Rockwood Adults CH34

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CHAPTER 34 • Glenohumeral Instability

A, B

C

Figure 34-20.  A: Stryker notch view done in the standing position, the elbow points straight in front of the patient’s face. The beam is angled about 10 degrees cephalad to the shoulder and plate. B: West Point view is done with the patient in the prone position and the forearm hanging off the table with the head turned away from the plate. With the cassette on the superior aspect of the shoulder, the x-ray beam is centered on the axilla and aimed at 25 degrees downward form the horizon ( B ) and 25 degrees medial to the plate ( C ). With this view, the radiographic beam is tangential to the anteroinferior rim of the glenoid to allow excellent visualization and detection of bony Bankart lesions.

Notch and West Point views increase the detection of Hill–Sachs and Bankart lesions, respectively. For the Stryker Notch view, the patient can be standing or supine. The arm is voluntarily extended vertically with the hand placed behind the head, mak- ing the humerus parallel to the table. In the standing position, the elbow points straight in front of the patient’s face, and in the supine position, it points toward the ceiling. The beam is angled about 10 degrees cephalad to the shoulder and plate (Fig. 34-20A). For a West Point view, the patient is prone with the head turned away from the cassette. The forearm can hang off the table or with the elbow extended and the arm abducted 90 degrees from the long axis of the body, resulting in the humerus parallel to the tabletop. With the cassette on the superior aspect of the shoulder, the x-ray beam is centered on the axilla and aimed

at 25 degrees downward from the horizon and 25 degrees medial (Fig. 34-20B,C). With this view, the radiographic beam is tangen- tial to the anteroinferior rim of the glenoid to allow excellent visu- alization and detection of bony Bankart lesions. The Bernageau profile view originated from France and can be used to evaluate anterior glenoid bone loss (Fig. 34-21A). 19 Ahmed et al. described using this view to calculate the dis- tance between the anterior and posterior glenoid rims and to compare these measurements between the left and right shoul- ders (Fig. 34-21B). 2 The Bernageau view has been shown to have similar accuracy and reproducibility as CT in detecting and measuring the degree of glenoid erosion. 3 There is also the added benefit that radiographs are less costly, easier to perform, and available to a larger population.

Figure 34-21.  A: Bernageau view is done with the patient’s arm flexed and the radiographic beam positioned in line with the scap- ula spine. The angle of the beam is coming down toward the plate at about 30 to 40 degrees in line with the glenoid. This view provides a glenoid profile view. B: The anterior rim of the glenoid is perfectly visu- alized. In this patient, there was no anterior glenoid bone loss.

A

B