DPT 650 - shoulder imaging

What is the normal "standard" view for X-raying the shoulder?

The AP view and the lateral view

what are the standard ways the GH joint are positioned in the AP view?

AP in external rotation

AP in internal rotation

How is the patient positioned in the AP view?

back against the image receptor

scapula is parallel to the image receptor

humerus is rotated internally or externally

What does AP in external rotation mean?

Standing in an anatomical position, the GH joint is externally rotated to get a better view of the greater tubercle

What does AP in internal rotation mean?

Standing in an anatomical position, the GH joint is internally rotated to get a better view of the lesser tubercle

where does the center ray (CR) positioned in the AP external rotation?

CR is directed perpendicular to point 1 inch inferior to the coracoid process

in a standard case, how far is the distance from the glenoid fossa to the humeral head?

usually 5 mm

but can be 5-10mm

What is the West Point view?

a view used to visualize the glenoid rim and the relationship of the proximal humerus to the glenoid

What is the West Point view used for?

When there is suspicion of a previous history of instability

What injury/lesion can be better seen in the west point view?

The Bankart lesion, and it may not be visible on the standard AP projection

What does the West Point view look like on an X-ray

Looks like a large golf ball sitting on a small tee

acromioclavicular joint (AC joint)

articulates the distal clavicle and the distal acromion

What ligaments hold the AC joint in place

the coracoclavicular ligaments

What two ligaments make up the coracoclavicular ligament?

the conoid and the trapezoid ligament

if tearing of these ligaments happen how does the distal clavicle shift?

The clavicle will shift cephalad

What causes the ligaments to tear and the clavicle to shift cephalad?

usually a fall onto the shoulder that depresses the acromion to a level that the clavicle is immobile

What is the purpose of using weights in an X-ray

to show how the joint behaves under stress, allowing the injury to be more prominent

If taking a weight x-ray, what is important to remember?

that you need to take one X-ray with weights and one without weights

When X-raying the AC joint, you should also...

include both halves of the body in the x-ray so you are able to compare/contrast to see what is normal/abnormal

position for AP radiograph of the scapula

CR is perpendicular to the midscapular area at 2 inches inferior to the coracoid process

What is the position for the lateral view of the scapula

CR is directed perpendicular to the midlateral border of the scapula

What position is the patient in during the anterior oblique scapular "Y" lateral view

patient in 60 degree anterior oblique position

CR is directed through the GH joint perpendicular to the image receptor

What structures can you see in the lateral radiographic view of the scapula

coracoid process, distal end of clavicle, humeral head, acromion, glenoid fossa, body of scapula, inferior angle, superior border of scapula, humeral shaft

What is the lateral "Y" view good at

coracoid and acromion vision

dislocations, scapula fractures, and degeneration

In the superior-inferior axial view of the shoulder, what structures can be seen

the lesser tubercle, humeral head, coracoid process, clavicle, GH joint, scapula, glenoid fossa, and the acromion

position of te inferosuperior axial projection of the GH joint

CR directly horizontally through the axilla toward the AC joint

What is the superior-inferior axial view good at seeing?

orthogonal images of shoulder dislocations, proximal humeral and glenohumeral articular surface problems

bankart lesion (bony) involved

injuries anteroinferior to the glenoid labral complex

bankart lesion (bony) is a common complication of what dislocation

anterior shoulder dislocation

Bankart lesion (bony) is often associated with

Hill-Sachs lesions

Falling forward with the arm stretched out will dislocate the shoulder, what way?

dislocate it posteriorly

Falling backward with an arm stretched out will dislocate the shoulder. Why?

dislocates anteriorly and is more common

Hill-Sacha Lesion happens when there is what?

compression on the humeral side

What does the hill-sach's lesion represent

a posterolateral humeral head compression fracture

What is shoulder osteoarthritis defined as?

losing joint space, and the bones are rubbing together

What is a mnemonic for remember causes of shoulder osteoarthritis

LOSS

In shoulder osteoarthritis, what does the "L" stand for

loss of joint space

In shoulder osteoarthritis, what does the "O" stand for

osteophytes

In shoulder osteoarthritis, what does the first "S" stand for

subchondral cysts

In shoulder osteoarthritis, what does the second "S" stand for

subchondral sclerosis