Radiographic technique of Shoulder joint

1
3rd presentation

• Radiographic technique of Shoulder joint

2

• Shoulder joint

BASIC SPECIAL
AP Shoulder External Rotation Non trauma Inferosuperior Shoulder (Axial) Lawrence Method NON trauma
AP Shoulder Internal Rotation Non trauma Inferosuperior Shoulder (Axial) West point Method NON trauma
AP neutral Rotation Shoulder(trauma) APO ( Glenoid Cavity) Grashey NON trauma
Transthoracic Lateral projection Lawrence Method Shoulder ( trauma). Tangential ( Intertubercular Groove) NON trauma Fisk Method
3
Shoulder Anatomy
A.C.Joint
4
AP Shoulder External Rotation Non trauma
Basic
Film Size 10x12 in.(24x30 cm).Crosswise or
lengthwise. SHIELDING pelvic area. Patient
Position May be taken erect or supine.(Erect is
usually less painful for patient if condition
allows). Rotate body slightly toward affected
side to place shoulder in contact with film
holder or table top. Part Position Position
patient to center scapulohumeral joint to
centered of IR. Abduct extended arm slightly ,
then externally rotate arm ( supinate hand )
until epicondyles of distal humerus are parallel
to film.
Distance 100 cm or 40 in. C R perpendicular to
film. CP (1 in ( 2.5cm ) inferior to Coracoid
process). Collimation collimate on four sides to
area of interest. NB/ (suspend respiration during
Exposure )to reduce movement and tension
5
AP Shoulder External Rotation Non trauma
Basic
AP Shoulder
1.Clavicle 2. Acromio-clavicular joint 3.
Acromion 4. Greater tubercle of Humerus 5. Head
of Humerus 6. Lesser tubercle of humerus 7.
Surgical neck of humerus 8. Coracoid process 9.
Glenoid fossa 10. Shoulder joint 11. Lateral
border of scapula Structure shown AP
projection of proximal Humerus and lateral of 2/3
of the clavicle and upper scapula is shown ,
including the relationship of the Humeral head to
the glenoid cavity.
6
AP Shoulder Internal Rotation Non trauma

Basic
Film Size 10x12 in. (24x30 cm).Crosswise or
lengthwise . SHIELDING pelvic area. Patient
Position May be taken erect or supine.( Erect
is usually less painful for patient if condition
allows). Rotate body slightly toward affected
side to place shoulder in contact with film
holder or table top. Part Position Position
patient to center scapulohumeral joint to
centered of IR. Abduct extended arm slightly ,
then internally rotate arm ( pronate hand ) until
epicondyles of distal humerus are perpendicular
to film.
Distance 100 cm or 40 in. C R perpendicular to
film. CP (1 in ( 2.5cm ) inferior to Coracoid
process). Collimation collimate on four sides
to area of interest. NB/ (suspend respiration
during Exposure )to reduce movement and tension
7
AP Shoulder Internal Rotation Non trauma
Basic
Acromion
Scapulohumeral joint
Structure shown lateral view of proximal Humerus
and lateral of 2/3 of the clavicle and upper
scapula is shown , including the relationship of
the Humeral head to the glenoid cavity.
coracoid process
Lesser tubercle of humerus
proximal Humerus
Greater tubercle of Humerus
8
AP neutral Rotation Shoulder(trauma)

Basic
Film Size 10x12 in. (24x30 cm). Crosswise or
lengthwise . SHIELDING pelvic area. Patient
Position May be taken erect or supine.( Erect is
usually less painful for patient if condition
allows)Rotate body slightly toward affected side
to place shoulder in contact with film holder or
table top. Part Position Position patient to
center scapulohumeral joint to centered of
IR. Place patients arm at side in neutral
rotation.(epicondyles are generally approximately
45 degree to plane of IR or film.
Distance 100 cm or 40 in. CR perpendicular to
film. C P To mid scapulohumeral joint (3/4 in
(2 cm ) inferior and slightly lateral to the
Coracoid process). Collimation collimate on
four sides to area of interest. NB/ (suspend
respiration during Exposure )to reduce movement
and tension .
9
AP neutral Rotation Shoulder(trauma)

