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Slide 2 Radiographic technique of Shoulder joint 3 rd presentation Slide 3 Shoulder joint BASICSPECIAL AP Shoulder External Rotation Non trauma Inferosuperior Shoulder (Axial) Lawrence Method NON trauma AP Shoulder: Internal Rotation Non trauma Inferosuperior Shoulder (Axial) West point Method NON trauma AP neutral Rotation: Shoulder(trauma) APO ( Glenoid Cavity) Grashey NON trauma Transthoracic Lateral projection Lawrence Method Shoulder ( trauma). Tangential ( Intertubercular Groove) NON trauma Fisk Method Slide 4 Shoulder Anatomy A.C.Joint Slide 5 AP Shoulder External Rotation Non trauma: Basic * Film Size: 10x12 in.(24x30 cm).Crosswise or lengthwise. * SHIELDING: pelvic area. Patient Position: May be taken erect or supine.(Erect is usually less painful for patient if condition allows). Rotate body slightly toward affected side to place shoulder in contact with film holder or table top. Part Position: Position patient to center scapulohumeral joint to centered of IR. Abduct extended arm slightly, then externally rotate arm ( supinate hand ) until epicondyles of distal humerus are parallel to film. Distance: 100 cm or 40 in. C R: perpendicular to film. CP: (1 in ( 2.5cm ) inferior to Coracoid process). Collimation: collimate on four sides to area of interest. NB/ (suspend respiration during Exposure )to reduce movement and tension Slide 6 1.Clavicle 2. Acromio-clavicular joint 3. Acromion 4. Greater tubercle of Humerus 5. Head of Humerus 6. Lesser tubercle of humerus 7. Surgical neck of humerus 8. Coracoid process 9. Glenoid fossa 10. Shoulder joint 11. Lateral border of scapula Structure shown: AP projection of proximal Humerus and lateral of 2/3 of the clavicle and upper scapula is shown, including the relationship of the Humeral head to the glenoid cavity. AP Shoulder AP Shoulder External Rotation Non trauma: Basic Slide 7 AP Shoulder: Internal Rotation Non trauma: Basic Film Size: 10x12 in. (24x30 cm).Crosswise or lengthwise. SHIELDING: pelvic area. Patient Position: May be taken erect or supine.( Erect is usually less painful for patient if condition allows). Rotate body slightly toward affected side to place shoulder in contact with film holder or table top. Part Position: Position patient to center scapulohumeral joint to centered of IR. Abduct extended arm slightly, then internally rotate arm ( pronate hand ) until epicondyles of distal humerus are perpendicular to film. Distance: 100 cm or 40 in. C R: perpendicular to film. CP: (1 in ( 2.5cm ) inferior to Coracoid process). Collimation: collimate on four sides to area of interest. NB/ (suspend respiration during Exposure )to reduce movement and tension Slide 8 coracoid process Scapulohumeral joint Acromion Greater tubercle of Humerus proximal Humerus Lesser tubercle of humerus Structure shown: lateral view of proximal Humerus and lateral of 2/3 of the clavicle and upper scapula is shown, including the relationship of the Humeral head to the glenoid cavity. AP Shoulder: Internal Rotation Non trauma: Basic Slide 9 AP neutral Rotation: Shoulder(trauma): Basic Film Size: 10x12 in. (24x30 cm). Crosswise or lengthwise. SHIELDING: pelvic area. Patient Position: May be taken erect or supine.( Erect is usually less painful for patient if condition allows)Rotate body slightly toward affected side to place shoulder in contact with film holder or table top. Part Position: Position patient to center scapulohumeral joint to centered of IR. Place patients arm at side in neutral rotation.(epicondyles are generally approximately 45 degree to plane of IR or film. Distance: 100 cm or 40 in. CR : perpendicular to film. C P: To mid scapulohumeral joint (3/4 in (2 cm ) inferior and slightly lateral to the Coracoid process). Collimation: collimate on four sides to area of interest. NB/ (suspend respiration during Exposure )to reduce movement and tension. Slide 10 Structure shown: the proximal one third of the Humerus upper scapula, and lateral of 2/3 of the clavicle is shown, including the relationship of the Humeral head to the glenoid cavity. AP neutral Rotation: Shoulder(trauma): Basic Slide 11 Inferosuperior Shoulder (Axial) Lawrence Method (Special) Non-trauma case Film Size: 8x10 in. (18x24 cm)Crosswise. SHIELDING: pelvic area. Patient Position: Pt supine Shoulder raised 5 cm from tabletop by placing support under arm and shoulder. Head rotated toward opposite side. Part Position: Arm abducted 90 . With external rotation (palm up), Vertical cassette placed close to the neck. Distance: 100 cm or 40 in. C R: Horizontal 25 - 30 medially to film center. C P: