Radiography of the Radiography of the ShoulderShoulder
Jennifer Nicol PGY-1August 6, 2009
ObjectivesObjectivesBRIEF Anatomy ReviewStandard shoulder viewsRadiographs of shoulder injuriesNOT:
◦Treatment◦Other imaging modalities◦Pediatric imaging
AnatomyAnatomy
Shoulder ViewsShoulder ViewsOver 15 views of shoulder
describedTrauma series:
◦3 views: AP Trans-scapular “Y-view” Axillary
Modified axillary
AP viewAP viewTrue AP - 45˚tilt
◦ Glenohumeral joint with no bony overlap
◦ Preferred in traumaAP int/ext rotation
◦ Highlight tuberosities
◦ Soft tissue injuriesClavicle and AC
joint
Transcapular viewTranscapular viewProjects along
long axis scapulaSimple,
reproducibleGood for
visualising anterior, posterior dislocations
Acromion Coracoid Body
Axillary ViewAxillary ViewGlenohumeral
joint in cephalocaudal plane
Lesions of glenoid rim, humeral head, caracoid
Axial view of shoulder
Modified Axillary ViewModified Axillary View
Reverse axillary when pt can’t abduct
Retrospective1690 shoulder exams
◦Mod axillary view used 104 times
◦ Identified additional pathology in 30 cases
No comparison b/t standard and modified axillary
Approach to Shoulder XRApproach to Shoulder XRAP:
◦If ext/int rotation look at tuberosity orientation
◦Glenohumeral region Alignment Distance b/t humeral head and glenoid Bones
◦AC region◦Other regions (clavicle, ribs, scapular
spine,lungs)
Approach to Shoulder XRApproach to Shoulder XROther views:
◦Humeral head to glenoid◦Prox humerus◦Glenoid rim◦Scapula◦Carocoid◦Acromion
1)GlenoidAlignmentDistancebones
2)ACAlignmentCarocoid-
clavicle space
3)OtherLungs,
scapula, ribs, clavicle
Type I AC injury
Type III AC injury
Posterior Dislocation
Positive Rim Sign
Trough Sign
No Mercedes!!!!
Avulsion Lesser Tuberosity
Bilateral shoulder dislocation spontaneously reduced with bilateral reverse Hill-Sachs lesions
Posterior DislocationsPosterior DislocationsHave high suspicion with correct
mechanismDon’t miss – clinical exam
importantLook for associated fracturesTypes:
◦Subacromial (98%)◦Subglenoid◦subspinosus
Anterior Dislocation
Scapular View: Anterior Dislocation
Hill-Sachs deformity
AP
Bankhart Injury
Axillary
Greater Tuberosity Fracture
Anterior DislocationsAnterior Dislocations4 Types
◦Subcoracoid◦Subglenoid◦Subclavicular◦Intrathoracic
Anterior DislocationsAnterior DislocationsCheck Neurovascular exam pre-
post reductionDon’t delay reduction – NV injury
increases with timeRecurrence high – 80% <30
Inferior Dislocation
Subglenoid anterior dislocation
Pseudodislocation
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