Shoulder

Question 1

CR: Perpendicular to a point 1 inch inferior to the coracoid process.
POSITION: hand in Supine position.Epicondyles are parallel with the plane of IR
SS: greatee tubercle is seen laterally and lesser tubercle is locatee anterioly, medial to the greater tubercle

Answer 1

external Rotation

Question 2

CR: Perpendicular to a point 1 inch inferior to the coracoid process.
P: palm of the hand placed against the hip. Epicondyles at an angle of about 45 degrees with the plane of IR
SS: greater tubercle anterioly, lateral to lessee tubercle

Answer 2

Neutral Rotation

Question 3

CR: Perpendicular to a point 1 inch inferior to the coracoid process
P: posterios aspect if the hand place against the hip. Epicondyles perpendicular to the plane of the IR
SS: lesser tubercle seen in profile medially

Answer 3

Internal Rotation

Question 4

• used when trauma exists, and the arm
  cannot be rotated or abducted because of
  an injury.

Answer 4

TRANSTHORACIC LATERAL PROJECTION
(LAWRENCE METHOD)

Question 5

CR:
- Perpendicular to the IR at the level of the surgical
neck.
- If the patient cannot elevate the unaffected shoulder,
angle the central ray 10 to 15 degrees cephalad.
POSITION:
-Raise the uninjured arm,
rest the forearm on the
head, and elevate the
shoulder as much as
possible.
- Midcoronal plane must be
perpendicular to the IR.
-Center the IR to the surgical
neck area of the affected
humerus
STRUCTURE SHOWN: A lateral image of the shoulder
and proximal humerus is projected through the
thorax

Answer 5

TRANSTHORACIC LATERAL PROJECTION
(LAWRENCE METHOD)

Question 6

CR:
- Horizontally through the axilla to the
Acromioclavicular joint.
- The degree of medial angulation is often between 15 and 30 degrees.
POSITION:
- Abduct the arm of the affected side at right angles
to the long axis of the body.
- Keep the humerus in
external rotation.
- Have the patient turn the head away from the side
being examined. Place
the IR on edge against the
shoulder.

Answer 6

INFEROSUPERIOR AXIAL PROJECTION
(LAWRENCE METHOD)

Question 7

• Anterior dislocation of the humeral head,
  called the Hill-Sachs defect can be seen
  through the exaggerated external rotation
  of the arm.

Answer 7

INFEROSUPERIOR AXIAL PROJECTION (RAFERT MODIFICATION)

Question 8

CR: Horizontal and angled approximately 15 degrees medially, entering the axilla and passing through the
acromioclavicular joint.
POSITION:
- With the patient in position exactly as for the Lawrence
method, externally rotate
the extended arm until the
hand forms a 45-degree
oblique. The thumb will be pointing downward.
STRUCTURE SHOWN: An inferosuperior axial image shows the proximal humerus, the scapulohumeral
joint, the lateral portion of the coracoid process, and
the acromioclavicular articulation. A Hill-Sachs
compression fracture on the posterolateral humeral
head may be seen using the Rafert modification.

Answer 8

INFEROSUPERIOR AXIAL PROJECTION (RAFERT MODIFICATION)

Question 9

CR: Directed at a dual angle of 25 degrees anteriorly
from the horizontal and 25 degrees medially. The
central ray enters approximately 5 inches inferior and 1.5 inch medial to the acromial edge and exit the
glenoid cavity.
POSITION:
- Abduct the arm of the affected side 90 degrees.
- Place a vertically
supported IR against the superior aspect of the
shoulder
STRUCTURE SHOWN: The resulting image shows bony
abnormalities of the anterior inferior rim of the glenoid in patients with instability of the shoulder.

Answer 9

INFEROSUPERIOR AXIAL PROJECTION (WEST POINT METHOD)

Question 10

CR:
1. Horizontal to the midcoronalplane, passing through the midaxillary region of the shoulder.
2. Angled 5 to 15 degrees medially when the patient cannot abduct the arm a full 90 degrees.
POSITION:
- The patient must be in lateral recumbent position lying on the unaffected side.
- Abduct the affected arm 90 degrees.
- Place the IR against the
superior aspect of the patient’s shoulder.

Answer 10

INFEROSUPERIOR AXIAL PROJECTION (CLEMENTS MODIFICATION)

Question 11

CR: Angled 5 to 15 degrees through the shoulder
joint and toward the elbow.
POSITION:
- Lean the patient laterally over the IR until the
shoulder joint is over the midpoint of the IR.
- Flex the patient’s elbow 90 degrees and place the hand in the prone position.
- Tilt the head toward the unaffected shoulder.
STRUCTURE SHOWN:
- A superoinferior axial image shows the joint relationship of the proximal end of the humerus
and the glenoid cavity.
- The acromioclavicular articulation, the outer
portion of the coracoid process, and the points of
insertion of the subcapularis muscle (at body of
scapula) and teres minor muscle (at inferior axillary
border) are demonstrated.

Answer 11

SUPEROINFERIOR AXIAL PROJECTION