fracture of the rim of the glenoid cavity?
bankart fracture
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Name some of the positioning aspects of the West Point Method (5):
- no grid
- 10x12 CW, 40"SID
- patient prone with forearm hanging freely from table
- shoulder elevated 3 " from tabletop, head rotated away
- CR angled 25 degrees anterior & 25 degrees medial
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How should the scapula be positioned in reference to the IR for the Scapular Y lateral projection?
scapula should be perpendicular to IR
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What type of projection is the Scapular Y lateral view?
PA oblique projection
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- PA Oblique shoulder projection (Scapular Y Lateral)
- (lateral position of scapula, humerus, and joint)
- (Body of scapula with no rib superimposition)
- (acromion and coracoid process nearly symmetrical upper limbs of the Y)
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Name some pathologies demonstrated by the Grashay Method (AP oblique projection):
- fractures and dislocations of the proximal humerus
- fractures of glenoid brim (Bankart fracture)
- osteoporosis
- osteoarthritis
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Where do you center the CR for the Grashey Method?
mid scapulohumeral joint
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How do you center to the scapulohumeral joint for the Grashey Method?
it's 2 inches inferior and 2 inches medial to the border of the shoulder
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- Grashey Method (AP Oblique projection)
- (no superimposition of humeral head and glenoid cavity)
- (joint space open)
- (soft tissue detail of joint space and axilla)
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What is the tangential projection demonstrating the bicipital groove (intertubercular groove)?
the Fisk Method
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What method is the AP projection of the AC joints?
Pearson Method
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What projections are made for the AC joints?
- 2 AP projections
- one with weights, one without weights
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In projections of the AC joint, what usually indicates a joint separation?
A widening of one joint space as compared with the view with weights
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Name some positioning aspects of the AC Joints:
- 72" SID for magnification
- CR centered approx. 1" superior to jugular notch
- use both markers
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What are the two common projections of the clavicle?
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Why do we use an AP projection of the clavicle instead of a PA projection which would give better recorded detail?
Patient comfort (pt condition usually requires AP projection)
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How should the CR be angled for the AP axial projection of the clavicle?
15-30 degrees cephalic to mid-clavicle
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What body habitus would require more angulation of the CR for the AP axial projection of the clavicle?
asthenic
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What are the breathing techniques for the clavicle projections?
- AP: expose on exhalation
- AP axial: expose on inhalation
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What is an alternative to angling the CR for the AP axial projection of the clavicle?
- placing patient in a lordotic position
- (projection will project most of clavivle above scapula and ribs)
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Name some aspects of positioning for the AP scapula:
- 10x12 LW, 40" SID
- arm abducted 90 degrees and supinate hand (external rotation)
- center CR to midscapula (2" inferior to coracoid process and 2" medial from lateral border)
- breathing technique if possible
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For the Scapula Y view of the scapula, what is better visualized with the arm behind the back? across the anterior surface of the chest?
- behind back: acromion and coracoid process (requires closer to 60 degree oblique)
- across anterior surface of chest: body of the scapula (requires closer to a 45 degree oblique)
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