Debbie Starkey

Queensland Diagnostic Imaging

“Evaluation of shoulder disorders should begin with radiographs” Goud et al 2008

So….Which projections?

Today … Review of anatomy – “What anatomy is relevant and

can be imaged?”

Review of literature – “What is required to be imaged?”

Recommendations

Anatomy

Weber.E., Vilensky,J., and Carmichael,S., “Netter’s Concise Radiologic Anatomy” Elsevier 2009

Pathology: Impingement

Rotator cuff disease

AP Projection of the Shoulder Median-sagittal plane perpendicular or Scapular Plane

Scapular Plane Median Sagittal Plane Perpendicular

Gleno-Humeral Joint Projection Posterior oblique position

Allows evaluation of gleno-humeral cartilage space

Performed in external, internal or neutral rotation

Functional Position

Internal Rotation

External Rotation Neutral Rotation

Subacromial Space Caudal angulation

No Angulation Caudal Angulation

Outlet Projection Caudal angulation in

lateral scapula position

Allows evaluation of acromion and subacromial space –shape , presence of osteophytes

Whole scapula or collimated

Full Scapula

Collimated

Axial Projection Subscapularis – anterior

to the lesser tuberosity

Best visualised on the axial projection

Required: Full shoulder girdle

Glenohumeral joint

Greater tuberosity

Lesser tuberosity

Subacromial space (in both AP and Lateral planes)

Region of the subscapularis

Recommended Projections

Conclusion: Diversity does exist

Specific bony structures are required to be visualized

Combinations of patient rotation and humerus position are possible

Departmental protocols are variable

References: Goud, A., Segal,D., Hedayati,P., Pan,J., and Weissman,B., “Radiographic

Evaluation of the Shoulder” European Journal of Radiology 2008 68:2-15 Farid, N., Bruce, D., and Chung, C., “Miscellaneous Conditions of the

Shoulder: Anatomical, Clinical and Pictorial review emphasizing potential pitfalls in Imaging Diagnosis” European Journal of Radiology 2008 68:88-105

Lugo, R., Kung, P., and Ma, B., “Shoulder Biomechanics” European Journal of Radiology 2008 68 16-24

McNally, E., and Rees, J., “Imaging in Shoulder Disorders” Skeletal Radiology 2007 36:1013-1016

Siegal,D., Wu,J., Newman, J., del Cura, J., and Hochman, M. “Calcific Teninitis: A Pictorial Review” Canadian Association of Radiologists Journal 2009 60:263-272

Stiles, R., and Otte, M., “Imaging of the Shoulder” Radiology 1993 188:603-613

Weber.E., Vilensky,J., and Carmichael,S., “Netter’s Concise Radiologic Anatomy” Elsevier 2009