Shoulder, Clavicle, Scapula

Question 1

AP shoulder, external rotation

Answer 1

Hand supinated
CR: enters at point 1 inch inferior to coricoid process
Collimation: 10 X 12 inches, 1.5 inches above shoulder 1 inch beyond lateral aspect
Respiration: suspend
Structures shown: humeral head in profile, greater tubercle in profile on lateral aspect of humorous, scapulohumeral joint visualized with slight overlap of humeral head on Glenoid cavity, outline of lesser tubercle between the humeral head and greater tubercle

Question 2

AP shoulder internal rotation

Answer 2

Back of hand rested on hip
CR: enters at a point 1 inch inferior to the core process
Collimation: 10” X 12” , 1.5 inches above the shoulder, 1 inch beyond the lateral aspect
Respiration: suspend
Structures shown: lesser tubercle in profile and pointing medially, outline of greater tubercle superimposing Humeral head, greater amount of humeral overlap of Glenoid cavity than in external and neutral position.

Question 3

AP oblique ( grashey method)

Answer 3

Hand on abdomen
(RPO or LPO)45° up to 60°
CR: perpendicular to IR, 2 inches mediately 2 inches inferior to the superolateral border of the shoulder
Collimation: 8X 10 inches, 1.5 inches above shoulder 1 inch beyond lateral aspect
Respiration: suspend
Structure shown: open joint space between humeral head and Glenoid cavity, glenoid cavity in profile

Question 4

Transthoracic Lateral Shoulder
Lawrence method

Answer 4

Non-injured arm raised, forearm on head
CR: perpendicular, entering the mid coronal plane at the level of surgical neck (Armpit)
Collimation: 10 X 12 inches
Respiration: Full inspiration, lungs full of air
Structure shown: scapula, clavicle, and proximal humerus scene through lung field, scapula superimposed over the thoracic spine, unaffected clavicle, and humerus projected above the shoulder, closest to the IR

Question 5

PA oblique shoulder
Scapular Y

Answer 5

Patient (RAO or LAO) 45-60°
Palpate scapula and align perpendicular to IR (superior angle – acromial tip)
Cr: perpendicular to the scapulohumeral joint
Collimation: 12 inches in length, and 1 inch beyond lateral aspect
Respiration: suspend
Structure shown: humeral head in glenoid cavity, super imposed, humeral shaft and scapular body, super imposed, no, super imposition of scapular body over the bony thorax, acromion projected laterally and free of super imposition, cricoid, possibly super imposed or projected below the clavicle, scapula in lateral profile with lateral vertebral border superimposed

Question 6

AP acromioclavicular (AC)
W/ & W/O weights

Answer 6

Upright position, height of IR midpoint lies same level as AC joint
72” SID
Weights attached to wrists
Thyroid shield
CR: perpendicular to the midline of the body at level of AC joints
Collimation: 6“ x 17“ on Colter for both joints or 6“ x 8“ for separate exposures
Respiration: suspend
Structure shown: both AC joints, with, and without weights, included on one or two radiographs
No rotation, or leaning by the patient
Joint separation, if present, clearly seen on the images with the weights

Question 7

AP clavicle

Answer 7

Arms at side, shoulders to lie in same horizontal plane, center clavicle on IR
CR: perpendicular to the mid shaft of the clavicle
Collimation: 8” x 12” adjust 1.5 inches above shoulder 1 inch beyond lateral aspect
Respiration: suspended, the end of exhalation to obtain more uniform density
Structure shown: entire clavicle centered on the image,
lateral half of the clavicle above the scapula with the medial half superimposing the thorax

Question 8

AP axial clavicle

Answer 8

Back against the IR
center clavicle on IR
Arms at side and shoulders in same horizontal plane
CR: directed to enter at mid shaft of clavicle with cephalic angulation of 15°
Collimation: 8” x 12” with 1.5 inches above the shoulder and 1 inch beyond the lateral aspect
Respiration: suspend at end of full inspiration, to elevate angle of clavicle farther
Structure shown: entire clavicle, along with AC and SC joints
Lateral 2/3 of clavicle, projected above the ribs and scapula with medial end superimposing the thorax
Clavicle in a more horizontal orientation as compared with AP projection

Question 9

AP scapula view

Answer 9

Affected arm, abducted to right angle flex elbow and support hand (swear-in stance)
Positioned the IR 2 inches above the top of the shoulder
CR: perpendicular to the mid scapular area at a point, approximately 2” inferior to the coracoid process
Collimation: 10” x 12” include 1.5 inches above the shoulder and 2 inches beyond the lateral aspect and 1” below the inferior angle of the scapula
Respiration: make exposure during slow breathing to obliterate lung detail
Structure shown: scapula, free of superimposition from the ribs
Scapula horizontal and not slanted
Scapular detail through the superimposed, lung and ribs,
acromion and inferior angle

Question 10

Lateral scapula view

Answer 10

RAO or LAO positioning 45° toward IR
Flex, elbow and place, the back of hand on the posterior thorax at level, sufficient to prevent the humerus from overlapping the scapula ( affected arm behind back)
Cr: perpendicular to the mid medial border of protruding scapula (palpate)
Collimation: 12 inches in length 1.5 inches above the shoulder and 1 inch beyond the lateral shadow
Respiration: suspend
Structure shown: lateral and medial scapular borders superimposed
No superimposition of the scapular body on the ribs
No superimposition of the humor on the area of interest
Inclusion of the acromion and inferior angle