Shoulder (lateral scapula view)

The lateral scapula shoulder or Y view is part of the standard shoulder series.

Indications

Orthogonal to the AP shoulder (note: as is an axillary view); this view is a pertinent projection to assess suspected dislocations, scapula fractures, and degenerative changes. It is also useful in seeing both the coracoid and acromion process in profile.

Patient position

• erect or sitting, facing the upright detector
• rotated in an anterior oblique position so the anterior portion of the shoulder is touching the upright detector
• the hand is placed on the patient's abdomen with the arm flexed
• degree of anterior rotation can vary from patient to patient
• scapula should be end-on to the upright detector, and this can be done via palpation of the scapula border

Technical factors

• posteroanterior lateral projection
• centering point
  • the level of the glenohumeral joint on the posterior aspect of the patient (5 cm below the top of the shoulder)
  • central to the medial scapula border
• collimation
  • laterally to include the skin margin
  • medially to cover the entirety of the medial scapula
  • superior to the skin margin
  • inferior to the inferior angle of the scapula
• orientation  
  • portrait                        
• detector size
  • 24 x 30 cm
• exposure
  • 60-70 kVp
  • 10-20 mAs
• SID
  • 100 cm
• grid
  • yes

Image technical evaluation

• the scapula is clearly demonstrated in a lateral profile, giving the clear appearance of a ‘Y’
• acromion and the coracoid process form the upper arms of the ‘Y’
• if intact, the humeral head is superimposed at the base of the ‘Y’

Practical points

The lateral scapula projection can be technically demanding, especially when patients are in pain. An anecdotal method amongst radiographers is to feel for the medial border of the scapula and line it up with the anterior portion of the acromion and x-ray straight down the line.

The idea being, if they are lined up there will be a superimposition of the medial and lateral borders of the scapula and hence a perfect lateral position, although this isn't always the case.

The best defense against positional errors is having a thorough understanding of radiographic anatomy and how it changes positionally when assessing for under/over rotation of the lateral shoulder, assess the borders of the scapula.

Over rotation

Over rotation in this projection refers to the patient's unaffected side sitting too far away from the image receptor, otherwise known as lying ‘too square’ to the detector.

Over-rotation is clearly established as the lateral border of the scapula (significantly thicker than the medial) is projected over the thorax along with the humeral head; to adjust this, rotated the unaffected side towards the image receptor slightly.

Under rotation

Under rotation in this projection refers to the patient's unaffected side sitting too close to the image receptor, otherwise known as lying ‘flat’ to the detector.

The lateral border, as well as the humeral head, will be sitting overly lateral in the image; to fix this, rotated the unaffected side away from the detector to increase obliquity.

Some departments will recommend a 15-degree caudal angle to achieve the ‘perfect’ lateral shoulder; it should be noted this is an entirely different projection known as an ‘outlet projection’ used primarily for the visualization of the supraspinatus outlet; often aiding in the investigation of impingement, spurs and calcifications.