Mar 07, 2014 the patients sits facing the x ray tube with the cassette placed cassette holder. Conventional radiography of the shoulder timothy g. Jun 5, 2017 radiographic positioning radiology notes. Start studying radiographic positioning of scapula lecture 12. In this quiz on human anatomy, well be focusing in on the shoulder, clavicle, scapula ac joints and their respective positions in the body. Clinical assessment of scapular positioning in musicians. Occasionally, a patients inability to externally rotate for the ordered views as noted by the radiology tech may be a helpful clue in the case of a unsuspected posterior dislocation. Learning radiology dislocation, shoulder, posterior. If the patient is in the lpo position, for the scapular y view. Osteochondroma is a benign tumor that consists of cartilage and bone. Practitioners in several of the health care professions use anatomical landmarks to identify spinal levels, both in order to enhance diagnostic accuracy and to specifically target the site of intervention.
Some holders allow 15 degrees angulation towards the shoulder. X ray cassette is placed at anterolateral shoulder perpendicular to scapular spine. You may not embed one of our images on your web page without a link back to our site. Positioning for the scapular y projection of the shoulder joint this projection obtains its name as a result of the appearance of the scapula. The unaffected shoulder is raised slightly to bring the scapula in contact. A rare case presentaion of osteochondroma of scapula salgia a. Scapular downward rotation syndrome sdrs is common scapular and clavicular alignment impairment in individuals with shoulder pain. It is the easiest way to get a y view and i hardly ever miss. Shoulder scapular pa y view oblique rao or lao purpose and structures shown. Position same as external except have patient rotate arm internally pronate hand. Posterior shoulder dislocation xr yview scapular xray.
Y view of the shoulder with xray beam parallel to scapular blade. Yscapula projection positioning, anatomy and correction. The erect position is usually more comfortable for the patient. Define various xray positioning of human body flashcards. The scapular y method is used to view what kind of trauma. Xray beam directed along the spine of the scapula from posterior to anterior, perpendicular to cassette. A diagnostic aid in shoulder trauma radiology login to your account. The location of the inferior angle of the scapula in relation. Free radiology flashcards about positioning quizzes. How can you tell if the patient is under rotated when looking at a scapular y xray.
In this projection fracture of the scapula is demonstrated. Shoulder, clavicle, scapula, ac joints positioning proprofs. Type ii corresponds, at rest, to the prominencewith nonimpaired subjects 7. Ap, scapula y, and axillary see approach to traumatic shoulder pain for normal x ray anatomy anterior dislocation. Position patient is positioned as for ylateral view, erect with arm comfortably at the side. Scapular fractures including glenoid musculoskeletal.
Radiographic anatomy of a true lateral yscapula projection. The dislocated humeral head usually lies in a subcoracoid position figure 7. This view demonstrates the lateral projection of the scapular body. Indications american college of radiology acr appropriateness criteria for musculoskeletal imaging in shoulder trauma developed in 1995. This article discusses radiographic positioning for the radiologic technologist x ray tech to show the shoulder and humerus. Position patient is positioned as for y lateral view, erect with arm comfortably at the side. Trans scapular lateral view advanced orthopedic associates. Authoritative sources usually state the upright inferior scapular angle ias aligns with the spinous process sp of t7, but some specify the t78 interspace or the t8 sp.
Orthogonal to the ap shoulder note so is an axillary view. An anecdotal method amongst radiographers is to feel for the medial border of the scapula and line it up with the anterior portion of the acromion and x ray straight down the line. The glenohumeral joint is the most unstable joint in. Excellent projection to see both the coracoid and acromion process in profile. Yscapula projection positioning, anatomy and correction of. The scapula series is the plain radiographic assessment of the scapular bone of the shoulder girdle, seldom used in departments with 24 hour computed tomography departments. Erect or leaning over the end of the x ray table, in a slight 510 degree anterior oblique. There is a general recommendation for the care of orthopedic trauma patients, which is to obtain at least two radiographic views in orthogonal planes for proper evaluation of the traumatized limb or joint. Patient is supine for trauma patients, but the erect position may be more comfortable for the patient. Anatomical parts of the scapula include body, neck, glenoid, coracoid, spine and acromion. Additionally, the subjects were asked to relax their shoulder girdle muscles and hold breath during radiographic measurement. The scapula should be clearly demonstrated in the lateral profile.
The many advantages of the view include a simple technique. Radiographic positioning humerus and shoulder flashcards. What are you looking for with the oblique scapula y projection. Average patient will be in a 45 to 60 degree anterior oblique position.
