ShoulderShoulder

Glenohumeral JointGlenohumeral Joint

AP shoulder girdleAP shoulder girdle

Three projections with different positions of Three projections with different positions of the arm will demonstrate the humeral head the arm will demonstrate the humeral head & neck in different views.& neck in different views.

AP with arm in external rotation – True APAP with arm in external rotation – True AP AP with arm in neutral position AP with arm in neutral position AP with arm in internal rotation –humerus AP with arm in internal rotation –humerus

in lateralin lateral

External rotation

Neutral rotation Internal rotation

Greater tubercle (arrow)

Lesser tubercle (arrowhead)

AP with arm in external rotation – AP with arm in external rotation – True APTrue AP

Patient & part positionPatient & part position Supine or erectSupine or erect Rotate patient slightly to place the Rotate patient slightly to place the spinespine of of

the scapula approximately parallel with the the scapula approximately parallel with the plane of the cassetteplane of the cassette

Abduct the arm slightly andAbduct the arm slightly and the palm the palm forward to bring the coronal plane of the forward to bring the coronal plane of the epicondyles parallel to the cassetteepicondyles parallel to the cassette

AP with arm in neutral positionAP with arm in neutral position

Patient & part positionPatient & part position Supine or erectSupine or erect Rotate patient slightly to place the spine of Rotate patient slightly to place the spine of

the scapula approximately parallel with the the scapula approximately parallel with the plane of the cassetteplane of the cassette

Rest the palm of the hand against the thigh Rest the palm of the hand against the thigh to bring the humerus in neutral positionto bring the humerus in neutral position

Direct Central ray perpendicular to the Direct Central ray perpendicular to the cassette over coracoid process.cassette over coracoid process.

AP with arm in internal rotation –AP with arm in internal rotation –humerus in lateralhumerus in lateral

Patient & part positionPatient & part position Supine or erectSupine or erect Rotate patient slightly to place the spine of the Rotate patient slightly to place the spine of the

scapula approximately parallel with the plane of scapula approximately parallel with the plane of the cassettethe cassette

Flex the elbow somewhat and rotate the arm Flex the elbow somewhat and rotate the arm internally and rest the back of the hand on hips internally and rest the back of the hand on hips to bring the humerus in lateral positionto bring the humerus in lateral position

Direct Central ray perpendicular to the cassette Direct Central ray perpendicular to the cassette over coracoid process.over coracoid process.

AP oblique for glenohumeral jointAP oblique for glenohumeral joint

AP oblique for glenohumeral jointAP oblique for glenohumeral joint

Patient & part positionPatient & part position Supine or erectSupine or erect Rotate patient about 35Rotate patient about 3500 to place the to place the bodybody

of the scapula parallel with the plane of the of the scapula parallel with the plane of the cassettecassette

Abduct the arm slightly in internal rotationAbduct the arm slightly in internal rotation Direct Central ray perpendicular to a point Direct Central ray perpendicular to a point

5 cm medial and 5 cm below superolateral 5 cm medial and 5 cm below superolateral border of the shoulder (over coracoid border of the shoulder (over coracoid process).process).

Shoulder AxialShoulder Axial

Supero-inferiorSupero-inferior Infero-superiorInfero-superior

Shoulder AxialShoulder Axial SuperoinferiorSuperoinferior Direct the central ray through the shoulder joint Direct the central ray through the shoulder joint

with the tube angled 5 -10 degrees towards the with the tube angled 5 -10 degrees towards the elbowelbow

Shoulder AxialShoulder Axial SuperoinferiorSuperoinferior

Patient seated on a chair close to the edge Patient seated on a chair close to the edge of the tableof the table

Raise the arm as close as possible right Raise the arm as close as possible right angles to the bodyangles to the body

Lean the patient laterally to bring the axilla Lean the patient laterally to bring the axilla over the cassette while elbow rests on the over the cassette while elbow rests on the tabletable

Elbow flexed at 90Elbow flexed at 9000 and hand pronated and hand pronated Turn the head towards unaffected sideTurn the head towards unaffected side

InferosuperiorInferosuperior

PA oblique (scapula Y) PA oblique (scapula Y)

Useful in the evaluation of suspected shoulder dislocations

Supraspinatus “Outlet”Supraspinatus “Outlet”

To demonstrate tangentially the To demonstrate tangentially the coracoacromial arch or outlet to diagnose coracoacromial arch or outlet to diagnose shoulder impingementshoulder impingement

The tangential image is obtained by The tangential image is obtained by projecting the x-ray beam under the projecting the x-ray beam under the acromion and AC joint, which defines the acromion and AC joint, which defines the superior border of the coracoacromial superior border of the coracoacromial outlet.outlet.

Outlet view – for shoulder impingement Outlet view – for shoulder impingement RAO/LAORAO/LAO(Modified scapula Y projection)(Modified scapula Y projection)

Patient upright and lateral with affected Patient upright and lateral with affected shoulder to center of the buckyshoulder to center of the bucky

Rotate patient forward to make body of Rotate patient forward to make body of scapula perpendicular to cassettescapula perpendicular to cassette

Elbow flexed and forearm across the Elbow flexed and forearm across the anterior (or posterior for body of scapula) anterior (or posterior for body of scapula) chestchest

Direct central ray angled 10Direct central ray angled 1000 down from down from horizontal through head of humerushorizontal through head of humerus

Outlet view – for shoulder impingement Outlet view – for shoulder impingement (modified scapula Y)(modified scapula Y)

AP axial (Stryker ‘notch’ view)AP axial (Stryker ‘notch’ view)

To demonstrate ‘Hill-Sachs defect’To demonstrate ‘Hill-Sachs defect’ Anterior dislocations of the shoulder Anterior dislocations of the shoulder

frequently result in posterior defects frequently result in posterior defects involving the posterolateral head of the involving the posterolateral head of the humerus, called humerus, called Hill-Sachs defects.Hill-Sachs defects.

AP axial (Stryker ‘notch’ view)AP axial (Stryker ‘notch’ view)

Transthoracic lateralTransthoracic lateral To demonstrate proximal humerus in a 90 To demonstrate proximal humerus in a 90

degree projection from the AP projection degree projection from the AP projection when trauma exists and the arm cannot be when trauma exists and the arm cannot be rotated or abducted because of an injuryrotated or abducted because of an injury