Shoulder (Velpeau view)
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The Velpeau view of the glenohumeral joint is a modified axial projection performed in the context of shoulder immobilization.
This projection is performed on patients with a shoulder sling (Velpeau bandage) in place, often in the context of post-operative or a post-reduction presentation whereby the patient is unable to abduct the arm. It is particularly useful in the diagnosis of posterior shoulder dislocations.
This view, performed erect with a 30° backward lean demonstrates the anterior and posterior humeral head and the glenoid fossa.
- the patient is erect (or sitting) facing away from the table
- the image receptor is placed on the table behind the patient beneath the shoulder
- patient leans 30° backward toward the table (allowing for an axial view of the shoulder)
- axial projection (superior-inferior)
- the x-ray tube straight up and down, centered at the glenohumeral joint (check that it casts a shadow on the detector)
- tight the to glenohumeral joint
- 18 cm x 24 cm
- 8-15 mAs
- 100-150 cm
Image technical evaluation
Clear visualization of the humeral head and its relationship with the glenoid of the scapula should be seen. The humeral shaft will be foreshortened and the image overall will be magnified, however, it should resemble a somewhat standard axial image.
This is an ideal projection when patients are unable to move their arm from the immobilized position, you just have to make sure the patient is not in too much lumbar pain as leaning back like that can be hard, sometimes it is best to give them a chair.
Use the shadow the light casts on the detector to get an idea of the magnification, place your finger on the glenohumeral joint and observe if it is in fact cast onto the detector.
History and etymology
The name was coined after the Velpeau bandage 1, and was first described in 1967 by Bloom and Obata 2.
- 1. HALL MC. The Velpeau bandage. (1963) Canadian Medical Association journal. 88: 92-3. Pubmed
- 2. Bloom MH, Obata WG. Diagnosis of posterior dislocation of the shoulder with use of Velpeau axillary and angle-up roentgenographic views. (1967) The Journal of bone and joint surgery. American volume. 49 (5): 943-9. Pubmed