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Which ap shoulder projection demonstrates the lesser tubercle in profile medially?

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Condition Definition
Bursitis Inflammation of the bursa
Dislocation Displacement of a bone from the joint space
Fracture Disruption in the continuity of bone
 Hills-Sachs defect Impacted fracture of posterolateral aspect of the humeral head with dislocation
Metastases Transfer of a cancerous lesion from one area to another
Osteoarthritis or degenerative joint disease Form of arthritis marked by progressive cartilage deterioration in synovial joints and vertebrae
Osteopetrosis Increased density of atypically soft bone
Osteoporosis Loss of bone density
Rheumatoid arthritis Chronic, systemic, inflammatory collagen disease
Tendinitis Inflammation of the tendon and tendon-muscle attachment
Tumor New tissue growth where cell proliferation is uncontrolled
 Chondrosarcoma Malignant tumor arising from cartilage cells

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Citation, DOI & article data

Citation:

Murphy A, Fahrenhorst-Jones T, O'Shea P, et al. Shoulder (inferior-superior axial view). Reference article, Radiopaedia.org (Accessed on 24 Nov 2022) https://doi.org/10.53347/rID-52966

The inferosuperior axial view also known as a Lawrence view of the shoulder is a modified axial projection best utilized with supine patients. It is an orthogonal projection to the AP view and replaces the lateral shoulder projection.

On this page:

It is an appropriate projection to assess suspected dislocations, proximal humerus pathology and effective in demonstrating the articular surfaces of the humeral head and glenoid 1-3 . Hill-Sachs lesions are well demonstrated on this projection along with the lesser tubercle of the humerus.

This view is performed when the patient can only lie supine; thus making the superior-inferior axial view difficult to achieve. This view provides additional information for assessing dislocations and glenohumeral instability; particularly if these are not seen well on a standard AP view 4.

  • the patient is supine 
  • image receptor is rested upon the superior part of the affected shoulder 
  • the affected arm is abducted as much as achievable 
  • the arm is externally rotated 
  • the patient's head is to be tilted away towards the unaffected side 
  • axial projection (inferosuperior)
  • centering point
    • the x-ray tube is in the same plane as the glenohumeral joint shooting inferosuperior 
  • there is a 20-30° medial angle aimed at the glenohumeral joint
  • collimation
    • anterior-posterior to the skin margins 
    • lateral to proximal third of the humerus 
    • medial to include glenohumeral joint
  • orientation  
    • landscape
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 50-60kVp
    • 8-15 mAs
  • SID
    • 100-150 cm
  • grid
    • no

Clear visualization of the humeral head  (with no superimposition)  and its relationship with the glenoid of the scapula. In addition to the acromion and the coracoid process. The lesser tubercle should be seen projected anteriorly in profile. The coracoid process is pointing anteriorly 

This is an ideal projection when patients are unable to move from the supine position. It can cause patient pain when abducting but nowhere near as much as the standard axial projection. 

Be wary of your surroundings when moving the x-ray tube in position, there is a high potential of hitting the patients feet. 

Other projections suitable for supine patients that require an orthogonal view of the AP view include: 

  • modified trauma axial 
  • modified transthoracic supine lateral (spinal patients)
  • supine lateral

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Which ap shoulder projection demonstrates the lesser tubercle in profile medially?

