Shoulder

Glenohumeral Joint

AP shoulder girdle

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

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

External rotation Greater tubercle (arrow) Neutral rotation Internal rotation Lesser tubercle (arrowhead)

AP with arm in external rotation – True AP

Patient & part position  Supine or erect  Rotate patient slightly to place the spine of the scapula approximately parallel with the plane of the cassette  Abduct the arm slightly and the palm forward to bring the coronal plane of the epicondyles parallel to the cassette

AP with arm in neutral position Patient & part position  Supine or erect  Rotate patient slightly to place the spine of the scapula approximately parallel with the plane of the cassette  Rest the palm of the hand against the thigh to bring the humerus in neutral position  Direct Central ray perpendicular to the cassette over coracoid process.

AP with arm in internal rotation – humerus in lateral

Patient & part position  Supine or erect  Rotate patient slightly to place the spine of the scapula approximately parallel with the plane of the cassette  Flex the elbow somewhat and rotate the arm internally and rest the back of the hand on hips to bring the humerus in lateral position  Direct Central ray perpendicular to the cassette over coracoid process.

AP oblique for glenohumeral joint

AP oblique for glenohumeral joint

Patient & part position  Supine or erect  Rotate patient about 35 0 to place the body of the scapula parallel with the plane of the cassette  Abduct the arm slightly in internal rotation  Direct Central ray perpendicular to a point 5 cm medial and 5 cm below superolateral border of the shoulder (over coracoid process).

Shoulder Axial

 Supero-inferior  Infero-superior

Shoulder Axial

Superoinferior

 Direct the central ray through the shoulder joint with the tube angled 5 -10 degrees towards the elbow

Shoulder Axial

Superoinferior

 Patient seated on a chair close to the edge of the table  Raise the arm as close as possible right angles to the body  Lean the patient laterally to bring the axilla over the cassette while elbow rests on the table  Elbow flexed at 90 0 and hand pronated  Turn the head towards unaffected side

Inferosuperior

PA oblique (scapula Y) Useful in the evaluation of suspected shoulder dislocations

Supraspinatus “Outlet”

 To demonstrate tangentially the coracoacromial arch or outlet to diagnose shoulder impingement  The tangential image is obtained by projecting the x-ray beam under the acromion and AC joint, which defines the superior border of the coracoacromial outlet.

Outlet view – for shoulder impingement RAO/LAO (Modified scapula Y projection)  Patient upright and lateral with affected shoulder to center of the bucky  Rotate patient forward to make body of scapula perpendicular to cassette  Elbow flexed and forearm across the anterior (or posterior for body of scapula) chest  Direct central ray angled 10 0 down from horizontal through head of humerus

Outlet view – for shoulder impingement (modified scapula Y)

AP axial (Stryker ‘notch’ view)

 To demonstrate ‘Hill-Sachs defect’  Anterior dislocations of the shoulder frequently result in posterior defects involving the posterolateral head of the humerus, called Hill-Sachs defects.

AP axial (Stryker ‘notch’ view)

Transthoracic lateral

 To demonstrate proximal humerus in a 90 degree projection from the AP projection when trauma exists and the arm cannot be rotated or abducted because of an injury