In trauma radiology, the exam of the shoulder takes a slightly different twist since the doctor is more worried about fractures or dislocations than arthritis.  It is more difficult to say for sure how your exam will be done as well, since various injuries can greatly effect the patient's ability to move his or her arm in certain ways.  No matter which way your exam is done, the first x-ray shot will be an external rotation view identical to the view describe in the preceding paragraph if you are able to turn your hand in the prescribed manner.  If you, as the patient, are not able to turn your hand, then a neutral rotation view will do.  The problem I mentioned comes in on how to obtain a side or lateral view of the shoulder.  The best x-ray in terms of clarity of the anatomy shown and ease of reading is an axial view where the patient's arm is extended straight out to the side and the x-rays are directed in a beam running parallel to the thorax or trunk of the body.  The problem with this view is that if the shoulder is injured in certain ways, then the patient may not be able to move the arm straight out from the body like that.  In this case, an x-ray commonly referred to as a modified Y view will commonly be done.  In this x-ray, the patient is rolled to a forty five degree angle with the film resulting in a picture that shows the head of the humerus resting between two projections off the scapula or shoulder blade that appear to form a Y, thus giving this position it's name.

Sometimes the doctor is not worried about the shoulder so much as he or she is about the shoulder blade, or Scapula.  The scapula is a triangular shaped bone resting on the back of the rib cage that helps to give the human shoulder the ability to move backwards and forwards the way it does.  Because of it's position in the human body, the scapula is a rather difficult bone to break since it is protected by the rib cage.  However difficult does not mean impossible (take it from me, I managed to break mine once when I tried to stop one of my fraternity brothers from getting into a fight at a party with a man who had just insulted his fiancée and my brother drove us back into the corner of a table hard enough to break the table and my scapula).  Since the scapula normally rests at a slight angle to the body, one of two positions will be used to get a frontal or AP view of the scapula.  In the first position, the patient will be placed with his or her back to the film and asked to raise their arm to place their hand on top of their head.  This draws the scapula out from the body a bit and flattens it out slightly.  If the patient cannot move his or her arm in this manner, then he or she is rolled to about a 5 to 10 degree angle which will achieve about the same thing.  It should be noted that if the patient can stand up, doing this x-ray while they are standing will be much less painful if the area around the scapula is tender.   To get a side or lateral shot of the scapula, the patient is rolled or turned so that they are at a 45 degree angle with the film, preferably with the injured shoulder near the film and the patient facing the film instead of the x-ray camera, though it can be done the other way if needed.  The technologist will often place his or her fingers on the edges of the shoulder blade to be sure that the scapula is perpendicular to the film.  The patient will then be asked to raise his or her arm so that it is at a right angle to the body and place their hand on their other shoulder so that the arm will not be superimposed over the edge of the shoulder blade.

The Humerus, or upper arm, is perhaps the most straight forward exam of all the upper extremities, but it can still be a bit tricky.  The front shot, or AP view will be shot with the patient's arm held slightly away from the body, and the patient's hand will be rolled to place the palm facing the x-ray camera.  This places the epicondyles (those little bumps you can feel on the sides of your elbow) parallel with the film and the humerus in a true anatomical position (a position similar to that used by Leonardo Divinci in his drawings of the human anatomy which has become accepted by the medical community as a guide line to what constitutes the "front" of the body and what is the "back").  For the side, or lateral shot, the patient is asked to roll his hand in to a neutral position so that he or she can rest the palm of the hand against his or her hip.  This rotates the humerus so that the epicondyles are now perpendicular to the film, thus giving us a view of the humerus 90 degrees to the AP or frontal view.  The thing that makes this tricky is that many patients cannot move their arm enough to obtain these position naturally when they are injured, so we must often roll the patient or place the film and the x-ray camera in odd positions to obtain equivalent pictures,

The juncture of the humerus with the two bones of the forearm, the Radius and the Ulna is what forms the Elbow.  Depending upon your complaint or injury and the facility at which your x-rays are taken, an elbow series can consist of anywhere from two to four x-rays.  In doing these x-rays, it generally works best if the elbow can be placed at the same level as the patients shoulder, otherwise the bones will tend to be twisted slightly from the ideal positions.  The frontal, or AP shot is done with the patient's arm extended straight out in front of them with the back of the hand touching the table so that the palm is facing up.  For the side shot, or lateral, the patient is asked to bend his or her elbow to form a 90 degree angle with the hand held with the outer edge of the hand touching the table, the thumb pointing up at the ceiling, and the palm of the hand facing towards the patient.  These two positions will show most injuries and diseases of the elbow just fine, but the both have parts of the radius and ulna slightly overlapping each other which may result in some injuries or illnesses being partially hidden.  When the doctor or radiologist has reason to believe that this may be the case, one or two of the various obliques, or angled shots available will be added to the study.  The two most common, but by no means only methods for this both start from the lateral position.  In these methods, the hand is rotated from the straight up and down position used in the lateral so that one x-ray will be shot with the patient's hand resting palm down on the table and the other will be shot with the back of the patient's hand turned towards the table so that the palm is facing upwards as much as possible.  These two changes have the effect of rotating the radius around the ulna to better demonstrate the various portions of the radius and ulna which overlap each other in a normal side shot.  In some cases the patient may not be able to bend or straighten his or her elbow because of the way they were injured.   While this rarely causes us any problems with the lateral views since such injuries normally leave the patient holding their elbows at least slightly bent, it can result in some problems getting the frontal shot since any flexion of the elbow can result in considerable distortion of one part or another on the x-ray image.  The solution to this problem is to shoot two x-rays instead of one for the AP.  One shot will be made with the upper arm flat against the film and the second x-ray will be shot with the forearm flat against the film.   Neither film will be as good as a true AP, but taken together, they will show most of what the doctor needs to see, and it is quite a bit safer than forcing the patient to straighten their elbow, especially if the elbow proves to be dislocated.