shoulder

• Shoulder Articulations


  • Acromioclavicular Joint (Synovial Gliding)
  • Scapulohumeral Joint (Synovial Ball and Socket)
  • Sternoclavicular Joint (Synovial Double-gliding)
• Upper margin of the IR placement for AP humerus


  1 ½" above humeral head
• Breathing technique for humerus PA or Lateral


  Suspend respiration
• Arm position for AP humerus


  Abduct the arm slightly and supinate the hand
• Coronal plane passing through the epicondyles should be parallel to the plane of IR
• Structures demonstrated in profile in AP humerus


  • Humeral head and Greater Tubercle in profile laterally
• Arm position for lateral humerus


  Unless contraindicated (possible fx), internally rotate arm and flex elbow 90° & place palm of hand on the hip for lateromedial projection. Patient in PA with arm moved posteriorly away from the thorax for mediolateral projection
• Humeral epicondyles should be perpendicular to the IR
• Lateral projection to provide true lateral elbow without OID of proximal humerus


  Mediolateral projection with patient PA
• Tubercle shown in profile on lateral humerus


  • Lesser tubercle in profile
• Projections for lateral humerus with trauma


  Transthoracic Lateral (Lawrence method) for the proximal end and a Lateral of the distal end separately
• Structures shown in profile on AP humerus


  • Greater tubercle and humeral head
• Rotating the arm medially for a lateral projection of the humerus will place the epicondyles perpendicular with the plane of the IR
• Breathing technique for AP humerus


  Suspended Respiration (Shallow or full inspiration is used on the transthoracic for trauma)
• For AP humerus projection, epicondyles should be parallel to the IR
• When epicondyles are parallel to the IR, greater tubercle and humeral head are demonstrated in profile
• For AP shoulder projection in internal rotation, epicondyles are perpendicular to the IR
• When epicondyles are perpendicular to the IR, the lesser tubercle is demonstrated in profile
• Arm position for AP shoulder in neutral


  Have patient rest palm against thigh
• For AP shoulder in neutral, epicondyles are at 45 degrees
• AP shoulder projection that demonstrates greatest overlapping of humeral head and glenoid


  • Internal Rotation
• Projection to demonstrate proximal humerus laterally if patient unable to move arm


  Transthoracic Projection (Lawrence Method)
• Modification if patient unable to abduct unaffected arm for Lawrence transthoracic


  Angle the CR 10-15 degrees cephalic
• For Lawrence transthoracic lateral of proximal humerus, the surgical neck is centered to the IR
• Arm position for Inferosuperior (Lawrence) projection of shoulder


  Arm abducted as close to 90 degrees from body as possible with arm in external rotation
• Modification to Inferosuperior (Lawrence) projection to demonstrate Hill-Sachs defect


  Rafert Modification: same except arm in extreme or exaggerated external rotation (thumb pointing downward, hand at 45 degree oblique)
• Shoulder Anatomy


  • Coracoid Process
  • Scapular Neck
  • Acromion Process
  • Clavicle
  • Scapulohumeral joint at the glenoid cavity
  • Acromioclavicular joint
• Projection and method for demonstrating Hill-Sachs defect and Bankart lesions

  Inferiosuperior Projection, West Point Method
• CR angle and location for West Point Method


  25 degrees anteriorly (down) from horizontal and 25 degrees medially entering 5" inferior and 1 1/2" medial to the acromial edge and exits the glenoid cavity
• Hill-Sachs Defect


  • Compression fracture of the articular surface of the humeral head often associated with an anterior dislocation of the humeral head
• 97% of dislocations are anterior
• Arm position for superoinferior projection of shoulder joint


  Arm over cassette on table at right angles with anterior surface of forearm on table surface and hand pronated
• CR location and angle for superoinferior projection of shoulder joint


  Angled 5-15 degrees through the shoulder joint
• Purpose of PA oblique projection: scapular Y


  • Demonstrate anterior/posterior dislocations of the shoulder
• Patient position for scapular Y


  45-60 degree oblique, can be done in RPO/LAO or LPO/RAO (RPO/LPO affected side farthest from IR, RAO/LAO affected side closest to IR)
• CR location and angle for PA oblique: scapular Y


  Perpendicular to the scapulohumeral joint
• Arm location is not important for PA oblique: scapular Y because location of humeral head in relation to joint remains the same
• Patient oblique angle for AP oblique (Grashey) projection


  35-45 degrees toward affected side, may need more if patient is supine
• CR angle and location for AP Oblique (Grashey)


  Perpendicular to the Glenoid Cavity at a point 2" medial and 2" inferior to the superolateral border of the shoulder
• Purpose of AP Oblique (Grashey) projection


  • Demonstrate the scapulohumeral joint space with the glenoid cavity in profile