The document discusses various radiographic views of the shoulder joint including the glenohumeral joint, acromioclavicular joint, clavicle, and scapula. Standard anteroposterior, superoinferior, outlet, and stress views of the shoulder are described along with positioning of the patient and direction of the x-ray beam. Specific views are also provided to assess recurrent dislocations, calcified tendons, and fractures.

2.  GENERAL INTRODUCTION
 BASIC VIEW of SHOULDER RADIOGRAPH
 OUTLET PROJECTION
 RECURRENT DISCOLATION
 CALCIFIED TENDONS
 BASIC VIEWS OF CLAVICLE
 BASIC VIEWS OF SCAPULA
 GLENO-HUMERAL JOINT (GH JOINT)
 ACROMIO-CLAVICULAR JOINTS (AC JOINT)

3.  Shoulder joint is simply the articulation of the head of humerus
and glenoid cavity of scapula.
 The shoulder is a complex joint capable of a great range of
movements.
 Also known as the pectoral girdle.
 It is a type Ball and Socket Joint.
 Consists of:-
 Clavicles
 Scapulae
 Humeral Head

4. CONTD….
 Radiographic examinations of the shoulder joint and
shoulder girdle can be carried out with the patient
supine on the X-ray table or trolley.
 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.
 It is common practice to obtain two views of the
shoulder joint, particularly in cases of suspected
dislocation: an antero-posterior (supine/erect) view and
a supero-inferior (axial) view.

5. BASIC VIEWS
ANTERO POSTERIOR (AP) - Erect
Position of patient and image receptor
The patient stands with the affected shoulder
against the image receptor.
The patient is externally rotated 15° to bring
the shoulder under examination closer
to the image receptor and the plane of AC
joint perpendicular to the image receptor.
The arm is supinated and slightly abducted
away from the body.
Direction and location of the X-ray beam
oThe collimated horizontal beam is directed to
the palpable coracoid process of the scapula
and collimated to include the structures.
Fig:-Shoulder AP Radiograph

6. BASIC VIEWS (CONTD)…
SUPERO-INFERIOR - AXIAL
 Position of patient and image
receptor:-
 Patient is seated by the side of the table and
the image receptor is placed on the table
top. The arm under examination is abducted
over the table.
 The patient leans towards the table to
reduce the object-to receptor distance and to
ensure that the glenoid cavity is included in
the image.
 Direction and centering of the X-ray
beam
 The vertical central ray is directed through
the proximal aspect of the humeral head.
 Some tube angulations, towards the palm of
the hand, may be necessary to coincide with
the plane of the glenoid cavity.
Fig:- Supero-inferior radiograph of
the shoulder

7. OUTLET PROJECTION
ANTERO-POSTERIOR (AP)
Fig:- AP outlet radiograph of the
shoulder
 Position of patient and cassette
 The patient stands with the affected
shoulder against a cassette and is
rotated 15° to bring the plane of the
scapula parallel with the cassette.
 Direction and centering of the X-
ray beam
 The horizontal central ray is
directed 30° caudally and centred
to the palpable coracoid process of
the scapula.

8. OUTLET PROJECTION (CONTD)…
LATERAL OBLIQUE
Fig:- Lateral oblique shoulder
outlet Radiograph
 POSITION OF PATIENT AND CASSETTE
o The patient stands or sits facing the cassette, with
the lateral aspect of the affected arm in contact
with the cassette.
o The affected arm is extended backwards, with
the dorsum of the hand resting on the patient’s
waist.
o The patient is adjusted so that the head of the
humerus (coracoid process) is in the centre of the
cassette.
o The patient is now rotated forward until a line
joining the medial and lateral borders of the
affected scapula is at right-angles to the cassette
(i.e. the body of the scapula is at right-angles to
the cassette).
 DIRECTION AND CENTERING OF THE X-
RAY BEAM
 The horizontal central ray is angled 10 degrees
caudally and centred to the head of the humerus.

