for health professional and B.Sc Radiology students

1. RADIOGRAPIC VIEWS FOR
SHOULDER JOINT
BY
MS.HARISREE .CH
B.Sc.(MIT),2nd year
SHRI SATHYA SAI MEDICALCOLLEGE, THIRUPORUR
GUIDED BY PROF.DR.I.GURUBARATH

2. ANATOMY OF SHOULDER JOINT

3. BASIC VIEWS OF SHOULDER JOINT
 ANTERIO-POSTERIOR (AP)
 SUPERIO-INFERIO(AXIAL)
 INFERO-SUPERIOR (REVERSE AXIAL)

4. ANTERIO-POSTEROR (AP)
 POSITIONING :
 The arm is supinated and
slightly abducted away
from the body. The medial
and lateral epicondyles of
the distal humerus should
be parallel to the cassette
 The cassette is positioned
so that its upper border is at
least 5 cm above the
shoulder to ensure that the
oblique rays do not project
the shoulder off the
cassette.

5. TECHINICAL DETAILS
IR SIZE : 24x30 CM
FFD :100 CM
GRID :YES
KvP:65 ;MAS:16
CENTRAL BEAM:
PERPENDICULAR TO IR
CENTRAL POINT:
GLENOHUMERAL JOINT,
THIS IS 2.5CM BELOW THE
PALPATABLE CORACOID
PROCESS

6. RADIOGRAPHIC ANATOMY OF SHOULDER
AP view

7. SUPERIO-INFERIOR (AXIAL)
 POSITIONING:
• The patient is seated at the side of the
table, which is lowered to waist level.
• The cassette is placed on the tabletop,
and the arm under examination is
abducted over the cassette.
• The patient leans towards the table to
reduce the object-to film distance (OFD)
and to ensure that the glenoid cavity is
included in the image. A curved cassette,
if available, can be used to reduce the
OFD.
• The elbow can remain flexed, but the
arm should be abducted to a minimum
of 45 degrees, injury permitting. If only
limited abduction is possible, the
cassette may be supported on pads to
reduce the OFD

8. TECHINICAL DETAILS
 IRSIZE: 18X24cm
 GRID: NO
 FFD: 100 cm
 CENTRALBEAM:
CR IS PENPENDICULAR TO IR
 CENTRAL POINT:
CR TO SHOULDERJOINT AT AN ANGLE OF 5 TO 15
DEGREES TOWARDS THE ELBOW

9. RADIOGRAPIC ANATOMY OF SHOULDER
AXIAL VIEW

10. INFERIO-SUPERIOR (REVERSE AXIAL)
 INTRODUCTION:
 This projection may be used as an
alternative to the
superoinferiorprojection in cases of
dislocation or when the patient is
supine
 POSITIONING:
 The patient lies supine, with the
arm of the affected side slightly
abducted and supinated without
causing discomfort to the patient.
 The affected shoulder and arm are
raised on non-opaque pads.
 A cassette is supported vertically
against the shoulder and is pressed
against the neck to include as much
as possible of the scapula on the
film.

11. TECHINICAL DETAILS
 IRSIZE :18X24CM
 GRID:NO
 FFD:100CM
 CENTRAL BEAM :
CR IS PERPENDICULAR TO IR
 CENTRAL POINT:
HORIZONTAL BEAM IS CENTRED
TOWARDS THE AXILLA WITH MINIMUM
ANGULATION TOWARDS TRUNK

12. RADIOGRAPIC ANATOMY OF SHOULDER REVERSE
AXIAL VIEW

13. SPECIAL PROJECTIONS
 GARTH PROJECTION (APICAL OBLIQUE)
 WALLACE PROJECTION (SUPERO-INFERIOR
MODIFIED)
 “Y” PROJECTION (ANTERIO OBLIQUE)
 WEST POINT PROJECTION (INFERIO-SUPERIOR)
 STRYKERS PROJECTION
 GRASHEY PROJECTION

14. GRATH PROJECTION
 INTRODUCTION :
This projection is recommended as
the second projection should an axial
not be possible. It will more readily
demonstrate Hill-Sachs lesions and
glenoid rim fractures.
 POSITIONING:
 The patient is positioned erect (either
standing or sitting)with their back against
a vertical Bucky
 The patient is then rotated toward the
affected side so they attain a 45 degree
posterior oblique position.
 The elbow is usually flexed with the
patient’s arm held across the chest.

