The document discusses positioning for an AP shoulder x-ray. It provides details on anatomy visualized in the AP view and optimal positioning techniques. The positioning used for the sample patient did not employ a true AP (Grashey) view, as the arm was externally rotated rather than neutral. For standardized shoulder x-rays, neutral rotation of the arm is preferable to avoid increased valgus angle of the humeral head-shaft angle.
The document discusses positioning for an AP shoulder x-ray. It provides details on anatomy visualized in the AP view and optimal positioning techniques. The positioning used for the sample patient did not employ a true AP (Grashey) view, as the arm was externally rotated rather than neutral. For standardized shoulder x-rays, neutral rotation of the arm is preferable to avoid increased valgus angle of the humeral head-shaft angle.
The document discusses positioning for an AP shoulder x-ray. It provides details on anatomy visualized in the AP view and optimal positioning techniques. The positioning used for the sample patient did not employ a true AP (Grashey) view, as the arm was externally rotated rather than neutral. For standardized shoulder x-rays, neutral rotation of the arm is preferable to avoid increased valgus angle of the humeral head-shaft angle.
The document discusses positioning for an AP shoulder x-ray. It provides details on anatomy visualized in the AP view and optimal positioning techniques. The positioning used for the sample patient did not employ a true AP (Grashey) view, as the arm was externally rotated rather than neutral. For standardized shoulder x-rays, neutral rotation of the arm is preferable to avoid increased valgus angle of the humeral head-shaft angle.
Proximal humerus articulates with the scapula, making up the shoulder joint. AP view of humerus : A. Caput humerus B. Greater tubercle C. Intertubercular sulcus D. Lesser tubercle E. Anatomic neck F. Surgical neck G. 1/3 proksimal diafisis Minicon Positioning
Shoulder Girdle consists of two bones: the clavicle and the scapula that connect each upper limb to the trunk, Anteriorly : to the trunk at the upper sternum. Posteriorly : to posterior rib cage (by muscles only).
The Clavicle (collarbone)
medial (sternal) end articulates with manubrium, lateral (acromial) end articulates with acromion of scapula. AP view of clavicle should visualize : A. Sternoclavicular joint B. Sternal extremity C. Body D. Acromial extremity E. Acromioclavicular joint Minicon Positioning
The Scapula is a triangular bone with three borders, three angles, and two surfaces. AP view of scapula should visualize : A. Acromion B. Neck of scapula C. Suprascapular notch D. Superior angle E. Medial (vertebral) border F. Inferior angle G. Lateral (axillary) border H. Glenoid fossa or scapulohumeral joint 02 Antero-Posterior View TRUE AP VIEW (GRASHE Y) 1. Have the patient upright or in the supine position. The upright position should be used in shoulder-trauma TRUE AP (Grashey) patients whenever possible to avoid movement and pressure. 2. Center the shoulder joint to the midline of the grid. 3. Adjust the position of the cassette so that its center is 2.5 cm inferior to the coracoid process. The coracoid process is about 2 cm inferior to the lateral portion of the palpable clavicle. 4. The central ray (CR) should be perpendicular to the center point. 5. Position the arm in the external, internal, or neutral rotation. 6. Rotate the patient or the cassette parallel with the body of the scapula. 7. Suspend respiration during the exposure. Minicon Positioning
AP Projection and Rotation of Humerus
01 02 03 AP WITH AP WITH AP WITH NEUTRAL EXTERNAL INTERNAL ROTATION ROTATION ROTATION Minicon Positioning
01 AP WITH NEUTRAL ROTATION
Indication : • for trauma patients • Glenohumeral arthritis • Fractures of the coracoid, glenoid, and proximal humerus • Posterior glenohumeral instability
Oblique view of humerus.
Visualize both greater and lesser
tubercle. Minicon Positioning
02 AP WITH EXTERNAL ROTATION
Indication : • For non-trauma patients • Best for greater tubercle lession
Anatomical view of humerus
(greater tubercle visualized in full profile on the lateral aspect of the proximal humerus). Minicon Positioning
03 AP WITH INTERNAL ROTATION
Indication : • Combine with external rotation to visualize the entire humeral head. • To view posterolateral aspect of the humeral head. Lession in this area called Hill-Sachs lesion : a compression fracture due to repetitive anterior shoulder dislocations. • Bankart lession
Lesser tubercle in full profile, and greater
tubercle visualize in anterior. 03 Real Patient Positioning Minicon Positioning Hasil Foto Hasil Foto 04 Diskusi - Standard/routine AP view should be Positioning of shoulder x-ray differentiated from True AP view didn’t use True AP View (Grashey). - True AP : avoid overlapping of humerus and glenoid
- Neutral rotation is preferable to
avoid increased valgus angle of Patient’s arm was in external humerus head shaft angle (HAS) rotation, but the photo was not in - Arm positioning should be part of accordance standardized protocol in shoulder x- ray. Hengg C, Mayrhofer P, Euler S, Wambacher M, Blauth M, Kralinger F. The relevance of neutral arm positioning for true ap-view X-ray to provide true projection of the humeral head shaft angle. Arch Orthop Trauma Surg. 2016 Feb 1;136(2):213–21. Adikrishna A, Hong H, Deslivia MF, Zhu B, Tan J, Jeon IH. Head-shaft angle changes during internal and external shoulder rotations: 2-D angulation in 3-D space. Orthopaedics & Traumatology: Surgery & Research. 2017 Apr;103(2):159–63. Terima Kasih References 1. Long BW, Rollins JH, Smith BJ. Shoulder Girdle. In: Merrill’s Atlas of Radiographic Positioning and Procedures. 13th ed. Missouri: Elsevier; 2016. p. 174–224. 2. Lampignano JP, Kendrick LE. Humerus and Shoulder Girdle. In: Bontrager’s Textbook of Radiographic Positioning and Related Anatomy. 9th ed. Missouri: Elsevier; 2018. p. 177–210. 3. Hengg C, Mayrhofer P, Euler S, Wambacher M, Blauth M, Kralinger F. The relevance of neutral arm positioning for true ap-view X-ray to provide true projection of the humeral head shaft angle. Arch Orthop Trauma Surg. 2016 Feb 1;136(2):213–21. 4. Aydingöz Ü, Canbulat N, Demirhan M. Omuz bölgesinin radyolojik deǧerlendirmesi. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi. 2014;60(SUPPL. 1). 5. Adikrishna A, Hong H, Deslivia MF, Zhu B, Tan J, Jeon IH. Head-shaft angle changes during internal and external shoulder rotations: 2-D angulation in 3-D space. Orthopaedics & Traumatology: Surgery & Research. 2017 Apr;103(2):159–63.
What Process Is Best Seen Using A Perpendicular CR With The Elbow in Acute Flexion and With The Posterior Aspect of The Humerus Adjacent To The Image Receptor
What Process Is Best Seen Using A Perpendicular CR With The Elbow in Acute Flexion and With The Posterior Aspect of The Humerus Adjacent To The Image Receptor
