Shoulder

 Glenohumeral joint
Indications for imaging
Trauma - dislocations, fractures, tendon calcifications
Arthritis survey

 

Anatomy  Demonstrated
Glenohumeral joint



Shoulder Rt AP Anatomy
Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London

 

Basic Patient Position
The patient stands erect AP median saggital plane 90 degrees to the film coronal plane parallel to the film, the patient is then rotated 35 to 45 degrees to the affected side until the dorsal surface of the scapula is parallel to the film. The arm is placed in normal  anatomical position palm forwards with the distal humeral epicondyles equidistant from the film, with slight (15 degree) abduction. Take care to prevent the patient leaning backwards and hunching up the shoulder.

Projections may be made in a variety of internal and external rotations to evaluate rotator cuff calcifications.


Shoulder Rt Joint Projection
Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London

 

Radiation protection
Direct lead rubber gonad protection using a "half apron".
Avoid irradiating the thyroid and breast tissue as much as possible.

 

Central Ray
The horizontal central ray is direct to palpable glenohumeral joint.
Exposure is made on suspended expiration.

 

Exposure Factors

Kv mAS FFD (cm) Grid Focus AEC Cassette
80 8 100 No Fine No 18x24 cm
85 12 100 Yes Fine Yes 18x24 cm

Thickset patients may require the use  of a grid

 
Evaluation of the Image
ID and markers must be present and correct in the appropriate area of the film.
Limits of the examination, superiorly the skin surface above the clavicle, medially the lateral one third of the clavicle, laterally the skin margin of the humerus.
Evidence of collimation on four sides equally around the centering point
The glenohumeral joint space must be visualised with the joint surfaces separated.
The greater tubercle of the head of the humerus should be seen in profile.
There must be adequate penetration of the area around the coracoid process and the contrast should be low enough to visualise the soft tissues around the head of the humus.


Shoulder Glenohumeral Joint Lt Radiograph

 

Related Projections
Shoulder joint Survey
Supero-inferior
Modified AxialP
Scapula lateral
Clavicle PA
Acromio-clavicular joint AP

 
Additional modalities
MRI  (replaces arthrography)  for the joint structures
CT
RNI evaluation of metastases