Shoulder Girdle Projections (PDF)

EVALUATION PROJECTION PART POSITION CENTRAL RAY REFERENCE POINT STRUCTURE SHO...

EVALUATION PROJECTION PART POSITION CENTRAL RAY REFERENCE POINT STRUCTURE SHOWN RATIONALE External: Hand supinated, humeral epicondyles // to IR Neutral: Palmar/anterior aspect of hand against hip, humeral epicondyles 45° to IR Humerus, glenoid cavity, 1. AP (External, Neutral, Internal: Dorsal/posterior aspect of hand 1 in. inferior to coracoid acromion, coracoid process, Fractures, dislocations, Internal Rotation) against hip, humeral epicondyles ┴ to IR Perpendicular process clavicle, rotator cuff muscles rotator cuff tears Lateral image of shoulder and Glenoid cavity, humeral 2. Transthoracic Lateral Uninjured arm raised, forearm rested on Horizontal or 10- Midcoronal plane at the proximal humerus (projected head, rotator cuff muscles, (Lawrence) head, midcoronal plane ┴ to IR 15° cephalad level of surgical neck through thorax) acromion Proximal humerus, glenohumeral joint, lateral portion of coracoid process, AC articulation, subscapularis 3. Inferosuperior Axial Arm abducted 90°, humerus externally Horizontal, 15- tendon insertion, teres minor Glenohumeral joint, rotator (Lawrence) rotated, IR against neck, head turned away 30° medially Axilla tendon insertion cuff muscles, acromion Arm abducted 90°, exaggerated external Coracoid process pointing 4. Inferosuperior Axial rotation, hand 45° to IR, thumb downward, Horizontal, 15° Axilla, passing through anteriorly, lesser tubercle in Hill-Sachs compression (Rafert Modification) IR against neck, head turned away medially acromion profile fracture Prone, shoulder elevated, head turned 5 in. inferior & 1.5 in. Bony abnormalities of the Chronic shoulder instability, 5. Inferosuperior Axial away, arm abducted 90°, forearm rested on 25° anteriorly & medial to acromial edge, anterior inferior rim of the Bankart's lesion, Hill-Sachs (West Point) table, IR placed vertically 25° medially exiting glenoid cavity glenoid defect Lateral recumbent, unaffected side against Acromioclavicular joint, IR, affected arm abducted 90° pointing scapulohumeral joint, 6. Inferosuperior Axial towards ceiling, IR against superior aspect of Horizontal, 5-15° glenohumeral joint in lateral When prone or supine (Clements Modification) shoulder medially Midaxillary region position positions are not possible Perpendicular to 7. PA Transaxillary Upright, body slightly rotated 5-10° anterior axilla and Lateral projection of the Humeral head, glenoid (Hobbs Modification) oblique, arm raised superiorly humeral head Glenohumeral joint proximal humerus cavity, rotator cuff muscles Oblique image of shoulder, scapula in lateral profile, Shoulder dislocations, 8. PA Oblique (Scapular RAO or LAO, scapula // to IR, arm slightly superimposed humeral head anterior/subcoracoid or Y, Rubin-Gray-Green) abducted, hand on abdomen Perpendicular Scapulohumeral joint and glenoid cavity posterior/subacromial Posterosuperior and 9. AP Axial (Stryker Supine, arm flexed slightly beyond 90°, palm posterolateral areas of "Notch") of hand on top of head 10° cephalad Coracoid process humeral head Hill-Sachs defect RAO or LAO, body rotated 35-45° towards 2 in. medial & 2 in. inferior Glenohumeral joint, joint 10. AP Oblique affected side, scapula // to IR, arm slightly to superolateral border of Joint space between humeral space narrowing, rotator (Grashey) abducted, hand on abdomen Perpendicular shoulder head and glenoid cavity cuff tears RAO or LAO, body rotated 35-45° towards affected side, scapula // to IR, arm abducted Loss of articular cartilage in 11. AP Oblique (Apple) 90°, hand holding 1 lb. weight Perpendicular Level of coracoid process Glenoid cavity scapulohumeral joint  Seated or standing, facing vertical grid device, unaffected side rotated away, Superior aspect of Posterior surface of acromion 12. Tangential (Neer) scapula flat and perpendicular to IR 10-15° caudad humeral head and AC joint Shoulder impingement Upright/seated-upright, arms along sides, IR 13. AP (Bilateral) centered to AC joint, 2 exposures with and Dislocation, separation, Pearson without weights Perpendicular Between level of AC joints Bilateral AC joints function of AC joint Upright/seated-upright, coracoid process 14. AP Axial centered to IR, IR height adjusted to AC subluxation or (Alexander) midpoint of acromioclavicular joint 15° cephalad Coracoid process AC joints above acromion dislocation RAO or LAO, hand of affected side under 15. PA Axial Oblique opposite axilla, midcoronal plane 45-60° to Acromioclavicular joint and AC joint subluxation or (Alexander) IR, shoulder pulled firmly across chest 15° caudad Acromioclavicular joint relationship of shoulder bones dislocation Clavicle fractures, 16. AP Supine/upright, arms along sides Perpendicular Midshaft of clavicle Frontal image of clavicle dislocations Upright: 1 foot in front, lean backward, neck 0-15° cephalad & shoulder against IR, neck in extreme (upright), 15-30° flexion; Supine: suspended at end of full cephalad Axial projection of clavicle, Clavicle fractures, 17. AP Axial (Lordotic) inspiration (supine) Midshaft of clavicle clavicle above ribs dislocations 25-35° anteroinferiorly Seated, slightly forward lean, IR placed in to midshaft of When lordotic or recumbent 18. Tangential (Tarrant) lap clavicle Midshaft of clavicle Clavicle above thoracic cage position is not possible Supine/upright, arms along sides, unaffected Scapula, lateral portion of shoulder elevated 15 degrees, affected arm 2 in. inferior to coracoid scapula free of Scapula fractures, 19. AP abducted, elbow flexed, hand pronated Perpendicular process superimposition dislocations Upright/seated, RAO/LAO, arm flexed & hand on posterior thorax or arm extended Midmedial border of Scapula, acromion, 20. Lateral upward, forearm rested on head Perpendicular protruding scapula Lateral image of scapula coracoid process RAO or LAO, arm of affected side 90° to long Between chest wall & 21. PA Oblique (Lorenz- axis of body or obliquely upward, hand midarea of protruding Glenoid cavity, humeral Lilienfeld) rested on head Perpendicular scapula Oblique image of scapula head 45° caudad (35° 22. Tangential Supine, scapular body // to IR, head turned for obese/round- Scapular spine in profile, free (Laquerrière-Peirquin) away shouldered) Scapular spine of superimposition AC joint instability Supine, unaffected shoulder elevated 15 23. AP (Subscapularis degrees, affected arm abducted, elbow Subscapularis insertion at Subscapularis tendon Insertion) flexed, hand pronated Perpendicular Coracoid process lesser tubercle tears, impingement