SHOULDER JOINT
L. Ashritha Naik
ANATOMY
• The glenohumoral joint is a ball
and socket type of synovial joint.
• Articular surfaces are head of
humerus and glenoid cavity of
scapula.
• Glenoid cavity is made deeper by
a fibrocartilagenous ring -
labrum glenoidale.
• Articular surfaces of humerus is
4 times more than that of glenoid
cavity.
• Ap internal rotation position
• Ap external rotation position
• Ap abduction position
AP INTERNAL ROTATION PROJECTION
• It demonstrates proximal
humerus, scapula, clavicle, rib
cage, lung.
• Patient’s arm is internally rotated
30 degrees such that epiconsyles
lie perpendicular to the film.
• Central Ray: To the coracoid
process
COMMON PITFALLS
• Obscured glenohumeral joint space
• Insufficient internal humeral rotation
• Tennis racquet appearance superimposition of
humeral head on metaphysis in this position
creates impression of presence of cyst in
humeral head
• Uneven exposure
SPECIALIZED PROJECTIONS
1. Grashey’s view: The body is rotated 45 degrees towards the
affected side, with the central ray at coracoid process
2. Apical oblique: The body is rotated as if for Grashey’s view, and the
tube is angled 45 degrees caudally. Used to demonstrate fractures
of glenoid rim, dislocation and impaction fractures of humeral head
(Hill-Sachs defect).
3. Subacromial impingement view: An AP view with 30 degree caudal
tube angulation and no body rotation. Used for depiction of
acromegaly growth spurs and impingement of supraspinatus.
AP EXTERNAL ROTATION
PROJECTION
• It demonstrates proximal
humerus (especially greater
tuberosity), scapula, clavicle,
rib cage, lung.
• The patient is rotated 30
degrees to the bucky and the
arm is externally rotated such
that epicondyles are parallel
to the film.
• Central ray to the coracoid
COMMON PITFALLS
• Obscured glenohumoral joint space
• Insufficient external humeral rotation: will
impair visualization of greater tuberosity.
Greater external rotation can be attained by
flexing elbow 90 degrees for free movement.
• Uneven exposure
SPECIALIZED PROJECTIONS
1. Grashey’s view: The body is rotated 45
degrees towards the affected side with central
ray to the coracoid process.. It gives
tangential exposure of articular surfaces.
AP ABDUCTION PROJECTION
• It demonstrates proximal humerus,
scapula(especially acromian and coracoid
process), acromioclavicular joint, upper rib
cage, clavicle, lung apex.
• The patient’s position is flat to the bucky and
the arm is abducted to 90 degrees, the elbow
is flexed 90 degrees and the palm faces the
tube.
• Central ray at the mid clavicular line at the
level of coracoid process.
COMMON PITFALLS
• Obscured glenohumeral joint space
• Insufficient abduction: cannot show
impingement of rotator cuff muscles
SPECIALIZED POSITIONS
• Axillary view: This view shows anterior and posterior glenoid rims and
relative position of humerus, acromian and coracoid process.
• Westpint view: A variant of axillary view that demonstrates the
glenoid margin (Bankart‘s lesions) and humeral head (Hill-Sachs
lesion) and assess the position of humerus.
• Bicipital groove: The patient is in supine with arm externally rotated,
cassette placed at the superior aspect of shoulder and central ray
directed at the humeral head.
• Styker notch: In this patient hand is placed back of his head by flexing
elbow and placing anteriorly. Helps to identify posterior dislocation
compression fracture of humerus head and avulsion of anterior-
inferior glenoid margin.
• AP scapula view: The body is rotated 10-15 degrees to the
affected side, with the arm abducted in the baby arm position.
The tube is horizontal with the central ray at 2-3 inches below the
coracoid process.
• Lateral scapula view: The scapulothoracic joint, subscapular
surface, and ribs can be assessed.
• Coracoid process view: The patient is in supine or erect. The
central ray is directed to the coracoid process, with the tube
angled 15- 45 degrees.
• Outlet (tunnel) views: This view demonstrates coracoclavicular
space where the supraspinatus exits, the under surface of the
acromion (to assess for spurs), and the acromiohumeral joint
space, all important factors for demonstrating rotator cuff
Impingement.
• Scapula notch view: The suprascapular notch is where the