Changes in the alignment of the scapula and clavicle can potentially influence the biomechanics of the shoulder region. The scapula body has lateral, medial and superior borders. X ray beam directed perpendicular to the scapula and x ray cassette, i. Radiographs are often the first imaging study obtained in the patient presenting with the chief complaint of shoulder pain. Free flashcards to help memorize facts about radiographic positioning quizzes. Posterior shoulder dislocation xr y view scapular x ray. Suspicion of a scapula fracture should prompt a trauma series of the shoulder, consisting of a true anterioposterior ap view, an axillary view, and a scapular y view true scapular lateral. Learn vocabulary, terms, and more with flashcards, games, and other study tools. A video tutorial from using a 3d model to demonstrate positioning for a lateral scapula y view. Transscapular lateral view advanced orthopedic associates. The acromion and coracoid processes should appear as nearly symmetric upper limbs of the y. A posterior dislocation cannot be excluded without a y view. Place ir vertically between arm and thorax with top of image receptor at axilla and place shield between image receptor and patient. The apical oblique view detected 153 81% of the 190 injuries.
See also overview of shoulder dislocation reduction techniques, overview of. Beam from posterior along line of scapula to plate held perpendicular to scapular spine over front of shoulder. See evaluation of the adult with shoulder complaints and acromioclavicular joint injuries. Start studying radiographic positioning humerus and shoulder.
Radiologic assessment of reverse shoulder arthroplasty. All acquired images were converted to digital images using a conversion program and. This reduces the distortion caused by the cranial angulation. This position requires a greater xray exposure than the other two. If a patient wearing arm sliding due to shoulder dislocation or fracture is. 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. The reliability of the measurement of the distance between the posterior border of the acromion and the wall and the reliability of the modified lateral scapular slide test have not been studied. Laboratory measurement of scapular kinematics laboratory measurements of scapular displacements are typically capable of quantifying the scapular kinematics 3dimensionally 3d. Scapular lateral yscapular, transverse scapular if axillary view not possible.
Affected scapula is flat against the x ray cassette. The thin body of the scapula should be seen on end without rib superimposition. It is a benign cartilagecapped outgrowth, connected to bone by a s it generally occurs at the end of the growth plates of long bones and most commonly form at the shoulder or the knee, but it has also been known to occur in the long bones of the forearm i. Shoulder lateral scapula view radiology reference article. Radiographic evidence of injury detected on each view was recorded. Lateral view lateral of view of the scapula can be done in left posterior oblique lpo or right posterior oblique rpo. This study presents an objective evaluation of both scapular upward and axial rotational tilts in shoulder impingement syndrome, using a scapular spine line defined on anteroposterior ap radiographs of the shoulder as the referential line. X ray cassette is placed at anterolateral shoulder perpendicular to the scapula. Steve ramsey woodworking for mere mortals 2,465,099 views. Oct 23, 2014 radiographic positioning radiology notes. This projection can be performed erect or supine, involving 90degree abduction of the affected arm. Xray beam directed along the supraspinatus fossa slightly anterior to the scapular spine and angled 10 to 20degrees caudally.
How to reduce anterior shoulder dislocations using scapular. In particular, a full shoulder series anteriorposterior ap, scapular y, and axillary views is an essential part of the diagnostic workup. What position is the scapula in when doing a scapular y projection. Effects of scapular upward rotation exercises on alignment of. The thing that makes the y view particularly tricky is that its a much more 3dimensional structure than most other projections. The scapular y view is also used to evaluate the contour of the undersurface of the acromion process when typing the acromion. I cannot get the y view for a lateral shoulder xray. If you would like a large, unwatermarked image for your web page or blog, please purchase the appropriate license. In the context of trauma there are 2 standard views used to assess this joint. Central ray is aimed from posteriorly along the scapular spine. Radiographic assessment of scapular rotational tilt in. This view should demonstrate the bones and soft tissue of the shoulder specifically the scapular y.
The complex anatomy of the shoulder girdle has led to the development of numerous radiographic views, each designed to optimize the evaluation of a specific part of the shoulder girdle. Prosthesis positioning is best assessed on radiographs, which include an anteroposterior view and either an axillary or a scapular y view. The best views to demonstrate the ac joint relationships are the axillary view, scapular y view, or the ap view with 3035 degree cephalic angulation. 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. Y view of the shoulder with x ray beam parallel to scapular blade. It is often used for examination of suspected shoulder dislocations. Other activities to help include hangman, crossword, word scramble, games, matching, quizes, and tests. Good positioning to demonstrate the ac joint and coracoid is required. The idea being, if they are lined up there will be a superimposition of the medial and lateral borders of the scapula and hence a perfect lateral position, although. The purpose of this study was to investigate the effects of a 6week scapular. Twentyseven patients with unilateral shoulder motion pain, who were diagnosed as having chronic shoulder impingement syndrome, were enrolled in the.
