Troubleshooting the supraspinatus outlet view

Radiographic evaluation of the acromion is integral to the management of subacromial impingement syndrome. The supraspinatus outlet view reveals acromial morphologic traits, acromial slope, subacromial excrescences, and inferior osteophytes at the acromioclavicular joint. The major dis-advantage of the outlet view is reproducibility. The purpose of this article is to describe technical factors that allow for obtaining this view consistently. In this study 7 different outlet views were obtained of the shoulder of an asymptomatic, voluntary subject. One view was obtained correctly; the other 6 were taken by simulating common technical errors. Each radiograph was then evaluated to determine how each technical error affected the radiographic image. Guidelines were then formulated for obtaining a proper outlet view on no more than 2 attempts. Correction of a faulty supraspinatus outlet view should be guided by the shape of the scapular body, the position of the floor of the supraspinatus fossa, and the distance between the humeral head and acromion.