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Stryker notch view
4%
110/2671
West Point view
6%
159/2671
Supraspinatus outlet view
3%
78/2671
Velpeau view
113/2671
Zanca view
82%
2198/2671
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A Zanca view is the most accurate view to evaluate suspected AC joint injuries. Proper radiographic evaluation of the AC joint requires 1/3 to 1/2 of the x-ray penetration needed for glenohumeral joint exposure. This explains why, in a standard anteroposterior view of the shoulder, the AC joint will be over-penetrated (dark) and small or subtle lesions may be overlooked. When the history and physical examination indicate possible AC joint injury, specific directions must be given to the radiology technician in obtaining the appropriate view. AP, lateral, and axial views are standard views taken for the shoulder; however, a Zanca view is the most accurate view to look at the AC joint. Mazzocca provides a review of AC injuries and states that the "Zanca view is the most accurate view to look at the AC joint". This view is performed by tilting the x-ray beam 10° to 15° toward the cephalic direction and using only 50% of the standard shoulder anteroposterior penetration strength. The paper by Bradley & Elkousy discusses using plain films to make the diagnosis and determine the type on Rockwood classification to use as a guide for determining nonoperative treatment (Types 1 & 2), operative (Types 4-6), while Type 3 remains controversial. Obtaining views of both AC joints may be helpful. Illustrations A-E demonstrate the radiographic technique and example of a radiograph for each of the answer options 1-5, respectively.
3.8
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