Shoulder (Velpeau view)

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The Velpeau view of the glenohumeral joint is a modified axial projection performed in the context of shoulder immobilization. The name was coined after the Velpeau Bandage , and first described in 1967 by Bloom and Obata

Indications

This projection is performed on patients with a shoulder sling (Velpeau Bandage) in place, often in the context of post-operative or a post-reduction presentation whereby the patient is unable to abduct the arm. It is particularly useful in the diagnosis of posterior shoulder dislocations.

This view, performed erect with a 30° backward lean demonstrates the anterior and posterior humeral head and the glenoid fossa.

Patient position

  • the patient is erect (or sitting) facing away from the table
  • the image receptor is placed on the table behind the patient beneath the shoulder
  • patient leans 30° backward toward the table (allowing for an axial view of the shoulder)

Technical factors

  • axial projection (superior-inferior)
  • centering point
    • the x-ray tube straight up and down, centered at the glenohumeral joint (check that it casts a shadow on the detector)
  • collimation
    • tight the to glenohumeral joint
  • orientation  
    • landscape
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 50-60kVp
    • 8-15 mAs
  • SID
    • 100-150 cm
  • grid
    • no

Image technical evaluation

Clear visualization of the humeral head and its relationship with the glenoid of the scapula.  The humeral shoulder will be foreshortened and the image overall will be magnified, however, it should resemble a somewhat standard axial image.

Practical points

This is an ideal projection when patients are unable to move their arm from the immobilized position, you just have to make sure the patient is not in too much lumbar pain as leaning back like that can be hard, sometimes it is best to give them a chair.

Use the shadow the light casts on the detector to get an idea of the magnification, place your finger on the glenohumeral joint and observe if it is in fact cast onto the detector.