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Debbie Starkey
Queensland Diagnostic Imaging
“Evaluation of shoulder disorders should begin with radiographs” Goud et al 2008
So….Which projections?
Today … Review of anatomy – “What anatomy is relevant and
can be imaged?”
Review of literature – “What is required to be imaged?”
Recommendations
Anatomy
Weber.E., Vilensky,J., and Carmichael,S., “Netter’s Concise Radiologic Anatomy” Elsevier 2009
Pathology: Impingement
Rotator cuff disease
AP Projection of the Shoulder Median-sagittal plane perpendicular or Scapular Plane
Scapular Plane Median Sagittal Plane Perpendicular
Gleno-Humeral Joint Projection Posterior oblique position
Allows evaluation of gleno-humeral cartilage space
Performed in external, internal or neutral rotation
Functional Position
Internal Rotation
External Rotation Neutral Rotation
Subacromial Space Caudal angulation
No Angulation Caudal Angulation
Outlet Projection Caudal angulation in
lateral scapula position
Allows evaluation of acromion and subacromial space –shape , presence of osteophytes
Whole scapula or collimated
Full Scapula
Collimated
Axial Projection Subscapularis – anterior
to the lesser tuberosity
Best visualised on the axial projection
Required: Full shoulder girdle
Glenohumeral joint
Greater tuberosity
Lesser tuberosity
Subacromial space (in both AP and Lateral planes)
Region of the subscapularis
Recommended Projections
Conclusion: Diversity does exist
Specific bony structures are required to be visualized
Combinations of patient rotation and humerus position are possible
Departmental protocols are variable
References: Goud, A., Segal,D., Hedayati,P., Pan,J., and Weissman,B., “Radiographic
Evaluation of the Shoulder” European Journal of Radiology 2008 68:2-15 Farid, N., Bruce, D., and Chung, C., “Miscellaneous Conditions of the
Shoulder: Anatomical, Clinical and Pictorial review emphasizing potential pitfalls in Imaging Diagnosis” European Journal of Radiology 2008 68:88-105
Lugo, R., Kung, P., and Ma, B., “Shoulder Biomechanics” European Journal of Radiology 2008 68 16-24
McNally, E., and Rees, J., “Imaging in Shoulder Disorders” Skeletal Radiology 2007 36:1013-1016
Siegal,D., Wu,J., Newman, J., del Cura, J., and Hochman, M. “Calcific Teninitis: A Pictorial Review” Canadian Association of Radiologists Journal 2009 60:263-272
Stiles, R., and Otte, M., “Imaging of the Shoulder” Radiology 1993 188:603-613
Weber.E., Vilensky,J., and Carmichael,S., “Netter’s Concise Radiologic Anatomy” Elsevier 2009