15. TECHINICAL DETIALS
 IR SIZE : 24X30 CM
 FFD :100CM
 GRID: YES
 CENTRAL RAY:
Horizontal beam is centered to the
image receptor and 45 degrees caudal tube
angulation is employed

16. Garth projection

17. WALLACE PROJECTION
 INTRODUCTION:
 Axillary view is an excellent method for
evaluating for anterior or posterior
glenohumeral subluxation or
dislocation and may also be helpful in
the detection of an osseous Bankart
fracture involving the anterior glenoid
rim.
 POSITION OF PATIENT:
 The patient sits erect with their back to
the X-ray table.
 The torso is adjusted to bring the body
of the scapula parallel with the table.
 The image receptor is placed flat on the
tabletop immediately behind the
shoulder under examination.

18. TECHINICAL DETIALS
 IR SIZE:24X30 CM
 FFD: 150 CM
 CENTRAL RAY:
 CENTRED TO THE MIDDLE OF THE
GLENO HUMERAL JOINT USING 30 DEGREES
ANGULATION FROM THE VERTICAL POSITION

19. Glenohumeral subluxation Osseous Bankart fracture

20. ANATOMICAL LESSIONS

21. ‘Y’ PROJECTION INTRODUCTION:
 This projection is useful for
differentiating the direction of a
dislocation but it is less useful
for demonstrating associated
fractures
 PATIENT POSITION:
 The patient stands or sits with
lateral aspect of the injured arm
against the image receptor and
is adjusted so that the axilla is in
the centre of the receptor
 The unaffected shoulder is
raised to make an angle between
the trunk and the receptor
approximately 60degrees. A line
joining the medical and lateral
borders of scapula is now at
right angles to receptor.

22. TECHINICAL DETIALS
 Exposure:70 kVp 20 mAs (in Bucky)
 FFD :100cm
 Central Beam:
CR perpendicular to IR
 Central Ray:
CR directed to the scapulohumeral joint (5 - 6cm)
below top of shoulder

23. Radiographic anatomy of shoulder Y view

24. WEST POINT PROJECTION
 INTRODUCTION:
 Demonstrates the anterior aspect
of the glenoid rim and is useful for
detecting Bankart lesions
 PATIENT POSITION:
 Patient prone on the X-ray table
 Abduct affected arm away from the
body 90° if possible, with elbow
flexed to allow forearm to hang
freely over side of table
Rotate the head away from the
affected side
 Place IR against the superior
surface of the affected shoulder

25. TECHINICAL DETAILS
 IR Size :18 x 24cm
 Gird :No
 Exposure:55 kVp8 mAs
 FFD / SID:100cm
 Central Ray:
CR directed 25° cranially and 25° medially through
the midscapulohumeral joint

26. Radiographic anatomy of WestPoint projection
Glenoid
Glenoid

27. STRYKER PROJECTION
INTRODUCTION:
• This projection is highly effective
in demostrating a
Hills-sachs deformity of humeral
head.
PATIENT POSITION:
• The patient lies supine on the
table.
• The arm of affected side is
extended fully and the elbow then
flexed to allow the hand to rest on
the patient head
• The line joining the epicondyles
of humerus remains parallel to
tabletop
• The center of the receptor is
positioned 2.5cm superior the
head of the humerus

28. Technical Details
 Exposure:65 kVp16 mAs
 FFD / SID: 100cm
 CENTRAL RAY:
Vertical beam is angled 10degree cranially
and centre through the centre of axilla to the
head of the humerus and the centre of
receptor.

29. Radiographic anatomy of strykers projection
Hills-Sachs

30. GRASHEY PROJECTION
 INTRODUCTION:
 Demonstrate a clear joint
space between the head of
humerus and glenoid cavity.
 PATIENT POSITION
 The patient stands wit the
affected shoulder against the
image receptor and torso is
rotted approximately 35-45
degrees toward the affected
side to bring the plane of
glenoidfossa perpendicular
to receptor.
 The arm is supinated and
slightly abducted away from
the body.

31. Technical Details
 CR SIZE: 24X30cm
 FFD:100 cm
 CENTRE RAY:
Horizontal beam is centered just below the
palpable coracoid process of scapula

32. Radiographic anatomy of Grashey projection
The glenohumeral joint is seen in profile (arrows) without overlap of the
humerus and glenoid