Shoulder (West Point view)

The West Point view of the glenohumeral joint is a modified axial projection of the glenohumeral joint in which the patient is prone. 

Indications

The West Point view is a highly specific radiographic projection to assess the anteroinferior glenoid rim often in the context of recurrent instability ^1,2. This is a useful projection to assess for bony Bankart lesions or other glenoid rim fractures.

It should be noted that this projection requires the patient to lay prone, and may not be possible in some contexts for a multi-trauma setting. 

Patient position

• the patient is prone
• the shoulder is placed on a sponge to elevate it approximately 8 cm for the projection
• the arm is abducted approximately 90 degrees with the forearm hanging over the table 
• image receptor is rested upon the superior part of the affected shoulder 
• the patient's head is to be tilted away towards the unaffected side 

Technical factors

• modified axial projection (inferosuperior)
• centering point
  • the x-ray tube is in the same plane as the glenohumeral joint shooting inferosuperior 
  • 25° medial angle 
  • 25° anterior angle
• 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. The glenoid rim should be able to be easily inspected. 

History and etymology

The West Point view was first described by Rokous, Feagin, and Abbott in 1972 ¹ by as a 'modified axial projection' to assess the glenoid rim while working at the US Military Academy at West Point, New York ³. 

Practical points

This is not an easy projection to perform on patients in pain and requires a thorough explanation. Elevating the shoulder is good for comfort but also important to ensure you are able to image the shoulder with the anterior angle.

Other suitable axial projections include:

• modified trauma axial 
• inferior superior axial
• superior-inferior axial
• Stryker notch view