Conventional Radiography of the Shoulder

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Radiographic Technique and Anatomy

Radiographs are often the first imaging examination performed on an individual with a suspected shoulder abnormality, and the complex anatomy of the shoulder has lead to the development of numerous radiographic views and techniques, each designed to optimize the evaluation of specific parts of the shoulder girdle. Knowledge of the standard views that are available as well as the advantages and disadvantages of each projection will aid in optimizing the radiographic evaluation based on the

Trauma

Trauma is a common indication for obtaining radiographs of the shoulder and indeed radiography is often the first imaging study to be performed in the setting of shoulder pain following trauma. The specific injury is usually dependent on both the age of the patient as well as the mechanism of injury, and the most common injuries include AC joint separation, fracture of the clavicle, scapula, or proximal humerus, and glenohumeral dislocation. Selection of the proper radiographic views as well as

Impingement

Painful impingement of the shoulder is a clinical entity that results from compression of the rotator cuff and subacromial-subdeltoid bursa between the greater tuberosity of the humeral head and the protective overriding osseous outlet and acromion. The diagnosis of impingement is a clinical diagnosis and cannot be established on the basis of imaging findings alone.32, 33 It is typically established on the basis of pain produced by abduction and elevation of the arm. Clinical impingement

Arthritis

Arthritis is a common clinical entity that often involves either the glenohumeral joint or the AC joint. Conventional radiography is an excellent means of evaluating the shoulder for the presence of arthritis and is often the preferred imaging modality to establish a specific diagnosis, as well as to determine the extent of disease and to follow response to therapy.

Summary

Conventional radiography is a useful tool in the evaluation of shoulder pain whether in the setting of acute trauma or chronic pain and in most clinical situations should be the first imaging modality performed. Knowledge of the various projections and radiographic findings described above will ensure an optimal evaluation of the shoulder regardless of the suspected etiology of the shoulder pain.

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    Work performed at Uniform Services University of the Health Sciences. The opinions and assertions contained herein are those of the authors and should not be construed as official or as representing the opinions of the Department of the Air Force or the Department of Defense.

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