Lateral Scapula

Lateral Scapula Position Diagram

Reference Lateral Scapula Radiograph

Patient positioning for lateral scapula

True lateral position evaluation

Demonstrated Pathology

Main indications: Fractures and dislocations of the proximal humerus and scapula.

Anterior Dislocations

The humeral head will be seen below the coracoid process.

Characteristic position of an anteriorized humeral head.

Posterior Dislocations

In posterior dislocations (less frequent), the humeral head will be seen below the acromion.

Characteristic position of a posteriorized humeral head.

Exposure Factors

Kilovoltage (kV)

Milliampere-seconds (mAs)

Small Focal Spot

Focal Spot Type

100 cm

SID (Source-Image Distance)

With Bucky

Configuration

Low exposure: Optimal parameters for lateral scapula visualization

Visible Anatomical Structure

The following must be clearly observed:

True lateral of the scapula
Full proximal humerus
Scapulohumeral joint
Scapular profile without superimposition
Humeral head-glenoid relationship

Cassette Size and Orientation

24 × 30 cm

Longitudinal (Portrait)

Longitudinal orientation to cover the full scapula and proximal humerus

Patient Positioning

Rotate the patient into an anterior oblique position facing the cassette

Anterior oblique position between 45 and 60°

Palpate scapular borders to determine the correct rotation for a true lateral position

Center the scapulohumeral joint to the center of the bucky

Place the arm in slight abduction if possible

Do not attempt to rotate the arm to avoid superimposition over the ribs

Central Ray Point

5-6 cm below shoulder

Direction: Perpendicular to the bucky

Location: Directed to the scapulohumeral joint, 5-6 cm below the shoulder

Importance of Correct Positioning

This projection is crucial for:

Evaluating the humeral head-glenoid relationship in dislocations
Visualizing fractures of the surgical neck of the humerus
Identifying fractures of the scapular body
Differentiating anterior vs posterior dislocations

Key: The 45-60° anterior oblique position is essential to obtain a true lateral scapula

Patient Instructions

"Hold your breath during the exposure"

Maintain position without movement and apnea during the radiographic exposure

Special Technical Considerations

Slight arm abduction

Prevents humerus-rib superimposition

Scapular palpation

Determines correct rotation

Do not rotate arm

Maintains natural position

45-60° Angle

Optimal anterior oblique position

Common Technical Challenges

Frequent problems in lateral scapula projection:

Insufficient oblique position failing to achieve a true lateral
Humerus-rib superimposition due to insufficient abduction
Excessive arm rotation altering the joint relationship
Difficulty palpating scapular borders in obese patients

Technical Variations

Acute Pain Patient

Minimize movement of the affected arm, position with maximum possible comfort.

Geriatric Patient

Consider mobility limitations; may require a smaller oblique angle.

Pediatric Patient

Reduce exposure according to age and ALARA protocol, adjust angle according to size.