Indications humerus radiographs are performed for a variety of indications including. The angle of the x ray beam is approximately 30 degrees toward the spine with the beam centered on the middle of the glenohumeral joint. The shoulder ap view is a standard projection that makes up the two view shoulder series. This article discusses radiographic positioning for the radiologic technologist xray tech to show the shoulder and humerus. She was diagnosed with glenohumeral joint arthritis, a complete loss of the joint space, the inability to abduct her arm more than 15 degrees, the loss of active or passive motion of her right arm i. These are the anteriorposterior ap view, and the lateral or yview. The glenohumeral joint is a nonconforming joint with an index of 0. The beam was directed tangentially to the glenohumeral joint, and upper arm rotation was neutral. Oct 22, 2015 positioning of the patient and the articulation. Ce4rt radiographic positioning of the shoulder for xray techs. Therefore, the body of the scapula is laying parallel with the image receptor. The angle of the xray beam is approximately 30 degrees toward the spine with the beam centered on the middle of the glenohumeral joint. Rating is available when the video has been rented.
The glenohumeral, or shoulder, joint is a synovial joint that attaches the upper limb to the axial skeleton. The symptoms of postarthroscopic glenohumeral chondrolysis typically occur months after the individual has undergone a surgical procedure known as shoulder arthroscopy. District radiopacity of the great tubercle of the humerus in fact, we all know that a reduction of. Cr and center of the collimation field should be at the midglenohumeral joint. Due to the relatively small contact area between the two joint surfaces, it is the most mobile joint in the body. Positioning for the mta shoulder projection with the supine patient. Routine radiographic projections for imaging of the acute shoulder include the ap with an additional. Conventional radiography of the shoulder request pdf. Soft tissue detail of the joint space and axilla should be visualized. May 12, 2020 the glenohumeral, or shoulder, joint is a synovial joint that attaches the upper limb to the axial skeleton.
District radiopacity of the great tubercle of the humerus in fact, we all know that a reduction of the joint space between acromion and humeral. Standard operating procedures and notes for the shoulder team. The glenoid cavity depth is increased by a rim of fibrocartilage that surrounds it. The glenohumeral joint is a ball and socket articulation between the glenoid fossa of the scapula and the head of the humerus. The shoulder ap glenoid view also known as a grashey view is an additional projection to the two view shoulder series. If the positioning is difficult to achieve, the inferiorsuperior axial view can be performed. The acromioclavicular joint can be assessed with standard shoulder xrays. Glenohumeral joint morphometry with reference to anatomic. It is often difficult to see details of the rotator cuff on ct scans. Shoulder joint glenohumeral joint 3d anatomy tutorial. Media in category xrays of the glenohumeral joint dislocation the following 26 files are in this category, out of 26 total.
Alternate axial shoulder projections idaho state university. Imaging essentials provides comprehensive information on small animal radiography techniques. The shoulder joint is more accurately termed the glenohumeral joint. B corresponding 125 mhz us image shows the normal recess and articular cartilage arrowheads located deep to the infraspinatus infra.
The acromioclavicular joint can be assessed with standard shoulder x rays. It is a ballandsocket joint, formed between the glenoid fossa of scapula gleno and the head of humerus humeral. Radiography positioning book or reference is strongly advised. Apr 24, 2012 center scapulohumeral joint to cr and midir. Xray appearanceabnormal widening of acromioclavicular joint space.
Radiography of the acutely injured shoulder radiography. Symptoms of postarthroscopic glenohumeral chondrolysis. Any xray acquired with the humerus held in internal rotation will mimic this appearance. The impact of glenohumeral joint oa on quality of life is comparable to congestive heart failure, diabetes, and acute myocardial infarction. This view should demonstrate the bones and soft tissue of the upper arm, specifically the full length of the humerus, elbow and shoulder joints, and epicondyles without rotation. Nov 30, 2017 the glenohumeral joint is the main articulation of the shoulder joint.
