it is just to learn radiography of shoulder joint

1. SHOULDER JOINT
Dr Dharmendra Kumar

2. CLAVICLE
GREATER TUBERCLE
HUMERAL
HEAD
GLENOID
ACROMION
CORACOID
ACROMIOCLAVICULAR
JOINT
LESSER
TUBERCLE
VERTEBRAL BORDER
OF SCAPULA
BICIPITAL
GROOVE
RADIOLOGICAL ANATOMY

3. OSSIFICATION CENTRES
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CLAVICLE –
1. Lateral head – 5th weeks in utero
2. Medial head – 15th years
SCAPULA –
1. Body – 8th weeks in utero
2. coracoid process ( two centres ) – 12 – 18th months
3. Glenoid – 10 – 11 years
4. inferior angle – 14 – 20 years
5. acromian ( three centres) – 14 – 20 years
6. medial border – 14 – 20 years
PROXIMAL HUMERUS –
1. Diaphysis – 8th weeks in utero
2. Head – 1-6th months
3. Greater tubercle – 1 year
4. Lesser tubercle – 3-5 years

4. Recommended Projections for
shoulder joint
• 1) Basic Projections
i) Antero-posterior (15 Degree) erect
ii) Supero-inferior (Axial)
iii) Infero- superior (Reverse axial)
2) Alternate Projections for Trauma
i) Anterior Oblique (Y-projection)
ii) Apical Oblique (Garth Projection)
iii) Supero-inferior modified/ Modified axial
(Wallace projection) Cntd…….

5. ..
3) Additional projections
i) Infero-superior modified (West point projection)
ii) Antero-posterior modified (stryker projection)

6. TECHNICAL FACTORS
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kVp mAs FFD Grid Collimatio
n
Film size
40-50 10 100cm-
120 cm
No Yes 10” x 8”

7. Patient position:-
 The patient stand with the affected shoulder against
the cassette and is rotated 15 degrees .
Part position:-
 The arm is supinated with slightly abducted away
from the body.
 The cassette is positioned 5 cm above the shoulder.
Centre:-
 The horizontal central ray is directed to the
palpable coracoid process of the scapula.
Antero-posterior erect

8. Essential image characteristics :-
 The head and proximal end of the humerus, the inferior angle of the scapula and
the whole of the clavicle.
 The apex of lung should be included
 Arrested respiration - good rib detail in acute trauma.
 The head of humerus slightly overlapping the glenoid cavity.
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9. Patient position:-
 The patient seated with their affected side
adjacent to the table.
Part position:-
Arm abducted over the cassette.
 The cassette is placed on the table top ,
and arm under examination is abducted over
the table
Centre:-
Mid gleno-humeral joint.
(SUPERO-INFERIOR (AXIAL)

10. Essential image characteristics :-
 The image must demonstrate the
humeral head in relation to the glenoid
cavity.
 The acromion process should be visible
over the neck of humerus and ideally the
coracoid process will be visible.
Radiological considerations :-
The lesser tuberosity will be seen in
profile while the greater tuberosity is
superimposed over the humeral head.
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11. Patient position:-
 The patient lies supine on the table.
Part position:-
 The arm of the affected side abducted and
supinated.
 A cassette is supported vertically against the
shoulder.
(Infero-superior (reverse axial)
Centre:-
The horizontal central ray is directed towards the axilla with minimum angulation
towards the trunk.

12. Essential Image characteristics :-
> Image must demonstrate the humeral
head in relation to the glenoid cavity
> The acromion process should be
visible over the neck of the humerus .
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13. Patient position:-
The patient stands or sits with the lateral
aspect of the injury arm against the cassette.
Part position:-
 The unaffected shoulder is raised to
make the angle between the trunk and
cassette approximately 60 degrees.
 The cassette is positioned to include the
superior border of the scapula.
Centre:
 The horizontal ray is centred towards
the head of the humerus.
Anterior Oblique (‘Y’ projection )

14. Radiographic criteria:
 The exposure should demonstrate the
position of the head of the humeus in
relation to the glenoid cavity between
coracoid and acromion processes
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15. .
Patient position:-
 The patient lies supine on the X-ray table.
Part position:-
 The arm of the affected side is extended fully
and the elbow then flexed to allow the hand
to rest on the patient’s head.
 The centre of the cassette is positioned 2.5
cm superior to the head of the humerus.
Centre:-
The central ray is directed through the
centre of the axilla to the head of the humerus.
(AP modified) – Stryker’s view

16. Radiographic criteria:-
The projection demonstrates the postero-
lateral aspect of the humeral head.
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17. Bankart’s Lesion
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18. Hill Sach’s Lesion
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19. Centre:-
The horizontal central ray is directed to the palpable lateral end of the clavicle
at the acromio-clavicular joint.
Patient position:- The patient stands facing the
Xray tube.
Part position:-
 The shoulder being examined is placed in
contact with the cassette,
 The patient is then rotated approximately
15 degrees towards the side being
examined to bring the acromio-clavicular
joint space at right-angles to the film
Radiography of Acromio-clavicular joint
(AP projection)

20. • Radiographic criteria:-
 Acromio-clavicular joint and
the clavicle projected above
the acromion process.
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21. The AC joint has a week joint capsule and
is vulnerable to trauma. Subluxation may be
difficult to diagnose in the standard AP
image.
To prove subluxation, it is necessary to do
weight-bearing comparison projections of
both AC joints
The position of the patient and cassette
are same as normal AP view.
The normal joint is between 3-8 mm in
width. Normal variation between two sides
should be less than 2-3mm.
Radiography of Acromio-clavicular joint
(Weight-bearing AP projection))

22. Acromioclavicular injury
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23. THANK YOU