Basic
Structure shown the proximal one third of the
Humerus upper scapula , and lateral of 2/3 of the
clavicle is shown , including the relationship of
the Humeral head to the glenoid cavity.
10
Inferosuperior Shoulder (Axial) Lawrence
Method
(Special)
Non-trauma case
Film Size 8x10 in. (18x24 cm)Crosswise.
SHIELDING pelvic area. Patient Position
Pt supine Shoulder raised 5 cm from tabletop by
placing support under arm and shoulder. Head
rotated toward opposite side. Part Position Arm
abducted 90?. With external rotation (palm up) ,
Vertical cassette placed close to the
neck. Distance 100 cm or 40 in. C R Horizontal
25? - 30? medially to film center. C P Humeral
head (axilla). Collimation collimate on four
sides to area of interest. NB/ (suspend
respiration during Exposure )to reduce movement
and tension
11
Inferosuperior Shoulder (Axial) Lawrence
Method
(Special)
coracoid process
Structure shown lateral view of proximal
Humerus in relationship to the scapula cavity is
shown coracoid process Of scapula , Lesser
tubercle of humerus is shown , the spin of the
scapula will be seen on edge below the
scapulohumeral joint
Acromion
Glenoid fossa
spin of the scapula
12
Inferosuperior Shoulder (Axial) West
point Method
(Special)
Non-trauma case
Film Size 8x10 in. (18x24 cm). Crosswise.
SHIELDING pelvic area. Patient Position
Patient prone, head rotated away from affected
side, film held vertically against superior
surface of the shoulder. Part Position affected
shoulder raised 8 cm, affected arm abducted 90
deg., elbow flexed with forearm hanging freely
over table side. Distance 100 cm or 40 in. C
R 25? anterior( down from horizontal ) and then
25? medially to film center. C P Mid
scapulohumeral joint. Collimationcollimate on
four sides to area of interest. NB/ (suspend
respiration during Exposure ) to reduce movement
and tension
13
Inferosuperior Shoulder (Axial) West
point Method
(Special)
Structure shown An axial view of the shoulder
girdle is shown .The anteroinferior aspect of
glenoid rim is well demonstrated, humeral head is
seen free of coracoid superimposition.
Acromion
scapulohumeral joint
Lesser tubercle
14
APO ( Glenoid Cavity) Grashey
NON trauma
Special
Film Size 8x10 in. (18x24 cm). Crosswise
SHIELDING pelvic area. Patient Position
Patient erect or supine ,body rotated 35? to 45?
toward affected side . Part Position Place
support under elevated shoulder and hip (in the
supine) Arm abducted slightly in a neutral
position. Top of the cassette 2 in (5 cm) above
shoulder. Distance 100 cm or 40 in. C R
perpendicular to film. CP Scapulohumeral joint
2in (5cm ) inferior and medial to Superolateral
border of shoulder. Collimation collimate on
four sides to area of interest. NB/ (suspend
respiration during Exposure )to reduce movement
and tension.
15
APO ( Glenoid Cavity) Grashey
NON trauma
Special
Acromion
coracoid process
humeral head
Structure shown glenoid cavity should be seen in
profile without superimposition , humeral head.
glenoid cavity
16
Tangential ( Intertubercular Groove) NON trauma
Fisk Method (Special)
Film Size HD 8x10 in. (18x24 cm). Crosswise
SHIELDING place lead shield over pelvic area.
Body and Part position
Patient standing, leaning over end of table
elbow flexed and posterior surface of forearm
resting on table, hand supinated holding
cassette. patient leans forward to place humerus
10? 15? from vertical.
CR 90? to film center. CP directed to the
groove at mid anterior margin of humeral head .
Collimation collimate on four sides to area of
interest. NB/ (suspend respiration during
Exposure )to reduce movement and tension.
17
Tangential ( Intertubercular Groove) NON trauma
Fisk Method (Special)
intertuberclar bicipital groove.
Structure shown the anterior margin of humeral
head is seen in profile . The humeral tubercles
and intertuberclar groove seen in profile
Lesser tubercle
greater tubercle
coracoid process
Lat end clavicle
18
Transthoracic Lateral projection Lawrence
Method Basic Shoulder ( trauma).
Film Size 10x12 in. (24x30 cm) lengthwise.
SHIELDING pelvic area. Patient Position May be
taken erect or supine.( Erect is usually less
painful for patient if condition allows). Place
patient in lateral position with side of interest
against cassette. Part Position Place affected
arm at patients side in neutral rotation drop
shoulder if possible. Raise opposite arm and
place hand over top of the head elevate shoulder
as much As possible To prevent superimposing
affected shoulder. Ensure that thorax is in true
lateral position or with slightly anterior
rotation of unaffected shoulder to minimize
superimposition of hummers by thorax
vertebrae. Distance 100 cm or 40 in. CR
perpendicular to film. CP directed through
thorax to surgical neck. Collimation collimate
on four sides to area of interest. NB/ breathing
technique is preferred if patient can co-operate
Pt should be asked to gently breathe short,
shallow breaths without moving affected arm or
shoulder. (this will best visualize proximal
hummers by blurring out ribs and lung structure.)
19
Structure shown lat view of the proximal half
of the humerus and glenoihumeral joint should be
visualized through the thorax without
superimposition of the opposite shoulder.