SHOULDER Flashcards
PP:
- Upright (more comfortable) or supine; patient slightly rotated; scapula // to IR
-hand supinated; humeral epicondyles // to IR; arm abducted slightly
RP: 1 in. inferior to coracoid process
CR: ┴
SS:
-Shoulder & proximal humerus
-greater tubercle & site of insertion of the supraspinatus tendon
AP PROJECTION
EXTERNAL ROTATION
PP:
- Upright (more comfortable) or supine; patient slightly rotated; scapula // to IR
-palmar/anterior aspect of hand placed against the hip; humeral epicondyles 45o to IR
RP: 1 in. inferior to coracoid process
CR: ┴
SS:
-Shoulder & proximal humerus
-greater tubercle partially superimposing humeral head; posterior part of supraspinatus insertion
AP PROJECTION
NEUTRAL ROTATION
PP:
- Upright (more comfortable) or supine; patient slightly rotated; scapula // to IR
-dorsal/posterior aspect of hand against hip; humeral epicondyles ┴ to IR
RP: 1 in. inferior to coracoid process
CR: ┴
SS:
-Shoulder & proximal humerus
- lesser tubercle; site of the insertion of the subscapular tendon; proximal humerus in true lateral position
AP PROJECTION
INTERNAL ROTATION
PP: Upright (more comfortable) or supine; patient in lateral position; uninjured arm raised; forearm rested on head; midcoronal plane ┴ to IR; full inspiration (improves contrast & reduces exposure) or breathing technique (slow, deep breathing)
RP: Level of surgical neck
CR: Horizontal or 10-15o cephalad (cannot elevate unaffected shoulder)
SS: Proximal humerus
LAWRENCE METHOD
TRANSTHORACIC LATERAL PROJECTION
PP: Supine; head, shoulder & elbow elevated (3 in.); arm abducted 90o; humerus rotated externally; IR placed against the neck; head turn away from side of interest
RP: Axilla
CR: Horizontal; 15-30o medially (greater abduction, greater angle)
SS:
-Proximal humerus
-Scapulahumeral joint
-Lateral portion of coracoids process
-Acromioclavicular (AC) articulation
-Insertion site of subscapular tendon
Point of insertion of teres minor tendon
LAWRENCE METHOD
INFEROSUPERIOR AXIAL PROJECTION
PP: Supine; head, shoulder & elbow elevated (3 in.); arm abducted 90o; exaggerated external rotation of the arm; hand 45o to IR; thumb pointing downward; IR placed against the neck; head turn away from side of interest
RP: Axilla
CR: Horizontal; 15o medially
SS: Coracoid process pointing anteriorly; lesser tubercle in profile
ER: Hill-Sachs compression fracture (defect)
RAFERT-LONG MODIFICATION
INFEROSUPERIOR AXIAL PROJECTION
PP: Prone; shoulder elevated (3 in.); head turn away from side of interest; arm abducted 90o; forearm rested over the edge of table; IR placed vertically
RP: 5 in. inferior & 1.5 in. medial to acromial edge
CR: 25o anteriorly & 25o medially
SS: Humeral head projected free of the coracoid process
ER:
-Used when chronic instability of shoulder is suspected
-To demonstrate Bankart’s Lesion & associated Hills-Sachs defect
WEST POINT METHOD
INFEROSUPERIOR AXIAL PROJECTION
PP: Lateral recumbent; unaffected side against IR; affected arm abducted 90o; IR against superior aspect of shoulder
RP: Midaxillary region
CR: Horizontal or 5-15o medially (cannot abduct arm 90o)
SS: Acromioclavicular joint; scapulohumeral joint; glenohumeral joint
ER: When prone (Westpoint) or supine (Lawrence & Rafert-Long) position is not possible
CLEMENTS MODIFICATION
INFEROSUPERIOR AXIAL PROJECTION
PP: Seated; patient lean laterally; elbow flexed 90o & rested on table; hand pronated; humeral epicondyles ┴ to table
RP: Shoulder joint
CR: 5-15o toward the elbow
SS: Relationship of the proximal end of the humerus to the glenoid cavity
-AC articulation
-Outer portion of the coracoid process
-Points of insertion of the subscapularis muscle & teres minor muscle
-Coracoids process above clavicle
-Lesser tubercle in profile
SUPEROINFERIOR AXIAL PROJECTION
PP: Upright/supine; scapulohumeral joint centered to IR
RP: Scapulohumeral joint
CR: 35o cephalad
SS: Relationship of the head of humerus to the glenoid cavity
Scapula humeral joint
Proximal humerus
Clavicle projected above the superior angle of scapula
ER: Useful in diagnosing cases of posterior dislocation
AP AXIAL PROJECTION
PP: Upright/recumbent; RAO/LAO; MCP 45-60o to IR; scapular flat surface ┴ to IR; RPO/LPO (for severely injured patient)
RP: Scapulohumeral joint
CR: ┴
SS: Scapular body (form the vertical component); acromion & coracoid processes (form the upper limbs)
Superimposed humeral head & glenoid cavity
Superimposed humeral shaft & scapular body
Coracoid process superimposed or projected below the clavicle
ER: Useful in evaluation of suspected shoulder dislocations
-Anterior/subcoracoid dislocation: humeral head beneath the coracoid process
-Posterior/subacromial dislocation: humeral head beneath the acromion process
SCAPULAR Y
PA OBLIQUE PROJECTION
RUBIN-GRAY-GREEN
PP: Supine; arm flexed slightly beyond 90o; palm of hand on top of head w/ fingertips resting on head (places humerus in a slight internal rotation); body of humerus // to MSP of body
RP: Coracoid process
CR: 10o cephalad
SS: Posterosuperior & posterolateral areas of humeral head
ER: Useful for demonstration of Hill-Sachs defect
STRYKER “NOTCH” METHOD
AP AXIAL PROJECTION
HALL-ISAAC-BOOTH