Cortical irregularity of the humeral head indicates an impaction fracture. Mri often provides information about the degree of tear, tendon retraction, and muscle. This article is the first in a 3part series covering cervical, thoracic, and lumbar spine radiography. Flex elbow and place arm across chest, or with trauma, place arm at side as is. Erect or leaning over the end of the x ray table, in a slight 510 degree anterior oblique. Under fluoroscopy guidance, the optimal positioning occurs when the needle can be inserted straight along the direction of the x ray beam without tube angulation. The patient is placed in a manner appropriate for the injected joint.
For every 5 degrees of rotation or tilting the tube, the tube is moved one inch closer to the patient to reduce distortionmagnification. Shoulder superiorinferior axial view radiology reference article. Merrills atlas of radiographic positioning and procedures. The primary stabilizers of the shoulder include the biceps brachii on the anterior side of the arm, and tendons of the rotator cuff. The axillary projection is obtained with the patient in the supine position and the arm placed in 90 degrees of abduction. If the patient can tolerate holding the arm in abduction, an axial view is an alternative to the yview. Treatment of glenohumeral arthritis pain utilizing spinal. C corresponding 125 mhz us image shows ghj effusion distending the posterior recess asterisk. During shoulder arthroscopy, the joint of the shoulder is examined, and possibly operated on, using a miniature camera, lighting equipment, and surgical tools. Imaging xray loss of glenohumeral joint space osteophytes beard osteophyte. An 84yearold female presented with pain and stiffness in her right shoulder of 3 years duration.
Oblique glenohumeral radiogram in indifferent position of the limb zero starting position zsp. The radiographic study in the relationship of the glenohumeral joint article in journal of orthopaedic research 222. Damage to the cartilage surfaces of the glenohumeral joint the shoulders ballandsocket structure is the primary cause of shoulder arthritis. In the context of trauma there are 2 standard views used to assess this joint. Kitayama s, sugaya h, takahashi n, matsuki k, kawai n, tokai m, et al. Glenohumeral instability can be defined as pain associated with loss of shoulder function due to excessive translation of the humeral head on the glenoid fossa. Following posterior dislocation the humerus is held in internal rotation and the contour of the humeral head is said to resemble a light bulb note. Conventional radiography of the shoulder timothy g. Erect or leaning over the end of the xray table, in a slight 510 degree anterior oblique. X ray appearanceabnormal widening of acromioclavicular joint space. It is the multiaxial ballandsocket synovial joint formed by the articular surfaces of the glenoid cavity and the head of the humerus.
Minor ligamentous disruption may not be detectable on a plain radiograph as alignment is not lost. The arm is positioned at the side superimposed on the scapula. Relationship between probability of future shoulder. Digital xray articles proper positioning for the pelvis and proximal femur the lowdown on lumbar spine positioning radiographic positioning techniques for the cervical spine boning up on humerus, clavicle, and ac joint positioning getting the most from shoulder positioning the bends and flexures of forearm and elbow xray positioning. The glenohumeral joints should be bilaterally symmetrical, so always compare the left and the right. The projection demonstrates the shoulder in its natural anatomical position allowing for adequate radiographic examination of the entire clavicle and scapula, as well as the glenohumeral, acromioclavicular and sternoclavicular joints of the shoulder girdle. Apr 07, 2012 cr and center of the collimation field should be at the mid glenohumeral joint.
Loss of alignment of the inferior surfaces of the clavicle and acromion indicates disruption of the acromioclavicular ligaments at the acromioclavicular joint acj. Perpendicular to the axilla and humeral head to pass through the glenohumeral joint. The humerus series is usually used for the detection of traumatic injury to the shaft of the humerus. Glenohumeral shoulder arthritis is a common source of pain and disability that affects up to 20% of the older population. Optimal density and contrast with no motion will visualize soft tissue margins and clear, sharp bony trabecular markings. Charles sloane msc dcr dri cert ci principal lecturer and radiography course leader, university of cumbria, lancaster, uk ken holmes msc tdcr dri cert ci senior lecturer, school of medical imaging sciences, university of cumbria, lancaster, uk craig anderson msc bsc clinical tutor, xray department, furness general hospital, cumbria, uk a. The extension of the shoulder series depends on the radiography department protocols and the clinical indications for imaging. Oct 24, 2016 clarks pocket handbook for radiographers 1.
