3rd presentation
Radiographic technique of Shoulder joint
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
Shoulder Anatomy
A.C.Joint
AP Shoulder External Rotation Non trauma:
* 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
Basic
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.
AP Shoulder: Internal Rotation Non trauma:
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
Basic
AP Shoulder: Internal Rotation Non trauma:
Basic
Acromion
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.
Scapulohumeral joint
coracoid process
Lesser tubercle of humerus
proximal Humerus
Greater tubercle of Humerus
AP neutral Rotation:
Shoulder(trauma):
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 .
Basic
AP neutral Rotation:
Shoulder(trauma):
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.
Basic
Inferosuperior Shoulder (Axial)
Lawrence Method
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
(Special)
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
spin of the scapula
Glenoid fossa
Inferosuperior Shoulder (Axial)
West point Method
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.
Collimation:collimate on four sides to area of interest.
NB/ (suspend respiration during Exposure )
to reduce movement and tension
(Special)
Inferosuperior Shoulder (Axial)
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.
West point Method
(Special)
Acromion
scapulohumeral joint
Lesser tubercle
APO ( Glenoid Cavity)
Grashey
NON trauma
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.
Special
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
Tangential ( Intertubercular Groove) NON trauma Fisk Method
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.
(Special)
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
Transthoracic Lateral projection : Lawrence Method
Basic
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.)
Shoulder ( trauma).
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.