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Normal Shoulder Xrays

True AP in neutral rotation (taken in the plane of the scapula) (Grashey view)

Helpful for: GH arthritis, Coracoid fx,Glenoid fx, Proximal humerus fx.Posterior shoulder dislocation. Evaluate: humeral head postion relative to glenoid; AC joint position/arthritis; RTC calcifications, acromial spurring Acromiohumeral interval: normal = 7-14mm. <7mm indicates massive RTC tear. (Weiner DS, JBJS 1970;52B:524). May appear falsely decreased with posterior subluxation of the humeral head.

Blue dot = Greater Tuberosity Red dot = Lesser Tuberosity Position: Patient erect, turned 3035 toward the side being xrayed Tube: Perpendicular to plate AP in External rotation (taken in the plane of the scapula)

Helpful for: GH arthritis, Coracoid fx,Glenoid fx, Proximal humerus fx, compression fracture of humeral head.

Blue dot = Greater Tuberosity Red dot = Lesser Tuberosity Position: Patient erect, turned 3035 toward the side being xrayed; arm maximally externally rotated Tube: Perpendicular to plate

AP in Internal rotation (taken in the plane of the scapula)

Helpful for: Hill-Sachs lesions, GH arthritis, Coracoid fx, Glenoid fx,Proximal humerus fx.

Blue dot = Greater Tuberosity Red dot = Lesser Tuberosity Position: Patient erect, turned 3035 toward the side being xrayed; arm maximally internally rotated Beam: aimed perpendicular to plate

Scapular Y

Demonstrates: lateral projection of scapular body and humeral head overlapping the glenoid. Helpful for: Shoulder dislocation;Proximal humerus fx. ; scapular body fracture

Position: Erect with anterior aspect of affected shoulder against x-ray plate and rotating other shoulder out 40 deg. Beam: aimed from posteriorly along scapular spine

Axillary

Demonstrates: glenohumeral joint narrowing (best view), Os Acromionale, glenoid version, glenoid erosion, humeral head subluxation. Helpful for: determining the amount of acromion which remains in patients who have undergone previous surgery; relation of humeral head to glenoid; Hill-Sachs lesions, Os Acromionale, AC joint, Shoulder dislocation,

Position: Patient seated at side of radiographic table with the arm abducted and axilla over the cassette.

Beam:angle 5-10 toward the elbow, central beam directed at the shoulder joint. Many alternative postions for similar xray, can be supine etc.

Supraspinatus Outlet view

Demonstrates: outlet/impingement of the supraspinatus and coracoacromial arch. Helpful for: Subacromial impingement, assessing acromial morphology, unfused acromial epiphysis.

Position: Erect with anterior aspect of affected shoulder against x-ray plate and rotating other shoulder out 40 deg. Beam: aimed from posteriorly along scapular spine but with the beam aimed with 10 caudal tilt Zanca View

Demonstrates: AC joint and distal clavicle Helpful for: AC arthritis, AC separations, dista l clavicle osteolysis. AC joint spurring and cystic changes indicates AC arthritis Distal clavicle elevation indicates AC separations.

Position: Erected with cassette behind shoulder. Beam:Xray beam aimed at the AC joint in 10 to 15 cephalic tilt. Xray penetration should be 1/2 normal to avoid overpenetration of AC joint.

West Point Axillary View

Demostrates: anteroinferior glenoid rim., best for osseous Bankart lesion. Helpful for: Shoulder Instability, Glenoid fractures, osseous Bankart lesion.

Postion:Patient prone with affected shoulder resting on a pad @8cm for the table top. Casette positioned against the superior apsect of the shoulder. Beam: aimed 25 from horizontal (to tables surface) and 25 medially (to patients midline). (Rokous JR, CORR 1972;82:84) Stryker Notch View

Demonstrates: humeral head Helpful for: Hill-Sachs lesions (best view), Bankart lesion.

Position: Patient supine with cassette posterior to the shoulder. The hand placed on top of the head. The elbow should point straight upward. Beam directed 10 superiorly/toward the head, centered over the coracoid process. (Hall RH, JBJS 1959;41-A:489-94)

Serendipity View

Demonstrates: sternoclavicular joints and medial 1/3 of the clavicles. Helpful for: Clavicle Fracture, Distal Clavicle Fracture, Sternoclavicular Dislocation,

Postion: supine with cassette under upper chest Beam aimed at clavicle or manubrium (SC pathology) with a 40 cephalic tilt.

Bennett's View (modified)

Obtained by angling the tube 5 cephalad with the arm abducted 45. Approximates an AP in ER view. Wright RW, AJSM 2004;32:121

Bennett's view

External rotation of the humerus with tilting of the xray tube 5 cephalad Bennett GE: Elbow and shoulder lesions of baseball players. Am J Surg 98: 484 492, 1959

Acromiohumeral Interval

average = 10.5mm. <7mm=full-thickness RTC tear. Measure on Grashey view. (Cotty P, J Radiol 1988;16:633).

Garth View (apical oblique)

Demostrates: the full extent of the glenoid rim bone loss and Hill-Sachs lesions Helpful for: Shoulder Instability, Glenoid fractures, osseous Bankart lesion. HillSachs lesions.

Postion: Seated with shoulder adjacent to cassette and arm adducted and internally rotated (place hand over heart). Chest rotated 45 Beam: beam perpendicular to the anterior-inferior glenoid rim and posterior-superior humeral head. (45 to the coronal plane and 45 caudally). Rollover for example rendition. Garth WP Jr, JBJS1984;66A:1450 Site Terms | Copyright Information | Contacts | Advertisements
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