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Shoulder Girdle/Clavicle

QuestionAnswer
Name the scapular borders Superior Border, Medial/Verterbral Border, Lateral/Axillary Border
Name the scapular angles Lateral Angle, Superior Angle, Inferior Angle
What are the shoulder articulations and what type of joints are they? A. Acromioclavicular Joint-Synovial Gliding B. Sternoclavicular Joint-Synovial Double Gliding C. Scapulohumeral Joint-Synovial Ball and Socket
How should the epicondyles be positioned for the AP projection external rotation? Parallel to the IR
How are the epicondyles positioned for the AP projection of the shoulder in Internal Rotation? Perpendicular to the IR
How is the arm positioned for the AP projection in neutral position? Have patient rest palm against thigh, epicondyles are at 45 degrees
Which position demonstrates the greatest amount of overlapping of the humeral head and the glenoid cavity in the AP projection? Internal Rotation
If the patient is unable to move the arm for internal and external rotation of the shoulder, what view will demonstrate the proximal humerus in a lateral position? Transthoracic Projection Lawrence Method
If the patient is unable to abduct the unaffected arm of the head for the lawrence transthoracic, what can be done to separate the shoulders? Angle the CR 10-15 degrees cephalic
What is centered to the IR for the Lawrence transthoracic lateral of the proximal humerus? The surgical neck
How is the arm positioned for the inferiorsuperior projection Lawrence method of the shoulder? Arm is abducted as close to 90 degrees from the body as possible with the arm in external rotation
What modification can be made to the inferior superior (Lawrence Method) Projection of the shoulder to demonstrate a possible Hill-Sachs deffect Rafert Modification: Same except arm is in extreme or exaggerated external rotation. (Thumb pointing downward and hand at a 45 degree oblique)
What is the CR angle and location for the West Point Method? 25 degrees anteriorly (down) from horizontal and 25 degrees medially entering at 5 in. inferior and 1.5 in. medial to the acromial edge and exits the glenoid cavity.
The West Point Method is useful in demonstrating what? Hill-Sachs defect and Bankart lesions associated with anterior dislocations of the shoulder
What is the Hill-sachs defect? Compression fracture of the articular surface of the humeral head often associated with an anterior dislocation of the humeral head. 97% of dislocations are anterior.
How is the arm positioned for the superoinferior projection of the shoulder joint? Arm is over cassette on the table at right angles with the anterior surface of the forearm on the table surface and the hand pronated.
What is the CR location and angle for the superiorinferior projection of the shoulder joint? CR:Angled 5-15 degrees through the shoulder joint
The PA oblique projection; scapular Y is used to demonstrate what? Anterior/Posterior Dislocations of the shoulder
What position is the patient in for the scapular Y? The patient is in a 45-60 degree oblique. Can be done in the RPO or LAO and the LPO or RAO. (RPO and LPO the affected side is farthest from the IR) (RAO and LAO the affected side is closest to the IR)
What is the CR location and angle for the PA oblique projection: scapular Y? Perpendicular to the scapulohumeral joint?
How is the arm positioned for the PA oblique projection scapular Y? Arm location is not important because the location of the humeral head in relation to the joint will remain the same so the arm can hang by the side
For the AP oblique projection (Grashey Method) how much and which way is the patient obliqued? 35-45 degrees toward the affected side: If patient is supine it may need more
What is the CR angle and location for the AP oblique projection (Grashey Method)? CR: Perpendicular to the Glenoid Cavity at a point 2" medial and 2" inferior to the superolateral border of the shoulder
What is demonstrated in the AP oblique projection (Grashey Method) of the shoulder joint? The scapulohumeral joint space with the glenoid cavity in profile?
The tangential projection (Fisk Method) is done to demonstrate what? Intertubercular groove
When the Fisk method is utilized how much is the patient leaned forward? So the humerus makes a 10-15 degree angle from the vertical
What is the CR angle for the Tangential projection for the intertubercular groove? 10-15 degrees down from the horizontal (posterior)
The acromial extremity of the clavicle articulates with the: acromion process of the scapula
The large rounded elevated process prominently located on the lateral surface of the proximal humerus is the: Greater tubercle
The small synovial fluid-filled sacs, which relieve pressure and reduce friction in joint tissues are called: bursae
The articulation between the glenoid cavity and the head of the humerus is called the: scapulohumeral joint
The scapulohumeral articulation is classified as a: Synovial joint, ball and socket type
In order to demonstrate the greater tubercle of the humerus on an AP projection of the shoulder, the epicondyles must be: parallel with the plane of the IR
The respiration phase for an AP projection of the shoulder should be: Suspended
