The Approach to Shoulder Radiographs

The first snowflakes of the year are falling as you head into your midday Minor Care shift.  Slipping on an icy patch of compacted snow and nearly falling as you head from your car to the ED entrance, you have a sneaking suspicion what the day will bring: falls, slips, and trips.  Indeed, you settle down to the computer, log in to your EMR and pull up the minor care screen to see 2 unseen patients with the chief complaint of “Fall”.  

Joan, the first patient you go see, is a very pleasant 75 year old woman who was carrying some groceries to her car when she slipped on a patch of ice and fell onto her right shoulder.  She immediately had sharp pain in her right shoulder and upper arm and wasn’t able to move the shoulder without severe pain.  Examining her you note a deformity of the proximal humerus with intact sensation throughout the arm and 2+ radial and ulnar pulses.  You order up some x-rays and head to see the next patient.

John, your second patient, is a 20 year old male who was playing flag football with some friends when he juked to avoid an opponent and slipped on a patch of snow, landing hard on his left shoulder.  He tells you he has a history of left shoulder dislocations and feels like it might be dislocated again.  Examining him you note that his left arm is held to the side of his body, with an empty glenoid, and intact sensation in the axillary nerve distribution and intact radial and ulnar pulses.  You order up an x-ray and head back to your work station looking for a quick reference on how to read these films.

Take a look at this video below by Nicole Soria, MD, PGY-1 resident at the University of Cincinnati for a brief primer on how to read x-rays of the shoulder.