Shoulder (Stryker notch view)

Last revised by Dr Joshua Yap on 11 Aug 2022

The Stryker notch view is a specialized projection of the shoulder, aimed at assessing the posterior humerus.

The Stryker notch view can be used post anterior glenohumeral dislocation, assessing for Hill-Sachs defects 1.

  • the patient is preferably erect
  • the mid-coronal plane of the patient is parallel to the image receptor: the patient's back is against the image receptor
  • the glenohumeral joint of the affected side is at the center of the image receptor
  • the patient is turned toward the affected side to show the glenohumeral joint space; this is achieved by rotating the patient 30-45°
  • affected arm is abducted anteriorly and rested on the patient's head while maintaining internal rotation (if possible)
  • anteroposterior inferosuperior axial projection
  • centering point
    • 10-15° cephalad angle of the x-ray tube
    • mid-axilla at the level of the glenohumeral joint 
  • collimation
    • superior to include the entire neck of the humerus 
    • inferior to include the glenoid 
    • lateral to the extent of the humeral head 
    • medial to the extent of the humeral head 
  • orientation  
    • portrait
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 60-70 kVp
    • 10-18 mAs
  • SID
    • 100 cm
  • grid
    • yes (this can vary departmentally)
  • the glenohumeral joint should be open
  • the humerus is pointing superiorly 
  • the lateral portion of the humeral head should be free from any superimposition 
  • it is important to demonstrate to the patient how this projection needs to be performed
  • set the patient up (similar to an AP glenoid projection), then ask the patient to abduct the arm and place it on their head
  • tight collimation avoids any unwanted scatter
  • rotation of the patient will vary due to body habitus: this is an obvious point but highly relevant
    • patients who require these films are often suffering from either chronic or acute shoulder pain and palpating the affected shoulder is far from ideal
    • it is advisable to observe the clavicle when rotating the patient until the midshaft of the clavicle is almost end on

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Cases and figures

  • Figure 1: Stryker notch view
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  • Figure 2: Stryker notch view patient unable to abduct
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