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) Lesser tubercle (arrowhead) Neutral rotation Internal rotation

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 350 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 900 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 100 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