What are the routine views of the shoulder?
- AP in IR
- AP in ER
- WB vs NWB of AC joint
- Scapula AP
- Scapula Lateral
What can should be noted when comparing WB vs NWB views of the AC joint?
- AC gap
- Coracoclavicular gap
for ligament sprains
What 4 things is the axillary view of the shoulder useful in evaluating?
- Coracoid
- Rim of glenoid
- Humeral head and shape
- Subluxation/ dislocation
What is the scapular Y lateral view of the shoulder useful in evaluating?
- GH dislocations
- Subacromial space
How is the patient oriented in relation to the image receptor for the scapula AP view?
- Image posterior to patient
- Shoulder abducted 90 degrees and externally rotated.
- Should position causes scap to be abducted, upwardly rotated, and clear of the rib cage laterally
- Otherwise in AP
How is the patient oriented in relation to the image receptor for the scapula lateral view?
- Patient sidelying with the scapula being evaluated positioned upwards towards the x-ray beam
- Shoulder flexed to 90 degrees, horizontally adducted to free view of scap
- Elbow flexed for comfort
- Arm positioned across front of the Pt’s chest to free the body of the scap from superimposition of the humeral shaft.
- The arm may be positioned behind the Pt’s back to free the acromion and coracoid processes from superimposition of the humeral head
How is the patient oriented in relation to the image receptor for the axillary view?
- Shoulder abducted 90 degrees
- Patient supine or prone
- Image receptor placed on superior aspect of shoulder
- X-ray beam passes inferiolateral to superiormedial through the joint
What is the more technical name of the axillary view?
- inferiosuperor axial projection of GH joint
How is the patient orient in relation to the image receptor for the scapular Y lateral view?
- patient is standing facing the image receptor with their affected shoulder in direct contact, but their body canted at an angle of 60 degrees.
- X-ray enters joint perpendicular to image receptor
What is the more technical name of the scapular Y lateral view?
- anterior oblique view of the shoulder
What two fractures/ bony deformities may occur due to GH dislocations?
- Bankart fracture of glenoid
- Hill-sachs deformity of humeral head
What is a bankart fracture?
- Pocket at front of glenoid forms that the humeral head dislocates into anteriorly
What is a hill-sachs lesion?
Compressed posterolateral head of humerus due to forceful impaction of the humerus into the anterioinferior glenoid.
What is a primary impingement? What are some examples of them in the shoulder joint?
- Skeletal or structural problem
- Spurs (hooked acromion)
What is secondary impingement, and what is an example in the shoulder?
- Changes in muscle lead to compression of tissue against bony structures
- Deltoid/ rotator cuff imbalance leads to humeral head being pulled superiorly
How can impingements be viewed in radiographic studies?
- Dislocation of bones into impingement
- Calcific deposits indicating injury
- Bone spurs
- White masses in tendons in T-2 MRI indicating tears
What are some radiologic signs of adhesive capsulitis?
- A lack of redundant capsule hanging inferiorly to the shoulder when contrast in injected into the GH joint.
- MRI can demonstrate a thickened capsule
