Shoulder radiograph (an approach)

Shoulder radiographs are common films to see in the Emergency Department, especially during the weekend after sporting events.

  • cortex should be smooth
    • humeral head
    • glenoid fossa
    • clavicle
    • body of scapula
  • look for fracture fragments
  • remember the ribs
  • up to 10% of all fractures
  • predominantly midshaft
  • mostly children and the elderly
  • fall onto outstretched hand or shoulder
  • more: clavicle fracture
  • very common injury
  • range from strain to complete joint disruption
  • direct blow or fall onto shoulder with adducted arm
  • step at AC joint, widening of AC joint and/or increased CC distance
  • more: acromioclavicular joint injury
  • common injury resulting in significant disability
  • elderly females: mean age 65 years
  • fall on an outstretched arm
  • more: proximal humeral fracture
  • less than 5% of glenohumeral dislocations but often overlooked
  • common in adults following a seizure or in the elderly
  • humeral head forced posteriorly in internal rotation whilst arm is abducted
  • classically, the humeral head is rounded on AP - light bulb sign
  • associated with anteromedial fracture of humeral head
  • more: posterior shoulder dislocation
  • usually secondary to trauma
  • an effusion or haemorrhage into the joint displaces the humeral head inferiorly
  • this effusion suggests intra-articular fracture
  • do not confuse with dislocation!
  • more: shoulder pseudosubluxation
  • primary bronchogenic carcinoma arising in lung apex
  • account for up to 5% of all bronchogenic cancers
  • always review lung parenchyma, ribs and supraclavicular fossa in AP shoulder radiographs
  • more: Pancoast tumour
Approaches to radiographs
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Article information

rID: 28289
Section: Approach
Synonyms or Alternate Spellings:
  • shoulder x-ray
  • shoulder XR
  • shoulder xray

Cases and figures

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    Figure 1: Annotated frontal view
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    Case 1: anterior shoulder dislocation
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    Case 2: clavcicle fracture
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    Case 3: acromioclavicular joint injury
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    Case 4: proximal humeral fracture
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    Case 5: posterior shoulder dislocation
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    Case 6: lipohaemarthrosis and pseudosubluxation
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    Case 7: Pancoast tumour
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