The Shoulder Girdle

1
The Shoulder Girdle

• Technique Part 2
• Denise Ogilvie
• October 2006

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Learning Objectives

• Be able to identify and perform the following
  views
• AP Clavicle
• Axial Clavicle
• AP Scapula
• Lateral Scapula
• Acromio-clavicular joints
• AP and Lateral Humerus

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AP Clavicle

• Patient erect or supine
• Centre clavicle to middle of IR or bucky
• Arms resting beside body
• Suspend respiration
• CP perpendicular to midshaft of clavicle
• 24 x 30 cm landscape

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AP Image Critique

• Should demonstrate all shoulder structures as in
  AP shoulder
• Distal clavicle seen above scapula with joint
  shown clearly

5
Axial Clavicle

• Patient in same position as AP
• Tube angled 30 degrees cephalic
• Move IR upward to centre clavicle to IR
• 18 x 24cm landscape

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Axial Clavicle Image Critique

• Most of clavicle projected above ribs
• AC joints and SC joints will be seen

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AP Scapula

• Patient erect-more comfortable
• Can be supine
• Abduct arm as much as possible to bring scapula
  away from chest
• Top of IR above top of shoulder
• CR perpendicular to mid scapula 5cms below
  coracoid process
• 24 x 30 landscape

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AP Scapula Image Critique

• Lateral border of scapula away from chest
• Bony detail of chest
• Acromion process clearly seen as well as inferior
  angle of scapula

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Lateral Scapular (Y)

• This view is the same as lateral shoulder.
• I would have the arm across the abdomen as
  apposed to behind the patient-less painful
• In cases of severe pain perform lateral in
  whatever position the arm presents

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Lateral Scapula Image Critique
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Acromio- Clavicular Joints

• Both joints imaged routinely for comparison
• Imaged separately
• Arms relaxed by side
• CR over each AC jt
• Cone down close to joint to stop scatter
• Use 18 x 24 divided into 2 or 24 x 30 divided
  into 4
• Out of bucky best

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Acromio- Clavicular Joints

• Weight bearing views of the AC jts are commonly
  performed still at many sites
• Current trend is not to perform weight bearing as
  it is believed not to show a great deal more
• If the trauma is very recent I would look at the
  neutral images before any weight bearing views.
• Equal weights are attached with a band around the
  wrist

13
Acromio- Clavicular Joints

• Do not hold the weights in the hand as this seems
  to make the shoulder muscles contract and may
  prevent seeing a slight AC jt separation
• Each side imaged separately
• Instruct patient to let shoulders relax

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Acromio- Clavicular Joints Image Critique

• 
  What not to do.
• 
  Why?

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Acromio-Clavicular Joints Image Critique

• Reduced exposure-AC jts close to skin surface
• Good coning for scatter reduction
• Clearly marked L R
• Non-weight bearing or weight bearing-4 separate
  images

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AP Humerus

• Erect or supine
• Body position may vary
• Humerus in true AP position abducted slightly
  away from body
• Hand supinated
• Top of IR 4 cm above head of humerus
• CR perpendicular to humerus, midshaft

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AP Humerus Image Critique

• Elbow and shoulder on film
• Epicondyles parallel to IR
• Humeral head and greater tubercle in profile
• Even density along humerus

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Lateral Humerus

• Patient facing IR
• Elbow flexed 90 degrees
• Hand resting on abdomen
• CR midshaft and perpendicular to humerus
• IR 4cm above head of humerus
• If lateral shoulder required rotate body-may need
  a wedge filter across lower humerus for even
  density

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Lateral Humerus Alternative

• Almost same image can be obtained with patient in
  AP position
• Elbow flexed 90 degrees
• Hand supinated against thigh

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Lateral Humerus Image Critique

• Shoulder and elbow joint seen
• Epicondyles superimposed (lateral)
• Lesser tubercle in profile medially
• Even density of humerus
• McQuillen Martinson p210 good comparison of
  latero-medial to medio-lateral laterals

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Supine Humerus
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Supine Distal Humerus Lateral

• When patient presents with known or suspected
  fracture
• IR slid between humerus and body taking care to
  move arm as little as possible
• If elbow can flex, so epicondyles are lateral,
  only if not contraindicated

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Supine Distal Humerus LateralImage Critique

• Shows distal humerus only
• Epicondyles lateral
• For proximal humerus do a lateral scapula view

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References

• McQuillen Martinson, Radiographic Image Analysis,
  2nd edn
• Ballinger, Frank, Merrill's Atlas of Radiographic
  Positions Radiologic Procedures 10th edn