Shoulder X-Ray: What it is and What it Can Diagnose 

An x-ray is a relatively quick, painless type of medical scan that doctors and specialists use to diagnose (or rule out) various conditions affecting the bones, joints, organs and soft tissues. X-rays produce black, white and grey images of the inside of the body and are useful for discovering what might be causing pain and problems with movement. They can be used to scan most parts of the body, including the shoulder. 

What is a Shoulder X-Ray?

A shoulder x-ray focuses on the bones and soft tissues of the shoulder joint - the area of the body where the arms are attached to the upper torso. It looks at the health and shape of the bones and the tissues that surround them, and can detect any abnormalities that may be causing shoulder pain, stiffness and mobility problems. 

Who Performs a Shoulder X-Ray?

A shoulder x-ray is normally performed by a medical specialist called a radiographer. They are highly trained imaging technicians. Once the radiographer is happy with the images they’ve taken, they’ll be sent to a radiologist for interpretation. A radiologist is a type of medical doctor that specialises in the interpretation of images.

What a Shoulder X-Ray Can Diagnose

The shoulder is a type of ball-and-socket joint - the top of one bone having a rounded, “ball” shape, and the end of another bone having a concave depression, or “socket”. The ball-shaped bone fits inside the socket-shaped bone, and a layer of soft tissue called cartilage keeps the joint lubricated and mobile.

Within the shoulder joint, there are three bones:

• Humerus - the long bone of the upper arm, with a ball-shaped head called the humeral head

• Clavicle - the collarbone 

• Scapula - the shoulder blade with the outer edge, or glenoid cavity, acting as the “socket”

Another bone within the shoulder joint is the coracoid process - a hook-shaped bone attached to the scapula that helps to stabilize the joint. A muscle called the rotator cuff sits between the scapula and humerus.

The shoulder joint is made up of two joints:

• The acromioclavicular joint - at the top of the shoulder where the scapula meets the clavicle

• The glenohumeral joint - down the side of the shoulder, where the humeral head meets the scapula

A ball-and-socket joint is very mobile, and the shoulder is no exception - a healthy shoulder joint allows freedom of movement in any direction, allowing us to lift, stretch, twist, turn and raise our arms or move them in a circular motion. 

However, the shoulder can be prone to various different conditions, all causing pain and a restriction on the freedom of movement. Shoulder x-rays can be helpful, either on their own or alongside another scan such as an MRI or CT scan, in detecting what’s causing pain and immobility in the shoulder. 

A shoulder x-ray can help to diagnose the following: 

Fractures

A break to one or more of the bones within the shoulder joint, often caused by car or bike accidents and sports injuries.

Dislocations

A shoulder dislocation happens when the humeral head (ball) is forcibly moved away from the socket, or glenoid cavity, of the scapula, due to accident or injury. 

Arthritis

The cartilage of the shoulder joint can wear away through age or overuse (such as in the case of sportspeople) causing the pain and inflammation associated with arthritis. 

Bone Spurs

The bones of the shoulder can develop abnormal growths called bone spurs, due to wear and tear or injury, causing pain, swelling and inflammation. 

Rotator Cuff Tears 

The rotator cuff can be prone to damage and tears, particularly in those who repeatedly have their arms above their heads through work, such as painters and plasterers. A rotator cuff tear causes a dull ache in the shoulder, often made worse by laying down. 

Joint Space Narrowing

If the cartilage between the bones begins to wear away through age or an overuse injury, it can cause a narrowing of the space between the bones, causing the bones to painfully rub against each other. 

Calcium Deposits

Sometimes, shoulder stiffness and weakness can be caused by calcium deposits collecting in the rotator cuff. The cause of this isn’t clear but it can be more common in patients with high blood calcium levels or kidney stones.

Tumours

A sarcoma is a type of cancerous soft tissue tumour. They can develop in any soft tissue, and can occur in the shoulder where they may feel like a soft lump. Cancer of the bones could also affect the shoulder joint. 

