Quinnipiac University Diagnostic ImagingRS 211 Radiographic Positioning Laboratory

Lab Three – Shoulder Positioning

OBJECTIVE: Identify and perform proper positioning for shoulder radiography including the following views:

Routine Views and Apical AP, Grashey, Garth, Y-View, Neer, Transthoracic, Inferosuperior Axial, Superinferior Axial.

SHOULDER RADIOGRAPHY (Routine Views)

AP with Internal Rotation:

Patient AP Rotate upper extremity internally CR directed 1” inferior to coracoid Must include entire shoulder girdle

AP with External Rotation:

Patient AP Rotate upper extremity externally CR directed 1” inferior to coracoid Must include entire shoulder girdle

Apical AP

PT placed AP against upright bucky Arm in neutral position CR 30 degrees caudal 40” SID 10x12 crosswise

Posterior Oblique (Grashey/ AP Oblique)

Patient AP Rotate patient 35-45 degrees toward affected side Arm in neutral CR 2” inferior and medial from superlateral border of humerus

Apical Oblique (Garth/ 45-45)

Patient AP Rotate patient 35-45 degrees toward affected side Tube angled 45 degrees caudal CR slightly above coracoid IR Lengthwise

Y View: 3 Methods

1. PA Y View Patient positioned PA Rotate affected shoulder 30-45˚ toward bucky CR perpendicular to Mid scapula IR Lengthwise

2. AP Y View (Trauma View) Patient positioned AP Supine Affected shoulder rotated 60˚ away from IR CR perpendicular to midscapula IR Lengthwise

3. Neer Y view Patient positioned same as PA Y view CR angled 10-15˚ caudal

Inferosuperior Axial

Supine Affected arm abducted 90˚ Externally rotate extremity Horizontal central ray CR 15-20˚ medially into the axilla

Superoinferior Axial

Patient seated 8 x 10 IR placed under arm with patient leaning over CR angled 8-10˚ toward distal humerus **Increased OID**

QUESTIONS: Be thorough in your answers

1. Describe the position of the greater tubercle, lesser tubercle and humeral epicondyles in the following positions: AP, Internal rotation, external rotation.AP Internal moves the lesser tubercle inferomedial and into profile. AP External moves greater tubercle superiolateral and into profile. Internal rotation is when the epicondyles are perpendicular to image receptor. External rotation is when the humeral epicondyles are parallel with the plane of the IR.

2. What bones make up the shoulder girdle? What is the function of the shoulder girdle?Scapula and clavicle make up the shoulder girdle. The major function of shoulder girdle is to provide flexibility. It consists of articulation between the clavicle, scapula and the proximal end of the humerus, which in turn helps in free movement of arms, head and the rest.

3. What is the joint classification for the scapulohumeral joint?Ball and socket

4. What are the four muscles of the rotator cuff?

The four muscles that form the rotator cuff are the supraspinatus, infraspinatus, teres minor, and subscapularis.

5. Which view(s) will demonstrate an open subacromial space? Why?Any shoulder position that has a caudal angle of 15 degrees or more opens the subacromial space. Garth Method or the AP Apical Oblique Axial Projection, Supraspinatus outlet, and Neer Y view.

6. What anatomical space is open when the patient is obliqued 45 degrees toward the affected side?Glenoid

7. Give a pathology that is best demonstrated on the AP with External rotation.This Projection may demonstrate calcium deposits in the muscles, tendons, or bursal structures. Some pathologies, such as osteoporosis and ostearthritis, also may be demonstrated. You can see the greater tubercle and “Bankart lesions” which is anterior dislocation of the rim of the glenoid

8. What is the orthopedics choice for a lateral of the shoulder?Lawrence Method or the Inferosuperior axial projection is the orthopedics choice for a lateral of the shoulder.

9. What pathology can be seen on the “Y” view? How can you tell?Fractures and/or dislocations of the proximal humerus and scapula are demonstrated. The humeral head will be demonstrated inferior to the coracoid process with anterior dislocations, and for less common posterior dislocations, the humeral head will be demonstrated inferior to the acromion process. This is an excellent projection to demonstrate profile of coracoid process and scapular spine.