1. Shoulder
Glenohumeral Joint

2. 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

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

4. 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

5. 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.

6. 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.

7. AP oblique for glenohumeral joint

8. 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).

9. Shoulder Axial
Supero-inferior
Infero-superior

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

11. 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

12. Inferosuperior

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

14. 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.

15. 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

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

17. 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.

18. AP axial (Stryker ‘notch’ view)

19. 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