Shoulder (superior-inferior axial view)

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The axial shoulder view is a supplementary projection to the lateral scapula view for obtaining orthogonal images to the AP shoulder. It is an appropriate projection to assess suspected dislocations, proximal humerus pathology, and glenohumeral articular surface abnormalities .

Indication

The axial view provides additional information when assessing dislocations and glenohumeral instability; particularly if these are not seen well on a standard AP view . If the positioning is difficult to achieve, the inferior-superior axial view can be performed instead.

Patient position

  • patient seated next to the image receptor
  • image receptor at mid thoracic height
  • affected arm is abducted with the elbow resting on the detector
  • the arm must be abducted enough that the glenohumeral joint is central to the image detector (the patient may need to lean slightly)
  • the patient's head is to be tilted away towards the unaffected side (and slightly forward if possible); check your collimation light to ensure the head will not be irradiated. 

Technical factors

  • axial projection (superior-inferior)
  • centering point
    • glenohumeral joint with a 5-15° degree towards the patient's elbow
  • collimation
    • anterior-posterior to the skin margins 
    • lateral to proximal third of the humerus 
    • medial to include glenohumeral joint
  • orientation  
    • landscape
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 50-60kVp
    • 8-15 mAs
  • SID
    • 100 cm
  • grid
    • no

Image technical evaluation

  • clear visualization of the humeral head (with no superimposition)
  • relationship of the humeral head to the glenoid of the scapula
  • assessment of the acromion and the coracoid process

Practical points

Obtaining this projection can cause great discomfort even in healthy patients. The standard axial view as described may not be suitable for patients with dislocations or significant glenohumeral trauma. In these cases, it may be best to perform a modified trauma axial projection of the glenohumeral joint .