RAD 110 - Ch 5 Humerus & Shoulder Girdle Positioning - Positioning

Humerus Routine

- AP

- Lateral (rotational & horizontal beam)

AP Humerus Recumbent

What projection is this?

AP Humerus Erect

What projection is this?

Evaluation Criteria Humerus

- Include both shoulder and elbow joints

- CR to midhumerus

- Entire humerus demonstrated

- Greater tubercle in profile

- Medial and lateral epicondyles in profile

- Exposure factors

Lateromedial Humerus Erect

What projection is this?

Mediolateral Humerus Erect

What projection is this?

Rotational Lateral Humerus Recumbent

What projection is this?

Evaluation Criteria Lateral Humerus

- Epicondyles perpendicular to IR

- CR to midhumerus

- Entire humerus demonstrated

- Lesser tubercle in profile

- Epicondyles superimposed

- Exposure factors

Lateral Mid & Distal Humerus Recumbent Trauma

What projection is this?

Evaluation Criteria Lateral Mid & Distal Humerus Recumbent Trauma

- Mid and distal humerus

- Distal ⅔ humerus demonstrated

- 90° perspective from AP projection

- Epicondyles superimposed

- Exposure factors

Horizontal Beam Transthoracic Lateral Humerus Trauma

What projection is this?

Evaluation Criteria Horizontal Beam Transthoracic Lateral Humerus Trauma

- Demonstrates entire humerus without rotation

- Unaffected limb raised over head

- CR to mid aspect to involved humerus

Shoulder Girdle Technical Factors

- kV range: analog 70 to 75; digital 75 to 85 kV

- Grid (>10 cm)

- High mA (short exposure time)

- Small focal spot

- AEC (center chamber)

- 40 inches (102 cm) SID (except AC joints)

AP Proximal Humerus/Shoulder Routine

- External (AP)

- Internal (Lateral)

External Rotation AP Proximal Humerus/Shoulder

What projection is this?

Evaluation Criteria External Rotation AP Proximal Humerus/Shoulder

- Epicondyles parallel

- CR 1 inch (2.5 cm) inferior to coracoid process

- Greater tubercle profiled laterally

- Scapulohumeral joint centered

- Proximal humerus, upper scapula, and clavicle visualized

- Optimal exposure factors

Internal Rotation Lateral Proximal Humerus/Shoulder

What projection is this?

Evaluation Criteria Internal Rotation Lateral Proximal Humerus/Shoulder

- Epicondyles perpendicular

- CR 1 inch (2.5 cm) inferior to coracoid process

- Lesser tubercle profiled medially

- Scapulohumeral joint centered

- Proximal humerus, upper scapula, and clavicle visualized

- Optimal exposure factors

Shoulder - Inferosuperior Axial (Lawrence Method)

What projection is this?

Shoulder - Inferosuperior Axial (Lawrence Method) Alternate Position w/Exaggerated Rotation

- Demonstrate possible Hill-Sachs defect

- When there is an anterior dislocation, sometimes it may result in a wedge shape compression fracture on the humeral head.

Evaluation Criteria Shoulder - Inferosuperior Axial (Lawrence Method)

- CR 25° to 30° medial to axilla

- Arm supinated, abducted 90° (or as near 90° as possible)

- Supine with shoulder elevated 2" from the TT, sponge

- Lesser tubercle profiled anteriorly

- Humeral head and glenoid fossa profiled

- Optimal exposure factors

Shoulder - Inferosuperior Axial (Clements Modification)

What projection is this?

Evaluation Criteria Shoulder - Inferosuperior Axial (Clements Modification)

- CR perpendicular to IR

- If patient cannot abduct arm, CR 5° to 15° to axilla

Shoulder - Posterior Oblique Glenoid Cavity (Grashey Method)

What projection is this?

Evaluation Criteria Shoulder - Posterior Oblique Glenoid Cavity (Grashey Method)

- 35° to 45° oblique

- CR perpendicular to IR 2 inches (5 cm) inferior and medial from superolateral border of humerus

- Glenoid cavity profiled

- Scapulohumeral joint centered

- Optimal exposure factors

Shoulder - Posterior Oblique Glenoid Cavity (Grashey Method) Graphic

- 35° to 45° oblique

- CR perpendicular to IR 2 inches (5 cm) inferior and medial from superolateral border of humerus

Shoulder - Tangential Projection (Fisk Method) Intertubercular Groove (Erect)

What projection is this?

Position & CR Shoulder - Tangential Projection (Fisk Method) Intertubercular Groove (Erect)

- Humerus 15° to 20° to CR, which is perpendicular to IR

- Patient leaning forward slightly to place humerus 10 to 15 from vertical

- Turn head away from affected side

- Midanterior on humerus, carefully palpated

Shoulder - Tangential Projection Intertubercular Groove (Supine)

What projection is this?

CR Shoulder - Tangential Projection Intertubercular Groove (Supine)

- CR 15° to 20° posterior to humerus

Evaluation Criteria Shoulder - Tangential Projection

- Anterior humeral head profiled

- Groove profiled between greater and lesser tubercles

- Optimal exposure factors

Trauma Shoulder Routine

- AP—neutral rotation

- Scapular Y

- Transthoracic lateral (if required)

AP Neutral Rotation

What projection is this?

Evaluation Criteria for AP Neutral Rotation

- CR to scapulohumeral joint (¾ inch inferior and slightly lateral to coracoid process)

- Greater tubercle superimposed

- Scapulohumeral joint centered

- Optimal exposure factors

Transthoracic LateralProximal Humerus/Shoulder

What projection is this?

Evaluation Criteria for Transthoracic LateralProximal Humerus/Shoulder

- CR perpendicular to surgical neck

- Breathing technique

- Proximal humerus clearly seen

- Humeral head and glenoid cavity seen

- Humeral head in neutral rotation

- Optimal exposure factors

Scapular Y Lateral

What projection is this?

Evaluation Criteria for Scapular Y Lateral

- For lateral shoulder and proximal humerus

- CR to proximal humerus—2 inches (5 cm) below top of shoulder

- Body of scapula superimposed on end

- Acromion and coracoid processes in profile

- Humeral head and glenoid cavity superimposed

- Optimal exposure factors

Outlet Projection (Neer Method)

What projection is this? (note: CR angle)

Evaluation Criteria for Outlet Projection (Neer Method)

- CR 10° to 15° caudad

- Supraspinatus outlet open and in profile

- Demonstrates coracoacromial arch

- Optimal exposure factors