Fig. 3.1
Anteroposterior shoulder radiograph. While achieving anteroposterior shoulder X-ray in neutral position, the patient is erect or in supine position. Central X-ray should be directed to 2.5 cm inferior to the coracoid process. Anteroposterior shoulder view allows assessment of especially the humeral head lesions and clavicular fractures. Because the posterior glenoid rim and humeral head overlap, glenohumeral joint space cannot be assessed in optimum way
Fig. 3.2
Grashey view (anteroposterior oblique shoulder radiograph). Grashey position is also named true anteroposterior shoulder radiograph. Central ray is centralized into glenohumeral joint space with 35° angle. This position allows optimum imaging of the glenohumeral joint space
Fig. 3.3
Axilla-superoinferior shoulder radiograph. In order to obtain axilla-superoinferior radiograph, the patient abducts the arm to a nearly right angle to the long axis of the body while sitting. The elbow of patient is flexed 90° and placed their hand in the prone position. Central ray is angled 5–15° toward the elbow. Axillary superoinferior position allows optimum imaging of joint space between the humeral head and the glenoid. It is helpful for detecting the anterior and posterior glenohumeral dislocations. The coracoid process is seen projecting above the clavicle
Fig. 3.4
Lateral scapular Y radiograph. While achieving lateral scapular Y position, the patient’s body is taken to anterior oblique position. Central ray is aimed from posteriorly along the scapular spine. This view demonstrates the lateral projection of the scapular body and humeral head overlapping the glenoid. The body of the scapula constitutes the body of “Y,” while the acromion and the coracoid constitute the arms. Lateral scapular Y radiograph is helpful for detecting the anterior and posterior glenohumeral dislocations and the fractures of the scapula
Fig. 3.5
Anteroposterior shoulder radiograph in internal rotation. Patient is either erect or in supine position. In order to position the shoulder in internal rotation, the posterior aspect of the hand is placed against the hip. Anteroposterior shoulder radiograph in internal position shows a lateral position of the humerus. The lesser tuberosity is seen medially in profile. This position is one of the positions utilized in order to evaluate the Hill-Sachs deformity (AC., acromioclavicular)
Fig. 3.6
Anteroposterior shoulder radiograph in external rotation. Supinating the hand will position the humerus in the external rotation. With the external rotation position, the greater tuberosity is positioned in profile laterally. This view is helpful for detecting the compression fracture of the humeral head, glenohumeral arthritis, and the fractures of the proximal humerus and the glenoid
Fig. 3.7
Apical oblique shoulder radiograph. Apical oblique shoulder radiograph, is also named as Garth view shoulder radiograph. Patient is seated. Patient’s arm is adducted and internally rotated. Chest is rotated 45°. Central ray is directed through the anterior-inferior glenoid rim and posterosuperior humeral head toward the cassette at angle of 45° to the plane of the thorax and directed 45° caudally. This position is helpful for detecting the glenoid fracture, shoulder instability, bony Bankart, and Hill-Sachs lesions
3.2 Computed Tomography of the Shoulder
CT is most helpful in the evaluation of shoulder trauma but gives limited information on the soft tissues. It is superior to plain radiographs in evaluation of complex fractures and fracture dislocations involving the proximal humerus. CT allows planning of treatment of complex proximal humeral fractures [1]. CT provides better detail of cortical and trabecular bone structures than MRI. Therefore it is optimal for visualization of bony defects [8]. The ability to visualize images in the axial, sagittal, and coronal planes and in three-dimensional (3D) format can help in preoperative planning of complex proximal humeral fractures. 3D reconstructions are also useful to visualize glenoid version for total shoulder arthroplasty.
The patient is most commonly in the supine position during CT scanning, with the arm in neutral rotation. The important anatomical structures of the normal shoulder joint are shown in axial, coronal, and sagittal CT images below (Figs. 3.8a–s, 3.9a–j, and 3.10a–l). The open arrow is showing the physiological concavity at the posterolateral margin of the humeral head on Fig. 3.8l. The bicipital groove is being seen between the lesser tuberosity and greater tuberosity (arrow).
