Glenohumeral Joint Imaging
At a minimum, radiographs of the glenohumeral joint should include true anteroposterior (AP) and axillary lateral views. The commonly obtained AP views in internal rotation and external rotation are not generally helpful and do not adequately screen for common shoulder disorders.
There are three series of radiographs used to image the glenohumeral joint in different clinical situations. In all three series, true AP and axillary lateral views (orthogonal images) are included. These series are described as follows. Select the specific view for additional instruction and pictures demonstrating view.
A glenohumeral joint trauma series of radiographs is obtained to evaluate patients of any age with proximal humerus fractures, direct blunt or penetrating trauma or indirect trauma to the shoulder. This series should include the following radiographs:
True AP View
A glenohumeral joint impingement series of radiographs is obtained to evaluate patients with subacromial bursitis, rotator cuff tendinitis or rotator cuff tear. Patients are usually 35 years of age or older. This series should include the following radiographs:
A glenohumeral joint instability series of radiographs is obtained to evaluate patients with symptoms or signs of recurrent glenohumeral subluxation or dislocation. Commonly, these patients are 25 years of age or younger. This series should include the following radiographs:
Special imaging of the glenohumeral joint may be indicated in some clinical situations. For example, CT scan of the severely arthritic glenohumeral joint in the axial plane is useful preoperatively to assess glenoid anatomy including presence or absence of subchondral cysts and glenoid version. This study helps the surgeon to plan for shoulder hemiarthroplasty (humeral head replacement only) or for total shoulder arthroplasty (humeral head and glenoid replacement).
Non-contrast MRI evaluation of the shoulder may be used to confirm rotator cuff tears or to evaluate bone marrow or soft tissue lesions. However, MR-arthrography of the glenohumeral joint with intra-articular gadolinium injection may be more helpful in younger patients to diagnose partial thickness rotator cuff tears or labral tears. To avoid duplicative or unnecessary studies, we recommend orthopaedic consultation prior to obtaining advanced imaging of the shoulder.