Positioning of the Shoulder Girdle (RADS 220)

AP Projection Shoulder Internal Rotation: Postion

Patient erect (more comfortable for the patient) or supine elevate opposite shoulder to bring affected shoulder closer to the IR just like a lateral humerus

-roate arm (hand) internally, rest back of hand on table or hip

SID for shoulder projections

40 in.

kVp for shoulder projections

75 - 90

IR for most shoulder projections

10 x 12 CW

For a AP Projection Shoulder Internal Rotation the epicondyles are ________________ to the IR

perpendicular

AP Projection Shoulder Internal & Eternal Rotation, & Neutral: CR

perpendicular to a point 1 in inferior to the coracoid process

Breathing for Shoulder Projections

Suspend Respiration

Marking for internal and external Shoulder Projections

mark w/ internal or external lead markers or make the letter (L or R) lie whick way the arm is rotating

AP Projection Shoulder Internal Rotation: SS

proximal humerus in a true lateral, lesser tubercle in profile

AP Projection Shoulder Internal Rotation: EC

- lesser tubercle in profile pointing medially

- greater tubercle superimposing the humeral head

- more humeral overlap of the glenoid cavity than in the other projections

AP Projection Shoulder External Rotation: Position

abduct and rotate arm externally so expicondyles are parallel to IR like an AP projection of humerus - hand supinated

-in case of suspected fracture, do not rotate arm

For a AP Projection Shoulder External Rotation the epicondyles are ________________ to the IR

parallel

AP Projection Shoulder External Rotation: SS

greater tubercle and site of insertion of suprinatus tendon (inserts at greater tubercle), scaphulohumeral joint relationship are seen

AP Projection Shoulder External Rotation: EC

-humeral head in profile

-greater tubercle in profile

-scaphulohumeral joint visualized with slight overlap of humeral head on glenoid cavity

-ouline of lesser tubercle between the humeral head and greater tubercle

AP Neutral- Trauma: Position

patient erect and place the palm of the hand against the thigh

AP Neutral- Trauma: SS

posterior part of supraspinatous insertion, which sometimes profiles small calcific deposits

AP Neutral- Trauma: EC

-greater tubercle partially superimposing the humeral head

-humeral head in partial profile

-slight overlap of the humeral head on the glenoid cavity

Purpose of the PA Oblique (Scapular Y)

to evalaute suspected shoulder dislocations

-NOT A LATERAL SCAPULA

PA Oblique (Scapular Y): Position

patient is stading erect in anterior position with the humerus hanging not placed across the body, we will rotate the pt so that the midcoronal plane forms a 45-60 degree angle with the plane of the IR

-want the flat surface of the scapula perpendicular to IR

The mid coronal plane of the pt during a PA Oblique (Scapular Y) will form what angle degree?

46-60 degree

Is a grid used for shoulder projections?

Yes

PA Oblique (Scapular Y): CR

Perpendicular to the scapulohumeral joint

PA Oblique (Scapular Y): Anterior Dislocations

the humeral head is beneath the coracoid process

PA Oblique (Scapular Y): Posterior Dislocations

the humeral head is below the acromian process

Superoinferior Axial Projection: IR SIze

10 x 12 LW

Superoinferior Axial Projection: CR

Angled 5 to 15 degrees through the shoulder joint and toward the elbow

Superoinferior Axial Projection: Position

pt seated with shoulder centered over the IR, raise arm and place at right angle to long axis of the body; elbow is flexed 90 degrees with hand in prone position

-bend neck towards unaffected shoulder

Superoinferior Axial Projection: SS

shows the joint relatonship of the proximal end of the humerus and the glenoid cavity AC articulation, outer portion of the coracoid process

Superoinferior Axial Projection: EC

-scaphulohumeral joint

-coracoid process projected above the clavicle

-lesser tubercle in profile

-AC joint through the humeral head

Inferosuperior Axial Projection is what method?

Lawrence Method

Inferosuperior Axial Projection: CR

horizontal through the axilla to the AC articulation 15-30 degrees medially

Inferosuperior Axial Projection: SS

an inferosuperior image demonstarting schapulohumeral joint, lateral portion of coracoid process and AC articulation

Inferosuperior Axial Projection: Position

IR placed vertical above the shoulder, pt supine, elevate head and shoulders, try to abduct arm 90 ddegrees to body keeping humerus in external rotation, turn head away

What is the method for the AP Oblique Projection of the Shoulder?

Grashey Method

AP oblique projection (grashey): Position

rotate the body 35-45 degrees toward the affected side, abduct the arm with slight internal rotation; palm of hand on abdomen

For the AP oblique projection (grashey) this position places the scapula ___________ to the IR

Parallel

AP oblique projection (grashey): CR

perpendicular entering 2 in medial and 2 in inferior to the superolateral border of shoulder @ glenoid cavity

AP oblique projection (grashey): SS

joint space open between the humeral head and glenoid cavity (scaphulohumeral joint)

Shoulder Routine Projections

-Grashey Method: AP projection external rotation of hand

-Scapular Y

-Axillary