 AP View

 PA View

 Lateral View

 Erect or supine  Body position may vary  Humerus in true AP position abducted slightly away from body  Hand supinated  Top of IR 4 cm above head of humerus  CR: perpendicular to humerus, midshaft

 Almost same image can be obtained with patient in AP position  Elbow flexed 90 degrees  Hand supinated against thigh

 Patient facing IR  Elbow flexed 90 degrees  Hand resting on abdomen  CR: midshaft and perpendicular to humerus  IR: 4cm above head of humerus  If lateral shoulder required rotate body-may need a wedge filter across lower humerus for even density

 Shoulder and elbow joint seen  Epicondyles superimposed (lateral)  Lesser tubercle in profile medially  Even density of humerus  McQuillen Martinson p210 good comparison of latero- medial to medio-lateral laterals

 Erect or supine  Internal or external rotation  Ext-hand supinated  Int-back of hand against thigh  Suspended respiration  IR- 24 x 30-landscape  CP- 2.5cm inferior to coracoid process  CR-perpendicular

 External Rotation  Bony and soft tissue structures shown  Entire clavicle  Proximal humerus  Greater tubercle visible  GH jt seen with slight overlap of humeral  head

 Internal Rotation  Lesser Tubercle in profile

 Can be seated or standing so arm can be abducted out  Patient leans laterally adjusting arm out over IR  IR placed on table under shoulder jt  Elbow flexed 90degrees and rested on table-hand pronated  Head tilted away from affected side

 Patient’s body needs top be vertical so as not to rotate shoulder forward or backward  CR degrees toward elbow through the shoulder joint  IR needs to be displaced appropriately so the shoulder is centre of film  IR 18 x 24 crosswise

 Shows relationship of humeral head and glenoid  AC jt, coracoid process seen under humeral head  Lesser tubercle in profile & seen anteriorly  Bony & soft tissue detail

 Trauma-? # or dislocation  Preferably erect  Patient facing IR (PA)  Rotate body degrees to IR  Body of scapula perpendicular to IR  CR-humeral head perpendicular to mid medial scapular border  IR 24 x 30 portrait

 Humeral head superimposed over junction of Y of scapula  Scapula not overlying the thorax  Medial & lateral borders superimposed  Inferior angle of scapula at lower edge of film and acromian at top  Glenoid cavity seen on end at meeting point of arms & leg of Y

 45 45

 Both joints imaged routinely for comparison  Imaged separately  Arms relaxed by side  CR: over each AC jt  Cone down close to joint to stop scatter  Use 18 x 24 divided into 2 or 24 x 30 divided into 4  Out of bucky best

 Reduced exposure-AC jts close to skin surface  Good coning for scatter reduction  Clearly marked L & R  Non-weight bearing or weight bearing-4 separate images

 What not to do.  Why?

 Patient erect or supine  Centre clavicle to middle of IR or bucky  Arms resting beside body  Suspend respiration  CP: perpendicular to midshaft of clavicle  24 x 30 cm landscape

 Should demonstrate all shoulder structures as in AP shoulder  Distal clavicle seen above scapula with joint shown clearly

 Patient in same position as AP  Tube angled 30 degrees cephalic  Move IR upward to centre clavicle to IR  18 x 24cm landscape

 Most of clavicle projected above ribs  AC joints and SC joints will be seen

 Patient erect-more comfortable  Can be supine  Abduct arm as much as possible to bring scapula away from chest  Top of IR above top of shoulder  CR: perpendicular to mid scapula 5cms below coracoid process  24 x 30 landscape

 Lateral border of scapula away from chest  Bony detail of chest  Acromion process clearly seen as well as inferior angle of scapula

 This view is the same as lateral shoulder.  I would have the arm across the abdomen as apposed to behind the patient-less painful  In cases of severe pain perform lateral in whatever position the arm presents