Shoulder joint replacement arthroplasty xray evaluation the purpose of imaging of the shoulder is to help establish the diagnosis, to determine the severity of the pathoanatomy, to help in surgical planning, and to enable the surgeon to illustrate the condition of the shoulder for the patient. Digital x ray articles proper positioning for the pelvis and proximal femur the lowdown on lumbar spine positioning radiographic positioning techniques for the cervical spine boning up on humerus, clavicle, and ac joint positioning getting the most from shoulder positioning the bends and flexures of forearm and elbow x ray positioning. Under fluoroscopy guidance, the optimal positioning occurs when the needle can be inserted straight along the direction of the xray beam without tube angulation. Clinical outcome and glenoid morphology after arthroscopic repair of chronic osseous bankart lesions. Glenohumeral osteoarthritis oa is a disabling condition characterized predominantly by pain, stiffness, and subsequent decreased functional activity. Cr 45 degree caudad, centered to the scapulohumeral joint. Figure 510 a and b, positioning of the patient to obtain an apical oblique radiograph. The glenohumeral joint is the main articulation of the shoulder joint. Orthopaedic positioning in diagnostic radiology andreas. The following anatomic areas have been addressed in previous columns. The xray beam is directed through the glenohumeral joint toward the cassette at an angle of 45 degrees to the plane of the thorax and is also tipped 45 degrees caudally fig. The patients positioning for the radiograph was named the senna position. Feb 01, 2015 positioning correct obliquity of the patient is evidenced by.
The x ray beam is directed through the glenohumeral joint toward the cassette at an angle of 45 degrees to the plane of the thorax and is also tipped 45 degrees caudally fig. Shoulder joint replacement arthroplasty xray evaluation. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Therefore, any two injuries within the sssc may result in a highly unstable glenohumeral joint floating shoulder 45,47. The shoulder series is fundamentally composed of two orthogonal views of the glenohumeral joint including the entire scapula. Radiographs of the scapula, shoulder joint, and humerus are needed in dogs and. The main advantage of fluoroscopicguided glenohumeral joint injection over blind injection is that the needle position can be confirmed and injection of contrast medium can be controlled. Back to chiropractic ce seminars xray of sport injuries. The cartilage and the labrum make it a semiconforming joint. A practical guide for performing arthrography under. It provides an overall impression of the glenohumeral joint, acromioclavicular joint, proximal humerus and.
The shoulder joint is a muscledependent joint as it lacks strong ligaments. Shoulder ap glenoid view radiology reference article. The focus of these articles has been related to the technical positioning of a. The humeral head is visible on frontal chest x ray and should be located within the cup of the glenoid fossa. It will be recalled that the arm has an osseous connection to the torso via the glenohumeral joint, which in turn is attached to the clavicle and sternoclavicular joint via the fibroosseous sssc.
Xrays and other imaging are one of the big four in diagnosing shoulder and elbow problems the four being hx, sst, pe, and xrayfilms. For an accurate diagnostic injection, and for those patients with an altered anatomy, fluoroscopicguided glenohumeral joint injections are important techniques. Ce4rt radiographic positioning of the shoulder for xray. Positioning correct obliquity of the patient is evidenced by. What central ray angle should be used for the inferosuperior. Obtaining axillary radiographs of the shoulder in acute trauma is not always. This article discusses radiographic positioning for the radiologic technologist x ray tech to show the shoulder and humerus. All patients need to have a current xray for evaluation purposes. The images can be used to create 3d models of the shoulder joint to help with surgical planning in cases of glenohumeral arthritis and instability repairs where bone loss is a concern. Charles sloane msc dcr dri cert ci principal lecturer and radiography course leader, university of cumbria, lancaster, uk ken holmes msc tdcr dri cert ci senior lecturer, school of medical imaging sciences, university of cumbria, lancaster, uk craig anderson msc bsc clinical tutor, xray department, furness general hospital, cumbria, uk a stewart. The humeral head is visible on frontal chest xray and should be located within the cup of the glenoid fossa. The projection is used to assess the integrity of the glenohumeral joint.
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