RAD 141 CH.5 PROXIMAL HUMERUS + SHOULDER

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what is the joint classification of the shoulder girdle

synovial and diarthrodial (freely moveable)
what joint is the scapulohumeral joint or shoulder joint

spheroidal or ball and socket joint
what type of joint or movement classification are the AC and SC joints

gliding joints
what is the shoulder routine positions (non trauma) and special
- ap external rotation
- ap internal rotation
- inferosuperior - Lawrence method
- Inferosuperior Axial - West Point Method
- Posterior Oblique _glenoid Cavity (grashey Method)
- Tangential Projection - Intertubercular groove (fisk method)
what position shoulder is used to isolate the greater tubercle of the humerus in profile laterally

ap external rotation
what position of shoulder would you use to view the lesser tubercle in profile more medially

ap internal rotation
when do we perform the neutral rotation of the scapula

when the patient is in pain and cannot move it at all
what are the exposure factors
- 70-80 kvp use a grid depending on size of patient
- high mA short exposure time
- small FSS
- center cell AEC
- 40-44in SID
what joint calls for a 72 inch SID

AC joint or acromioclavicular joint
List all positioning requirements for ap shoulder external rotation
- 10x12 crosswise or lengthwise
- erect or supine
- abduct arm slightly; then externally rotate the arm until epicondyles of distal humerus are parallel to IR
- Hold respiration
- CR perpendicular to the IR centered 1 inch inferior to the coracoid process (above armpit midway)(3/4 inch inferior to the lateral portion of the clavicle)
where is the lesser tubercle on an ap external rotation

superimposed by the humeral head so will not be seen best
List all positioning requirements for ap shoulder internal rotation
- 10x12 crosswise or lengthwise
- erect or supine
- abduct arm slightly; then internally rotate the arm until epicondyles of distal humerus are perpendicular to IR
Hold respiration

CR 1in inferior to the coracoid process (above armpit midway)(abt 3/4 inch inferior to the lateral portion of the clavicle
where is the lesser tubercle on an ap internal rotation radiograph
where is the greater tubercle
- medial aspect of the humerus it puts lesser tubercle into profile
- superimposed over the humeral head
what is the position of the arm in an inferosuperior axial projection

externally rotated
what is the position factors in an inferosuperior axial projection
- shoulder raised 2 inches from table top
- rotate head toward opposite side place vertical IR on the table as close to neck as possible
- abduct the arm 90 degrees and arm externally rotated (palm up)
why is the exaggerated rotation of the arm done for an inferiorosuperior axial projection
what is this reason
- hill sachs defect
- it is a compression fracture of the articular surface of the humeral head
what are other reasons we would use the inferosuperior axial projection

osteoperosis osteoarthritis and fractions and dislocations of the proximal humerus
what is the best position to view the glenoid cavity in perfect profile

posterior oblique position (grashey method)
how do we position for the grashey method
where is the CR
- erect or supine
- rotate body 35-45 degrees toward affected side
- CR perpendicular to the IR centered to the scapulohumeral joint which is 2 inferior and medial to the superolateral border of the shoulder
- suspend respiration
what are the routine trauma positions if the patient cannot move
- AP neutral
- transthoracic lateral -lawrence method
- scapular y lateral (patients arm over the stomach
what structures are best shown when doing the FISK method
what position of the body is this method best done
- anterior margin of the humeral head and intertubercular groove and other pathologies
- supine
what is the positioning for the tangential projection -fisk method
- best supine
- set up like an inferosuperior but do no abduct the arm
- CR is 10-15 degrees posterior from horizontal directed to intertubercular groove
where is the CR when doing an ap projection neutral rotation position and position
what is the breathing instructions
- leave patients arm "as is" erect or supine
- perpendicular to IR centered to
- midscapulohumeral joint (3/4 inch and slightly lateral to the coracoid process)
- suspend respiration
why do we do a transthoracic lateral projection (lawrence method)

if patient cannot get into position so this position is used to see certain structures through the ribs that are on the shoulder

Demonstrates fractures and dislocations of the proximal humerus
list the positioning factors for a transthoracic lateral projection
where is the CR
what is the breathing technique
- erect or supine
- place patient in a lateral position with a side of interest against IR
- leave affected arm in a neutral position and aks patient to drop shoulder as much as possible
- raise opposite arm and place hand over head
- surgical neck of the affected side
- shallow breaths like panting and (long exposure tech factors)
what do we do to prevent superimposition of the shoulder if the patient is unable to drop the shoulders and raised the unaffected arm in a transthoracic lateral projection

angle the tube 10+15 degrees cephalad
why do we perform a scapular y and transthoracic positioning (reason pathologically)

demonstrates fractures and dislocations of proximal humerus and scapula
how do we perform a scapular y
where is the CR
- 10x12 crosswise or lengthwise
- erect or recumbent
- rotate the patient into a 45 to 60 degree oblique
- palpate scap borders to determine correct rotation for a true lateral
- CR perpendicular to the IR centered to midscapulohumeral joint
- affected side arm stays down
- suspend respiration

Author

anatomy12

246749

Card Set

RAD 141 CH.5 PROXIMAL HUMERUS + SHOULDER

Description

xray

Updated

2013-12-14T19:26:33Z

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