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Shoulder Positioning

SJC Zerbe S1U3

What's this?Oh, duh.
AP Projection
 External Rotation: Cassette size and orientation 10 x 12 CW with Grid
AP Projection
 External Rotation: CR location CR 1” inferior to coracoid
AP Projection
 External Rotation: Patient Position Hand supinated with epicondyles parallel to IR
AP Projection 
External Rotation: What is shown? Humeral head in profile
Greater tubercle in profile (laterally)
Site of insertion of the supraspinatus tendon
AP Projection
 Internal Rotation: Cassette size and orientation 10 x 12 CW with Grid
AP Projection 
Internal Rotation: CR location CR 1” inferior to coracoid
AP Projection
 Internal Rotation: Patient Position Posterior hand on thigh and epicondyles perpendicular to IR
AP Projection 
Internal Rotation: What is shown? Lesser tubercle in profile medially. 
Site of insertion of subscapular tendon
AP Projection 
Neutral Rotation: Cassette size and orientation 10 x 12 CW with Grid
AP Projection 
Neutral Rotation: CR location CR 1” inferior to coracoid
AP Projection
 Neutral Rotation: Patient Position Palmar surface of hand against thigh with epicondyles at a 45 degree angle
AP Projection
 Neutral Rotation: What is shown? Humeral head and greater tubercle in partial profile
. Posterior part of the supraspinatus insertion.
AP Oblique Projection Grashey Method: Cassette size and orientation 8 x 10 CW with Grid If available, if not then 10x12 with Grid
AP Oblique Projection Grashey Method: CR location CR 2” medial and 2” inferior to superolateral border of shoulder
AP Oblique Projection Grashey Method: Patient Position Patient rotated 35 to 45 degrees toward affected side until scapula is parallel to IR
AP Oblique Projection Grashey Method: What is shown? Scapulohumeral joint and Glenoid cavity (fossa) in profile.
Transthoracic Lateral Lawrence Method Trauma for proximal humerus/shoulder: Cassette size and orientation 10 x 12 LW
Transthoracic Lateral Lawrence Method Trauma for proximal humerus/shoulder: CR location CR perpendicular to IR and exits surgical neck
(if patient cannot raise unaffected arm, CR is angled 10 to 15 degrees cephalic)
Transthoracic Lateral Lawrence Method Trauma for proximal humerus/shoulder: Patient Position MCP perpendicular to IR with affected side against IR and unaffected arm raised over head
Transthoracic Lateral Lawrence Method Trauma for proximal humerus/shoulder: Breathing Technique Shallow breathing is recommended respiration phase, 

If unable to do breathing technique then suspend respirations at end of inspiration
AP Projection
External Rotation: Technique and SID 75 kVp @ 12.5 mAs, SFS, 40"
AP Projection 
Internal Rotation: Technique and SID 75 kVp @ 12.5 mAs, SFS, 40"
AP Projection
 Neutral Rotation: Technique and SID 75 kVp @ 12.5 mAs, SFS, 40"
AP Oblique Projection Grashey Method: Technique and SID 75 kVp @ 16 mAs, SFS, 40"
Transthoracic Lateral Lawrence Method Trauma for proximal humerus/shoulder: Technique and SID SFS, 40", 80 kVp @ 2 second exposure. •Smaller than average Patient: 20 mAs (10mA @ 2 Sec) •Average: 32 mAs (16mA @ 2 Sec) •Above Average: 64 mAs (32mA @ 2 Sec)
Inferosuperior Projection
 Lawrence Method Axillary: Cassette size and orientation 10 x 12 Crosswise on the table, and lengthwise to the arm. Use 8x10 for smaller patient. IR Placed vertically against the superior surface of the shoulder as far into the neck as possible
Inferosuperior Projection
 Lawrence Method Axillary: CR location CR is horizontal and angled 15 to 30 degrees medially 
Enters axilla, exits AC joint
. The greater the abduction, the greater the angle you will use.
Inferosuperior Projection
 Lawrence Method Axillary: Patient Position Supine with arm abducted 90 degrees in external rotation with epicondyles parallel to Floor
Raefert Modification- extreme rotation for Hill Sachs
Inferosuperior Projection
 Lawrence Method Axillary: Technique and SID 60 kVp @ 8mAs, SFS, 40"
Inferosuperior Projection
 Lawrence Method Axillary: What is shown? You should see a gap in the scapulohumeral joint with minimal overlap.
Superoinferior Projection Axillary: Cassette size and orientation 8 x 10 LW If available, 10 x 12 if not
Superoinferior Projection Axillary: CR location CR angled 5 to 15 degrees from vertical toward the elbow. Enters AC and exits axilla. The less the abduction, the greater the angle.
Superoinferior Projection Axillary: Patient Position Seated with arm abducted over IR and flexed with anterior forearm resting on table

Superoinferior Projection Axillary: Technique and SID 60 kVp @ 8 mAs, SFS, 40"
Superoinferior Projection Axillary: What is shown? 
Axillary view demonstrating scapulohumeral joint, but not the preferred method due to OID. May also see ribs, scapulohumeral joint demonstrated with obvious superimposition, no gap.
PA Oblique Projection of the shoulder Scapular Y: Cassette size and orientation 10 x 12 LW
PA Oblique Projection of the shoulder Scapular Y: CR location CR perpendicular through the scapulohumeral joint
PA Oblique Projection of the shoulder Scapular Y: Patient Position Patient PA and rotated 45 to 60 toward the affected side until scapular body is perpendicular to the IR with arm hanging by the side. Can be done in recumbent LPO for trauma
PA Oblique Projection of the shoulder Scapular Y: Technique and SID SFS, 40", 75 kVp •Smaller than average patient size: 16 mAs •Average patient: 32 mAs •Above Average patient: 64 mAs
PA Oblique Projection of the shoulder Scapular Y: What is shown? Demonstrates anterior/posterior dislocations of the shoulder. Humerus and scapular body will be superimposed.
PA Oblique Projection of the shoulder Scapular Y: Modifications For Neer method (supraspinatus outlet view), angle 15 degrees caudal at the superior humeral head
Tangential Projection
 Intertubercular groove 
Supine method: Cassette size and orientation 8 x 10
placed vertically on the table against superior shoulder. If available if not then 10 x 12
Tangential Projection 
Intertubercular groove 
Supine method: CR location CR angled 10 to 15 degrees posteriorly from horizontal skims the anterior surface of humeral head through the bicipital groove
Tangential Projection 
Intertubercular groove 
Supine method: Patient Position Patient supine with arm by side and hand supinated
Tangential Projection 
Intertubercular groove 
Supine method: Modifications Can do standing (Fisk) with patient leaning over IR and humerus angled 10 to 15 degrees, with cassette held on forearm. Not preferred due to OID
AP Projection Acromioclavicular Joints Pearson Method: Cassette size and orientation 14 x 17 CW or 
2 – 8x10s
AP Projection Acromioclavicular Joints Pearson Method: CR location CR horizontal at the level of the AC joints and centered to MSP
AP Projection Acromioclavicular Joints Pearson Method: Patient Position Seated or standing in AP position. Patient's arms hang by the sides, plane of shoulders parallel to IR. 2 exposures– one without weights, one with 5-8lb affixed to each wrist, pt should let arms hang, not hold weights up.
AP Projection Acromioclavicular Joints Pearson Method: Technique and SID 75 kVp @ 12.5 mAs, SFS, *** 70" SID ***
AP Projection Acromioclavicular Joints Pearson Method: What is shown? Shows separation between acromial extremity and acromion process
AP Projection Acromioclavicular Joints Pearson Method: Collimation 6 × 17 or smaller if patient size allows.
AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): Cassette size and orientation 10 x 12 CW
AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): CR location CR perpendicular to IR and centered to clavicular midshaft
AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): Breathing Instructions Respiration suspended at end of expiration for uniform density or brightness levels
AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): Technique and SID 75 kVp @ 12.5 mAs, SFS, 40"
AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): What is shown? Sternal extremity will be demonstrated within the thorax
AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): Collimation 6 × 12 or smaller if patient allows
AP Axial Clavicle: Cassette size and orientation 10 x 12 CW
AP Axial Clavicle: CR location Centered to clavicular midshaft. CR angled 15 to 30 degrees cephalic. OR 0 to 15* if patient is in lordotic position (Caudal if done PA)
AP Axial Clavicle: Breathing Instructions Suspend at end of inspiration
AP Axial Clavicle: Technique and SID 75 kVp @ 16 mAs, SFS, 40"
AP Axial Clavicle: Collimation 6 × 12 or smaller if patient allows
AP Scapula: Cassette size and orientation 10 x 12 LW
AP Scapula: CR location CR: 2” inferior to the coracoid. Top of IR 2” above shoulder
AP Scapula: Breathing Instructions shallow breathing
AP Scapula: Technique and SID 70 kVp @ 10 mA @2 seconds "breathing technique" (20 mAs), 40"
AP Scapula: Collimation Collimate IR size or smaller if patient size allows. Mark lateral margin
AP Scapula: Patient Position Standing or supine with arm abducted 90 degrees "crossing guard"
Lateral Scapula: Cassette size and orientation 10 12 LW
Lateral Scapula: CR location CR entering mid vertebral border
Lateral Scapula: Breathing Instructions Suspend
Lateral Scapula: Technique and SID 75 kVp 32 mAs SFS
Lateral Scapula: Collimation Adjust to 12" in length and 1 " from the lateral shadow
Lateral Scapula: Patient Position Arm across the posterior thorax to demonstrate coracoid and acromion
. Arm across anterior chest or over the head to demonstrate body
AP Projection
 External Rotation: Breathing Instructions Suspend
AP Projection
 Internal Rotation: Breathing Instructions Suspend
AP Projection 
Neutral Rotation: Breathing Instructions Suspend
AP Oblique Projection Grashey Method: Breathing Instructions Suspend
Inferosuperior Projection
 Lawrence Method Axillary: Breathing Instructions Suspend
Superoinferior Projection Axillary: Breathing Instructions Suspend
PA Oblique Projection of the shoulder Scapular Y: Breathing Instructions Suspend
AP Projection Acromioclavicular Joints Pearson Method: Breathing Instructions Suspend
What percent of dislocations are anterior (subcorocoid)? 97%
Hill-Sachs defect Impacted fracture of posterolateral aspect of the humeral head with dislocation
Bursitis Inflammation of the bursa
Dislocation Displacement of a bone from the joint space
Fracture Disruption in the continuity of bone
Tendinitis Inflammation of the tendon and tendon-muscle attachment
Osteopetrosis Increased density of atypically soft bone (think petrified)
Osteoporosis Loss of bone density (think porous)
Rheumatoid Arthritis Chronic, systemic, inflammatory collagen disease
Osteoarthritis or degenerative joint disease Form of arthritis marked by progressive cartilage deterioration in synovial joints and vertebrae
For a transthoracic lateral projection of the shoulder, lung detail may be blurred to better visualize the shoulder area. According to your text what exposure time is recommended to blur the lung structures?
 Minimum of 3 seconds
The sternoclavicular articulation is formed by the sternal extremity of the clavicle and the: Manubrium and 1st rib cartilage
The superior surface of the greater tubercle slopes posteriorly 25 degrees and has how many flattened impressions for muscle (tendon) insertion? 3 Anterior, Middle, Posterior
The anterior impression of the greater tubercle provides the insertion site for what tendon? The tendon of the Supraspinatous muscle
The middle impression of the greater tubercle is the site of insertion for which tendon? The tendon of the infraspinatous muscle
The posterior impression of the greater tubercle is the insertion for which tendon? The upper fibers of the teres minor (the lower fibers attach to the body just below this site)
Which AP Projection will sometimes demonstrate calcific deposits in the joint that can be indicative of Bursitis Neutral Rotation
What Projections will demonstrate the humerus in a lateral projection AP internal rotation Transthoracic lateral
The superoinferior and inferosuperior Axillary projections demonstrates which tendon insertion sites? Subscapularis of less tubercle and Teres minor of greater tubercle
For a transthoracic lateral projection, the proximal humerus should be projected: between the vertebral column and sternum
When the tangential projection of the intertubercular groove is performed with the patient supine, the position of the hand is: Supinated
All of the joints of the shoulder girdle are: Synovial: freely movable
The lesser tubercle is situated on which surface of the humerus? anterior
How many degrees is the body rotated for the AP oblique projection (Grashey method) of the shoulder joint? 35-45* towards the affected side
Which shoulder projection clearly demonstrates the glenoid cavity? AP Oblique Projection (Grashey Method)
The West Point method is useful in demonstrating what? Hill-sachs defect and Bankart lesions associated with anterior dislocations of the shoulder
Test slide Ignore me
Created by: paigeduh