Shoulder radiograph (an approach)

Systematic review

Glenohumeral joint

  • articular surfaces should be parallel
  • the humeral head should on the glenoid on any other view
  • if the humeral head lies under the coracoid process, think anterior shoulder dislocation
  • if there is a joint effusion, think humeral head or glenoid fracture
Acromioclavicular joint

  • the inferior borders of distal clavicle and acromion should line up
  • if there is a step, think ACJ injury
    • AC distance > 8 mm: AC ligament rupture
    • CC distance > 13 mm: CC ligament rupture
Bony cortex

  • cortex should be smooth smooth
    • the humeral head
    • glenoid fossa
    • clavicle
    • body of scapula
  • look for fracture fragments
  • remember the ribs

Common pathology

Anterior shoulder dislocation

  • 95% of all shoulder dislocations
  • young males and the elderly
  • forced abduction, external rotation and extension
  • humeral head lies anterior, medial and inferior to glenoid fossa
  • common associated fractures:
  • more: 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

Don't miss

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 hemorrhage into the joint displaces the humeral head inferiorly
  • this effusion suggests intra-articular fracture
  • do not confuse with dislocation!
  • more: shoulder pseudosubluxation
Pancoast tumor

  • 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 tumor
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Publication date: 22nd Apr 2014 15:10 UTC

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