Home

Shoulder Xray
True AP Shoulder in neutral rotation
(taken in the plane of the scapula)
(Grashey view)
Helpful for: GH arthritis,
Coracoid fx, Glenoid fx,
Proximal humerus fx. Posterior
shoulder dislocation.
Evaluate: humeral head postion
relative to glenoid; AC joint
position/arthritis; RTC
calcifications, acromial spurring
Acromiohumeral interval:
normal = 7-14mm. <7mm
indicates massive RTC tear.
(Weiner DS, JBJS
1970;52B:524). May appear
falsely decreased with posterior
subluxation of the humeral head.
Blue dot = Greater Tuberosity
Red dot = Lesser Tuberosity
Position: Patient erect, turned 30-35
toward the side being xrayed
Tube: Perpendicular to plate
AP Shoulder in External rotation
(taken in the plane of the scapula)
Helpful for: GH arthritis,
Coracoid fx, Glenoid fx,
Proximal humerus fx,
compression fracture of humeral
head.
Blue dot = Greater Tuberosity
Red dot = Lesser Tuberosity

Position: Patient erect, turned 30-35

toward the side being xrayed; arm
maximally externally rotated
Tube: Perpendicular to plate

AP Shoulder in Internal rotation

(taken in the plane of the scapula)
Helpful for: Hill-Sachs lesions,
GH arthritis, Coracoid fx,
Glenoid fx, Proximal humerus
fx.
Blue dot = Greater Tuberosity
Red dot = Lesser Tuberosity

Position: Patient erect, turned 30-35

toward the side being xrayed; arm
maximally internally rotated
Beam: aimed perpendicular to plate
Scapular Y Shoulder Xray
Demonstrates: lateral projection
of scapular body and humeral
head overlapping the glenoid.
Helpful for: Shoulder
dislocation; Proximal humerus
fx. ; scapular body fracture
Position: Erect with anterior aspect of
affected shoulder against x-ray plate and
rotating other shoulder out 40 deg.
Beam: aimed from posteriorly along
scapular spine

Axillary view Shoulder Xray

Demonstrates: glenohumeral
joint narrowing (best view), Os
Acromionale, glenoid version,
glenoid erosion, humeral head
subluxation.
Helpful for: determining the
amount of acromion which
remains in patients who have
undergone previous surgery;
relation of humeral head to
glenoid; Hill-Sachs lesions, Os
Acromionale, AC joint,
Shoulder dislocation,
Position: Patient seated at side of
radiographic table with the arm
abducted and axilla over the cassette.
Beam:angle 5-10 toward the elbow,
central beam directed at the shoulder
joint.
Many alternative postions for similar
xray, can be supine etc.
Supraspinatus Outlet view Shoulder
Xray
Demonstrates:
outlet/impingement of the
supraspinatus and
coracoacromial arch.
Helpful for: Subacromial
impingement, assessing acromial
morphology, unfused acromial
epiphysis.

Position: Erect with anterior aspect of

affected shoulder against x-ray plate and
rotating other shoulder out 40 deg.
Beam: aimed from posteriorly along
scapular spine but with the beam aimed
with 10 caudal tilt

Zanca View Shoulder Xray

Demonstrates: AC joint and
distal clavicle
Helpful for: AC arthritis, AC
separations, distal clavicle
osteolysis.
AC joint spurring and cystic
changes indicates AC arthritis
Distal clavicle elevation
indicates AC separations.
Position: Erected with cassette behind
shoulder.
Beam:Xray beam aimed at the AC joint
in 10 to 15 cephalic tilt. Xray
penetration should be 1/2 normal to
avoid overpenetration of AC joint.
West Point Axillary View Shoulder
Xray
Demostrates: anteroinferior
glenoid rim., best for osseous
Bankart lesion.
Helpful for: Shoulder Instability,
Glenoid fractures, osseous
Bankart lesion.
Postion:Patient prone with affected
shoulder resting on a pad @8cm for the
table top. Casette positioned against the
superior apsect of the shoulder.
Beam: aimed 25 from horizontal (to
tables surface) and 25 medially (to
patients midline).

(Rokous JR, CORR 1972;82:84)

Stryker Notch View Shoulder Xray

Demonstrates: humeral head
Helpful for: Hill-Sachs lesions
(best view), Bankart lesion.
Position: Patient supine with cassette
posterior to the shoulder. The hand
placed on top of the head. The elbow
should point straight upward.
Beam directed 10 superiorly/toward the
head, centered over the coracoid
process.

(Hall RH, JBJS 1959;41-A:489-94)

Serendipity View Shoulder Xray
Demonstrates: sternoclavicular
joints and medial 1/3 of the
clavicles.
Helpful for: Clavicle Fracture,
Distal Clavicle Fracture,
Sternoclavicular Dislocation,
Postion: supine with cassette under
upper chest
Beam aimed at clavicle or manubrium
(SC pathology) with a 40 cephalic tilt.

Bennett's View (modified)Shoulder

Xray
Obtained by angling the tube 5
cephalad with the arm abducted
45. Approximates an AP in ER
view.
Wright RW, AJSM 2004;32:121
Bennett's view Shoulder Xray
External rotation of the humerus
with tilting of the x-ray tube 5
cephalad
Bennett GE: Elbow and shoulder
lesions of baseball players. Am J
Surg 98: 484492, 1959

Acromiohumeral Interval
average = 10.5mm. <7mm=full-
thickness RTC tear. Measure on
Grashey view. (Cotty P, J Radiol
1988;16:633).
Garth View (apical oblique) Shoulder
Xray
Demostrates: the full extent of
the glenoid rim bone loss and
Hill-Sachs lesions
Helpful for: Shoulder Instability,
Glenoid fractures, osseous
Bankart lesion. Hill-Sachs
lesions.
Postion: Seated with shoulder adjacent
to cassette and arm adducted and
internally rotated (place hand over
heart). Chest rotated 45
Beam: beam perpendicular to the
anterior-inferior glenoid rim and
posterior-superior humeral head. (45 to
the coronal plane and 45 caudally).
Rollover for example rendition.
Garth WP Jr, JBJS1984;66A:1450