Deck 5: Humerus and Shoulder Girdle

Question 1

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 sulcus

Answer 1

Deltoid tuberosity

Question 2

Part 5 refers to:

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

Answer 2

none of the above.

Question 3

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.

Answer 3

Perform exaggerated external rotation of the affected upper limb.

Question 4

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 5

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

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

Question 6

Which of the following projections can be performed using an orthostatic (breathing) technique?

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

Question 7

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 8

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 9

Part 3 refers to:

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

Question 10

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 11

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 12

How much CR angulation should be used for a PA oblique (scapular Y) projection?

A)No CR angle is required.
B)10° to 15°
C)20° to 30°
D)35° to 45°

Question 13

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 14

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 15

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

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

Question 16

Which term describes the medial end of the clavicle?

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

Question 17

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 18

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

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

Question 19

Which ionization chamber(s) for the AEC should be activated for a tangential projection (Fisk modification) for an intertubercular sulcus?

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

Question 20

Which of the following joints is considered to have a ball and socket (spheroidal) type of movement?

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

Question 21

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

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

Question 22

A radiograph of a PA oblique (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 23

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 24

A radiograph of an AP oblique (Grashey method) 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 toward the IR.
D)Abduct the arm slightly.

Question 25

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 26

What type of CR angle is required for the apical AP axial projection?

A)30° caudad
B)15 to 20° cephalad
C)45° caudad
D)10 to 15° caudad

Question 27

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

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

Question 28

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 29

Which of the following projections will best demonstrate the acromiohumeral space to detect possible spurring?

A)AP oblique projection-Grashey method
B)Inferosuperior axial projection-Clements method
C)PA transaxillary projection-Hobbs modification
D)Apical AP axial projection

Question 30

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 31

Which of the following best demonstrates the coracoacromial arch?

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

Question 32

A patient comes to the emergency department (ED) with a possible right AC joint separation.Right clavicle and AC joint examinations 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 33

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 34

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 35

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 36

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 37

What type of compensating filter is recommended for an AP shoulder projection?

A)Wedge
B)Boomerang
C)Trough
D)Gradient

Question 38

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

A)Tangential projection with 10° to 15° caudad angle
B)Tangential projection with 10° to 15° cephalad angle
C)AP oblique shoulder with 45° caudad angle
D)AP shoulder with 10° to 15° caudad angle

Question 39

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

Question 40

Which alternative landmark can be palpated if unable to locate the coracoid process for the shoulder projection for the obese shoulder?

A)Inferior angle of scapula
B)Greater tubercle of humerus
C)AC joint
D)Lesser tubercle of humerus

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 axial projection
B)AP shoulder and 35° to 45° AP oblique (Grashey method)
C)AP shoulder and Neer projection
D)AP shoulder and recumbent AP oblique (scapular Y) projection

Question 42

Where is the CR centered for the AP oblique (Grashey method) 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 43

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 44

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)Bone spurring in acromiohumeral space

Question 45

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 46

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 AP 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 47

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

Tangential, intertubercular sulcus projection

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

Question 48

Another term for osteoarthritis is:

A)rheumatoid arthritis.
B)bursitis.
C)degenerative joint disease.
D)osteoporosis.

Question 49

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

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

Question 50

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 types 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 51

What type of CR angle is required for the PA transaxillary 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 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

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 caudad CR angle during repeat exposure.
C)Increase the cephalic CR angle during repeat exposure.
D)Make the exposure upon complete inspiration.

Question 54

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 55

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 56

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 57

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 58

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 59

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 60

What is the common term for idiopathic chronic adhesive capsulitis?

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

Question 61

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

AP oblique, glenoid cavity projection

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

Question 62

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

Question 63

The recommended SID for AP AC joint study is 72 inches (~183cm).

Question 64

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

Question 65

All of the joints of the shoulder girdle are diarthrodial.

Question 66

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 67

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

Question 68

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

Question 69

The AP axial (Alexander method) for AC joints requires a 15° cephalic CR angle.

Question 70

Sonography is effective in the dynamic evaluation of the shoulder joint.

Question 71

Part 3 refers to the greater tubercle.

Question 72

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

Question 73

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 74

Part 10 refers to the vertebral border of the scapula.

Question 75

For an AP oblique (Grashey method) projection of the shoulder, the CR is centered to the acromion.

Question 76

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

Question 77

The affected arm should not be abducted for an AP scapula projection.

Question 78

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

Question 79

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

Question 80

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