EMRad: Radiologic Approach to the Traumatic Shoulder

This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department [1]. When applicable, it will provide pertinent measurements specific  to management, and offer a framework for when to get an additional view, if appropriate. We have already covered the elbow, the wrist, and the foot and ankle. Next up: the shoulder. Learning Objectives Interpret traumatic shoulder x-rays using a standard approach Identify clinical scenarios in which an additional view might improve pathology diagnosis Why the shoulder matters and the radiology rule of 2’s The Shoulder Third most common musculoskeletal complaint, second only to low back pain and neck pain [3] Most commonly dislocated major joint [4] Before we begin: Make sure to employ the rule of 2’s [5] 2 views: One view is never enough 2 abnormalities: If you see one abnormality, look for another 2 joints: Image above and below the injury (especially for forearm and leg) 2 sides: If unsure regarding a potential pathologic finding, compare to another side 2 occasions: Always compare with old x-rays if available 2 visits: Bring patient back for repeat films. An approach to the traumatic adult shoulder x-ray The American College of Radiology recommends at least 3 views for acute traumatic shoulder pain [5]: AP in internal rotation for visualization of the lesser tuberosity AP in external rotation for visualization of the greater tuberosity Scapula Y or axillary view in place of true lateral. For simplicity, we focus on the standard AP view. Because the axillary view is often difficult to obtain due to pain [2], we will focus on Scapula “Y” but will discuss the axillary view in the “one more view” section. Adequacy Bones … Continue reading EMRad: Radiologic Approach to the Traumatic Shoulder