Shoulder

Published on 01/04/2015 by admin

Filed under Radiology

Last modified 01/04/2015

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6

Shoulder

The standard radiographs

AP view and a second view (see p. 74).

Standard radiographs

Shoulder injury:

The AP view is standard in all departments.

The precise second view will vary.

We prefer the apical oblique projection (aka Modified Trauma Axial, MTA; see p. 76), because it allows gentle positioning of the patient, provides excellent demonstration of dislocations and shows fractures extremely well1,2.

Second best: the scapula Y lateral (see p. 77). The patient is comfortable as the arm is not moved, and a true scapula Y lateral will show posterior dislocations3. But this view must be technically very precise, and fractures can be difficult to identify.

The axial (armpit) view is not recommended. It will show a posterior dislocation and most fracture fragments, but it requires abduction of the injured arm which can be very painful. It can also cause further damage. Frequently it results in a poor radiograph.

Note our descriptive emphasis in this chapter

We are strong advocates that the second view for an injured shoulder should be the apical oblique radiograph rather than any alternative second view. Consequently, our descriptions concentrate mainly on the AP view and the apical oblique view of the injured shoulder.

Analysis: the checklists

The AP radiograph

Ask yourself five questions.