Shoulder : Tangential Projection - Neer Method

X-ray of the Shoulder Trauma Patient : Neer Method - Tangential Projection

Neer Method is an x-ray examination of the shoulder and best demonstrate the supraspinatus outlet of the shoulder. This projection uses tangential central ray of 10 to 15° angulation. When performing this projection donot attempt to rotate arm is fracture or dislocation is suspected.
Fracture and/or dislocations of the proximal humerus and scapula are visualized. Specifically demonstrates the core acromial arch for the supraspinatus outlet region for possible shoulder imprengement.

Technical Factor

Outlet Projection

IR size - 24 x 30 cm (10 x 12 inches), lengthwise
Moving or stationary grid
75 +- 5 kV range
AEC not recommended
mAs 13

Patient Position and Shielding

Take radiograph with the patient patient in an erect, sitting or recumbent position. ( The erect position is usually more comfortable for the patient.)
Shield pelvic area

Part Position and Central Ray

With patient facing the IR, rotate into anterior oblique position as for lateral scapula.
Average patient will be in a 45 to 60 degree anterior oblique position. Palpate scapular borders to determine correct rotation.
Center scapulohumeral joint to CR and to center of IR.
Abduct arm slightly so as not to superimpose proximal humerus over ribs; do not attempt to rotate arm.
Requires a 10 to 15 degree CR caudal angle, centered posteriorly to pass through the superior margin of humeral head
Minimum SID of 40 inches (100 cm)

Collimation and Patient Respiration

Collimate on four sides to area of interest.
Suspend respiration during exposure.

Radiographic Criteria

Structure Shown

Proximal humerus will be superimposed over thin body of the scapula, which should be seen on end without rib superimposition

Position

Supraspinatus Outlet - Arrow

The acromion and the coracoid processes should appear as nearly symmetric upper limbs of the Y.
The humeral head should appear superimposed and centered to the glenoid fossa just below the supraspinatus outlet region.
The supraspinatus outlet region will appear open, free of superimposition by the humeral head.

Collimation and CR

Collimation is visible on four sides to area of affected shoulder.
CR and center of collimation field to supraspinatus outlet region.

Exposure Criteria

Optimal density and contrast will demonstrate the Y appearance of the upper lateral scapula superimposed by humeral head with outline of body of scapula visible through humerus.
Bony margins will appear clear and sharp, indicating no motion.