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Shoulder Projections

Upper Extremities X-ray positioning guide.

Shoulder Projections
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Shoulder Projections

Patient Preparation

  • Explain the procedure to the patient.
  • Remove jewelry or metallic objects from the shoulder and upper arm.
  • Position the patient comfortably, standing, seated, or supine.
  • Use lead shielding as appropriate.

BASIC PROJECTIONS

1. AP Projection — Shoulder (External, Internal, and Neutral Rotation)

Positioning:

  • Patient standing, seated, or supine.
  • Arm extended by side. Choose rotation depending on the view:
    • External Rotation: Palm facing outward, epicondyles parallel to IR.
    • Internal Rotation: Hand pronated, epicondyles perpendicular to IR.
    • Neutral Rotation: Thumb pointing upward, epicondyles at 45° to IR.

Central Ray (CR):

  • Perpendicular to IR.
  • Directed to 1 inch inferior to coracoid process (mid-shoulder joint).

SID:

  • 100–110 cm (40–44 inches).

Collimation:

  • Include proximal humerus, glenohumeral joint, and lateral scapula.

2. Inferosuperior Axial Projection — Shoulder (Lawrence Method)

Positioning:

  • Patient supine or seated.
  • Shoulder abducted 90°, arm externally rotated.
  • IR placed on table beside shoulder.

Central Ray (CR):

  • Horizontal, directed medially 25–30° to axilla.
  • Centered to glenohumeral joint.

SID:

  • 100–110 cm (40–44 inches).

Collimation:

  • Include proximal humerus, glenohumeral joint, and lateral scapula.

OTHER PROJECTIONS

3a. PA Transaxillary — Shoulder (Hobbs Modification)

Positioning:

  • Patient prone or leaning over IR.
  • Arm elevated and abducted as needed.
  • IR under shoulder.

Central Ray (CR):

  • Horizontal, directed to glenohumeral joint.

SID:

  • 100–110 cm (40–44 inches).

Collimation:

  • Include glenohumeral joint and proximal humerus.

3b. Inferosuperior Axial — Shoulder (Clements Modification)

Positioning:

  • Patient supine or seated.
  • Shoulder slightly abducted, arm neutral.
  • IR angled 5° posterior to shoulder if needed.

Central Ray (CR):

  • Horizontal, directed to glenohumeral joint.

SID:

  • 100–110 cm (40–44 inches).

Collimation:

  • Include proximal humerus and glenohumeral joint.

3c. AP Oblique — Glenoid Cavity (Grashey Method)

Positioning:

  • Patient rotated 35–45° toward affected side.
  • Arm neutral.
  • Scapula parallel to IR.

Central Ray (CR):

  • Perpendicular to IR.
  • Directed to glenohumeral joint.

SID:

  • 100–110 cm (40–44 inches).

Collimation:

  • Include glenohumeral joint and proximal humerus.

3d. Tangential — Intertubercular Sulcus (Bicipital Groove)

Positioning:

  • Patient supine.
  • Hand externally rotated and palm up.
  • IR behind shoulder.

Central Ray (CR):

  • 10–15° posteriorly (or as per technique).
  • Directed to intertubercular sulcus.

SID:

  • 100–110 cm (40–44 inches).

Collimation:

  • Include proximal humerus and intertubercular sulcus.

3e. PA Oblique — Scapula Y Lateral

Positioning:

  • Patient upright or supine.
  • Rotate patient so affected scapula is perpendicular to IR.
  • Arm in neutral position.

Central Ray (CR):

  • Perpendicular to IR.
  • Directed to scapulohumeral joint.

SID:

  • 100–110 cm (40–44 inches).

Collimation:

  • Include scapula, glenohumeral joint, and proximal humerus.

3f. PA Oblique — Neer Method

Positioning:

  • Patient upright or prone.
  • Arm neutral or slightly internally rotated.
  • Body angled 10–15° anteriorly if upright.

Central Ray (CR):

  • Perpendicular to IR.
  • Directed to superior aspect of humeral head.

SID:

  • 100–110 cm (40–44 inches).

Collimation:

  • Include acromion, clavicle, and humeral head.

3g. Transthoracic Lateral — Shoulder

Positioning:

  • Patient upright or supine.
  • Affected arm neutral at side.
  • Opposite arm elevated or behind head.
  • Breathing technique to blur lung markings.

Central Ray (CR):

  • Perpendicular to IR.
  • Directed to surgical neck of humerus.

SID:

  • 100–110 cm (40–44 inches).

Collimation:

  • Include proximal humerus and glenohumeral joint.

3h. AP Apical Oblique Axial — Shoulder

Positioning:

  • Patient supine or upright.
  • Body rotated as needed to profile acromion and humeral head.
  • Arm neutral or slightly rotated.

Central Ray (CR):

  • 30° cephalad.
  • Directed to glenohumeral joint.

SID:

  • 100–110 cm (40–44 inches).

Collimation:

  • Include acromion, clavicle, and proximal humerus.

3i. Apical AP Axial — Shoulder

Positioning:

  • Patient supine or upright.
  • Arm neutral.
  • Body positioned to project acromion free of superimposition.

Central Ray (CR):

  • 30° caudad.
  • Directed to glenohumeral joint.

SID:

  • 100–110 cm (40–44 inches).

Collimation: