2. INTRODUCTION
Radiographic examinations of the shoulder joint and
shoulder girdle can be carried out with the patient supine on
the x-ray table or trolley, but in most cases it will be more
comfortable for the patient to sit or stand with the back of
the shoulder in contact with the cassette.
For a general survey of the shoulder, e.g. for injury, the
field size must be large enough to cover the whole of the
shoulder girdle on the injured side.
As in the lateral projection, the cassette is held in a vertical
cassette holder with the patient either standing or sitting
during the procedure.
3. Anatomy of shoulder
The shoulder girdle consists of two scapulae and two
clavicles.
Clavicle (collar bone):- The clavicle is an S-shaped long
bone.It articulates with the manubrium of the sternum at
the sternoclavicular joint with the acromion process of the
scapula.The clavicle provides the only bony link between
the upper limb and the axial skeleton.
Scapula (shoulder blade) :-The scapula is a flat triangular-
shaped bone, lying on the posterior chest wall superficial
to the ribs and sepeated from them by muscles. At the
lateral angle is a shallow articular surface,the glenoid
cavity,which with the head of the humerus ,forms the
shoulder joint.
4.
5. Radiography of shoulder
SHOULDER AP VIEW (supine)
Positioning of the patient:
a) Patient lies supine with elbow extended and palm facing
up. Unaffected shoulder is raised over sand bag so that
affected shoulder posterior aspect comes into contact with
the film. Upper border of cassette should be atleast 5cm
above the shoulder.
b) Immobilized with sand bag over the palm.
c) Marker R/L on left upper corner. Patient identification on
the right corner are placed.
8. Centering:
Coracoid process of scapula (palpable for general survey
of shoulder region).
FACTORS: Kvp-70, mAS-8 distance from x-ray table to
x-ray tube-7cm (for adult)
Kvp-55, mAS-2.5, D-4cm (for children)
9. SHOULDER AP VIEW (After injury)
Patient seats erect position and face up the x-ray
tube. To bring posterior aspects of shoulders to
close contact with the bucky.
Arm is supported in cellor sling.
Marker should be left or right and patient
identification is also required.
Centering point is coracoid process of scapula.
Horizontal beam at right angle to film.
11. LATERAL VIEW
Positioning of the patient: Patient stands facing a vertical
buckey with the arm abducted and elbow flexed and hand
resting on the hip. The effected side shoulder is in contact
with the buckey and the patient is rotated to bring the
scapula at right angle to the film.
Centering: Horizontal ray centered to the mid point of the
medial border of the scapula.
14. Anatomy of arm
Humerus: It consist of shaft, two articular
extremities. Lower part is broad and has medial
and lateral condyles and medial and lateral
epicondyles. On its inferior surface are two smooth
elevation, trachea for articulation with head of
radius. The proximal end of humerus consists of
head, anatomic neck and greater, lesser tuberosities
and surgical neck.
17. Radiography of arm
Humerus (AP View):
Film Size:- Use film long enough to include both ends of
bone.
Position of part:- Part should be lying in a supine position
on a table. Rotate hand and forearm until palm is up. Arm
should be as near parallel as possible to table top.
Central ray:- Directed vertically to film and part centre.
Factor:- mAs 12-18,
kVp 55-60
21. Film size:- 10”×12”
Position of part:- Patient should be lying
supine on the table. Abduct affected arm
slightly, flox elbow, rotate hand medically.
Central Ray:- Directed vertically to part and
film centre.
Factor:- mAs 12-18,
kVp= 55-60
HUMERUS: Lateral (supine position)
22.
23. HUMERUS: Lateral (erect position)
Film size:- 10”×12”
Position of part:- seat patient at the end of the table
on stool just high enough for him to extend his arm
over the table. The elbow and shoulder should lie
on the same plane. Respiration should be suspended
for the exposure.
Central Ray:- directed vertically to film centre.
Factor:- mAs 12-18 , kVp 55-60
