Shoulder Glenohumeral Joint AP shoulder girdle Three projections

Shoulder Glenohumeral Joint

AP shoulder girdle Three projections with different positions of the arm will demonstrate the humeral head & neck in different views. Ø AP with arm in external rotation – True AP Ø AP with arm in neutral position Ø 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 Ø Supine or erect Ø Rotate patient slightly to place the spine of the scapula approximately parallel with the plane of the cassette Ø 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 Ø Supine or erect Ø Rotate patient slightly to place the spine of the scapula approximately parallel with the plane of the cassette Ø Rest the palm of the hand against the thigh to bring the humerus in neutral position Ø Direct Central ray perpendicular to the cassette over coracoid process.

AP with arm in internal rotation – humerus in lateral Patient & part position Ø Supine or erect Ø Rotate patient slightly to place the spine of the scapula approximately parallel with the plane of the cassette Ø 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 Ø Direct Central ray perpendicular to the cassette over coracoid process.

AP oblique for glenohumeral joint

AP oblique for glenohumeral joint Patient & part position Ø Supine or erect Ø Rotate patient about 350 to place the body of the scapula parallel with the plane of the cassette Ø Abduct the arm slightly in internal rotation Ø Direct Central ray perpendicular to a point 5 cm medial and 5 cm below superolateral border of the shoulder (over coracoid process).

Shoulder Axial Ø Supero-inferior Ø Infero-superior

Shoulder Axial Superoinferior Ø Direct the central ray through the shoulder joint with the tube angled 5 -10 degrees towards the elbow

Shoulder Axial Superoinferior Ø Patient seated on a chair close to the edge of the table Ø Raise the arm as close as possible right angles to the body Ø Lean the patient laterally to bring the axilla over the cassette while elbow rests on the table Ø Elbow flexed at 900 and hand pronated Ø Turn the head towards unaffected side

Inferosuperior

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

Supraspinatus “Outlet” Ø To demonstrate tangentially the coracoacromial arch or outlet to diagnose shoulder impingement Ø 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) Ø Patient upright and lateral with affected shoulder to center of the bucky Ø Rotate patient forward to make body of scapula perpendicular to cassette Ø Elbow flexed and forearm across the anterior (or posterior for body of scapula) chest Ø Direct central ray angled 100 down from horizontal through head of humerus

Outlet view – for shoulder impingement (modified scapula Y)

AP axial (Stryker ‘notch’ view) Ø To demonstrate ‘Hill-Sachs defect’ Ø 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 Ø 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