Xray cassette is placed at anterolateral shoulder perpendicular to scapular spine. The sensitivity of primary radiography apview, scapular y and axial projection in. The scapular alignment and cta were measured from radiographic findings of chest x ray akel et al. If the patient can tolerate holding the arm in abduction, an axial view is an alternative to the y view. With patient facing the ir, rotate into anterior oblique position as for lateral scapula. The acromion and coracoid processes should appear as. A scapula fracture may first be discovered during an essential part of any trauma evaluation. Scapular manipulation is a preferred technique because it is gentle, easy to. Pdf does scapular positioning predict shoulder pain in. Tractioncountertraction technique for reducing anterior shoulder dislocations. Pdf scapular positioning and movement in unimpaired. While achieving lateral scapular y position, the patients body is taken to anterior oblique position. Radiographic anatomy of a true lateral y scapula projection.
Scapular fractures are uncommon, accounting for only 35% of shoulder. The scapular y view is taken with the beam directed parallel to the scapular body. The scapular y view10 is obtained with the patient upright or. Proposal of modified velpeau view as an alternative test method of. X ray beam directed along the spine of the scapula from posterior to anterior, perpendicular to cassette demonstrates anteroposterior relationship of humeral head with respect to glenoid. Ct scan was performed keeping patients head in supine position for axial. Lateral scapula y view evaluate relationship of humeral head with glenoid humeral head should be at bifurcation of the y 10. Humeral head dislocated anteriorly and rests under the coracoid process. Xray examination of the scapular y in lateral view. Position patient is erect or sitting with arm in sling or shoulder internally rotated. The lateral scapula shoulder or y view is part of the standard shoulder series. Many radiographic departments, do not have a stand alone scapula series, rather include the assessment of the scapula in the shoulder series. Every time i go to feel the scapula, it feels to me like i should have them at a 90 degree angle.
Ill position a patient for the y view, and then i will ask a tech to take a look before i expose and they always oblique them less. The glenohumeral joint is the most unstable joint in the body and is therefore frequently radiographed. Apr 21, 2012 a true lateral view of the scapula, proximal humerus, and scapulohumeral joint. It is a pertinent projection to assess suspected dislocations, scapula fractures, and degenerative change. Supraspinatus outlet view advanced orthopedic associates. Jan 27, 2012 scapularglenohumeral ap view aka oblique view better visualize glenohumeral jointspace suboptimal view of ac joint 7. Typically, a scapular y view or transthoracic lateral of the humeral head demonstrate a posterior dislocation better. Each study included anteroposterior, transthoracic lateral, and scapular y 60 degrees anterior oblique views as well as the apical oblique projection. It is a pertinent projection to assess suspected dislocations, scapula fractures, and degenerative changes. These are the anteriorposterior ap view, and the lateral or y view.
Other causes of chronic shoulder pain are labral injury, osteoarthritis of. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. Please practice handwashing and social distancing, and check out our resources for adapting to these times. The y view scapular lateral view is useful if the patient is unable to abduct the arm figure 2. Xray cassette is placed at anterolateral shoulder perpendicular to the scapula.
Describe different x ray views, why they are used and their. Overall, the reliability of the clinical tools used to assess scapular positioning has not been studied in musicians. Sep 21, 2014 lateral view shoulder x ray axillary view shoulder positioning stay safe and healthy. Radiographic positioning adult other related pages of interest applied. X ray beam directed along the supraspinatus fossa slightly anterior to the scapular spine and angled 10 to 20degrees caudally demonstrates acromial morphology and abnormalities of. Position patient is erect or sitting with arm in sling. In b on x ray a complete representation of the scapula is obtained.
Scapular positioning in athletes shoulder 371 ment of the shoulder dysfunction with which the patient presents. Gently lift the arm or the patient and place a support block under her arm, rotate slowly the hand into a lateral position is possible for a true lateral elbow projection. How much do you know about the way your body operates. Rotate into an anterior oblique position as for a lateral scapula with patient facing ir. Any tricks for a student on the y view of a shoulder xray. Ce4rt radiographic positioning of the shoulder for xray. Start studying x ray upper extremities, positioning and anatomy part two. Does scapular positioning predict shoulder pain in recreational overhead athletes. This projection results in magnified image because of increased oid. This x ray shows a gun shot wound like when the creature was shot in the shoulder by the girls dad despite his efforts to be a good person. The body of the scapula forms the vertical component of the y, while the acromion and coracoid processes form the upper limbs of the letter. Feb 22, 2010 a video tutorial from using a 3d model to demonstrate positioning for a lateral scapula y view. Axial projection definition of axial projection by medical dictionary.
Rim sign 66% distance between medial border of humeral head and anterior glenoid rim 6 mm. Average patient will be in 45degree to 60degree anterior oblique position. Introduction the lateral scapula y view of the shoulder is one of those. The scapula ap view is a specialized projection of the scapular bone, performed in conjunction with the lateral scapular view.
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