Anatomy and Radiography of Shoulder and Arm

Presented By: Prasanta Nath Roll No: 27 B.Sc R.I.T.

INTRODUCTION Radiographic examinations of the shoulder joint and

shoulder girdle can be carried out with the patient supine on the x-ray table or trolley, but in most cases it will be more comfortable for the patient to sit or stand with the back of the shoulder in contact with the cassette.

For a general survey of the shoulder, e.g. for injury, the field size must be large enough to cover the whole of the shoulder girdle on the injured side.

As in the lateral projection, the cassette is held in a vertical cassette holder with the patient either standing or sitting during the procedure.

Anatomy of shoulder The shoulder girdle consists of two scapulae and two

clavicles. Clavicle (collar bone):- The clavicle is an S-shaped long

bone.It articulates with the manubrium of the sternum at the sternoclavicular joint with the acromion process of the scapula.The clavicle provides the only bony link between the upper limb and the axial skeleton.

Scapula (shoulder blade) :-The scapula is a flat triangular- shaped bone, lying on the posterior chest wall superficial to the ribs and sepeated from them by muscles. At the lateral angle is a shallow articular surface,the glenoid cavity,which with the head of the humerus ,forms the shoulder joint.

Radiography of shoulderSHOULDER AP VIEW (supine)

Positioning of the patient:a) Patient lies supine with elbow extended and palm facing

up. Unaffected shoulder is raised over sand bag so that affected shoulder posterior aspect comes into contact with the film. Upper border of cassette should be atleast 5cm above the shoulder.

b) Immobilized with sand bag over the palm.c) Marker R/L on left upper corner. Patient identification on

the right corner are placed.

Positioning of the patient

Centering:Coracoid process of scapula (palpable for general survey of shoulder region).FACTORS: Kvp-70, mAS-8 distance from x-ray table to

x-ray tube-7cm (for adult) Kvp-55, mAS-2.5, D-4cm (for

children)

SHOULDER AP VIEW (After injury)

Patient seats erect position and face up the x-ray tube. To bring posterior aspects of shoulders to close contact with the bucky.

Arm is supported in cellor sling.Marker should be left or right and

patient identification is also required.

Centering point is coracoid process of scapula.

Horizontal beam at right angle to film.

After injury

LATERAL VIEW Positioning of the patient: Patient stands facing a vertical

buckey with the arm abducted and elbow flexed and hand resting on the hip. The effected side shoulder is in contact with the buckey and the patient is rotated to bring the scapula at right angle to the film.

Centering: Horizontal ray centered to the mid point of the medial border of the scapula.

Lateral view

Lateral position

Anatomy of armHumerus: It consist of shaft, two articular

extremities. Lower part is broad and has medial and lateral condyles and medial and lateral epicondyles. On its inferior surface are two smooth elevation, trachea for articulation with head of radius. The proximal end of humerus consists of head, anatomic neck and greater, lesser tuberosities and surgical neck.

Anatomy of humerus

Radiography of arm Humerus (AP View): Film Size:- Use film long enough to include both ends of

bone. Position of part:- Part should be lying in a supine position

on a table. Rotate hand and forearm until palm is up. Arm should be as near parallel as possible to table top.

Central ray:- Directed vertically to film and part centre.

Factor:- mAs 12-18, kVp 55-60

Humerus AP view

Ap supine view

Film size:- 10”×12”Position of part:- Patient should be lying

supine on the table. Abduct affected arm slightly, flox elbow, rotate hand medically.

Central Ray:- Directed vertically to part and film centre.

Factor:- mAs 12-18, kVp= 55-60

HUMERUS: Lateral (supine position)

HUMERUS: Lateral (erect position) Film size:- 10”×12” Position of part:- seat patient at the end of the table

on stool just high enough for him to extend his arm over the table. The elbow and shoulder should lie on the same plane. Respiration should be suspended for the exposure.

Central Ray:- directed vertically to film centre. Factor:- mAs 12-18 , kVp 55-60

ERECT RADIOGRAPH