Humeral head (axilla). Collimation: collimate on four sides to area of interest. NB/ (suspend respiration during Exposure )to reduce movement and tension Slide 12 Structure shown: lateral view of proximal Humerus in relationship to the scapula cavity is shown coracoid process Of scapula, Lesser tubercle of humerus is shown, the spin of the scapula will be seen on edge below the scapulohumeral joint Acromion Glenoid fossa coracoid process spin of the scapula Inferosuperior Shoulder (Axial) Lawrence Method (Special) Slide 13 Inferosuperior Shoulder (Axial) West point Method (Special) Non-trauma case Film Size: 8x10 in. (18x24 cm). Crosswise. SHIELDING: pelvic area. Patient Position: Patient prone, head rotated away from affected side, film held vertically against superior surface of the shoulder. Part Position: affected shoulder raised 8 cm, affected arm abducted 90 deg., elbow flexed with forearm hanging freely over table side. Distance: 100 cm or 40 in. C R: 25 anterior( down from horizontal ) and then 25 medially to film center. C P: Mid scapulohumeral joint. Collimation:collimate on four sides to area of interest. NB/ (suspend respiration during Exposure ) to reduce movement and tension Slide 14 Structure shown: An axial view of the shoulder girdle is shown.The anteroinferior aspect of glenoid rim is well demonstrated, humeral head is seen free of coracoid superimposition. Lesser tubercle Acromion scapulohumeral joint Inferosuperior Shoulder (Axial) West point Method (Special) Slide 15 APO ( Glenoid Cavity) Grashey NON trauma Special Film Size: 8x10 in. (18x24 cm). Crosswise SHIELDING: pelvic area. Patient Position: Patient erect or supine,body rotated 35 to 45 toward affected side. Part Position: Place support under elevated shoulder and hip (in the supine) Arm abducted slightly in a neutral position. Top of the cassette 2 in (5 cm) above shoulder. Distance: 100 cm or 40 in. C R: perpendicular to film. CP: Scapulohumeral joint 2in (5cm ) inferior and medial to Superolateral border of shoulder. Collimation: collimate on four sides to area of interest. NB/ (suspend respiration during Exposure )to reduce movement and tension. Slide 16 Structure shown: glenoid cavity should be seen in profile without superimposition, humeral head. humeral head Acromion coracoid process glenoid cavity APO ( Glenoid Cavity) Grashey NON trauma Special Slide 17 Tangential ( Intertubercular Groove) NON trauma Fisk Method (Special) SHIELDING: place lead shield over pelvic area. Body and Part position Patient standing, leaning over end of table elbow flexed and posterior surface of forearm resting on table, hand supinated holding cassette. patient leans forward to place humerus 10 15 from vertical. CR: 90 to film center. CP: directed to the groove at mid anterior margin of humeral head. Film Size : HD 8x10 in. (18x24 cm). Crosswise Collimation: collimate on four sides to area of interest. NB/ (suspend respiration during Exposure )to reduce movement and tension. Slide 18 Structure shown: the anterior margin of humeral head is seen in profile. The humeral tubercles and intertuberclar groove seen in profile intertuberclar bicipital groove. greater tubercle Lesser tubercle coracoid process Lat end clavicle Tangential ( Intertubercular Groove) NON trauma Fisk Method (Special) Slide 19 Transthoracic Lateral projection : Lawrence Method Basic Shoulder ( trauma). Film Size: 10x12 in. (24x30 cm) lengthwise. SHIELDING: pelvic area. Patient Position: May be taken erect or supine.( Erect is usually less painful for patient if condition allows). Place patient in lateral position with side of interest against cassette. Part Position: Place affected arm at patients side in neutral rotation drop shoulder if possible. Raise opposite arm and place hand over top of the head elevate shoulder as much As possible To prevent superimposing affected shoulder. Ensure that thorax is in true lateral position or with slightly anterior rotation of unaffected shoulder to minimize superimposition of hummers by thorax vertebrae. Distance: 100 cm or 40 in. CR perpendicular to film. CP: directed through thorax to surgical neck. Collimation: collimate on four sides to area of interest. NB/ breathing technique is preferred if patient can co-operate Pt should be asked to gently breathe short, shallow breaths without moving affected arm or shoulder. (this will best visualize proximal hummers by blurring out ribs and lung structure.) Slide 20 Structure shown: lat view of the proximal half of the humerus and glenoihumeral joint should be visualized through the thorax without superimposition of the opposite shoulder.