Radiography is a very important aid in making and confirming diagnosis of shoulder dislocation. It also helps to find if any associated injuries.
To make a wholesome diagnosis of the injury, the physician needs to know the following
- Direction of the dislocation
- Existence of associated fractures
- Difficulty if any in the reduction
Following views are used around the shoulder
Anteroposterior View
The anteroposterior (AP) view is obtained with the patient’s back flat on the cassette and the x-ray beam at right angles to this plane and centered on the shoulder..
Anteroposterior View In Plane of Scapula
This view is most easily accomplished by placing the scapula flat on the cassette and passing the x-ray beam at right angles to this plane, centering it on the coracoid process.
Lateral View
The view is at right angles to the AP in the plane of the scapula . The x-ray cassette is placed anterolateral to the shoulder, which will be perpendicular to the line on the scapula.
The x-ray is focused in line of spine of scapula onto the cassette.
In this view, in normal shoulder the head is at the center of the arms of the Y, that is, about the glenoid fossa.
In posterior dislocations the head is seen posterior to the glenoid.
In anterior dislocations it is anterior to the glenoid.
Axillary View
The cassette is placed on the superior aspect of the shoulder of the abducted arm. Beam passes between the chest and the arm in a direction perpendicular to the cassette from the shoulder.
An axillary radiograph is diagnostic of shoulder dislocation and also demonstrate fractures, as well as fractures of the head, the glenoid or of the lesser tuberosity of the humerus
The Apical-Oblique View
The patient sits with the scapula flat against the cassette. The x-ray beam is directed 45 degrees to the coronal plane and 45 degrees caudally and centered on the coracoid.
This view also reveals both anterior glenoid lip defects and fractures of the humeral head.
Special Views
Special views hav A number of special views have been described for identifying humeral head defects:
- AP radiograph in internal rotation
- Tangential view
- Hill-Sachs view
- Stryker notch view.
Arthrography
To evaluate rotator cuff tears. This is especially important if a patient fails to regain strength of flexion and rotation after a shoulder dislocation.
Computed Tomography
These are helpful in revealing the extent of fractures of the glenoid or humeral head compression fractures.
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