Shoulder series

The shoulder series is fundamentally composed of two orthogonal views of the glenohumeral joint including the entire scapula. The extension of the shoulder series depends on the radiography department protocols and the clinical indications for imaging.

Indications

Shoulder radiographs are performed for a variety of indications including:

• shoulder trauma 
• bony tenderness at the glenohumeral joint/region 
• restriction of rotation 
• instability
• suspected dislocation 
• AC joint injury
• scapula trauma
• suspected arthritis 
• non-traumatic shoulder pain

Projections

Standard projections

• AP view
  • demonstrates the glenohumeral joint in the natural anatomical position
  • shows the humeral head superimposing the glenoid of the scapula 
  • displays the entire clavicle, AC joint, scapula, superior ribs, SC joint and proximal humerus
• lateral or scapular Y view
  • orthogonal view of the AP shoulder view 
  • profile view of the scapula 
  • demonstrates the degree and direction of any suspected dislocations

Modified trauma projections

• modified trauma axial
  • a replacement examination to the lateral projection with a higher diagnostic yield
  • best used in trauma  
  • appropriate examination for inspection of the articular surfaces of both the humeral head and the glenoid 
  • can be conducted regardless of body habitus or patient condition 
• Garth projection 
  • ideal to assess the anterior inferior glenoid rim
  • demonstrated the superolateral aspect of the humeral head therefore useful to identify Hill-Sachs lesions
• supine lateral
  • modified lateral shoulder projection often utilized in trauma imaging where the patient can roll onto a sponge
  • cannot be used in trauma patients on spinal precautions
• modified transthoracic supine lateral
  • modified lateral shoulder projection often utilized in trauma imaging when the patient cannot move from the supine position
  • involves no patient movement
• supine axial view (inferosuperior)
  • modified axial projection for supine patients 
  • demonstrated the articular surfaces of the glenoid and humerus
  • lesser tubercle in profile
  • orthogonal view to the AP shoulder 

Additional projections

• AP shoulder external rotation
  • greater tubercle of the proximal humerus is in profile 
• AP shoulder internal rotation 
  • lesser tubercle of the proximal humerus is in profile 
  • ideal view for detection of a Hill-Sachs lesion
• AP glenoid or Grashey view
  • the view to prevent overlap of the humeral head over the glenoid 
  • this view is also known as the true AP
• outlet (Neers) view
  • specialized projection demonstrating the coracoacromial arch, often utilized in the investigation of speculated shoulder impingement
  • similar to lateral view, but with slight caudal tube angulation

Axial variants

• superior-inferior axial
  • displays the articular surfaces of the glenoid and humerus
  • orthogonal view to the AP shoulder 
• Stryker view
  • demonstrated the posterolateral margin of the humeral head
  • displays the articular surfaces of the glenoid and humerus
  • orthogonal view to the AP shoulder
• Westpoint view 
  • modified axial projection to elucidate the anteroinferior glenoid rim often in the context of recurrent instability
• Velpeau view 
  • axial projection for patients in a sling, requiring no abduction 
  • useful for suspected posterior dislcoations