The inferosuperior axial view also known as a Lawrence view of the shoulder is a modified axial projection best utilized with supine patients. It is an orthogonal projection to the AP view and replaces the lateral shoulder projection.

Indications

It is an appropriate projection to assess suspected dislocations, proximal humerus pathology and effective in demonstrating the articular surfaces of the humeral head and glenoid ^1-3. Hill-Sachs lesions are well demonstrated on this projection along with the lesser tubercle of the humerus.

This view is performed when the patient can only lie supine; thus making the superior-inferior axial view difficult to achieve. This view provides additional information for assessing dislocations and glenohumeral instability; particularly if these are not seen well on a standard AP view ⁴.

Patient position

• the patient is supine 

• image receptor is rested upon the superior part of the affected shoulder 

• the affected arm is abducted as much as achievable 

• the arm is externally rotated 

• the patient's head is to be tilted away towards the unaffected side 

Technical factors

• axial projection (inferosuperior)

• centering point

  • the x-ray tube is in the same plane as the glenohumeral joint shooting inferosuperior 

• there is a 20-30° medial angle aimed at the glenohumeral joint

• collimation

  • anterior-posterior to the skin margins 

  • lateral to proximal third of the humerus 

  • medial to include glenohumeral joint

• orientation

  • landscape

• detector size

  • 18 cm x 24 cm

• exposure

  • 50-60kVp

  • 8-15 mAs

• SID

  • 100-150 cm

• grid

  • no

Image technical evaluation

Clear visualization of the humeral head (with no superimposition) and its relationship with the glenoid of the scapula. In addition to the acromion and the coracoid process. The lesser tubercle should be seen projected anteriorly in profile. The coracoid process is pointing anteriorly 

Practical points

This is an ideal projection when patients are unable to move from the supine position. It can cause patient pain when abducting but nowhere near as much as the standard axial projection. 

Be wary of your surroundings when moving the x-ray tube in position, there is a high potential of hitting the patients feet. 

Other projections suitable for supine patients that require an orthogonal view of the AP view include: 

• modified trauma axial 

• modified transthoracic supine lateral (spinal patients)

• supine lateral