Shoulder XRay

Aka: Shoulder XRay, Shoulder Radiograph

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II. Indications: First-line Shoulder evaluation

  1. Shoulder Pain
  2. Shoulder Injury

III. Views: Standard

  1. Anterior-posterior (AP)
    1. Arm is typically externally rotated on a standard view
      1. May be internally rotated to better visualize the lesser tubercle
      2. May be left in neutral rotation in cases of Trauma
    2. Landmarks
      1. Humeral greater tuberosity
      2. AC Joint (acromion and clavicle)
        1. Inferior border of clavicle should align with the inferior border of acromion
      3. Glenohumeral Joint (glenoid, humeral head)
        1. Humeral head should overlap the glenoid (rim sign)
        2. Humeral head should appear asymmetric toward the glenoid
          1. Contrast with symmetric appearance in posterior dislocation (light bulb sign)
  2. Orthogonal View options
    1. Axillary View (preferred in Osteoarthritis, Dislocation, but requires arm manipulation)
      1. Coracoid process (aways points anteriorly)
      2. Humeral lesser tuberosity (anterior)
      3. Humerus articulates with glenoid posteriorly
      4. AC Joint (clavicular head and Scapular acromion) overlaps the humeral head
    2. Scapular Y View (alternative, lateral view which does not require repositioning of the arm)
      1. Image is perpendicular to the Scapular blade, forming a "Y" at the superior aspect
      2. Humeral head should be centered within the top of the Y
      3. Glenoid is at the center of the Y
  3. Images
    1. orthoShoulderAP.jpg
    2. OrthoShoulderScapularY.jpg

IV. Views: Impingement Series

  1. Anterior-posterior
  2. External rotation
  3. Outlet Y
  4. West Point

V. Views: Instability Series

  1. Anterior-posterior with and without Rotation
  2. Stryker Notch
  3. West Point

VI. Findings: Acute Shoulder Injury

  1. Proximal Humerus Fracture
  2. Humeral Shaft Fracture
  3. Glenohumeral Dislocation
  4. Acromioclavicular Separation
  5. Clavicle Fracture

VII. Findings: Chronic Shoulder Pain

  1. Acromioclavicular Osteoarthritis
  2. Glenohumeral Osteoarthritis
  3. Signs of Rotator Cuff conditions
    1. Superior migration of humeral head (large Rotator Cuff Tear)
    2. Humeral head cystic changes
    3. Inferior acromion sclerosis
  4. Signs of prior Anterior Shoulder Dislocation
    1. Hill-Sachs Lesion (posterior humeral head indentation)
      1. Impact occurs when Shoulder dislocates anterior to glenoid
  5. Signs of Osteoarthritis
    1. Axillary view best demonstrates joint space narrowing
    2. Subchondral sclerosis and osteophytes may also be seen

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