Shoulder radiograph (an approach)

Dr Jeremy Jones et al.

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

Glenohumeral joint
Acromioclavicular joint
Bony cortex
  • cortex should be smooth
    • humeral head
    • glenoid fossa
    • clavicle
    • body of scapula
  • look for fracture fragments
  • remember the ribs
Anterior shoulder dislocation
Clavicle fracture
  • up to 10% of all fractures
  • predominantly midshaft
  • mostly children and the elderly
  • fall onto outstretched hand or shoulder
  • more: clavicle fracture
Acromioclavicular joint injury
  • 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
Proximal humeral fracture
  • common injury resulting in significant disability
  • elderly females: mean age 65 years
  • fall on an outstretched arm
  • more: proximal humeral fracture
Posterior shoulder dislocation
  • 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
Shoulder pseudosubluxation
  • 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
Pancoast tumour
  • 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

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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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