1. Shoulder Radiography

2. Shoulder anatomy
• 3 bones:
– Humerus
– Scapula
– Clavicle
• 3 joints:
– Glenohumeral
– Sternoclavicular
– Acromioclavicular

3. Scapula Anatomy
Coracoid
• Scapula:
– Glenoid
– Acromion
– Coracoid

4. Scapula Lateral (Y) view

5. Routine (transthoracic) AP view of the
shoulder
• AP relative to thorax
• Suboptimal view of
glenohumeral joint
• Good view of AC joint

6. Scapular/Glenohumeral AP view (aka
Oblique view)
• Better visualize
Glenohumeral
joint/space
• Suboptimal view
of AC joint

7. Normal AP view

8. Normal oblique
Glenohumeral space

9. Lateral Scapula “Y” view
• Evaluate relationship of
humeral head with
glenoid
– Humeral head should be
at bifurcation of the Y

10. Axillary view
• Not routinely
performed
• Good for evaluating
anterior-posterior
relationship of
glenohumeral joint

11. Quiz time
Diagnosis?
AP and Y view

12. Anterior dislocation

13. Anterior dislocation
• Make up 96% of all shoulder dislocations
• May be associated with:
– Fracture of greater tuberosity (15%)
– Bankart lesion
• Fracture of anterior glenoid rim
– Hill-Sachs defect (50%)
• Impaction fracture of posterolateral humeral head 2/2
impaction of humeral head against glenoid during
dislocation

14. Bankart and Hill-Sachs
Hill Sachs deformity

15. Diagnosis?
AP view – not too revealing…

16. Same patient, axillary and Y views

17. Answer: posterior dislocation

18. Posterior dislocation
• Makes up about 2-4% of dislocations, may be
associated w/ convulsive seizure (boards
question)
• Common Xray findings:
– Rim sign (66%) = distance between medial border of
humeral head and anterior glenoid rim >6 mm
– Lightbulb sign = Humeral head held in internal
rotation, appearing bulb-like on AP view
– Trough sign (75%) = "reverse Hill-Sachs" =
compression fracture of anteromedial humeral head

19. Posterior dislocation
Lightbulb sign
Trough sign
Rim sign

20. Diagnosis?

21. Inferior dislocation, “LuxatioErecta”
Accounts for 1-2% of shoulder dislocations,
Arm often held above head
Results from severe hyperabduction of arm

22. Diagnosis?

23. Acromioclavicular separation, grade III

24. AC separation
Treatment:
Grade I-II: always conservative
Grade III: usually conservative,
surgical in few cases (young
athlete, laborer who does a lot
of lifting, etc)
Grade IV-VI: surgical

25. Diagnosis?

26. Clavicle fracture
Fracture
80% of fractures in middle third, 15% in distal third, 5% medial third
Treatment mostly conservative
Surgical mgmt if open fracture, severe skin tenting, neurovascular injury or
severely comminuted/displaced fractures

27. • Great site for x-ray cases:
• http://www.feinberg.northwestern.edu/emer
gencymed/residency/ortho-
teaching/shoulder/