9. RECURRENT DISCOLATION
AP-LATERAL HUMERUS
Fig:-Antero-posterior shoulder
(lateral humerus projection) for
recurrent dislocation
 Position of patient and cassette
 The patient is positioned erect, with the
affected shoulder raised approximately
30 degrees to bring the glenoid cavity at
right-angles to the centre of the cassette.
 The arm is partially abducted, the elbow
flexed and the arm medially rotated.
 Direction and centering of the X-ray
beam
 The horizontal central ray is directed to
the head of the humerus and the centre of
the cassette.

10. RECURRENT DISCOLATION
AP -OBLIQUE HUMERUS
Fig:-Antero-posterior shoulder
(oblique humerus projection) for
recurrent dislocation
 Position of patient and cassette
 The patient is positioned erect, with the
unaffected shoulder raised approximately 30
degrees to bring the glenoid cavity at right-
angles to the centre of the cassette.
 The elbow is extended, allowing the arm to
rest in partial abduction by the patient’s side.
 The humerus is now in an oblique position
midway between that for the antero-posterior
projection and that for a lateral projection.
 Direction and centering of the X-ray beam
 The horizontal central ray is directed to the
head of thehumerus and the centre of the
cassette.

11. RECURRENT DISCOLATION
INFERO-SUPERIOR
Fig:-Normal infero-superior
radiograph of shoulder
 Position of patient and cassette
 The patient lies supine on the x-ray table, with
the arm of the affected side abducted without
causing discomfort to the patient.
 The palm of the hand is turned to face
upwards, with the medical and lateral
epicondyles of the humerus equidistant from
the tabletop.
 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.
 The shoulder and arm are raised slightly on
non-opaque pads.
 Direction and centering of the X-ray beam
 The horizontal central ray is directed
towards the axilla with minimum
angulations towards the trunk.

12. CALCIFIED TENDONS
ANTERO-POSTERIOR
Direction and centering of the X-ray beam
In each case, the horizontal central ray is directed to the head of the
humerus and to the centre of the film.
 Position of patient and cassette
 The patient stands with the affected
shoulder against the vertical cassette
holder and rotated 15 degrees to bring
the plane of the scapula parallel with
the cassette.
 Position of the arm
 NO ROTATION OF HUMERUS
 The arm is supinated at the patient’s
side, palm facing forwards, with the
line joining the medial and lateral
epicondyles of the humerus parallel to
the vertical cassette holder.
 Demonstrates:-SUPRASPINATUS
TENDONS
 MEDIAL ROTATION OF HUMERUS
 With the elbow flexed, the arm is partially
abducted and medially rotated, with the
dorsum of the hand resting on the rear
waistline. The line joining the medial and
lateral epicondyles of the humerus is now
perpendicular to the vertical cassette holder.
 Demonstrates:-TERES MINOR TENDON
 LATERAL ROTATION OF HUMERUS
 With the elbow flexed, the arm is partially
abducted and medially rotated, with the
dorsum of the hand resting on the rear
waistline. The line joining the medial and
lateral epicondyles of the humerus is now
perpendicular to the vertical cassette holder.
 Demonstrates:-SUBSCAPULARIS TENDON

13. CALCIFIED TENDONS
ANTERO-POSTERIOR – 25 DEGREES
CAUDAD
Fig:-Antero-posterior radiograph
of shoulder with 25 degrees
caudad angulations to show
calcifications
 Position of patient and cassette
 The patient stands with the affected shoulder against a
vertical cassette holder and rotated 15 degrees to bring the
plane of the scapula parallel with the cassette.
 The arm is supinated at the patient’s side, palm facing
forwards, with the line joining the medial and lateral
epicondyles of the humerus parallel to the vertical cassette
holder.
 Direction and centering of the X-ray beam
 The collimated central ray is angled 25 degrees caudally
and centred to the head of the humerus and to the centre of
the film.
 DEMONSTRATES:-
 Insertion of INFRASPINATUS TENDON and the
Subacromial part of the SUPRASPINATUS Tendon.

