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:
  • Hill-Sachs lesion
  • Bankart lesion
• 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