Contributors: Justin Goggin, Patsy Whelehan

 Species: Canine   |   Classification: Techniques

Introduction Requirements Preparation Procedure Aftercare Outcomes Further Reading


  • Accurate centering is essential when radiographing any joint.
  • High resolution film-screen combinations are required.
  • A grid is necessary when tissue thickness >10 cm.
  • kV should not exceed about 60.
  • Close collimation is essential to avoid scatter.
  • If general anesthesia is not used, then sedation with analgesia is suggested.
  • The film must include the whole joint, with soft tissues, must be correctly exposed and developed and free from movement blur and artefact.
  • The anatomical marker must be clearly visible, along with the patient's identification, the date, and the name of the hospital or practice.


  • → An important diagnostic aid in determining the cause of lameness arising from the shoulder.
  • → Bony injury: fracture or dislocation Shoulder: luxation - traumatic Shoulder dislocation - radiograph CdCr.
  • → Osteochondrosis Shoulder: osteochondrosis Shoulder OCD - radiograph lateral.
  • → Bony neoplasia Bone tumor proximal humerus - radiograph , or soft tissue neoplasia Synovial cell sarcoma , invading bone.
  • → Investigation of soft tissue injury.
  • → Inflammatory, infectious or degenerative osteoarthrosis.
  • → Congenital elbow luxation.


  • Non-invasive.
  • Low cost and readily available.


  • Poor positioning can make subtle pathology impossible to detect.
  • The presence of severe pain can make the procedure difficult in a conscious patient.
  • Radiation exposure to patient/personnel.

Time Required


  • Dependent upon the method of chemical restraint (GA or sedation).


  • 10-15 min or longer, dependent upon skill of radiographer.

Decision Taking

Criteria for choosing test

Is the examination appropriate?
  • Can you make the diagnosis without it?
  • Can it tell you what you need to know?
  • Will your management be affected by the radiological findings?
Choosing the right projectionsLateral: standard projection.
  • Shows glenoid cavity and head of humerus.
  • Demonstrates joint space.
  • Shows soft tissue swelling and joint effusions.
  • Can show calcification in tendons.
    Lateral oblique views may be necessary to visualize some osteochondritis dissecans (OCD) lesions.
Caudocranial: second standard projection, or supplementary.
  • Necessary for minimum radiographic evaluation.
  • Essential second view in cases of known or suspected fracture.
  • Usually necessary in cases of dislocation.
  • Useful to confirm or further assess osteochondrosis lesions.
"Bicipital groove" (cranioproximal-craniodistal) projection
  • Most useful as part of a contrast arthrogram.
  • May be useful in plain radiography to demonstrate calcification in the bicipital tendon, or bony change secondary to bicipital tendon damage.
  • Also helpful to differentiate supraspinatous calcification from biceps tendon disease.



Other involvement

  • Radiographer or veterinary nurse/technician carrying out radiography.

Materials Required

Minimum equipment

  • X-ray machine.
  • Cassettes with high definition screens.
  • Processing facilities.
  • Immobilization and positioning aids: sandbags, foam wedges, tying tapes.
  • Protective clothing (lead-rubber aprons).
  • Film ID system.

Ideal equipment

  • High output X-ray machine.
  • Rare Earth high definition screens.
  • Automatic processing facilities.
  • Film ID camera.

Minimum consumables

  • X-ray film.
  • Pharmaceuticals for chemical restraint.
  • Film ID card or tape.



  • 1-2 competent people.
  • Sandbags.
  • Foam wedges.
  • Tying tapes.
  • Positioning trough.


Core Procedure


Step 1 - Lateral projection

  • Place the patient in lateral recumbency on the side to be examined and immobilize.
  • Use a sandbag to hold the contralateral limb out of the field caudally and dorsally.
  • Use a tie to distract the affected limb well cranially to avoid superimposition of the scapulotium joint and thoracic structures and secure.
  • Ensure the humerus is parallel to the film.
    Locate by palpation of the lateral aspect of the shoulder joint space.
  • Center with a vertical beam directly through the joint space Radiographic positioning shoulder - lateral projection.
  • Collimate to include the entire glenoid cavity, the soft tissues of the joint and the proximal third of the humerus Shoulder normal - radiograph lateral.

Step 2 - Caudocranial projection

  • Place the patient in dorsal recumbency in a trough and immobilize.
  • Rotate the thorax slightly away from the affected side.
  • Using a tie, extend the affected limb as far cranially as possible and secure.
  • Adjust position of thorax and limb to ensure the joint is in the true craniocaudal position.
  • Center the vertical beam through the joint space by palpation of the lateral aspect.
  • Collimate to include the soft tissues of the joint and the proximal third of the humerus.

Step 3 - Cranioproximal-craniodistal (bicipital groove) projection

  • Place the patient in sternal recumbency.
  • Flex the shoulder and the elbow.
  • Abduct the radius slightly so that it does not lie beneath the shoulder.
  • Palpate the groove on the cranial aspect of the head of humerus and direct the beam tangentially through it.
  • Collimate closely.



Reasons for Treatment Failure

  • Inadequate sedation.
  • Incomplete studies (one view only) lead to inaccurate diagnosis.
  • Poor technique: inaccurate positioning or collimation, wrong exposure factors, failure to label film.
  • Poor processing.
  • Equipment failure.

Further Reading


Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Bradley K (2005) Radiography and radiology of the shoulder joint. UK Vet 10 (3), 52-55.