Chapter- 3




Student must recall structural features / landmarks in
different images of Shoulder joint & Upper Limb.
Student must Distinguish between different landmarks / parts
of structures in different images of Shoulder & Elbow joint.
Student must Distinguish between normal and abnormal
X Ray images of Shoulder & Elbow joint.
Student must Analyse the pathological findings of different
images of Shoulder & Elbow joint.
Normal Shoulder
 AP view with external rotation
 AP view with internal rotation
 Axillary view
v AC
vvgreater/less
GH
joint,joint, glenoid
er
acromion,
tuberosity
fossa clavicle
GH joint,
glenoid Fossa
AC joint,
acromion, clavicle
greater/less er
tuberosity
greater/lesser tuberosity
scapula,
spine of scapula,
Coracoid process
• GH joint
• glenoid Fossa
•
•
•
•
•
•
AC joint
Acromion, clavicle
greater/lesser tuberosity
scapula,
spine of scapula,
Coracoid process
Axillary View
 Taken with arm abducted
 Cassette is placed on the superior aspect of
the shoulder
 Arm is abducted enough to allow the
radiographic beam to pass between the
Chest & Arm
GH joint,
Humeral head,
Glenoid
Greater tubercle
Acromion
Clavicle
coracoid
Acromion
Supraspinatus
Glenoid fossa
Subscapularis
Humerus
Clavicle
Hill-Sachs lesion- Notched defect of
flattening of humeral head
Glenoid fossa & labrum (low intensity)
Long head of biceps
Subscapularis
Humeral head
Infraspinatus, subscapularis
Scapula, spine of scapula, coracoid process
Clavicle
Humerus, greater /lesser tubercle,
long head of biceps
Anterior dislocation of the humeral had
toward coracoid process
Marked overlap of the humeral
head of the glenoid
Axillary View
Note: humeral head is not in the Glenoid
fossa
AP with internal rotation
Note: small & false “joint space” as the
humeral head sits behind the glenoid fossa
Lateral View –
Scapular fracture on the lateral border
Lateral View
Oblique fracture of the Shaft of Humerus
AP View - Mild displaced fracture
Tear of RC are associated with
intermediate signal on T1 images
Increased signal on T2-weighted images
May have fluid in the subdeltoid &
subacromial
bursae
Retraction
of
supraspinatus tendon with atrophy of the
muscles
Impingement: 40 y/o male was dx with shoulder impingement MRI shows fluid in the
subacromial bursa Arthroscopic finding: 2 cm supraspinatus tear
60 y/o with shoulder pain T2 oblique coronal image Increased signal in
the RC tendon. An effusion is also seen in the joint spaces & subdeltoid
bursae. --------ROTATOR CUFF TEAR
48 y/o paraplegic who fell T1 – weighted coronal image Focal
area of increased signal in the supraspinatus tendon
Tendon is also swollen with fluid in the subacromial bursae &
in the joint space- ROTATOR CUFF TEAR- Case-1
48 y/o paraplegic who fell Spin density coronal image Focal
area of increased s ignal in the supraspinatus tendon Tendon is
also swollen with fluid in the subacromial bursae & in the joint
space – ROTATOR CUFF TEAR – CASE-2
Radius : head/shaft
Humeroradial & humerulnar Joint
Humerus: Olecranon fossa, medial/lateral epicondyle,
capitulum trochlea
Ulna: olecranon, coronoid process, shaft