For an AP projection of the shoulder, the CR should enter: 1" inferior to the coracoid process
What structure is prominently shown "in profile" on an AP projection of the shoulder with the humerus in external rotation? Greater tubercle
For an AP projection of the shoulder with the arm in a neutral position, the epicondyles of the humerus should be: 45 degrees with the plane of the IR
If the patient places the palm of the hand against the thigh, the humerus will be in: neutral position
For an AP projection of the shoulder with the humerus in internal rotation, the epicondyles of the humerus should be: perpendicular to the plane of the IR
If the patient places the back of the hand against the hip, the humerus will be in: internal rotation
When the arm cannot be rotated or abducted due to imjury, what method can be used to perform a lateral projection of the shoulder? Lawrence (Transthoracic)
Where should the center of the IR be positioned for a transthoracic laterl projection of the shoulder? Surgical neck
For a transthoracic lateral projection of the shoulder, ling detail may be blurred to better visualize the shoulder area. According to your text, what exposure time is recommended to blur the lung structures? Minimum of 3 seconds
If a breathing technique cannot be used for the transthoracic lateral projection of the shoulder, the exposure should be made using: Suspended full inspiration
If the patient cannot elevate the unaffected shoulder for a transthoracic lateral projection of the shoulder, the CR should be angled: 10-15 degrees cephalic
How far should the head, shoulders, and elbow be elevated for the inferosuperior axial projection (Lawrence Method) of the shoulder? 3-4 in.
How far should the arm be abducted for an inferiorsuperior projection (Lawrence Method) of the shoulder joint? 90 degrees.
How should the humerus be positioned for an inferiorsuperior axial projection of the shoulder joint (Lawrence Method)? External rotation
How is the CR directed for an inferiorsuperior axial projection (Lawrence Method) of the shoulder joint? Horizontally with a 15-30 degree angle medially
The PA oblique projection of the shoulder joint (scapular Y) is performed in what body position? RAO or LAO (preferred) Can do LPO or RPO for trauma recumbent
PA oblique projection of the shoulder (scapular Y) is performed to evaluate: Dislocations-to determine if anterior or posteriorly dislocated
For the PA oblique projection (scapular Y) of the shoulder, the body is rotated so the midcoronal plane (MCP) is how many degrees from the IR? 45-60 degrees
What is the CR angle for the PA oblique projection (scapular Y) of the shoulder joint? 0 degrees
What structure of the humerus will be directly superimposed over the junction of the "Y" on the PA oblique (scapular Y) projection? Humeral head
What structure is demonstrated in "lateral profile" on a PA oblique (scapular Y) projection? Scapula
Which shoulder projection clearly demonstrates the glenoid cavity? AP oblique projection (Grashey Method)
How many degrees is the body rotated for the AP oblique projection (Grashey method) of the shoulder joint? 35-45 degrees toward the affected side
The Pearson method is an AP projection of the : acromioclavicular articulation (AP bilateral w/ weights) (AP bilateral w/o weights)
How many pounds of weight should be affixed to each wrist for the AP projection for the A-C joint? 5-8 lbs
Two exposure are commonly made of the A-C joints---one without weight and one with weights. How are the weights applied. Affixed to the wrists
How should the CR be angled for the AP projection (Pearson method) of the A-C joints? 0 degrees (no angle)
The AP projection of the acromioclavicular joints places the joints at an increased OID. What is the recommended SID to compensate for this distance? 72" SID
To obtain a more uniform IR density, the respiration phase for the AP projection of the clavicle should be: Suspended on expiration
Which of the following projections can be used to demonstrate the clavicle? AP or PA and AP axial or PA axial
The CR angle for an AP axial projection of the clavicle when performed on a patient in the supine position is: 15-30 degrees cephalic
In order to elevate the clavicle above the ribs and scapula for the AP axial projection, the phase of respiration should be: Suspended on full respiration
The respiration phase for an AP projection of the scapula is: shallow breathing if patient is able to
How is the arm positioned for an AP scapula? abducted 90 degrees, forearm flexed
For lateral projection of the scapula, the body is placed in which position? RAO or LAO preferred (can do RPO or LPO for trauma recumbent)
For delineation of the acromion and coracoid processes of the scapula in the lateral projection, the ar, is positioned Flex the elbow and place the hand on the posterior thorax
When the patient is positioned properly for a lateral projection of the scapula, the body of the scapula will be: Perpendicular to the plane of the IR
The clavicle is classified as a: long bone
The scapula is classified as a: flat bone
The lesser tubercle is situated on which surface of the humerus? anterior
The sternoclavicular articulation is formed by the sternal extremity of the clavicle and the Manubrium and 1st rib cartilage
