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How to identify the pathoanatomy and arthritic shoulder using plain xrays

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Before treatment can be discussed, surgeons and patients must understand the anatomy of the arthritic shoulder. Although there is a lot of enthusiasm to routinely obtain CT scans for this purpose in some cases, plain x-rays are able to provide the same information without the cost, radiation exposure, and time involved. 

The technical details are crucial for getting the information you need, as with all things orthopaedic.

The pair’s first member is the Anterior view of the plane of the capula. This view shows the patient’s scapula flat on an x-ray cassette. The x-ray beam is directed at the coracoid and perpendicularly to the plane of his scapula.  The humeral head is shown in profile by rotating the elbow of the flexed forearm 30 degrees from the beam.




This view shows pathological features such as flattening the humeral heads, humeral osteophytes and joint space narrowing. It also shows the superior/inferior relationship between the humeral and the glenoid.




The second pair is the The axillary view of truth. The beam is seen in this view. The patient’s arm is raised in the plane of his scapula.



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