Shoulder X-ray views

Shoulder X-ray views

AP Shoulder: in plane of thorax

AP in plane of scapula: Angled 45 degrees lateral

  • Neutral rotation: Grashey view (estimation of glenohumeral space)
  • Internal rotation/External rotation 30 degrees: Hill sach’s lesion and other humeral head morphology

Scapular Y lateral: Erect with opposite shoulder rotated 40 degrees out and beam centered on spine of scapula (shoulder dislocations and scapula fractures)

Supraspinatus outlet view: Scapular Y view with beam caudally tilted 10 degrees (Acromion morphology)

Axillary views:

  • Standard axillary (Lawrence): Supine; arm abducted 90 degrees; beam inferior to superior, 15 to 30 degrees medial angulation depending on abduction
  • West Point axillary: Prone; arm abducted 90 degrees and hanging over the table edge; beam angulated 25 degrees medially and anteriorly (detect Bankart fractures)
  • Velpeau: Standing; wearing arm sling, leans backward over table 30 degrees; beam directed superior to inferior
  • Trauma axillary lateral: Supine; arm supported in 20 degrees flexion by placing radiolucent material under elbow

Apical Oblique (Garth view): Grashey (True AP) view with beam 45 degrees caudally (to show anterior/inferior capsule; bony bankhart/Hill Sachs)

Stryker-notch view: Supine; palm on head with elbow straight up; beam directed AP with 10 degrees cephalic aiming coracoid (Hill Sachs)

Zanca view: Erect; Beam centered on AC joint with 10 degrees cephalic tilt and 50% exoisure (AC Joint)

Serendipity view: Supine; Beam centered on clavicle/manubrium with 40 degrees cephalic tilt (SC Joint)

For specific pathologies

a. Obligatory: AP, Lateral or axillary

b. Subacromial impingement: “Y” view

c. Coracoid impingement: Axillary, Lateral

d. Scapular pathology: “Y” view

e. Bankart: Garth view, West point view

f. Hill Sach’s: Stryker notch view, AP with Internal rotation

g. Glenohumeral arthritis: True AP in internal and external rotation and Axillary lateral view

h. Sternoclavicular pathology: Serendipity view

i. Acromioclavicular pathology: Zanca view; Stress view with 5 kg weight suspended on wrist and showing both shoulders

Refer to internet for images.

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