X-ray of the scapula

The scapula is one of the bones of the human supporting apparatus. It is triangular in shape and connects the humerus and collarbone. When this anatomical formation is damaged, a sharp pain appears, and mobility is limited. Since it is not always possible to immediately identify the cause of the pathology, doctors use an X-ray of the scapula. We are talking about a non-invasive, painless and affordable diagnostic method, which, moreover, is quite informative. [1]

Indications for the procedure

X-ray of the scapula is a mandatory method of investigation in case of suspicion of a fracture of this bone, as well as for assessing the dynamics of bone fusion after a violation of integrity. Other possible indications include:

• the assumption of the presence of a tumor process, benign or malignant;
• infectious and inflammatory foci in the area of the scapula.

X-rays of the scapula may be required:

• if the patient indicates pain in the scapular region;
• if there is a dislocation of the shoulder joint;
• if there is a suspicion of cystic formation or bursitis;
• if the mobility of the shoulder joint is limited.

When receiving an X-ray image of the scapula, the doctor has the opportunity to:

• find out the features of the location of the scapula in relation to the adjacent joints and humerus;
• to identify changes in the inter-articular gap dimensions, to trace the condition of the tendon and cartilaginous apparatus;
• examine bone structures, diagnose partial and complete fractures, dislocations of the scapula;
• detect areas of tissue necrosis.

Preparation

The X-ray of the scapula does not require any special preparation. It is advisable to refrain from smoking and drinking alcoholic beverages.

You do not need to change your diet or adhere to any special diet, but it is best to refrain from eating or drinking for several hours before the test. An x-ray of the scapula is best done on an empty stomach.

Going to the procedure, it is necessary to put on clothes without complex fasteners, loose, which can be easily and quickly removed (the patient will have to undress to the waist). Leave any metal ornaments or accessories at home that might get caught in the image and interfere with rendering. [2]

Patient positioning for scapula x-ray

To obtain a picture in the anteroposterior projection, the patient stands upright, with his back and scapula resting on a vertical stand. The opposite side is not pressed against the post, but 15 degrees away from it. The scapula to be examined is parallel to the bar. The patient raises his chin, turns his head to the side opposite to the study. The hand from the side of the diagnosis is raised and fixed at the back of the head, or brought to the hip and bent. X-rays are directed perpendicular to the film, from front to back. Central radiation is directed towards the center of the blade and film. You should hold your breath after exhaling. The position is correct if there is a free zone between the ribs and the scapula, the medial and lateral scapular margins are aligned, and the scapula is fully visualized. [3]

To obtain an image in a lateral projection, the technique differs from the previous one: the patient stands at a vertical stand and presses against it with the necessary side. The upper limb from the examined side is placed on the head or on the thigh. Slightly pulls the opposite shoulder to the side (the hand is held in front), while the lateral and medial scapular edges are aligned. Directional X-ray radiation goes along a tangent line relative to the blade and perpendicular to the film. The center is directed towards the scapular middle (in the middle of the axillary fossa). The breath is delayed. [4]

Another, less common styling option (for traumatic cases):

• the patient stands on his back or lies on his back, the side to be examined is retracted at an angle of 45 degrees, the upper limbs are bent at the elbows and are on the stomach;
• the center is directed through the shoulder and the area between the scapula and ribs, along the level of the armpit and further to the center of the cassette.

Contraindications to the procedure

The usual X-ray of the scapula has practically no contraindications due to the risk of adverse effects on the human body of X-rays. Contraindications are relative, which means the following: if the diagnosis can save the patient's life, then it is carried out in any case.

When is scapular x-ray not recommended?

• Women during pregnancy and lactation.
• Children in the absence of compelling evidence (up to 14-15 years old).
• Patients with decompensated conditions.
• Patients who have already received large amounts of radiation in the past few months.
• Insufficiency of renal and hepatic function.
• Expressed pathology of the thyroid gland.
• Individual sensitivity to X-rays.

Normal performance

Usually, an X-ray image shows the consequences of a violation - for example, an injury. These can be chips, complete or partial fractures. You can also see signs of an inflammatory reaction, the presence of seals, birth defects (in particular, a change in the configuration and size of the scapula). [5]

A fracture of the scapula on x-ray is determined by a change in bone color and the presence of a clear line of darkening. With such damage, it is important to identify the type of fracture:

• fracture of the scapular neck;
• body and angles of the scapula;
• scapular articular process;
• scapular spine;
• coracoid and acromial scapular process.

Fractures of the scapula are relatively rare, in about 1–2% of all bone fractures. They can appear after falling on the back, due to direct impact. More often, there is a transverse fracture of the body of the scapula on x-ray, in the area below the spine, somewhat less often - a fracture of the neck and processes. In isolated cases, longitudinal damage to the body of the bone is found, which are accompanied by a strong separation of the fragments. [6]

By examining a fracture of the scapula neck on x-ray, the radiologist can distinguish between single or multiple splinters. A multi-splinter fracture is referred to if one or more completely separated intermediate bone fragments are present.

