Humerus and Shoulder Girdle

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Chapter 3

Humerus and Shoulder Girdle

Humerus

AP (R)

Rotational lateral (R)

Trauma lateral (midhumerus and distal humerus) (S)

AP and lateral critique

Trauma transthoracic lateral (S)

Transthoracic lateral proximal critique

Shoulder

AP external and internal rotation (R)

AP external and internal rotation critique

Inferosuperior axial (Lawrence method) (S)

Inferosuperior axial critique

PA transaxillary projection (Hobbs modification) (S)

PA transaxillary projection critique

Inferosuperior axial (Clements modification) (S)

Inferosuperior axial (Clements modification) critique

Posterior oblique (Grashey method) (S)

Posterior oblique (Grashey method) critique

Tangential projection—intertubercular (bicipital) groove (Fisk modification) (S)

Tangential projection intertubercular groove critique

Scapular Y lateral—anterior oblique position and Neer method (S)

Scapular Y lateral and Neer method critique

AP trauma projection (neutral rotation) (S)

Transthoracic lateral (Lawrence method) (S)

Transthoracic lateral critique

AP apical oblique axial (Garth method) (S)

AP apical oblique axial critique

Clavicle

AP and AP axial (R)

AP and AP axial critique

Scapula

AP (R)

Lateral (R)

AP and lateral scapula critique

Acromioclavicular (AC) Joints

AP bilateral with and without weights (S)

AP AC joint critique

Important for humerus and shoulder projections: Do not attempt to rotate upper limb if fracture or dislocation is suspected without special orders by a physician.

(R) Routine, (S) Special

AP Humerus ^*

• 35 × 43 cm L.W. (14 × 17″) or for small patient 30 × 35 cm L.W. (11 × 14″)

• Grid >10 cm, IR only <10 cm

• Lead masking

Fig. 3-1 AP supine.

Rotational Lateral Humerus ^*

Warning:

Do not attempt to rotate arm if fracture or dislocation is suspected (see following page).

• 35 × 43 cm L.W. (14 × 17″) or 30 × 35 cm L.W.

• Grid >10 cm, IR only <10 cm

Fig. 3-3 Erect lateral (PA).

Fig. 3-4 Erect lateral (AP).

Position (May Be Taken Erect AP or PA, or Supine)

• Erect (PA): Elbow flexed 90°, patient rotated 15°–20° from PA or as needed to bring humerus and shoulder in contact with IR holder (epicondyles ⊥ to IR for true lateral)

• Erect or supine AP: Elbow slightly flexed, arm and wrist rotated for lateral position (palm back), epicondyles ⊥ to IR

• IR centered to include both elbow and shoulder joints

Fig. 3-5 Supine lateral.

Central Ray:

CR ⊥, to midhumerus

SID:

40-44″ (102-113 cm)

Collimation:

Collimate on sides to soft tissue borders of humerus and shoulder

Trauma Lateral Humerus ^*

(Midhumerus and Distal Humerus)

For proximal humerus, see transthoracic lateral or scapular Y.

• 30 × 35 cm L.W. (11 × 14″) or 24 × 30 cm L.W. (10 × 12″)

• Nongrid

Fig. 3-6 Lateral cross-table, midhumerus and distal humerus.

Position

• Gently lift arm and place support block under arm, rotate hand into lateral position if possible for true lateral elbow projection

• Place IR vertically between arm and thorax with top of IR at axilla (place shield between IR and patient)

Central Ray:

CR horizontal and ⊥ to IR, centered to distal ⅓ of humerus

SID:

40-44″ (102-113 cm)

Collimation:

Collimate on four sides, include distal and midhumerus, elbow joint, and proximal forearm

AP and Lateral Humerus

Fig. 3-7 AP humerus.

Fig. 3-8 Lateral erect humerus.

Evaluation Criteria

Anatomy Demonstrated:

• AP and lateral view of the entire humerus, including elbow and glenohumeral joints

Position: AP

• No rotation, medial and lateral epicondyles seen in profile, greater tubercle in profile laterally

• Humeral head and glenoid cavity demonstrated

Lateral (PA)

• True lateral, epicondyles are directly superimposed

Exposure:

• Optimal density (brightness) and contrast

• Sharp bony trabeculation clearly demonstrated, no motion

Trauma Transthoracic Lateral Humerus ^*

(Midhumerus and Proximal Humerus)

• 35 × 43 cm L.W. (14 × 17″)

• Grid

Fig. 3-9 Transthoracic lateral.

Position

• Patient recumbent or erect

• Affected limb closest to IR

• Raise opposite arm over head

Central Ray:

Center to mid-shaft of affected humerus

SID:

40-44″ (102-113 cm)

Collimation:

To soft tissue margins—entire humerus

Respiration:

Breathing technique is preferred.

If breathing lateral technique performed: Minimum of 2 seconds exposure time (between 2 and 4 seconds is desirable)

Transthoracic Lateral Proximal Humerus

Evaluation Criteria

Anatomy Demonstrated:

• Lateral view of the proximal half of humerus

Position:

• Proximal half of shaft of humerus should be clearly visualized

• Humeral head and glenoid cavity demonstrated

Fig. 3-10 Transthoracic lateral.

Exposure:

• Optimal density (brightness) and contrast

• Overlying ribs and lung markings blurred (with breathing technique)

AP Shoulder ^*

(External and Internal Rotation)

Warning: Do not attempt if fracture or dislocation is suspected.

• 24 × 30 cm (10 × 12″) C.W. (or lengthwise to show more of humerus)

• Grid

Fig. 3-11 External (AP humerus).

Fig. 3-12 Internal (lateral humerus).

Position

• Erect (seated or standing) or supine, arm slightly abducted

• Rotate thorax as needed to place posterior shoulder against IR

• Center of IR to scapulohumeral joint and CR

External Rotation:

Rotate arm externally until hand is supinated and epicondyles are parallel to IR.

Internal Rotation:

Rotate arm internally until hand is pronated and epicondyles are perpendicular to IR.

Central Ray:

CR ⊥, directed to 1″ (2.5 cm) inferior to coracoid process

SID:

40-44″ (102-113 cm)

Collimation:

Collimate closely on four sides.

Respiration:

Suspend during exposure.

AP Shoulder—External and Internal Rotation

Evaluation Criteria

Anatomy Demonstrated:

• Proximal humerus and lateral ⅔ of the clavicle (entire clavicle for crosswise IR) and upper scapula

Position: External Rotation

• Greater tubercle visualized in full profile laterally

• Lesser tubercle superimposed over humeral head

Fig. 3-13 AP shoulder external rotation.

Internal Rotation (Lateral)

• Lesser tubercle visualized in full profile medially

• Greater tubercle superimposed over humeral head

Exposure:

• Optimal density (brightness) and contrast

• Soft tissue and sharp bony trabeculation clearly demonstrated; no motion

Fig. 3-14 AP shoulder internal rotation.

Inferosuperior Axial ^*

(Lawrence Method)

Warning: Do not attempt if fracture or dislocation is suspected.

• 18 × 24 cm C.W. (8 × 10″)

• Grid; grid lines horizontal and CR to center line of grid

• Often performed nongrid for smaller shoulder

Fig. 3-15 Inferosuperior axial (Lawrence method).

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