Tenth edition merrills atlas radiographic postions and radiologic procedures Phillip W. Ballinger. Eugene D.

Frank shoulder girdle the shoulder girdle is formed by two bones, the cavicle and scapula. their function is to connect the upper limb to the trunk. Although the alignment of these two bones is considered a girdle. It is incomplete both in front and in back. The girdle is completed in front by the sternum, which articulates with the medial end of the clavicle. The scapulae are widely separated in the back. The proximal portion of the humerus is part of the upper limb and not the shoulder girdle proper: however, because the proximal humerus is included in the shoulder joint, its anatomy is considered with that of the shoulder girdle. Clavicle The clavicle, is classified as a long bone, has a body and two articular extremites. The clavicle lies in a horizontal oblique plane just above the first rib and forms the anterior part of the shoulder girdle. The lateral aspect is termed the acromial extremitiy, and it articulates with the acromion process of the scapula. the medial aspect , termed the sternal extremity , articulates with the manubrium of the sternum and the first costal cartilage. The clavicle, which serves as fulcrum for the movements of the arm, is doubly curved for strength. The curvanture is more acute in males than in females. Scapula The scapula, classified as a flat bone. Forms the posterior part of the shoulder girdle. Triangular in shape, the scapula has two surfaces, these borders, and three angles. Lying on the superoposterior thorax between the second and seventh ribs, the scapulas medial border runs

parallel with the vertebral column. The body of the bone is arched from the top to bottom for greater strength, and its surfaces serve as the attachment sites of numerous muscules. The costal ( anterior ) surface of the scapula is slightly concave and contains the subscapular fossa. It is filled almost entirely by the attachment of the subscapularis muscle. The anterior serratus muscle attaches to the medial border of the costal surface from the superior angle to the inferior angle. The dorsal ( posterior ) surface is divided into two portions by a prominent spinous process. The crest of supine arises at the smoth

Inferosuperior Axial Projection West point method Image receptor : 8 x 10 inch ( 18 x 24 cm ) crosswise placed in the vertical position in contact with the superior surface of the shoulder. Position of patient Adjust the patient in the prone position with approximately a 3 inch ( 7,6 cm ) pad under the shoulder being examined Turn the patients head away from the side being examined.

Position of part Abduct the arm of the affected side 90 degrees, and rotate so that the forearmrests over the edge of the tableor a bucky tray. Which may be used for support. Place a vertically supported IR against the superior aspect of the shoulder with the edge of the IR in contact with the neck. Support the IR in sandbags or a vertical IR holder. Shield gonads. Respiration : suspend.

Central Ray Directed at dual angle of 25 degrees anteriorly from the horizontal and 25 degrees medially. The central ray enters approximately 5 inches ( 13 cm ) inferior and 1 ( 3,8 cm ) medial to the acromial edge and exits the glenoid cavity.

Structure shown The resulting image shows bony abnormalities of the anterior inferior rim of the glenoid in patients with instability of the shoulder. Evaluation Criteria The following should be clearly demonstrated : Humeral head projected free of the coracoid process Articulation between the head of the humerus nd the glenoid cavity Acromion superimposed over the posterior portion of the humeral head Shoulder joint.

Inferosuperior Axial Projection Clements Modification Image reseptor :

8 x 10 inch ( 18 x 24 cm ) placed in the vertical position in contact with the superior surface of the shoulder. Position of patient When the prone or supine position is not possible. Clements suggested that the patient be radiographed in the lateral recumbent position lying. On the unaflected side. Flex the patient s hips and knees.

Position of part Abduct the affected arm 90 degrees and point it toward the ceiling. Place the IR against the superior aspect of the patients shoulder. Holding it in place with the unaffected arm or by securing it appropriately. Shield gonads. Respiration : suspend

Central ray Horizontal to the midcoronal plan passing through the midaxillary region of the shoulder. Angled 5 to 15 degrees medially when the patient cannot abduct the arm a 90 degrees. The resulting radiograph is seen in fig.

SCAPULAR Y PA OBLIQUE PROJECTION RAO or LAO position

This projection , described by Rubin. Gray. and Green. Obtained its name as a result of the appearance of the scapula. The body of the scapula forms the vertical component of the Y. and the acromion and coracoid processes form the upper limbs. The projection is useful in the evaluation of suspected shoulder dislocations. Image reseptor : 24 x 30 cm Position of Patient Radiograph the patient in the upright or recumbent body position:the upright position is preferred. When the patient is serverely injured. Modify the anterior oblique position by placing the patient in the posterior oblique position. Position of part Position the anterior surface of the shoulder being examined against the upright table. Rotate the patient so that the midcoronal plane forms an angle of 45 to 60 degrees to the IR. The position of the arm is not critical because it does not alter the relationship of the humeral head to the glenoid cavity. Palpate the scapula, and place its flat surface perpendicular to the IR. Position the center of the IR at the level of the scapulohumeral joint. Shield gonads. Respiration : suspend.

Computer radiography

Collomation must be very close to prevent unnecessary radiation from reaching the IR phosphor. Central Ray Perpendicular to the scapulohumeral joint. Structures shown The scapula Y is demonstrated on an oblique image of the shoulder. In the normal shoulder the humeral head is directly superimposed over the junction of the Y locations, the humeral head is beneath the coracoid process. In posterior ( subacromion process. An AP shoulder projection is shown for comparison. Evaluation Criteria The following should be clearly demonstrated : No, sumperimposition of the of the scapula body over the bony thorax. Acromion projected laterally and free of sumperimposition. Coracoid possibly superimposed of projected below the clavicle. Scapula in lateral profile.