The suprahumeral and beak-shaped processes often break off with direct impacts to the scapula, when falling on the back from a great height, or with an emphasis on the upper limb. A fracture of the coracoid process of the scapula on x-ray can be combined with injuries to the ribs.

X-ray anatomy of the scapula

When decoding an X-ray image by traumatologists and orthopedists, it is very important to know the anatomical features and the ability to spatially construct anatomical elements with the designation of changes in their relationship with each other, which is expressed in degrees and millimeters.

The scapula is a kind of triangle adjacent to the posterior surface of the chest in the space from the second to the seventh rib. Taking into account the shape of the bone, three edges are distinguished in it:

• medial edge ("looks" at the spine);
• lateral edge;
• the upper edge, on which the scapular notch is localized.

The specified edges are joined at specific angles. One of these angles - the lower - is directed downward, and the upper and lateral are located at the ends of the upper scapular edge. The lateral angle is thicker than the others and has a slightly deepened glenoid cavity. The edge of the cavity is separated from the rest of the scapula by a neck.

Above the upper border of the depression there is an elevation, a tubercle, to which the tendon of the long head of the biceps muscles is attached. The lower border also has a similar elevation with attachment of the long head of the triceps brachialis muscle. The coracoid process is retracted from the upper border of the scapula near the glenoid cavity. [7]

The anterior, or costal scapular surface is a flattened depression called the subscapular fossa. The spine of the scapula runs along the posterior plane, dividing this surface into two depressions: the supraspinatus and infraspinatus fossa. [8]

The scapula from the posterior projection is a triangular formation with three edges, corners and processes. At the base of the coracoid process, you can consider the notch: inexperienced specialists can take it for a zone of bone destruction, which is especially common during the diagnosis of elderly patients with signs of senile calcification, when the notch transforms into a hole.

Complications after the procedure

Many injuries and pathologies of the scapula cannot be accurately diagnosed without an X-ray. Accordingly, it becomes difficult to find the appropriate treatment. Visual inspection only makes it possible to assume this or that violation, therefore, in many cases, an X-ray is simply necessary.

During the procedure, using a modern digital device, the patient receives minimal radiation exposure. Even when taking 2-3 pictures, no harm is done to the body.

But it is very undesirable to perform an X-ray examination for women during pregnancy - especially in the first trimester. Nevertheless, in exceptional cases (for example, with a fracture or for the diagnosis of serious pathologies), such a method cannot be dispensed with. In order to protect the unborn baby, the doctor during the X-ray uses protective screening plates, aprons covering the patient's stomach and chest. If the situation allows, then it is better to opt for radiography, and not for computed tomography. [9]

Consequences after the procedure

X-ray radiation has the ability to break down molecules, so its effect can theoretically lead to the destruction of cell membranes and damage to DNA and RNA nucleic acids. But the theory and the real danger are somewhat different. Experts say that modern digital X-ray machines emit a lower radiation dose than older diagnostic devices. Each X-ray study and dose should be recorded by a doctor in a special dose log book. The entry is also made on the patient's outpatient card. [10]

The effective X-ray dose is measured in mSv or μSv. Modern X-ray machines are equipped with a built-in dosimeter that determines the amount of radiation received by the patient. Such a dose, even with a similar study, can be different, which depends on the area of the body, and on the distance to the ray tube, etc.

An x-ray of the scapula is considered a non-hazardous diagnosis. A person receives a much greater radiation exposure during computed tomography and fluoroscopy:

• fluoroscopy is performed within a few minutes, while an X-ray image takes a fraction of a second;
• with computed tomography, a series of images is performed, and the more of them, the higher the radiation exposure.

You can reduce the likelihood of harm to the body if you use special protective equipment: lead plates, plates, shields.

It is not recommended to do several types of X-ray studies in 1-2 days: the body needs recovery after the diagnostic procedure.

Care after the procedure

No special caring measures are required after radiography. However, in order to level the resulting radiation exposure, experts recommend:

• after the procedure, you should drink a lot of water, tea, compotes, and also have a good sleep (cell recovery occurs mainly at night);
• at least for a while, it is necessary to give up bad habits, do not smoke and do not drink alcohol (it is allowed to use a small amount of dry wine);
• physical activity and walks in the fresh air are encouraged: aerobic exercise reduces the risk of developing oncological processes;
• it is advisable to at least temporarily give up fatty foods, fast food, sweets, smoked meats, carbonated drinks.

A diet with the inclusion of plant foods in the diet will bring benefits:

• cabbage (broccoli, white cabbage);
• grape;
• beet;
• Garnet;
• blueberries, raspberries, currants;
• seaweed.

The use of dairy products, nuts, oatmeal, buckwheat, and prunes is encouraged.

If everything is done correctly, then the patient's body after the X-ray of the scapula is restored in 24 hours. During this period of time, radioactive substances are completely decayed and removed.