shoulder,humerus Flashcards
Supinate hand.
• Humeral epicondyles parallel with plane of film.
• Both epicondyles seen in profile.
• Best demonstrate the Greater tubercle in profile
• Routine projection for the humerus
HUMERUS AP
Rotate the arm medially
• Epicondylar line perpendicular to the film.
• Flex elbow approximately 90° (unless contraindicated) and place palmar aspect of hand on the hip.
• A true lateral is confirmed by the superimposed epicondyles.
• Best demonstrate the lesser tubercle in profile.
HUMERUS LATERAL
Superior border of the image receptor should be placed 1 inch (2.5 cm) above the affected shoulder.
• Instruct the patient to do shallow breathing to blur out ribs and lung structures to better visualize the proximal humerus.
• Place affected arm in neutral rotation and drop shoulder if possible.
• Raise unaffected arm and place over the top of the head.
CENTRAL RAY:
• 1. Perpendicular to the surgical neck.
• 2. 10°-15° cephalad if the patient cannot elevate the unaffected shoulder.
• Lateral view of the proximal 2/3 of the humerus seen anteriorly to the thoracic vertebrae.
• Alternative position taken primarily in cases of trauma to the upper arm or shoulder or when the patient is otherwise unable to rotate or abduct the arm.
HUMERUS/SHOULDER JOINT TRANSTHORACIC LATERAL PROJECTION LAWRENCE METHOD
Rest palm of hand against thigh/hip
• Medial and lateral epicondyles at a 45 degrees angle to plane of cassette.
• IR 2 in. above top of shoulder.
• CR perpendicular to the coracoid process 1 inch (2.5 cm) inferior to the coracoid process
Greater tubercle partially superimposed the humeral head
• Humeral head in partial profile.
• Best demonstrate the posterior part of the supraspinatus insertion.
• Oblique view of the proximal humerus.
SHOULDER JOINT AP PROJECTION NEUTRAL ROTATION
Medially (internally) rotate palm of hand (thumb side down).
• Back of the hand against thigh/hip.
• Medial and lateral epicondyles are perpendicular to the plane of the cassette.
• CR perpendicular to the coracoid process 1 inch (2.5 cm) inferior to the coracoid process
• Best demonstrate the lesser tubercle in profile medially.
• Profile image of the site of the supraspinatus tendon.
• Lateral view of the humerus.
SHOULDER JOINT AP PROJECTION INTERNAL ROTATION
CR perpendicular to the coracoid process 1 inch (2.5 cm) inferior to the coracoid process
• Laterally (Externally) rotate palm of the hand (extreme supination)
• Medial and lateral epicondyles are parallel to the plane of cassette.
• Best demonstrate the greater tubercle in profile on the lateral aspect of the humerus
• The true AP projection of the humerus in the anatomic position.
• Profile image of site of insertion of the supraspinatus tendon.
SHOULER
AP PROJECTION EXTERNAL ROTATION
• Patient in supine position
• Abduct arm of the affected side 90°
• Humerus in external rotation with the palm up.
CENTRAL RAY:
• 1. Horizontally through the axilla to the acromioclavicular joint.
• 2. 15°-30° if abduction of arm is less than 90°
• Best demonstrate the lesser tubercle in profile directed anteriorly
• Demonstrate an inferosuperior axial image of the proximal humerus.
SHOULDER JOINT INFEROSUPERIOR AXIAL PROJECTION LAWRENCE METHOD
Abduct arm of the affected side 90°
• Humerus in exaggerated external rotation.
• Hand form an angle of 45° oblique.
• Thumb pointing downward.
• Horizontal and angled 15° medially entering the axilla and passing through the acromioclavicular joint.
• Demonstrate an inferosuperior axial image of the proximal humerus.
• Best demonstrate the lesser tubercle in profile directed anteriorly
• Demonstrate Hill-Sachs defect - Compression
fracture of the articular surface of the humeral head with anterior dislocation of the humeral head.
SHOULDER JOINT INFEROSUPERIOR AXIAL PROJECTION RAFERT MODIFICATIONl
Abduct arm of the affected side 90°
• Patient in prone position with approximately 3 inch pad under the shoulder being examined.
• 25° anteriorly from the horizontal and 25° medially and enters 5 inches (13 cm.) and 1 1⁄2 medial to the acromial edge and exits the glenoid cavity.
• Humeral head projected free of coracoid process.
SHOULDER JOINT INFEROSUPERIOR AXIAL PROJECTION WEST POINT METHOD
Patient in lateral recumbent position lying on the unaffected side.
• Abduct the affected arm 90° and point it toward the ceiling.
• 1. CR horizontal to the midcoronal plane passing through the midaxillary region of the shoulder.
• 2. 5°-15° medially when the patient cannot abduct the arm for a full 90°.
• When the prone or supine is not possible for an inferosuperior projection of the shoulder joint.
• Lesser tubercle in profile
SHOULDER JOINT INFEROSUPERIOR AXIAL PROJECTION CLEMENTS MODIFICATION
Rotate patient’s body so that the midcoronal plane forms an angle of 45°-60° to the IR.
• CR perpendicular to the scapulohumeral joint.
• Alternate view of the shoulder used primarily with trauma patients to demonstrate possible shoulder dislocations.
• Demonstrate an oblique image of the shoulder.
• True lateral view of the scapula, proximal humerus.
SHOULDER JOINT SCAPULAR Y
PA OBLIQUE PROJECTION
Rotate the body 35°-45° toward the affected side.
• CR perpendicular to the glenoid cavity at a point 2 inches (5cm) inferior to the superolateral border of the shoulder.
• Abduct arm slightly with arm in neutral position
•
Glenoid cavity in profile without superimposition of the humeral head.
GLENOID CAVITY
AP OBLIQUE PROJECTION GRASHEY METHOD
Rotate unaffected side away from the IR 45°-60° from the plane of the film.
• CR 10°-15° caudad entering the superior aspect of the humeral head.
• Demonstrate tangentially the coracoacromial arch or outlet for the supraspinatus outlet to diagnose shoulder impingement.
SUPRASPINATUS “OUTLET’ TANGENTIAL PROJECTION NEER METHOD
Flex the arm slightly beyond 90°
• 10° cephalad entering the coracoid process.
• Demonstrate the posterosuperior and posterolateral areas of the humeral head.
PROXIMAL HUMERUS AP AXIAL PROJECTION STRYKER NOTCH METHOD
Rotate the body 35°-45° toward the affected side.
• CR perpendicular to level of the coracoid process.
• Abduct the arm 90° from the midline of the body holding a 1 pound weight on the affected side.
• •
Glenoid cavity in profile
Demonstrate loss of articular cartilage in the
scapulohumeral joint but uses a weighted abduction.
Similar to the Grashey method except for the use of the 1 pound
GLENOID CAVITY
AP OBLIQUE PROJECTION APPLE METHOD
