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Case: Posterior Shoulder Dislocation

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So this patient had a seizure

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and woke up with left-sided shoulder pain.

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They obtained a frontal projection of the left shoulder.

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And so if we use our anatomy by expectation

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and we look at this image here,

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we can identify the scapular borders.

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Notice where the glenoid is.

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Our acromial process here, our AC joint,

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so AC joint under service of the clavicle and acromium look.

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Okay, Glen humeral joint.

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We don't see as much overlap of the humeral head

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with the glenoid as we might expect

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from a frontal projection.

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And there's an additional opacity here

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over the inferior part of the lineal joint.

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So based on this finding, what would you do?

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Well, one recurrent theme is going to be

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that one view is no view.

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So we're gonna bring the patient back

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and do additional imaging in ideally orthogonal projections.

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So the patient was brought back.

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We have our Y view, a grassy view,

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and an apical oblique view.

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So on our Y view, we identify where the expected location

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of the glenoid is.

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Scapular body cricoid acromion.

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Humeral head is projected posterior to the glenoid, so

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that makes it suspicious for a posterior dislocation

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Grassy view, we don't see a congruent articulation here

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because the humeral head is now gone posterior

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and abutting against the posterior portion of the glenoid.

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In addition, its reveals that that little opacity

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is a fracture fragment likely coming from the lesser

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tuberosity and an apco oblique type view,

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while it's a little bit distorted,

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also very much demonstrates this relationship

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and if the patient was not able

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to tolerate other positioning, this type

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of view would be diagnostic as it is here.

Report

Faculty

John A Carrino, MD, MPH

Vice-Chairman, Radiology and Imaging

Hospital for Special Surgery

Tags

X-Ray (Plain Films)

Trauma

Shoulder

Musculoskeletal (MSK)