2.3 Shoulder Imaging

imaging of the shoulder order

plain radiographs, MRI, CT, DUS then bone scan

guidelines for radiographic rules/clinical decision making for shoulder trauma

ACR appropriateness criteria or imaging pathway

standard projections for shoulder includes

AP view in external and internal rotation and lateral scapular "y" view (90 degrees perpendicular to AP views)

AP external rotation

taken in true anatomic position, greater tubercle visualized at lateral aspect of humeral head

AP external rotation superimposes

lesser tuberosity and coracoid process

AP internal rotation view

taken with arm in internal rotation, lesser tubercle is visualized on medial aspect of humerus head (important with avulsion)

AP internal rotation superimposition of

greater tuberosity

scapular "y" lateral view position

UE remains neutral at patients side and pt is positioned in a 60 degree anterior oblique position (scapula appears as a Y - gets humerus out of the way of the scapula)

lighthouse to shoulder imaging

coracoid process - will be anterior always - pointing at you

axillary view of shoulder joint

pt supine, central ray through GH joint in an inferior-superior projection to view the humeral head in the glenoid fossa

in the axillary view, the coracoid process will always be

superior not matter what side

standard evaluation of AC joint

erect AP of affected arm (some perform bilateral)

to evaluate AC instability

stress view can be performed by adding weight to wrists, can widen AC joint and show pathology

routine radiologic eval of the elbow

AP and lateral views

oblique elbow views are used for

trauma or when superimposition may be causing poor visibility

central ray of rads for elbow

elbow joint

routine radiologic eval of the forearm

AP and lateral views

central ray for rads of the forearm

through mid-forearm long bones (to see radius and ulna)

patient position for AP elbow view

sitting with full shoulder ER and 90 degrees abduction with elbow extension and supination

AP view of elbow observations

distal humerus, valgus angle, olecranon process superimposed on trochlea of humerus, radial head, neck and tuberosity (somewhere superimposed by ulna), HRJ, HUJ and PRUJ

lateral view of elbow patient position

sitting with shoulder abducted to 90 with elbow flexed to 90 and neutral forearm

in lateral view of elbow, what side of the arm is touching the image receptor

medial epicondyle on image receptor

observations of lateral view of elbow

olecranon process, coronoid process superimposed by radial head, anterior portion of radius easy to view, distal humerus, trochlear sulcus

in the lateral elbow view, the epicondyles form a

superimposed teardrop shape

inner concentric arc is formed by

capitulum and trochlea

fat pads of HRJ and HUJ in the lateral view of the elbow are

superimposed together as a thin triangular lucency anterior and posterior to distal humerus

oblique view internal rotation of the elbow patient position

shoulder positioned in 90 degrees abduction and slightly internally rotated, elbow in extension with pronation

the oblique view with internal rotation of the elbow is the best projection to view the

coronoid process without superimposition

other observations in elbow oblique view internal rotation

articulation of coronoid process in olecranon fossa, posterior HUJ space and olecranon, medial epicondyle

oblique view external rotation of the elbow patient position

shoulder in 90 degrees abduction and slightly ER, elbow extended with supination

observations of the elbow in oblique external rotation view

radial head, neck and tuberosity, capitulum and lateral epicondyle, HUJ and HRJ