Shoulder Positioning

Shoulder joint

Humerus, scapula, clavicle

Shoulder girdle

Scapula, clavicle

What projection is performed first to rule out trauma?

AP Projection with external rotation

What projection is performed for a proximal humerus fracture?

Transthoracic lateral

What projection is performed for a dislocation?

PA Oblique Scapular Y

What projection is performed for arthritis?

AP neutral/internal and/or AP oblique Grashey

What is the IR placement for an AP shoulder?

IR centered 1” below coracoid

What is the collimation for a AP shoulder?

1.5” above the shoulder; 1” beyond lateral aspect of shoulder and sternal end of clavicle; include proximal third of humerus

What is the positioning for an AP shoulder with external rotation?

Abduct arm slightly and supinate hand, epicondyles parallel to IR

What should you see in an AP external?

Humeral head in profile medially, entire clavicle and prox. humerus, entire scapula, greater tubercle in profile laterally

What is the positioning for an AP neutral?

Rest palm of hand against thigh

Where are the epicondyles for an AP external?

Parallel to IR

Where are the epicondyles for an AP neutral?

45 degrees to IR

What is the evaluation criteria for an AP neutral?

Humeral head in partial profile, greater tubercle superimposes humeral head

What is the positioning for an AP internal?

Internally rotate arm; rest dorsal aspect of hand against thigh

Where are the epicondyles in an AP internal?

Perpendicular to IR

What is the evaluation criteria for an AP internal?

Lesser tubercle in profile and pointing medially, greater tubercle superimposed over humeral head

How much do you rotate the body for an AP oblique Grashey?

35-45 degrees toward affected side with scapula parallel to IR

Which obliques are done for a Grashey?

RPO or LPO

Where is the CR centered for an AP grashey?

Perpendicular to coracoid (2” medial and 2” inferior to superolateral border of shoulder)

What is the collimation for Grashey?

1.5” above shoulder, 1” beyond lateral aspect of shoulder, lateral half of clavicle, proximal third of humerus

What is in profile for Grashey?

Glenoid cavity

When do we use a transthoracic lateral projection?

When arm can’t be rotated or abducted

What arm is raised for a transthoracic lateral?

Non-injured arm

What kind of respiration for transthoracic lateral?

Full inspiration or breathing technique to blur lung markings

Where is the CR centered for transthoracic lateral?

Perpendicular to MCP at level of surgical neck

What do we see in a transthoracic lateral?

Scapula, clavicle, humerus seen through lung field; scapula superimposed over thoracic spine; unaffected clavicle and humerus projected above shoulder closest to IR

What is the patient’s position for an inferosuperior axial shoulder?

Supine, head/shoulder/elbow elevated approx. 3”, abduct affected arm 90 degrees, humerus in external rotation, turn head toward opp. shoulder

Where does the CR enter for inferosuperior axial?

Horizontally through axilla

What is the angulation for inferosuperior axial?

Medially angled 15-30 degrees

What structures are shown for inferosuperior axial?

Prox. humerus, scapulohumeral joint, AC joint, lateral projection of coracoid

What is the obliquity for a PA Oblique Scapular Y?

45-60 degrees (so scapula is perpendicular to IR)

Where does the CR enter for a scap Y?

Perpendicular to scapulohumeral joint

What is the collimation for a scap Y?

12” length and 1” beyond lateral shadow

What structures are shown for a PA scap Y?

Scap Y shown with humeral head directly superimposed over the junction of the Y

How do we see an anterior dislocation on a PA scap Y?

Humeral head will be beneath the coracoid

How do we see a posterior dislocation on a PA scap Y?

Humeral head will be beneath the acromion

What is the tangential supraspinatus “outlet” method called?

Neer

Which obliques do we do for a outlet?

RAO or LAO

What is the angulation for an outlet?

10-15 degrees caudad

Where does the CR enter for an outlet?

superior aspect of humeral head

What is the evaluation criteria for an outlet?

Humeral head will be projected below the AC joint and is superimposed with the scapular body`

What is the patient position for AP scapula?

Abduct arm at right angle to draw scapula out laterally, flex elbow

What is the IR placement for AP scapula?

Top of IR 2” above shoulder

What is the respiration for AP scapula?

Slow breathing

Where does the CR enter for an AP scapula?

Perpendicular to scapula, approx. 2” below coracoid

What structures are shown for AP scapula?

Entire scapula from acromion to inferior angle

To see acromion and coracoid, where is the arm placed in a lateral scapula?

Flex elbow and place back of hand against posterior thorax

To see scapular body, where is the arm placed in a lateral scapula?

Extend arm upward or place arm across anterior chest

Where does the CR enter for a lateral scapula?

Perpendicular to mid-medial border of the scapula

What structures are shown for a lateral scapula?

Entire scapula from acromion to inferior angle, lateral and medial borders of scapula superimposed

Where does the CR enter for an AP and PA clavicle?

Perpendicular to midshaft of clavicle

Where does the CR enter for AP axial clavicle?

Midshaft of clavicle

What is the angulation for an ap axial clavicle if the patient is upright or supine?

15-30 degrees cephalic

What is the angulation for an AP axial clavicle if the patient is lordotic?

0-15 degrees cephalic

What is the angulation for a PA axial clavicle?

15-30 degrees caudad

What is the SID for an AP bilateral AC joints?

72”

Which image is taken first for AP Bilateral AC Joints: with or without weights?

Without weights

Where does the CR enter for AP bilateral AC joints?

Perpendicular to MSP at level of AC joints

What is the method called for AP Bilateral AC joints?

Pearson

Depression or compression fracture of the posterolateral humeral head

Hills-sachs defect

Protective cartilage that protects your bones wears down

Osteoarthritis