Shoulder
Glenohumeral Joint
AP shoulder girdle
Three projections with different positions of
the arm will demonstrate the humeral head
& neck in different views.
 AP with arm in external rotation – True AP
 AP with arm in neutral position
 AP with arm in internal rotation –humerus
in lateral
External rotation
Greater tubercle
(arrow)
Neutral rotation
Internal rotation
Lesser tubercle
(arrowhead)
AP with arm in external rotation –
True AP
Patient & part position
 Supine or erect
 Rotate patient slightly to place the spine of
the scapula approximately parallel with the
plane of the cassette
 Abduct the arm slightly and the palm
forward to bring the coronal plane of the
epicondyles parallel to the cassette
AP with arm in neutral position
Patient & part position
 Supine or erect
 Rotate patient slightly to place the spine of
the scapula approximately parallel with the
plane of the cassette
 Rest the palm of the hand against the thigh
to bring the humerus in neutral position
 Direct Central ray perpendicular to the
cassette over coracoid process.
AP with arm in internal rotation –
humerus in lateral
Patient & part position
 Supine or erect
 Rotate patient slightly to place the spine of the
scapula approximately parallel with the plane of
the cassette
 Flex the elbow somewhat and rotate the arm
internally and rest the back of the hand on hips
to bring the humerus in lateral position
 Direct Central ray perpendicular to the cassette
over coracoid process.
AP oblique for glenohumeral joint
AP oblique for glenohumeral joint
Patient & part position
 Supine or erect
 Rotate patient about 350 to place the body
of the scapula parallel with the plane of the
cassette
 Abduct the arm slightly in internal rotation
 Direct Central ray perpendicular to a point
5 cm medial and 5 cm below superolateral
border of the shoulder (over coracoid
process).
Shoulder Axial
 Supero-inferior
 Infero-superior
Shoulder Axial Superoinferior

Direct the central ray through the shoulder joint
with the tube angled 5 -10 degrees towards the
elbow
Shoulder Axial Superoinferior
 Patient
seated on a chair close to the edge
of the table
 Raise the arm as close as possible right
angles to the body
 Lean the patient laterally to bring the axilla
over the cassette while elbow rests on the
table
 Elbow flexed at 900 and hand pronated
 Turn the head towards unaffected side
Inferosuperior
PA oblique (scapula Y)
Useful in the evaluation of suspected shoulder
dislocations
Supraspinatus “Outlet”
 To
demonstrate tangentially the
coracoacromial arch or outlet to diagnose
shoulder impingement
 The tangential image is obtained by
projecting the x-ray beam under the
acromion and AC joint, which defines the
superior border of the coracoacromial
outlet.
Outlet view – for shoulder impingement
RAO/LAO(Modified scapula Y projection)
 Patient
upright and lateral with affected
shoulder to center of the bucky
 Rotate patient forward to make body of
scapula perpendicular to cassette
 Elbow flexed and forearm across the
anterior (or posterior for body of scapula)
chest
 Direct central ray angled 100 down from
horizontal through head of humerus
Outlet view – for shoulder impingement
(modified scapula Y)
AP axial (Stryker ‘notch’ view)
 To
demonstrate ‘Hill-Sachs defect’
 Anterior dislocations of the shoulder
frequently result in posterior defects
involving the posterolateral head of the
humerus, called Hill-Sachs defects.
AP axial (Stryker ‘notch’ view)
Transthoracic lateral
 To
demonstrate proximal humerus in a 90
degree projection from the AP projection
when trauma exists and the arm cannot be
rotated or abducted because of an injury