RADIOGRAPHIC PROCEDURES Essential Projections of the Shoulder 2/2

Seated

Shoulder SUPEROINFERIOR AXIAL PROJECTION Patient Position

5 to 15 degrees through the shoulder joint and toward the elbow,

Shoulder SUPEROINFERIOR AXIAL PROJECTION Central Ray

Head of humerus & glenoid cavity

Shoulder SUPEROINFERIOR AXIAL PROJECTION Structure Shown

Rubin, gray, green

SCAPULAR Y also known as

Gray & green

et al

Coracoid process

mas anterior kaysa ni acromion

PA OBLIQUE PROJECTION (SCAPULAR Y)

This projection is useful in the evaluation of suspected shoulder dislocations

Y

The body of the scapula forms the vertical component of the __ and the acromion and the coracoid process form the upper limbs

• Upright, recumbent

• Posterior oblique position (severely injured)

PA OBLIQUE PROJECTION (SCAPULAR Y) Patient Position:

45-60 degrees

PA OBLIQUE PROJECTION (SCAPULAR Y) Rotate patient's body so that the MCP forms an angle of __ to the image receptor.

Perpendicular to the scapulohumeral joint

PA OBLIQUE PROJECTION (SCAPULAR Y) Central Ray

• Anterior (subcoracoid) dislocations

• Posterior (subacromial) dislocations

PA OBLIQUE PROJECTION (SCAPULAR Y) Structure Shown:

Posterior (subacromial) dislocations

Projected beneath the acromion

Anterior (subcoracoid) dislocations

Humeral head is beneath the coracoid process

TANGENTIAL PROJECTION (NEER METHOD) SUPRASPINATUS OUTLET

This radiographic projection is useful to show tangentially the coracoacromial arch or outlet to diagnose shoulder impingement (nerve impingement) NERVE NA NAIPIT

coracoacromial outlet

The tangential image is obtained by projecting the x-ray beam under the acromion and AC joint, which defines the superior border of the

Increase rotation

__, if nka supine ang patient

Seated or in standing position

TANGENTIAL PROJECTION (NEER METHOD) SUPRASPINATUS OUTLET Patient Position

45-60 degrees

TANGENTIAL PROJECTION (NEER METHOD) SUPRASPINATUS OUTLET Rotate unaffected side away from the image receptor __ from the plane of the film.

40-60 degrees

From PA rotate

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

TANGENTIAL PROJECTION (NEER METHOD) SUPRASPINATUS OUTLET Central Ray

Posterior surface of the acromion and the AC joint

TANGENTIAL PROJECTION (NEER METHOD) SUPRASPINATUS OUTLET Structure Shown

Upright or supine

AP AXIAL PROJECTION Patient Position

Center the scapulohumeral joint of the shoulder being examined to the midline of the grid.

AP AXIAL PROJECTION Part Position

Scapulohumeral joint at a cephalic angle of 35 degrees

AP AXIAL PROJECTION Central ray

AP AXIAL PROJECTION

This is useful in diagnosing cases of posterior dislocation

head of the humerus to the glenoid cavity

AP AXIAL PROJECTION Structure Shown

Supine/upright

AP AXIAL PROJECTION (STRYKER NOTCH METHOD) patient position

10 degrees cephalad entering the Coracoid process

AP AXIAL PROJECTION (STRYKER NOTCH METHOD) Central ray

Posterosuperior and posterolateral areas of the humeral head

AP AXIAL PROJECTION (STRYKER NOTCH METHOD) Structure shown

• rafert

• Westpoint

Hill sachs defect: