Chapter 6 Positions

Shoulder (AP Projection) (External Rotation)

• Upright or Supine

• Center the shoulder joint to the midline of the grid

• Center the IR at 1inch inferior to coracoid process

• Suspend Respiration

• CR is perpendicular to 1inch inferior to coracoid process

External Rotation

• Supinate the hand

What’s in Profile

• Greater Tubercle

Shoulder (AP Projection)(Internal Rotation)

Upright or Supine

• Center the shoulder joint to the midline of the grid

• Center the IR at 1inch inferior to coracoid process

Respiration

• Suspend

Central Ray

• CR is perpendicular to 1inch inferior to coracoid process

Internal Rotation

• Flex the elbow and rotate arm internally,rest the back of the hand on the hip.

What’s in Profile?

• Lesser Tubercle

Shoulder (AP projection) (Neutral Rotation)

Upright or Supine

• Center the shoulder joint to the midline of the grid

• Center the IR at 1inch inferior to coracoid process

• Suspend Respiration

• CR is perpendicular to 1inch inferior to coracoid process

Neutral Rotation

• Rest the palm of hand against thigh

• epicondyles 45 degrees with the plane of IR

Shoulder (Glenoid Cavity/Grashley method) (AP Oblique Projection)

Position

• RPO or LPO

• Supine or Upright

• Center IR to scapulohumeral joint.

• Rotate body 35 to 45 degrees to affected side

• Abduct the arm slightly in internal rotation and place the palm of hand on abdomen.

Central Ray

• CR is perpendicular to the IR, 2 inches medial and 2 inches inferior to superolateral border of shoulder. (Armpit)

Respiration

• Suspend

What’s in profile?

• Joint space between humeral head and glenoid cavity

• Glenoid Cavity

Shoulder Joint (Tangential Projection) (Supraspinatus Outlet\Neer Method)

Position

• Upright

• RAO or LAO

• Affected shoulder centered and close to IR

• Unaffected side away from IR

• Flat part of Scapular needs to be perpendicular to IR

• Rotation will be anywhere from 45 to 60 degrees

• Arms by side

Central Ray

• Angled 10 to 15 degrees caudad, entering superior aspect of humeral head

Respiration

• Suspend

What’s in profile?

• Humeral head lower than Y

• AC joint

• Humerus and scapular body usually parallel.

Shoulder (Transthoracic Lateral Projection) (Lawerence Method)

• Right or Left lateral position

• Upright or Supine (Upright may be less painful for trauma patients)

• Raise unaffected arm, rest forearm on head

• Center the IR to the surgical neck area of humerus

Respiration

• Full inspiration

• Breathing technique (slow deep breathing)

Central Ray

• Perpendicular to the IR

• Enters at the midcoronal plane at the level of the surgical neck

• If patient is unable to lift unaffected shoulder angle the central ray 10 to 15 degrees cephalad.

What’s in Profile?

• Scapula, Clavicle and proximal humerus seen through lung field

• Unaffected shoulder projected above the shoulder closer to the IR

Shoulder (Superoinferior Axial Projection)

Position

• IR at the end of the table parallel with long axis

• Have patient lean laterally until shoulder joint is over midpoint of IR

• Elbow flex 90 degrees with hand prone

• Head tilted toward unaffected shoulder.

• Epicondyles should be vertical

Respiration

• Suspend

Central Ray

• Angled 5 to 15 degrees through shoulder joint toward elbow

• Greater angle when patient is unable to extend shoulder over midpoint of IR.

What’s in profile?

• Joint relationship of the proximal end of humerus and glenoid cavity.

• AC articulation

• Outer portion of coracoid process

• Lesser tubercle

• Scalpulohumeral joint

Shoulder (Inferiosuperior Axial Projection) (Lawrence)

Position

• Supine

• Shoulder needs to be built up

• Head turned away from IR

• Place IR crosswise in the crook of patient’s neck and shoulder. (Shoulder Joint)

Respiration

• Suspend

Central Ray

• Horizontal

• Enters Axilla

What’s in profile?

• Proximal Humerus

• Scapulohumeral joint (slight overlap)

• AC articulation

• Lateral part of corocoid

• Lesser tubercle

Shoulder (PA oblique)(Scapular Y/ Y-View)

Position

• Upright or recumbent

• RAO or LAO

• Affected shoulder closer to IR

• 45 degree oblique

Central Ray

• Perpendicular to Scapulohumeral Joint

Respiration

• Suspend

What’s in profile?

• Humeral head and scapular body superimposed

• Acromion projected laterally and free of superimposition

• Scapula in lateral position

AC joints (AP Projection)

Position

• Upright

• Arms hanging by side

• 2 seperate exposures made; one with weights and one without.

• Shoulder in same horizontal plane

Central Ray

• If one image (perpendicular to midline of body at AC joints)

• If two images ( perpendicular to individual AC joint)

• SID 72

What’s in profile?

• AC joints

  
  

Clavicle (PA axial projection)

Position

• Upright or Supine

• Clavicle centered to Wall Bucky

• Arms at side

• Patient facing wall bucky

Central Ray

• CR enters the mid shaft of clavicle

• CR is angled 15 to 30 degrees caudad (15 for larger body habitus, 30 for smaller)

Respiration

• Suspend at the end of full inspiration

What’s in profile?

• Clavicle (SC and AC joints) above ribs

• Horizontal Clavicle

• Lateral 2/3rds of clavicle above scapula and medial end superimposing thorax

Clavicle (AP Axial Projection)

Position

• Upright or Supine

• Clavicle centered to Wall Bucky

• Arms at side

• Patient facing wall bucky

Central Ray

• CR enters the mid shaft of clavicle

• CR is angled 15 to 30 degrees cephalic (15 for larger body habitus, 30 for smaller)

Respiration

• Suspend at the end of full inspiration

What’s in profile?

• Clavicle (SC and AC joints) above ribs

• Horizontal Clavicle

• Lateral 2/3rds of clavicle above scapula and medial end superimposing thorax

Clavicle (AP Projection)

Position

• Upright or supine

• Mid line of IR should align with level of clavicle

• Arms by side

• Shoulders same plane

Respiration

• suspend at the end of exhalation.

Central Ray

• perpendicular to the midshaft of clavicle

What’s in profile?

• Entire Clavicle

• Lateral half of clavicle will be above scapula, medial half superimposing thorax

Clavice (PA Projection)

Position

• Upright or supine

• Mid line of IR should align with level of clavicle

• Arms by side

• Shoulders same plane

Respiration

• suspend at the end of exhalation.

Central Ray

• perpendicular CR exits the midshaft of clavicle

What’s in profile?

• Entire Clavicle

• Lateral half of clavicle will be above scapula, medial half superimposing thorax

Scapula (AP Projection)

Position

• Upright or supine.

• Center affected scapula to midline of grid.

• Arm in stop sign position

• Top of IR 2 inch above shoulders

Central Ray

• CR perpendicular to midscapular area 2 inches below coracoid process

Respirations

• Slow breathing

What’s in profile?

• Lateral portion of scapula free of superimposition from ribs

• Scapula Horizontal

• Acromion and inferior angle

Scapula (Lateral Projection)

Position

• Upright (Prone can be used but difficult)

• RAO or LAO

• Affected scapula centered to grid

• 45 to 60 degree angle from IR

• Move arm out of way to get Humerus out of way.

Respiration

• Suspend

Central Ray

• CR is perpendicular to mid medial border of the protruding scapula

What’s in profile?

• Lateral and medial scapular borders superimposed.

• No superimposition of scapular body on the ribs.

• No superimposition of humerus

• Acromion and inferior angle