AP Shoulder with External Rotation

AP Shoulder with External Rotation X-ray

Position Diagram 1

Position Diagram 2

Exposure Factors

Kilovoltage (kV)

Milliamperage (mAs)

Fine Focus

Focus Type

100 cm

Source-Image Distance

With Bucky

Configuration

Low exposure: Optimized parameters for visualization with external rotation

Anatomical Structures Visible

Should be clearly observed:

Proximal humerus with external rotation
Two-thirds of clavicle
Superior scapula
Relationship of humeral head with glenoid cavity
Greater tuberosity in lateral profile

Pathology demonstrated:

GREATER TUBEROSITY

Fractures assessment

CALCIFICATIONS

Tendon deposits

Specific evaluation: Greater tuberosity fractures and calcific tendonitis

Cassette Size and Orientation

24 × 30 cm

Transverse

For standard evaluation

24 × 30 cm

Longitudinal

If injury involves proximal half of humerus

Patient Positioning

Patient in standing or supine position

Rotate patient toward affected side if necessary

Place shoulder in contact with bucky

Arm in complete external rotation

Elbow extended or slightly flexed

Palm facing forward or upward

Center shoulder joint on cassette

Hand Position

Specific positioning for external rotation:

Palm facing forward or upward
Arm in full external rotation
Elbow extended or 90° flexed

Central Ray Point

2.5 cm inferior to coracoid process

Direction: Perpendicular to entry point

Location: Centered on glenohumeral joint

Purpose: Optimal visualization of greater tuberosity

Optimal Image Characteristics

Greater Tuberosity

In lateral profile

Articular Relationship

Humeral head - glenoid

No Superposition

Differentiated structures

Full Field

Proximal humerus to clavicle

Common Technical Challenges

Frequent problems in AP with external rotation:

Insufficient external rotation due to pain or joint limitation
Poor shoulder placement relative to bucky
Movement during exposure due to muscle fatigue
Structure superposition from incomplete rotation
Incorrect hand position affecting humeral rotation

Solution: Ensure maximum tolerable external rotation and support extremity to avoid fatigue

Special Considerations

Limited Rotation

Rotate to maximum tolerable without forcing

Document achieved rotation degree

Painful Patient

Position with maximum comfort

Consider pre-exposure analgesia if needed

Geriatric Patient

Consider mobility limitations, possible need for additional support.

Patient Instructions

"Hold your breath during the exposure"

Maintain external rotation position without movement during radiographic exposure

1. "Turn your arm outward as much as possible"
2. "Keep your palm facing upward"
3. "Hold your position without moving"
4. "Take a deep breath and hold it"
5. "Stay still during the exposure"

Clinical Indications

Greater tuberosity fractures

Tendon calcifications

Calcific tendonitis

Post-dislocation evaluation