Infections

Redness, pain, heat, swelling and inflammation could be a sign of an infection in the soft tissues of the shoulder joint. An infection in the shoulder can occur after an injury or surgery to the shoulder, or it can spread there from other parts of the body. 

Osteoporosis

Osteoporosis, or brittle bone disease, causes weak, fragile bones that can be more susceptible to fractures. It’s more common in post-menopausal women and older people. 

Types of Shoulder X-Rays

The type of shoulder x-ray performed will depend on the patients’ symptoms, where the pain is being experienced and the level of freedom of movement in the shoulder. There are a few main types of shoulder x-ray, all are taken with the patient in a sitting or standing position:

AP (Anteroposterior) View

The AP view is the most common type of shoulder x-ray, taken from the front, with the shoulder in a relaxed position with the arm by the side. 

Lateral (Scapular Y) View

The lateral view is taken with the arm in the same position as the AP view, but the image is taken from the side. 

Axial View

The axial view is taken from the same angle as the lateral view, but the arm is held up and out, parallel with the floor if possible.

Grashey View

The Grashey view is taken from the side, with the arm internally rotated to about 35-45 degrees. 

Outlet View

The outlet view is taken from the side, with the arm bent inwards and the hand on the abdomen.

Internal Rotation View

The internal rotation view is taken from the side, with the arm internally rotated towards the body. 

External Rotation View

The external rotation view is taken from the side, with the arm externally rotated away from the body. 

How an X-Ray Works

An x-ray machine passes very low doses of radiation through the body. This radiation creates energy and different types of tissues absorb this energy at different rates. Hard tissues such as bone make it difficult for the x-rays to pass through, whereas soft tissues including muscles, tendons, ligaments and organs make it easier. 

Within the x-ray machine, a special detector picks up these differences in energy absorption, and turns them into an image. The denser the tissue, such as bone, the whiter it will appear on an x-ray. Softer tissues appear black or grey. 

A radiologist is trained to know what each tissue should look like, and to detect abnormalities such as fractures, damaged cartilage and tumours. 

Benefits

A shoulder x-ray is quick, painless and relatively safe and is an effective way for doctors to look inside the shoulder joint without having to operate. They can diagnose a range of conditions and are suitable for most people. 

Risks & Side Effects

Unlike MRI scans, x-rays use radiation to create an image. Although this level is very low (equivalent to spending between a few days and a few years being exposed to the normal background radiation that exists in the atmosphere, depending on the environment), it’s still not without risk. 

It’s thought that repeated x-rays throughout life could lead to a small increased risk of developing certain cancers later in life. However, it’s often considered generally safe if the benefit of having an x-ray outweighs the potential risk. It’s not advised that pregnant women or young children have an x-ray unless it’s deemed absolutely necessary. 

How to Prepare for a Shoulder X-Ray

A shoulder x-ray doesn’t require much preparation as a patient. Your medical team will advise you, but on the whole, you can eat, drink and carry on taking your medications as normal beforehand.

The Procedure Explained: What to Expect

Here’s what you can expect to happen on the day of your shoulder x-ray appointment. 

Remove Metal Objects

Metal objects will show on an x-ray, so you will be asked to remove clothing that has any metal zips, buttons, buckles or decorations. You will also be asked to remove any watches and jewelry and to leave your mobile phone, keys, bank cards, coins and any other metal objects in a secure place outside of the x-ray machine room. 

Wear a Hospital Gown if Needed

It’s helpful to wear loose clothing that’s easy to remove to your appointment. You may be able to pull your top to one side, but in some cases, you may be asked to remove your upper clothing and wear a hospital gown. You will need to remove your bra if it has a metal clasp. 

Stand or Sit as Instructed

Your radiographer will inform you how you need to sit or stand ready for your x-ray. Each image is taken very quickly, so you may only need to be in the right position for a moment. They will move behind a lead-lined screen in order to work the x-ray machine and take the images. 

