Rockwood Adults CH34

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SECTION TWO • Upper Extremity

Figure 34-18.  A: Scapular “Y” view. B: Velpeau view is done with the patient sitting down and the plate is positioned behind the patient. The radiographic beam is aimed down toward the plate at about 60 degrees.

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under the shoulder (Fig. 34-18B) with the patient leaning back and the beam directed down to the plate. Alternatively, a modified axillary view has been proposed by positioning the patient sitting on the radiographic table with the hand of the affected side on the table and the arm abducted 60 degrees. 208 The x-ray beam is pointed down to the glenohu- meral joint, perpendicular to the table, in a superior to inferior direction. The radiographic plate is directly positioned on the table under the shadow formed by the shoulder contour with the anterior border behind the greater tuberosity. The body

should lean slightly (approximately 10 degrees) toward the plate and tilted slightly backwards (Fig. 34-19A). Another modified axillary view is obtained with the patient leaning slightly for- ward. The plate is positioned behind the patient with the radio- graphic beam aiming down about 45 degrees toward the plate (Fig. 34-19B). This position provides greater comfort for the patient especially in the setting of acute traumatic dislocation. Other special radiographic views that can assist in identify- ing pathology related to shoulder instability include the Stryker Notch, West Point, and the Bernageau profile views. The Stryker

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Figure 34-19.  A: Modified Velpeau view is done with positioning the patient sitting on the radiographic table with the hand of the affected side on the table and the arm abducted 60 degrees. The x-ray beam is pointed down to the glenohumeral joint, perpendicular to the table, superior to inferior in direction. The radiographic plate is directly positioned on the table under the shadow formed by the shoulder contour with the anterior border behind the greater trochanter. The body should lean slightly 10 degrees toward the plate and slightly tilted backwards. B: Boston Medical Center modified Velpeau view is done with the patient leaning slightly forward. The plate is positioned behind the patient with the radiographic beam aiming down 45 degrees toward the plate. This position provides comfort for the patient especially in the setting of acute traumatic dislocation.