The outlet or Neers projection of the shoulder is a specialised projection demonstrating the coracoacromial arch often utilised in the investigation of speculated shoulder impingement 1
This projection is most commonly seen in orthopaedic clinics and closely resembles a lateral scapular projection however it incorporates a 10-15 degree caudal angulation of the tube.
Note: This projection is not advisable in acute imaging of the shoulder, angulation of the tub may result in elongation of decisive structures. For lateral views of the shoulder in trauma see lateral shoulder view.
- 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
- the 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
- posteroanterior lateral projection
- the level of the glenohumeral joint on the posterior aspect of the patient (5 cm below the top of the shoulder)
- 10-15 degree caudal angulation of the x-ray tube
- central to the medial scapula border
- 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
- 24 x 30 cm
- 60-70 kVp
- 10-20 mAs
- 100 cm
Image technical evaluation
- the scapula is demonstrated in a lateral profile, giving the clear appearance of a ‘Y.'
- clear visualisation of the supraspinatus outlet
- 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.'
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 is not always the case.
The best defence 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, evaluate the borders of the scapula.
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 scapular (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 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.
- radiographic positioning and terminology
- systematic radiographic technical evaluation
- chest radiography
- abdominal radiography
upper limb radiography
shoulder girdle radiography
- scapula series
- AP view
- internal rotation view
- external rotation view
- superoinferior axial view
- inferosuperior axial view
- modified trauma axial
- supine lateral
- modified supine lateral
- Y lateral view
- AP glenoid view
- apical oblique view (Garth view)
- humerus (neck) AP view
- humerus axial (bicipital groove) view (Fisk view)
- outlet view (Neer view)
- Stryker notch view
- acromioclavicular joint series
- clavicle series
- sternoclavicular joint series
- arm and forearm radiography
- wrist and hand radiography
- wrist series
- scaphoid series
- hand series
- thumb series
- fingers series
- rheumatology hands series
- bone age series
- shoulder girdle radiography
lower limb radiography
- pelvic girdle radiography
- pelvis series
- hip series
- sacroiliac joint series
- thigh and leg radiography
- ankle and foot radiography
- pelvic girdle radiography
- skull radiography
paranasal sinus and facial bone radiography
- facial bones
- Caldwell view (angled skull PA view)
- nasal bones
- zygomatic arches
- paranasal sinuses
- temporal bones
- dental radiography
- cervical spine radiography
- thoracic spine radiography
- lumbar spine series
- sacrococcygeal radiography
- scoliosis radiography