Positioning

If you struggle to move your arm and shoulder, or get into position, your radiographer will help to position you before moving back behind the screen to take the x-rays. 

Selecting the X-Ray View

They will position the x-ray machine into place remotely, to ensure that the correct images are taken. 

Adjusting the X-Ray Machine

If you’re having shoulder x-rays taken from more than one angle or position, they will need to adjust the position of the machine as well as help you into different positions. 

Taking the X-Ray Exposure

Your radiographer will take each x-ray when they’re happy that both you and the machine are in the correct position. Each x-ray takes a couple of seconds once positioned.

Sending for Analysis

The most useful images will then be sent to a radiologist and your referring doctor for discussion and analysis, before they contact you to discuss your results. 

X-Ray Equipment

An x-ray machine is a large piece of medical equipment, housed in its own room and usually attached to the ceiling. A bed is normally situated beneath the x-ray machine that patients lay or sit on, in order for the x-rays to take place. On the bed is a digital recording plate that captures the images and sends them to a computer. In some cases, shoulder x-rays are taken from a standing position, next to an upright digital recording plate. 

What Happens After a Shoulder X-Ray?

Once your radiographer is happy that they have the right range of images, you will be asked to get dressed and to meet them outside the x-ray room. They will explain how long it may take for you to get your results, and then you’ll be able to return to your normal duties. 

Getting the Results

It’s not normal to get your results at the same time as having a shoulder x-ray as the results need to be interpreted by a radiologist and discussed with your referring doctor. You may get them later the same day, but it’s normal to have to wait a number of days. Your referring doctor will then discuss your results and any further scans and treatment plans that will follow. 

Costs

You can expect to pay around £150 to £200 for a private shoulder x-ray in the UK. Consultation and treatment costs will be extra. 

Get a Shoulder X-Ray

If you’re experiencing shoulder pain, stiffness, swelling or immobility, book a private shoulder x-ray with us today. The sooner your pain is diagnosed, the sooner you can begin treatment, allowing you to get back to your normal life. 

FAQs

Can a Shoulder X-Ray Show Cancer?

Yes, a shoulder x-ray can detect tumours in the bones and soft tissues. 

What Does a Normal Shoulder X-Ray Look Like?

On an x-ray, a healthy shoulder will clearly show the bones of the shoulder ball-and-socket joint, the rotator cuff muscle and the cartilage layer between the bones. 

What Can an X-Ray Show for Shoulder Pain?

An x-ray can show bone fractures, bone abnormalities, cartilage damage, muscle damage, arthritis and calcium deposits - all of which could be the cause of shoulder pain, swelling, stiffness and immobility.

What Does Arthritis Look Like on a Shoulder X-Ray?

Arthritis causes the cartilage in the shoulder to wear away - on an x-ray, this will show as a narrowing of the space between the bones.

What to Wear for a Shoulder X-Ray?

Wear a loose fitting top that’s easy to remove, and avoid wearing anything containing metal. You may be required to wear a hospital gown. 

How Long Does a Shoulder X-Ray Take? 

Shoulder x-rays normally take around 20 to 30 minutes. 

References 

Website, N. (2022b, May 4). X-Ray. nhs.uk. https://www.nhs.uk/conditions/x-ray/

Website, N. (2024a, February 27). Shoulder pain. nhs.uk. https://www.nhs.uk/conditions/shoulder-pain/

Pietrangelo, A. (2023, May 22). Why does my shoulder hurt? Healthline. https://www.healthline.com/health/chronic-pain/shoulder-pain

Professional, C. C. M. (2024b, May 1). Shoulder joint. Cleveland Clinic. https://my.clevelandclinic.org/health/body/24780-shoulder-joint

Professional, C. C. M. (2024f, December 19). Shoulder X-Ray. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/22531-shoulder-x-ray