14. CALCIFIED TENDONS
INFERO-SUPERIOR
Fig:- Infero-superior
radiograph of shoulder
showing calcification
 Position of patient and cassette
 The patient lies supine on the table, with the arm of
the side being examined abducted to a right-angle.
 The palm of the hand faces upwards and the line
joining the medial and lateral epicondyles is in a
plane parallel to the tabletop.
 The cassette is supported vertically against the upper
border of the shoulder and pressed into the neck.
 Direction and centering of the X-ray beam
 The horizontal central ray is directed to the centre of the
axilla, with the minimum angulation towards the trunk.
 DEMONSTRATES:-
 The insertion of the SUBSCAPULARIS TENDON and
TERES MINOR TENDON and the course of tendons
anterior and posterior to the capsule of the shoulder joint.

15. CLAVICLE
POSTERO-ANTERIOR
Fig:-Normal postero-anterior
radiograph of clavicle
 Position of patient and cassette
 The patient sits or stands facing vertical
cassette holder. The patient’s position is
adjusted so that the middle of the clavicle is in
the centre of the cassette.
 The patient’s head is turned away from the
side being examined and the affected shoulder
rotated slightly forward to allow the affected
clavicle to be in close contact with the cassette.
 Direction and centering of the X-ray beam
 The horizontal central ray is directed to the
centre of the clavicle and the centre of the
cassette, with the beam collimated to the
clavicle.

16. CLAVICLE
INFERO-SUPERIOR
Fig:- Infero-superior radiograph of
clavicle showing fracture
 Position of patient and cassette
 The patient sits facing the x-ray tube.
 The affected shoulder is raised slightly to
bring the scapula in contact with the
cassette.
 The patient’s head is turned away from the
affected side.
 The cassette is displaced above the
shoulder to allow the clavicle to be
projected into the middle of the image.
 Direction and centering of the X-ray
beam
 The central ray is angled 30 degrees
cranially and centered to the centre of the
clavicle.
Fig:- normal Infero-superior
radiograph of clavicle

17. SCAPULA
ANTERO-POSTERIOR (BASIC) – ERECT
Fig:-AP radiograph of scapula showing a
fracture through the neck of
the glenoid.
 Position of patient and cassette
 The patient stands with the affected
shoulder against a cassette and rotated
slightly to bring the plane of the
scapula parallel with the cassette.
 The arm is slightly abducted away
from the body and medially rotated.
 Direction and centering of the X-ray
beam
 The horizontal ray is directed to the
head of the humerus.

18. SCAPULA
LATERAL (BASIC)
Fig:-Normal lateral radiograph of
scapula
 Position of patient and cassette
 Patient stand/sits facing vertical bucky.
 Keeping the affected shoulder in contact
with the vertical Bucky, the patient’s
trunk is rotated forward until the body of
the scapula is at right-angles to the
cassette.
 The arm is abducted with the elbow
flexed to allow the back of the hand to
rest on the hip.
 Direction and centering of the X-ray
beam
 The horizontal central ray is directed to
the midpoint of the medial border of the
scapula and to the middle of the cassette.

19. GLENOHUMERAL JOINT (GH JOINT)
Antero-posterior – erect
Fig:-Normal AP radiograph of
the shoulder showing GH-Joint
 Position of patient and cassette
 The patient stands with the affected
shoulder against the cassette and is
rotated approximately 30 degrees to
bring the plane of the glenoid fossa
perpendicular to the cassette.
 The arm is supinated and slightly
abducted away from the body.
 Direction and centering of the
X-ray beam
 The horizontal central ray is centered
to the palpable coracoid process of
the scapula.

20. ACROMIOCLAVICULAR JOINT
(AC JOINT)
ANTERO-POSTERIOR
Fig:-Normal AP
Radiograph of AC Joint
 Position of patient and cassette
 The patient stands facing the X-ray tube,
with the arms relaxed to the side.
 The posterior aspect of the shoulder being
examined is placed in contact with the
cassette, and the patient is then rotated
approximately 15 degrees towards the side
being examined to bring the
acromioclavicular joint space at right
angles to the film.
 Direction and centering of the X-ray
beam
 The horizontal central ray is centered to the
palpable lateral end of the clavicle at the
acromioclavicular joint.