All of the joints of the shoulder girdle are: Synovial: freely movable
Which position of the hand will place the humerus in external rotation? Supinated
For delineation of the body of the scapula for the lateral projection, the arm is positioned: extend the arm upward and rest the forearm on the head
When the tangential projection of the intertubercular groove is performed with the patient supine, the position of the hand is: supinated
When the Fisk Modification is used for the tangential projection of the intertubercular groove, the patient is: Standing
When the Fisk Modification is used for the tangential projection of the intertubercular groove, the vertical humerus is placed at an angle of : 10-15 degrees
If the patient cannot elevate the unaffected shoulder for a transthoracic lateral projection of the proximal humerus, the CR should be angled: 10-15 degrees
For a transthoracic lateral projection, the proximal humerus should be projected: between the vertebral column and sternum
Where should the center of the IR be postioned for a transthoracic lateral projection of the proximal humerus? The surgical neck
The lesser tubercle is on which surface of the humerus? Anterior surface Just below the anatomical neck
Which tendon inserts at the lesser tubercle? The tendon of the subscapularis muscle
Which AP Projection of the shoulder demonstrates the site of insertion of the subscapularis tendon? Internal rotation: because it places the lesser tubercle in profile
What surface of the humerus is the greater tubercle located? Lateral surface
The superior surface of the greater tubercle slopes posteriorly 25 degrees and has how many flattened impressions for muscle (tendon) insertion? 3 Anterior, middle, posterior
Muscles are attached to bone via" tendons
The anterior impression of the greater tubercle provides the insertion site for what tendon? The tendon of the supraspinatous muscle
The middle impression of the greater tubercle is the site for insertion for which tendon? the tendon of the infraspinatous muscle
The posterior impression of the greater tubercle is the insertion for which tendon? The upper fibers of the teres minor (the lower fibers attach to the body just below this site)
Which AP projection demonstrates the site of insertion of the supraspinatous tendon? External rotation (neutral demonstrates the posterior part of the insertion
Which AP projection will sometimes demonstrate calcific deposits in the joint that can be indicative of bursitis neutral roation
What are the small synovial fluid-filled sacs that relieve pressure and reduce friction in tissue? Bursae
What projections will demonstrate the humerus in a laterl projection? AP internal rotation Transthoracic lateral
An impacted fracture of the posterolateral aspect of the humeral head with dislocation is termed: Hill Sachs defect
The superiorinferior and inferiorsuperior axillary projections demonstrates which tendon insertion sites? Subscapularis of lesser tubercle Teres minor of greater tubercle
AP Oblique Grashey Method Glenoid Cavity in Profile
Lawrence Method trauma lateral of the humerus
Suprpapinatus “Outlet” Neer Method shoulder impingement
Lateral Scapula with arm overhead or across the chest body of the scapula
AP Internal Rotation Lesser tubercle in profile medially
Inferosuperior Axillary with Rafert Modification HIll-Sachs deffect
Scapular Y view anterior or posterior dislocation
Pearson Method Acromioclavicular separation
Lateral with arm on posterior thorax acromion and coracoid process
AP external rotation Greater tubercle in profile laterally
Which of the following make up the shoulder girdle proper Scapula and Clavicle
Which of the following make up the shoulder joint? Scapula and humerus
What is the ONLY bony attachment of the upper limb to the trumk? (completes the shoulder girdle anteriorly) Clavicle and sternum
What are classified as long bones? Clavicle and humerus
What is classified as flat bones? Scapula
Which of the following structures are located on the medial end of the clavicle? Sternal extremity and sternoclavicular joint

Which position of the shoulder demonstrate the lesser tubercle in profile medially?

In the AP projection of the shoulder the lesser tubercle is in profile medially, when the humerus is in internal rotation. In the AP projection of the shoulder neither tubercle is in profile when the humerus in in neutral rotation.

Which AP projection is used to demonstrate the greater tubercle profile?

Shoulder Girdle/Clavicle.

Which of the following AP shoulder projections demonstrates the greater tubercle in profile laterally?

A RADIOGRAPH PROJECTION WITH EXTERNAL ROTATION OF THE PROXIMAL HUMERUS SHOWS THE GREATER TUBERCLE IN PROFILE LATERALLY.

Which should be demonstrated on an AP axial shoulder projection?

Evaluation criteria for the clavicle Only the medial portion of the clavicle will be superimposed by the first and second ribs. On an AP axial projection, the entire clavicle should be clearly demonstrated in a horizontal placement along with the acromioclavicular (AC) joint and the sternoclavicular (SC) joint.

ap shoulder projection demonstrates lesser tubercle profile medially

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